March. 17, 2015

How to Snatch Personal Medical
Record and to Make Medical
Supplies and Medicines
Available in Time of Disaster

Kochi Organization for
Medical Reformation and Renewal

Shu KURAMOTO

Kochi Prefecture
Government Building

Seismic Isolationof Toyo Tite !!

Kochi Castle
高知城

19
98

99

20
00

01

02

03

04

05

06

07

08

National University

National University Corporation

Department ofGeneral Medicine

President ofKochi Medical School Hospital

To Radiographic inspection

Informations in the HospitalTo the wards

Japanスウェーデン
Sweden

75

73.3

スイス
Switzerland

73.2

イタリア
Italy

72.9

オーストラリア
Australia

72.6

スペイン
Spain

72.6

カナダ
Canada72

フランス
France72

ノルウェー
Norway72ドイツGermany

71.8

7071

7273

74

75 （years）

WHO World Health Statistics 2010

40.1

Japan
USA
Iceland
Italy
Austria
Korea
Finland
Switzerland
GreeceOECD mean
Luxembourg
Denmark
Spain
Portugal
New ZealandIrelandUK
GermanyJapan
Australia
Belgium
Korea
USA
Iceland
Italy
Austria
Luxembourg
Portugal
GreeceThe OECD mean
Switzerland
Denmark
FinlandGermany
Spain
Ireland(omitted)

25.9
19.3
18.6
17.7
16
15.3
14.4
13.2
11
10.5
10.2
9.3
8.9
8.8
8.5
8.2
8.2

(omitted)

Hungary
Mexico2.7
1.5

PolandMexico0102030

4050

92.6

56
41.637.1
34.3
32.1
30.3
29.8
27.3
26
25.8
22.8
18.7
17.4
16.4
16.3
14.6
14.3

7.3
40204060

80( per population of 100,000 in 2002)

100

National medical expenses relative to GDP

USA
Switzerland
FranceGermany
Belgium
Austria
Portugal
GreeceCanadaAustralia
IcelandNetherland
Denmark
NorwaySwedenNew Zealand
Italy
Luxemburg
UK
Spain
HungaryJapan
TurkeyFinland
Ireland
Czech
Slovakia
MexicoPolandKorea

Database

Vertificationn

DataminingClinicalApplication

Retrieval sYstem for Open Medical Analysis
Preparation
For Anonymity

Preparation
Oct, 1981～ For Analysis

RYOMAIMIS・Electric Medical
Records・Ordering System

Kochi
MedicalSchool
Hospital

NonAnonymous
DWH

Physicians

Anonymatized
DWH

Any Scholars• Anonymity : Name, Patient ID, Birthday
date of examination, and so and so• Reconstruciton of Database• Data Cleansing

RYOMA
Anonymatized
DWH

Any Scholars

Automated hematology Analyzer
Sysmex XE2100

Neutrophil Stab Cell
Segmented Cell
Eosinophil
Basophil
Monocyte
Lymphcyte

Counting Differentiating Leukocytes by Flow Cytemetry
Automated hematology Analyzer
Using Semiconductor Laser
Sysmex XE2100

Side Fluorescence

Side Scatter(RNA/DNA cell content)(Internal cell structure)

Forward Scatter(Cell size information)

Neutro好中球
Eosino
好酸球

Baso
好塩基球
WBC白血球Forward Scatter

Lymph
リンパ球

Forward Scatter

単球
Mono

WBC/BASOScattergram

前方散乱光

DIFF Scattergram

前方散乱光

側方蛍光

Side Fluorescence

Laser
Beam

RETScattergram
RBC
赤血球
Reticulo
網赤血球

血小板
PlateletSide Scatter

SideScatter

SideFluorescencePredicted CRP

CBC = complete blood count

Actual CRP after 4～7days

A half of CRP examinations could be unnecessary

3450 3.43 1.65 2.15 1.820120.8

0.6890.7 1.11 0.69

670.4

1 2.59 2.68 1.66 1.97 0.77 0.82 0.39 0.79

1011121314

1516171819202122232425

2627

28

29

4.1 0.18 0.12 0.59 1.95 1.44 1.42 1.28 1.55 2.34 3.27 3.34 2.55 1.91 1.04 1.55 3.16 9.92 10.6 4.42

0.9 0.19 0.23 0.26 0.42 0.18

0.3 0.73 0.86 1.94 1.07 1.64 1.27 1.11 2.19 2.09 0.92 1.38 4.66 7.99 12.7 8.25

2 2.73 1.91 1.61 1.22 1.47 0.67 0.47

0.4 0.58 0.27 0.35 0.41 0.19 0.31 0.34 0.29 0.59 0.67 0.81 0.96 1.08 0.86 1.11 0.59 0.52 0.82 3.69 8.91 11.1

3 3.55 1.46 1.37 1.06 1.06 0.98 0.62

0.4 0.74 0.27 0.28 0.24 0.61 0.21 0.17 1.09 0.48 0.31 0.53 0.77 0.76 0.69 0.82 0.84 0.84 1.226.8

3 4.19 5.71 7.76

4 2.74 1.73 2.31 1.25 1.12 1.05 1.08 0.41 0.48 0.37 0.16 0.38 0.52 0.51 0.49 0.41 0.29 0.71 0.47 0.66 0.69 0.94 0.43 0.57 0.35 1.18 2.33 5.24 3.53 8.92
5 4.15 2.35 1.04 1.93 1.54 1.16 0.68 0.84 0.41 0.42 0.49
6 3.27 2.26 1.92 2.05 1.58 1.417

0.8 0.99 0.76

3 2.74 2.57 2.25 1.15 1.69 0.76

0.4 0.48 0.32 0.89 1.48 0.69 0.42 0.36 0.54 0.85 0.48 0.34 0.51 0.66 0.53 1.98 1.78 4.02

1 0.57 0.42 0.25 0.49 1.13 2.26

0.8 1.16 0.87 0.79 0.59 0.44 0.31 0.84

0.9

0.4 0.65 0.33 0.74 1.15 0.97 0.96

1.8 0.85 1.09 0.99

0.9 0.65

0.5 0.56

0.7 0.55 0.71 0.45 0.55 1.43 0.46 7.44 4.34

8 3.71 2.46 1.52 1.82 0.97 1.85 1.14 1.03 0.64 0.97 0.88 0.98 0.83 0.67 0.75 1.11 0.82 0.66 0.39 0.56 0.45 0.54 0.28 0.46 0.29
9 3.34 2.15 1.52 1.96 1.12 2.02

0.5 1.24 0.79

0.8

1.4 1.82 0.82 1.05 2.04 1.98 0.53 0.25

10 2.88 2.37 1.03 2.01 1.71 2.57 1.35 0.76 1.43 1.09 0.93
11 3.36 2.52 2.41 2.51 2.18 1.51 1.02 1.93 1.08 1.96
12 4.27 3.14 2.95 2.22 2.25
13 3.32 3.47 2.84 2.86

15 4.84

2 1.781.6

1.2 0.43 0.76 0.46 0.65 0.47 0.13 0.34 0.35 0.63 0.43 0.51 0.23 0.59 2.67 15.4 8.55

2.2 2.15 1.92 1.03 1.44 2.17 1.08 1.65 2.06 0.69 0.55 0.37

2.8 3.27

2.2 1.87 1.35 1.28 0.86 1.42 1.32

17 6.55 4.94 5.08 3.93 3.32 2.58 2.32 2.72 2.67 3.34 1.74 2.03

19 6.31 3.86 3.28 4.95 4.52 4.03 3.63
4.7 6.81 4.98 4.44 4.04 4.29

21 8.08 5.97

23 7.68 6.63 6.55 6.28
24 9.18 8.78

4 3.61

1.9

0.7 0.55

13.2 2.88

2.3 1.51 1.65 2.34 1.88

0.5 0.16 0.34

0.6 0.29 0.43 0.36 0.36 0.98

0.9 0.69 0.53 0.29 0.23 0.29 0.21 0.26 0.14 0.31 0.82

1.3 0.45 0.81
0.9

0.7 0.37 0.44 0.23 0.16 0.35 0.24 0.28

0.7 0.83

0.6 0.44

0.6 0.57 0.31 0.21 0.35 0.37 0.26 0.23 0.42 0.32

1.6 1.05 1.14 0.89 0.69 0.38 0.34 0.33
1.6 1.21

1.8 0.02

0.6 0.52 0.33 0.29 0.36 0.24 0.17 0.46 0.48 3.74

1.2 1.13 0.51 0.62 0.41 0.25 0.32 0.25 0.19 0.25 0.51 1.37

2.3 1.32 1.75 2.52 1.58 1.97 1.59 2.86 0.91 1.62

0.2

0.2 0.21 0.09 0.31 0.14

0.4 0.24 0.63 0.19 0.21 0.29 0.34 0.28 0.57 0.55

3.4 3.08 2.41 3.78 2.93 2.07 2.82 1.72 2.31 1.42 0.82 0.72 0.59 0.54 0.28 0.35 0.21 0.17 0.19 0.27 0.37 0.23 0.34 0.94

4.3 5.96 4.38 4.88 3.44 2.62 3.42 2.77 1.61 2.53 2.05 1.64 1.17 0.37

7.4 5.39 5.38 5.03 4.99

3.3 2.81 2.69 2.08 2.94 2.99 2.52 2.35 1.1625 9.41 7.77 8.51 7.45 6.85 4.96 4.19 2.89 5.42 3.64 4.13 4.01 3.27 2.71 2.46
26 10.2

14 9.69 7.01 6.99 5.03 4.07 3.07 4.21 5.24 4.4227

12 8.95 8.82 7.86 5.56 4.61 5.34 7.13

6.8

13 12.8 11.3 9.69 10.2 13.3 13.8

0.5 0.54 0.64 0.19

0.3 0.17 0.19 0.21 0.25 0.29 0.75 0.51

1.2 1.37 0.63 0.35 0.68 0.42 0.69

1.7 1.35

0.7 0.26

0.7 0.58 0.55 0.41 0.67

1.7 1.93 0.54 0.31 0.38 0.65 0.44 1.190.5 0.35 0.49 0.71 0.74

4.5 4.54 4.04 3.35 1.94 1.77 2.04 1.87 1.04 0.99 0.92 1.33

6.5 5.66 5.94 5.82 4.88 2.88 2.25 2.13 0.67 1.03

28 12.9 14.3 11.9 8.64 7.36 8.35 8.59 10.8 10.1 8.63 8.56 7.61 9.15 9.96
29 13.8

2.3 1.01

2.1 3.53 3.46 2.11 1.94 3.21 1.79 3.03 3.62

3.9 5.93 5.25 3.65 3.92 3.82 3.02

22 7.88 6.65 6.06 5.14 5.05 4.99

12

1.1 0.58 1.39 0.75 0.44 0.24 0.21 0.34 0.31 0.28 0.31

0.7 0.89 1.96 1.67 1.71 0.81 0.78

18 6.17 5.84 4.91 4.19 4.99 3.23 3.03 3.44 2.59 2.89 2.79 2.44 1.32 2.53

20 4.270.3

1 2.17 1.89 2.18 1.53 1.14 0.86 0.77 0.61 0.49 0.47

2.8 2.73 1.92 3.29

2.8 6.61 13.3

1.7 0.69 0.38 0.47 0.37 0.36 0.61 0.57 0.61 0.46 0.18 0.57 0.14 0.31 0.23 2.45 0.27

3.3 3.13 2.41 2.62 3.41 2.72 2.15 2.55 1.54 3.05 2.07 2.59 1.26 0.61 0.51 0.64 0.58 0.89 1.07 0.54

16 4.52 4.79 3.87 3.91

0.6 0.37 3.24 6.67 3.41

0.3 0.19 0.47 0.29 0.71 0.43 0.24 0.31 1.18

1.9 1.69 2.26 1.24 1.02 0.36 0.28 0.78 0.37 0.15 0.24 0.72 0.47 0.17 0.24 2.92 2.11 10.9 9.36

2.1 1.16 0.75 2.27 1.45 1.32 0.79

14 4.07 3.24 2.82 2.34 2.07 2.43 1.94

7.7

0.8 1.57 2.86 6.43

5.3

0.9

0.4 0.61

0.9 0.54 0.79 1.12 0.62 1.04 0.56
0.6 0.39 0.31 0.67 0.78 1.49 1.194.6 3.03 1.64 1.33 0.86 0.81 0.67 0.49 0.21 0.24 0.65 0.57 1.24 1.26 1.56

12 11.1 9.64 10.2 7.72 8.82 6.81 5.52 3.41 2.31 1.27 0.65 0.85 1.15 0.51 0.35 0.31 0.42 1.03 0.72 1.39 2.31

MSN. 産経ニュース

DiagnosticImagings
Prescription
Complete Clinical
Record Card

Blood Tests

DataminingOut-Hospital
Backup

To Snatch Personal
Medical Record inTime of Disaster
Diagnostic
Imagings
Prescription
Complete Clinical
Record Card

Sharing mong
Institutes

Blood Tests

In-Hospital
Backup• Medical records are updated everyday• Rare diseases are carefully excluded even from the anonymous
DWHJan 12March 10May 8

July 5

Sept 2

Oct 31

T Protein

7.2

7.0

7.1

6.9

6.8

6.6

Albumin

4.4

4.3

4.4

4.2

4.0

3.8

AST2828

2048

2232

ALT23231867

3127

Creatinin

0.7

0.9

0.8

0.8

1.0

1.3

Standard Value(Normal Value)・Mesurement Method
・Analytical Instruments
・Purelity of Water
・Room Temperature
・Reactivities

Influencing the Result of Blood Test

Serum creatinine levels
from 1994 to 2012 at 2 hospitals
CREATININECREATININE

rather stablefluctuated(year)

Hospital Ａ

Hospital Ｂ

Longitudinal serum creatinine levels
from 1981 to 2013 at Hospital C
Frequencyn2013
Method B

LDH level1981

Method A

Normalization between methods ofmeasurement or along hospitals
Fluctuation and Difference
Total Variation

Normalization

Hospital A
Hospital B
Hospital C

PhysicalExamination

Blood
Chemistry

Diagnostic
Imaging

Prescription

Insurer
Hospital

処方内容
Pharmacy

Insurer70%
Patients30%

￥
Hospital

Insurer
Information foroutsideprescription

Pharmacy

medical record
notebookInsurer
HospitalDigital
電子化
prescription
処方箋

Digitalprescription

BackupcopiesDigitalprescription

処方
Digitalprescription 内容

Pharmacy
DigitalprescriptionHospital

InsurerDigitalprescription

Digitalprescription

Pharmacy

Backup Copies
Digitalprescription

Digitalprescription

Insurer
DigitalDigitalprescription
prescription

With Agree

処方内容Pharmacy

With Agree

Digitalprescription

Search for clinical record sheet（河北新報）

Women’s feminine products
Saled in Ho Chi Minh City
in Viet Nam

Birth Control
Protections

Stoma Bag

System Resilience
Shinkannsen
Hotels

Stoma Bagfeminine productsProtections

days