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ER Research Registry System

Customer : National Center for Global Health and Medicine, Hospital
(Independent Administrative Institution)

To “Surely save any life that can be saved,” symptom data is entered at the bedside and, to aid medical decision making, the system acquires and analyzes this data.
CF-H1 is on active service in the frontline of emergency medicine.

On both the treatment and research fronts, the National Center for Global Health and Medicine, Hospital is charged with leading the way to advanced general medical treatment in Japan. Here, concerned with developing emergency medicine for the nation, Director of the Emergency Department, Dr. Akio Kimura, undertakes studies “To establish basic clinical decision making standards to ensure, during emergency treatment, that all life-threatening symptoms and trauma are observed and recorded, and none are overlooked.” In the emergency room of the hospital, the TOUGHBOOK CF-H1 is used as the terminal for recording patient status data and presenting information that doctors need to make medical decisions.

Making sure not to overlook potentially serious conditions in patients whose symptoms appear light

Dr. Akio Kimura Director of Emergency Department National Center for Global Health and Medicine, Hospital

Dr. Akio Kimura
Director of Emergency Department
National Center for Global Health and Medicine, Hospital
“The CF-H1 has been useful for raising the accuracy of diagnosis and ensuring that nothing is overlooked during treatment.”

Accepting all patients from minor illnesses to critically serious difficulties, the emergency department has one of the finest models in Japan. In 2009, 24,000 emergency patients were accepted. Of these, about 1,000 had severe injuries or serious diseases.

While TV dramas have made people familiar with the image of ambulances rushing patients to hospital, where they are brought back from the brink of death with advanced resuscitation, Dr. Kimura explained that such scenarios do not give a complete picture:

“There are two types of emergency cases. Some patients arrive in extremely severe condition. In such cases, emergency management focuses on life support. But other patients initially do not seem to be in serious condition, but they are found to have serious underlying problems. For them, early diagnosis “helps life.” For example, we have had patients come to us with nothing more than a mild headache but, in some cases, this has actually turned out to be a symptom of subarachnoid hemorrhage.

About 3% of emergency patients require life-saving treatment. Similarly, about 3% of patients who make their own way to the hospital are seriously ill and in urgent need of early recognition. For such patients, if there are no clear-cut symptoms, it is an urgent but difficult task to identify any underlying serious condition. In the headache example I just gave, patients have also been misdiagnosed and been sent home being told they had a migraine.

To help to surely save any life that can be saved, I feel it is my mission to establish basic decision making criteria.”

Enabling even inexperienced doctors undergoing clinical training to carry out highly accurate clinical decisions

In the emergency room, where patients present diverse symptoms and require urgent treatment, the application of ICT (information and communications technology) was a special challenge.

“In fact, discerning whether or not mild symptoms are actually evidence of serious underlying diseases has largely relied on practical diagnostic principles that physicians get to know as they accumulate clinical experience. If don’t do anything about this situation, however, unless all doctors somehow become seasoned experts, we won’t be able to improve the quality health care. Until that happens, the health of patients remains a matter of luck, the outcome depending on who is on duty when they are examined. To remedy this, I wanted to try using ICT to systematize the practical sense carried in the minds of seasoned physicians, and make it available even to less experienced clinical residents.”(Dr. Kimura)

Using clinical prediction rules elaborated by Dr. Kimura, the concept was to construct a rule-based diagnostic system that could identify patients with severe underlying conditions.

In the initial consultation, when the patient is brought into the examination room, the physician makes detailed observations according to an itemized checklist and records the symptoms in a computer. Once the observations have been entered, the program carries out rule-based analysis and makes suggestions according to the symptoms. If the analysis discovers a possibility of serious underlying condition, detailed instructions are given to examine more closely for specific symptoms related to named diseases. The doctor then carries out treatment based on this and arranges for further tests. Thus, less experienced physicians are able to provide a higher level of decision making.

Complete implementation of this type of system depends on two things. First, to enable rules to be established, there have to be statistically sufficiently large amounts of data. Moreover, this data has to be precise enough to match the necessary checklist items. In other words, it is not easy to collect and process this kind of data. Second, there has to be a means of entering the data in real time at the bedside, and of promptly receiving diagnostic suggestions from rule-based data analysis.

Using a handheld terminal, highly accurate and detailed data can be entered at the bedside and diagnostic suggestions can be obtained promptly.

Using a handheld terminal, highly accurate and detailed data can be entered at the bedside and diagnostic suggestions can be obtained promptly.

Ordinary laptop computers not suitable for bedside use

Dr. Kimura explained that the CF-H1 is a suitable terminal for clinical settings because it allows physicians to face their patients.

Dr. Kimura explained that the CF-H1 is a suitable terminal for clinical settings because it allows physicians to face their patients.

To ensure the quality of clinical data, the most accurate method is to record observations at patient's bedside while carrying out the examination, and to collect as much data as possible. These needs, however, brought other problems.

In the past, ordinary laptop computers were tried but, handheld, it was hard to operate them. Then, because it was necessary to use the keyboard, it was not practical to enter the data at the bedside during the examination.

“In the end, the examining physician had to return to the office and transcribe the medical data from bedside notes. Mistakes and omissions were inevitable. It also involved extra work, and doctors seemed to find it burdensome. Above all, because it was not possible to refer to the suggested diagnosis there at the bedside, this system created a barrier between doctor and patient.”(Dr. Kimura)

At this point Fukuda Denshi, well known for its electrocardiograph and AED (automated external defibrillator) products, proposed an emergency patient data registry system using Panasonic TOUGHBOOK CF-H1.

With the CF-H1, more precise data can be recorded in real time at the bedside

ER Research Registry System

Advised by Dr. Kimura, Fukuda Denshi developed ER Research Registry System. An application was built to enable fingertip access to tabbed screens: using the touch screen, it was possible to enable confident operation even when data entry has to be done quickly.

ER Research Registry System

The CF-H1’s built-in camera functions were also use effectively.

According to the symptoms presented by the patient, lists of items for the examining physician to respond to are displayed on tabbed screens on the CF-H1. Holding a CF-H1 in one hand, the doctor can stand at the beside of any patient brought in for examination and, prompted by items shown on the screen, focus attention on the patient while asking questions, making observations, and immediately entering the data. Then, after analyzing the data according to clinical prediction rules the application promptly provides support for medical decision making.

With the introduction of the system, patients have benefitted from more accurate diagnosis and more appropriate medical care. Research has benefitted from greatly improved data collection accuracy and efficiency.

Considering the system and the CF-H1, Dr. Kimura observed: “To ensure proper medical decision making, while examining the patient, it is of the utmost importance to make it as simple as possible to enter the necessary data. On this point, usable at the bedside, I think that the CF-H1 is a device well suited to emergency conditions.”

Mr. Junichi Natsui, Fukuda Denshi Co., Ltd. the Specialist in the Acute-care Product Department of the Critical Care System Office who proposed the system explained, as follows, why the CF-H1 was selected.

“In a single device, the CF-H1 provides all the capabilities required for computer that is used in a clinical setting. In emergency situations, disinfectant tends to be liberally splashed around. Here, the superior resistance to chemicals is a breakthrough for a device of this type. Then, it can also survive dropping and strong impacts. The touch-screen, and the strap for handheld use are in line with the needs of emergency medicine. Because the CF-H1 was available, our system ended up being highly effective.”

ER Research Registry System

Bringing about emergency medical care that can surely save any life that can be saved

“The present rule-based decision-making system is tentatively based on data collected in our hospital. We are testing our assumptions and, to improve the accuracy of the system, are seeking to collect more data. We hope to enlist another ten or so hospitals to cooperate with data collection.” (Dr. Kimura)

“Our company (Fukuda Denshi) is considering giving more priority to emergency rooms in acute care hospitals. We put a great deal of effort into proposing solutions that actually work in emergency situations. Here, I think that computers designed to meet on-site conditions, such as the CF-H1, are able deliver a medical system solution as in the current system, which was evaluated as easy to use, and as able to be used with safety and confidence. If the system is used in emergency rooms, we believe it can contribute to improving the quality of emergency medical care.” (Mr. Junichi Natsui)

The CF-H1 has a promising future as a tool for realizing better medical care.

Mr. Junichi Natsui Fukuda Denshi Co., Ltd. Specialist, Acute-care Product Department Critical Care System Office

Mr. Junichi Natsui
Fukuda Denshi Co., Ltd.
Specialist, Acute-care Product Department
Critical Care System Office
“Intending to contribute to raising the quality of medical care, we set about applying what we know about clinical conditions and incorporating that knowledge in the CF-H1.”

Customers
Independent Administrative Institution
National Center for Global Health and Medicine, Hospital
Address
1-21-1 Toyama Shinjuku-ku Tokyo, 162-8655 Japan
Website
http://www.ncgm.go.jp/hospital.html
System vendor
Fukuda Denshi Co., Ltd.
http://www.fukuda.co.jp/
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