東海大学紀要情報通信学部
vol.4,No1,2011,pp.47-52
ᮾᾏ኱Ꮫ⣖せ᝟ሗ㏻ಙᏛ㒊Vol.4, No.1, 2011, pp. -ㄽᩥ
論文ࢡࣛ࢘ࢻᢏ⾡ࢆ⏝࠸ࡓᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࣔࢹࣝࡢᥦ᱌㔝ᆅ ಖ *1㸪Ⲷ㔝 ṇ *2

A Proposal Model for Hospital System Collaboration Service by Cloud Technologyby*1 *1

Tamotsu
NOJI
Tadashi Ogino
OGINO*2*2
TamotsuNoji and㸪Tadashi(received on October 29, 2010 & accepted on June 23, 2011)

Abstract
It is necessary to unite patient referral information between a clinic and the center hospital to improve the patient service inthe medical treatment for the global collaboration medical network system based on 3D patient information in 3D electronic
referral letters and 3D care cards. However, the handling systems of the letter of introduction with 3D image processing
support function and the care card on the internet differ at each clinic, and this point means being the hindrance of the medical
cooperation in a medical network area. Then, we propose to implement the patient service using the cloud technology. With oursystem, each hospital can reconstruct their patient support system by reviewing their current system. They don¶t have to build a
new patient support system from scratch.
Keywords: Global Collaboration Medical Cloud, 3D image processing, Medical Service, Software as a Patient Service䜻䞊䝽䞊䝗䠖་⒪䝃䞊䝡䝇䠈ᗈᇦ㐃ᦠ་⒪䜽䝷䜴䝗䠈㟁Ꮚ⤂௓≧䠈ᝈ⪅䝃䞊䝡䝇䠈Software as a Patient Service1㸬ᴫせ⑓㝔࡜デ⒪ᡤࡸ࠿࠿ࡾࡘࡅ་࡜ࡢᗈᇦ㐃ᦠ་⒪ศ㔝࡛ࡣ㸪୍ࡘࡢ⑓㝔ࡀࡍ࡭࡚ࡢ་⒪ᶵ⬟ࡸ་⒪᝟ሗࢆᥦ౪ࡍ
ࡿࡢ࡛ࡣ࡞ࡃ㸪ࡑࢀࡒࢀࡢ་⒪ᶵ㛵ࡢᣢࡗ࡚࠸ࡿ≉᭷ࡢᶵ⬟ࡸ་⒪ᶵჾ㸪་⒪᝟ሗࡢඹྠ฼⏝࡞࡝ࡑࡢᙺ๭ࢆศ
ᢸࡍࡿᚲせࡀ࠶ࡿ㸬ᗈᇦ㐃ᦠ་⒪ࡣᝈ⪅᝟ሗࢆඹ㏻໬ࡍ
ࡿࡇ࡜࡟ࡼࡾデ⒪ᡤࡸ⑓㝔㸪་⒪ᶵ㛵࠶ࡿ࠸ࡣಖ೺⚟♴ᶵ㛵ࡀ㐃ᦠࡋ࡚㐲㝸デ⒪ࡸᅾᏯデ⒪ᨭ᥼ࢆྍ⬟࡜ࡍࡿᝈ⪅ࢧ࣮ࣅࢫࢆᗈᇦⓗ࡟ᥦ౪࡛ࡁࡿࢿࢵࢺ࣮࣡ࢡࢩࢫࢸ࣒1)࡛࠶ࡿ㸬ᗈᇦ㐃ᦠ་⒪ࢆ⾜࠺ࡓࡵ࡟ࡣ㸪㛵㐃ࡍࡿᆅᇦࡢ⑓㝔࡟஫᥮ᛶࢆᣢࡕ㸪㐃ᦠྍ⬟࡞㟁Ꮚ࢝ࣝࢸࢆᑟධࡋ࡞ࡅࢀࡤ࡞ࡽ࡞࠸㸬ࡋ࠿ࡋ㸪㟁Ꮚ࢝ࣝࢸࡢᑟධ࡟ࡣከ㢠ࡢ㈝⏝ࡀᚲせ࡜࡞ࡗ࡚ࡋࡲ࠺ࡓࡵ㸪ᑠ⑓㝔ࡸデ⒪ᡤ࡛ࡣ㉎ධࡍࡿࡇ࡜ࡀᅔ㞴࡞⌧≧࡛࠶ࡿ㸬ࡑࡇ࡛㸪ྛ་⒪ᶵ㛵ࡢ㐃ᦠࢧ࣮ࣅࢫࢆᝈ⪅ࢧ࣮ࣅࢫ࡜ࡋ࡚ᥦ౪࡛ࡁࡿ࢚ࣥࢱࣉࣛ࢖ࢬࣔࢹࣝ㸦⑓㝔⤒Ⴀࢩࢫࢸ࣒ࣔࢹࣝ㸧࡜ࡋ࡚ᐇ⌧ࡋ㸪ࡑࡢ㐠Ⴀࢆ⊂❧ࡉࡏࡿ᪉ᘧ࡟ࡼࡾᗈᇦ㐃ᦠ་⒪ࢆಁ㐍ࡍࡿࡇ࡜ࢆᥦ᱌ࡍࡿ㸬ᝈ⪅ࢧ࣮ࣅࢫࢆ᭶ࠎࡢᏳ࠸㈝⏝࡛㈚ࡋฟࡍ࢚ࣥࢱࣉࣛ࢖ࢬࣔࢹࣝࢆᵓ⠏ࡍࡿࡇ࡜࡛㸪デ⒪ᡤ➼࡛ࡶ㟁Ꮚ࢝ࣝࢸࢆᑟධࡍࡿࡇ࡜࡞ࡃ㸪ࡑࡢᜠᜨࢆཷࡅࡿࡇ࡜ࡀྍ⬟࡜࡞ࡿ㸬௨ୖ࠿ࡽ㸪ᮏ◊✲ࡢ┠ⓗࡣ㸪㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒ࡢᑟධࡀ㧗౯࡟ࡘࡃࡢ࡛㸪デ⒪ᡤ࡟࠾ࡅ
ࡿ㈝⏝๐ῶࡢࡓࡵ࢚ࣥࢱࣉࣛ࢖ࢬࣔࢹࣝ໬ࢆᅗࡿࡇ࡜࡛࠶ࡿ㸬ࡑࡢࡓࡵ࡟ᗈᇦ㐃ᦠ་⒪ࢿࢵࢺ࣮࣡ࢡ࡟࠾ࡅࡿᝈ
⪅ࢧ࣮ࣅࢫࡢせồ௙ᵝࢆ᫂ࡽ࠿࡟ࡋ࡚㸪ᗈᇦ㐃ᦠ་⒪ࢧ
࣮ࣅࢫࡢ㝵ᒙࣔࢹࣝ໬ࢆᅗࡿࡇ࡜࡛࠶ࡿ㸬ࡉࡽ࡟ᝈ⪅ࢧ࣮ࣅࢫࡢ㝵ᒙࣔࢹࣝ࠿ࡽᗈᇦ㐃ᦠ་⒪ࢡࣛ࢘ࢻࡢᇶᮏࣔ
ࢹࣝࡢᥦ᱌࡜ᮏ᪉ᘧࢆ᳨ドࡍࡿࡇ࡜࡛࠶ࡿ㸬*1 ᝟ሗ㏻ಙᏛ㒊⤒Ⴀࢩࢫࢸ࣒ᕤᏛ⛉ᩍᤵ*2 ୕⳻㟁ᶵ࢖ࣥࣇ࢛࣓࣮ࢩࣙࣥࢸࢡࣀࣟࢪ࣮㸦ᰴ㸧௨ୗ㸪2㸬࡛ࡣ་⒪ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢᴫᛕࣔࢹࣝ㸪3㸬
࡛ࡣᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢࣔࢹࣝ໬㸪4㸬࡛ࡣࢡࣛ࢘ࢻ
ᆺᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢᵓᡂ㸪5㸬࡛ࡣᗈᇦ㐃ᦠ་⒪ࢧ
࣮ࣅࢫࡢ㐺⏝஦౛,6.࡛ࡣホ౯࡜⪃ᐹࢆ㆟ㄽࡋ㸪᭱ᚋ࡟7㸬࡛ᮏ᪉ᘧ࡟ࡘ࠸࡚ࡲ࡜ࡵࡿ㸬2㸬་⒪ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢᴫᛕࣔࢹࣝ
2.1. ⑓㝔⤒Ⴀࢆ࡜ࡾࡲࡃ⎔ቃ⌧௦ࡢ⑓㝔ࡣ➨3ḟ⏘ᴗ㸪ࢧ࣮ࣅࢫᴗ࡛࠶ࡿ㸬ࢧ࣮ࣅࢫᴗࡣ⤒Ⴀࡢ4኱せ⣲㸪ே(Human)㸪≀(Goods)㸪㔠(Capital)㸪
᝟ሗ(Information)࡛ᵓᡂࡉࢀ࡚࠸ࡿ(Fig.1)㸬
Information

Human

Medical treatment

DoctorMedical expenses
Capital

Goods

Medical treatment

Fig.1 The four major elements of the hospital

Fig.1࡟࠾࠸࡚ࠕேࠖせ⣲ࡣ་ᖌචチࢆ஺௜ࡉࢀ࡚࠸ࡿ་ᖌ࡛࠶ࡾ㸪௚ࡢ3኱せ⣲ࡢせ࡟఩⨨࡙ࡅࡽࢀࡿ㸬⌧ሙ࡟ࡣ㸪་ᖌ௨እࡢࠕேࠖࡶᏑᅾࡍࡿࡀ㸪ࡇࡇ࡛ࡣ་ᖌ࡛௦⾲ࡉࡏࡿ㸬ࠕ᝟ሗࠖせ⣲ࡣ㸪་ᖌࡀᝈ⪅ࡉࢇ࡟ᥦ౪ࡍࡿ⑓Ẽ࡟㛵ࡍࡿヲࡋ࠸ㄝ࡛᫂࠶ࡿ㸬ࡋ࠿ࡋ㸪ࡑࡢࠕ᝟ሗࠖࢆヲࡋࡃᥦ౪ࡍࡿ་ᖌࡶ࠸ࢀࡤ㸪ࡑ࠺࡛࡞࠸་ᖌࡶ࠸ࡿ㸬ࡲࡓ㸪ධ㝔ࡋ࡚ᡭ⾡ࢆࡍࡿሙྜ㸪඲࡚ࡢ་ᖌࡀ඲ࡃྠࡌࠕ᝟ሗࠖࢆᥦ౪ࡍࡿ࡜ࡣ㝈ࡽ࡞࠸㸬ࠕ≀ࠖせ⣲ࡣᝈ⪅ࡉࢇ࡟ᥦ౪ࡍࡿ⸆㸪᳨ᰝ㸪ฎ⨨㸪་⒪ᶵჾ࡞࡝࡛࠶ࡿ㸬་

̿
1 −
̿
− 47

クラウド技術を用いた広域連携医療サービスモデルの提案

࣊ࢵࢲ࣮ᖌࡀุ᩿ࡋࡓࠕ᝟ሗࠖࡀㄗࡗ࡚࠸ࡿሙྜ࡟ࡣ㸪་ᖌ࠿ࡽᥦ౪ࡉࢀࡿࠕ≀ࠖࡶኚ໬ࡍࡿ㸬ࠕ㔠ࠖせ⣲ࡣ་⒪㈝࡛࠶
ࡿ㸬4኱せ⣲ࡣ㸪⑓㝔⤒Ⴀࡢ㈨※㸦Resource㸧࡛࠶ࡾ㸪㈨※ࡢຠ⋡ⓗ࡞㐠⏝㸦Resource Management㸧ࡀ⑓㝔⤒Ⴀ࡟ᚲせ࡜ࡉࢀࡿ㸬㈨※ࠕேࠖ࡟ࡘ࠸࡚ࡣ㸪デ⒪ࡍࡿ་ᖌ࡟ࡼࡗ࡚ࡣ㸪ᝈ⪅ࡉࢇࡀᣢࡘ㸪⑓≧ࡸ⑓Ẽ㸪デ⒪᪉ἲ࡟㛵ࡍࡿ୙Ᏻࢆㄞࡳ㐪࠼ࡓࡾ㸪ぢ㏨ࡀࡋࡓࡾࡍࡿࡇ࡜ࡶ⪃࠼ࡽࢀࡿ㸬ᝈ⪅ࡉࢇࡢ୙Ᏻࡸッ࠼ࢆṇ☜࡟⌮ゎฟ᮶࡞࠸ࡇ࡜ࡣ㸪ᝈ⪅ࡉࢇࢆ‶㊊ࡉࡏࡿ஦ࡀฟ᮶࡞࠸デ⒪㸪⑓㝔࡟࡞ࡿྍ⬟ᛶࡀ㧗࠸㸬ࡇࡢࡼ࠺࡞⑓㝔ࡣ⑓㝔ࡑࡢࡶࡢࡢ㉁ࡢపୗࢆࡶࡓ
ࡽࡋ㸪་⒪⤒Ⴀࡀᝏ໬ࡍࡿせᅉ࡜࡞ࡿ㸬㈨※ࠕ᝟ሗࠖ㸪ࠕ≀ࠖ࡟ࡘ࠸࡚ࡣ㸪2001ᖺ࡟ཌ⏕ປാ┬ࡢࠕಖ㝤་⒪ศ㔝ࡢ᝟ሗ໬࡟ྥࡅ࡚ࡢࢢࣛࣥࢻࢹࢨ࢖ࣥࠖ2)ࡀⓎ⾲ࡉࢀࡓᚋ㸪኱つᶍ⑓㝔ࢆ୰ᚰ࡟㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒ࡀᚎࠎ࡟ᬑཬࡋ࡚ࡁࡓ㸬ࡋ࠿ࡋ௚᪉㸪୰ᑠ⑓㝔ࡸデ⒪ᡤ࡞࡝ࡢᑠつᶍ་⒪ᶵ㛵࡟࡜ࡗ࡚ࡣ㧗㢠࡞ฟ㈨࡜࡞
ࡾ㸪࡞࠿࡛ࡶデ⒪ᡤ࡟࠾ࡅࡿ㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒ࡢᑟධ౛ࡣ㸪࠿࡞ࡾᑡ࡞࠸ࡢࡀᐇ᝟࡛࠶ࡿ 3)㸬୍᪉࡛㸪㟁Ꮚ࢝ࣝࢸࢆ௓ࡋࡓᆅᇦ㐃ᦠ་⒪ 4)ࡣ࠸ࡃࡘ࠿ヨࡳࡽࢀ࡚࠸ࡿࡀ㸪ࡑࡢከࡃࡣ኱୰⑓㝔୺ᑟࡢ་⒪㐃ᦠ࡛࠶ࡿ㸬ࡑࡢࡼ࠺࡞
஦᝟ࡀデ⒪ᡤࢆྵࡵࡓᗈᇦ㐃ᦠ་⒪ᬑཬࡢ㐜ࢀ࡟ࡶ࡞ࡗ࡚࠸ࡿ㸬
2.2. ᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢᴫᛕࣔࢹࣝ་⒪⤒Ⴀ࡟࠾ࡅࡿ་⒪ࢧ࣮ࣅࢫ㸦MS㸸Medical Service㸧ࡣ㸪⑓㝔ࡀᥦ౪ࡍࡿ་⒪ࢧ࣮ࣅࢫ࡜ᥦ౪ࡉࢀࡿ་⒪ࢧ࣮
ࣅࢫࡀᏑᅾࡍࡿ㸬ᥦ౪ࡉࢀࡿࢧ࣮ࣅࢫࡣ㸪་⒪ᴗົ㸪㐠Ⴀ࡟㛵㐃ࡍࡿࢧ࣮ࣅࢫ࡛࠶ࡾ㸪་⒪ᶵჾࡢಖᏲⅬ᳨ᴗົ㸦་⒪ἲ᪋⾜つ๎➨9᮲ࡢ12㸧ࡸ་⒪ᶵ㛵࡟ᑐࡍࡿデ⒪㸪᳨ᰝ㸪་⸆ရ➼࡟㛵ࡍࡿ᝟ሗᥦ౪ࢆ⾜࠺་⒪᝟ሗࢧ࣮ࣅ
ࢫ㸪ᆅᇦ㐃ᦠ་⒪ࡢᕷሙືྥㄪᰝ㸪㐠Ⴀ࡟㛵ࡍࡿᣦᑟࢆ
⾜࠺་ᴗ⤒Ⴀࢥࣥࢧࣝࢱࣥࢺࢧ࣮ࣅࢫ㸪་⒪஦ົࢧ࣮ࣅ
ࢫ࡞࡝ࡀ࠶ࡿ㸬་⒪ࢧ࣮ࣅࢫࡢᥦ౪ඛࡢ୍ࡘ࡟ᝈ⪅ࡉࢇࡀ࠶ࡾ㸪ᡃࠎࡣ㸪ᝈ⪅ࡉࢇ࡟ᥦ౪ࡍࡿ㸪࠶ࡿ࠸ࡣ㸪ᝈ⪅ࡉࢇࡀཷࡅࡿ་⒪ࢧ࣮ࣅࢫࢆᝈ⪅ࢧ࣮ࣅࢫ㸦PS㸸PatientService㸧࡜࿧ࡪ㸬⑓㝔ࡢ4኱せ⣲ࡀ㸪ᝈ⪅ࡉࢇࡢࡓࡵ࡟
ᥦ౪ࡍࡿ་⒪ࢧ࣮ࣅࢫࡣ㸪ᝈ⪅ࢧ࣮ࣅࢫ࡛࠶ࡿ㸬᝟ሗฎ⌮ࢧ࣮ࣅࢫᴗົ㸦task㸧ࡀࣉࣟࢭࢫࡢᐇ⾜࡛㐩ᡂࡉࢀࡿࡢ࡜ྠࡌࡃ㸪ᝈ⪅ࢧ࣮ࣅࢫᴗົࡢᥦ౪ࡣ㸪ᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫ㸦PSP㸸Patient Service Process㸧ࡢᐇ⾜࡛㐙⾜ࡉࢀࡿ࡜⪃࠼ࡿ㸬PSࣉࣟࢭࢫࡢ㉳ືࡣ஦㇟㸦E:Event㸧ࡢⓎ⏕࡟ࡼࡾ⾜ࢃࢀࡿ㸬Fig.2࡟ᡃࠎࡀᥦ᱌
ࡍࡿ⑓㝔⤒Ⴀ࡟࠾ࡅࡿᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢᴫᛕࣔࢹࣝࢆ♧ࡍ㸬PSa
E

PSP1Information

Time TPSP2Resource
Human
Human
GoodsPSPnPS

CapitalCapitalFig.2 Conceptual Model for Patient Service Process̿2 ̿− 48−

Fig.2࡟࠾࠸࡚ᝈ⪅ࢧ࣮ࣅࢫᴗົPSaࡢせồ㸦஦㇟㸧ࡀⓎ⏕ࡍࡿ࡜PSP1㹼PSPnࡢࣉࣟࢭࢫࡀ㉳ືࡍࡿ㸬ྛࣉࣟࢭࢫࡣ㸪ᚲせ࡟ᛂࡌ࡚㈨※ࢆ౑࠸࡞ࡀࡽᝈ⪅ࢧ࣮ࣅࢫᴗົPSaࡢ┠ⓗࢆ㐩ᡂࡍࡿ㸬௨ୗᮏ✏࡛ࡣ㸪ᝈ⪅ࢧ࣮ࣅࢫ࡜ࡋ࡚3D㟁Ꮚ⤂௓≧ 5)࡟ࡼࡿᝈ⪅⤂௓ࢧ࣮ࣅࢫ࡟ࡘ࠸࡚ࡢࣉࣟࢭࢫศᯒ࡜ࣔࢹࣝ໬ࢆ᳨ウࡍࡿ㸬
2.3. ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢࣔࢹࣝ໬

ᗈᇦ㐃ᦠ་⒪㸦GCM㸸Global Collaboration Medical㸧ࢧ࣮ࣅࢫࡣᝈ⪅᝟ሗࢆඹ㏻໬ࡍࡿࡇ࡜࡟ࡼࡾデ⒪ᡤࡸ⑓㝔㸪་⒪ᶵ㛵࠶ࡿ࠸ࡣಖ೺⚟♴ᶵ㛵ࡀ㐃ᦠࡋ࡚ᝈ⪅ࢧ࣮ࣅࢫࢆᗈᇦⓗ࡟ᥦ౪࡛ࡁࡿ་⒪ࢧ࣮ࣅࢫᙧែ࡛࠶ࡿ㸬ᮏ⠇࡛ࡣ㸪ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢ㐺⏝⠊ᅖࢆ᫂ࡽ࠿࡟ࡍࡿ㸬㸦1㸧ࣔࢹࣝ໬ࡢ᪉㔪ᗈᇦ㐃ᦠ་⒪㸦GCM㸧ࢧ࣮ࣅࢫࡣ୍⯡ⓗ࡟ࡣ㸪ᆅᇦ㐃ᦠ་⒪࡜ᤊ࠼ࡿࡇ࡜ࡀ࡛ࡁࡿࡀ㸪⑓㝔⤒Ⴀࡢ᭱ᑠ༢఩ࡣ㸪⑓㝔ࡸデ⒪ᡤ࡛࠶ࡿ㸬≉࡟㸪400ᗋ௨ୖࡢ୰᰾⑓㝔࡛ࡣ㸪⑓㝔ෆ࡛ࡢ㐃ᦠ་⒪ࡶᚲせ࡜࡞ࡿ㸬ᡃࠎࡣ㸪ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢ⠊ᅖࢆ୰᰾⑓㝔ෆ㐃ᦠࡶྵࡵ࡚ࣔࢹࣝ໬ࡍࡿ㸬ࡲࡓ㸪ᅾᏯ་⒪ࢧ࣮ࣅࢫ㸪㐲㝸デ⒪ࢧ࣮ࣅࢫ㸪ᩆᛴ
་⒪ࢧ࣮ࣅࢫ࡜ࡢ㛵ಀࢆ᫂ࡽ࠿࡟ࡍࡿ㸬
㸦2㸧ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࣔࢹࣝ
Fig.3࡟タᐃࡋࡓᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢ㝵ᒙᵓ㐀ࢆ♧ࡍ㸬(d) Global Collaboration Medical Service
Remote Medical Service(c) Local Collaboration Medical Service
Emergent Service(b) Inter Hospital Medical Service
Home Medical Care(a) Intra Hospital Service

Fig.3 Patient service hierarchy in GCM㸦a㸧㝔ෆ㐃ᦠ་⒪ࢧ࣮ࣅࢫ
デ⒪ᡤෆࡸ୰᰾⑓㝔ෆࢆᑐ㇟࡜ࡍࡿẚ㍑ⓗᑠつᶍ࡛㸪࣮ࣟ࢝ࣝ࡞ࢩࢫࢸ࣒ࢆᵓ⠏ࡍࡿࡓࡵࡢ㐃ᦠ་⒪ࢧ࣮ࣅࢫ࡛࠶ࡿ㸬࢖ࣥࢺࣛࢿࢵࢺෆࢩࢫࢸ࣒ࡢ෌ᵓ⠏㸪⣬࣮࣋ࢫࡢᝈ⪅⤂௓᝟ሗࡢ㟁Ꮚ໬㸪ᝈ⪅⤂௓ᴗົࡢ㟁Ꮚ໬㸪་⒪᝟ሗࡢDB㸦Database㸧໬࡞࡝ࡀᑐ㇟࡜࡞ࡿ㸬ࣉࣛ࢖࣮࣋ࢺࢡࣛ࢘ࢻ࡛ࡢᑐᛂ࡜࡞ࡿ㸬㸦b㸧⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫ
⑓㝔࡜デ⒪ᡤࡸ࠿࠿ࡾࡘࡅ་࡜ࡢᆅᇦ་⒪㐃ᦠศ㔝࡟࠾࠸࡚㸪ᆅᇦෆࡢ⥭ᐦ࡞་⒪ᶵ㛵ࢢ࣮ࣝࣉ㛫࡛ࡢᐦ⤖ྜᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫ⥙ࢆ⑓㝔デ⒪ᡤ㐃ᦠ㸦⑓デ㐃ᦠ㸧་⒪ࢧ࣮ࣅࢫ⥙࡜ᐃ⩏ࡍࡿ㸬⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡣ㸪୰᰾⑓㝔ෆࡢᆅᇦ㐃ᦠᐊࡢ୺࡞ᝈ⪅⤂௓≧ᴗົ࡛࠶ࡾ㸪⣬࣮࣋ࢫࡢᝈ⪅⤂௓᝟ሗࡢ㝔ෆ࡬ࡢྲྀࡾ㎸ࡳ㸪࢖ࣥࢱ࣮ࢿࢵࢺ⎔ቃ࡛ࡢ㐃ᦠ་⒪ᨭ᥼࡞࡝࡛࠶ࡿ㸬ᝈ⪅⤂௓᝟ሗࡢ஺᥮㸪デ⒪ᒚṔ᝟ሗࡢ஺᥮ࢧ࣮ࣅࢫ࡞࡝ࡶᑐ㇟࡜࡞ࡿ㸬野地保・荻野正࣊ࢵࢲ࣮

ᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫ࡜ྠព࡛ᢅࢃࢀࡿࡇ࡜ࡶ࠶ࡿࡀ㸪ᮏ✏࡛ࡣ㸪ᐦ⤖ྜᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࢆ⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫ㸪␯⤖ྜᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࢆ༢࡟ᆅᇦ㐃ᦠ
་⒪ࢧ࣮ࣅࢫ࡜ᐃ⩏ࡍࡿ㸬㸦c㸧ᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫᆅᇦෆࡢ⑓㝔ࡸデ⒪ᡤ࡜࠿࠿ࡾࡘࡅ་㛫࡛ࡢ␯⤖ྜ㐃ᦠ་⒪ࢧ࣮ࣅࢫ࡛㸪⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫ࡜ẚ࡭࡚ྛ་⒪ᶵ㛵㛫ࡢࡘ࡞ࡀࡾࡀ⦆ࡸ࠿࡛࠶ࡿ㸬Web⎔ቃ࡛ࡢᝈ⪅⤂௓᝟ሗ㸪་⒪EBM㸦Evidence-based Medicine㸧⎔ቃࡢᥦ౪࡞࡝ࡀᑐ㇟࡜࡞ࡿ㸬ࣃࣈࣜࢵࢡࢡࣛ࢘ࢻࡲࡓࡣ㸪ࣁ࢖ࣈࣜࢵࢻࢡࣛ࢘ࢻ࡛ᑐᛂࡍࡿ㸬㸦d㸧ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫᆅᇦ௨እࡢ་⒪ᶵ㛵࠶ࡿ࠸ࡣಖ೺⚟♴ᶵ㛵㸪⾜ᨻᶵ㛵࡞࡝ࢆྵࡵࡓᗈᇦ㛫ࡢ㐃ᦠ་⒪ࢧ࣮ࣅࢫ࡛࠶ࡿ㸬ᗈᇦ㐃ᦠ་⒪ࡢຠᯝࡣ㸪ձ᝟ሗබ㛤ࢧ࣮ࣅࢫࡢྥୖ࡜་⒪ࡢ㉁ࡢྥୖ㸪ղ᝟ሗࢩࢫࢸ࣒࡞࡝㈨※ࡢ┦஫฼⏝࡟ࡼࡿ㔜」
ࡋࡓタഛࡢ⡆⣲໬㸪ճ་⒪㈝ࡢ๐ῶ㸪࡛࠶ࡿ㸬ᮏࢧ࣮ࣅࢫࣔࢹࣝࡢࡼ࠺࡞㸪ඹ㏻ࡢࢧ࣮ࣅࢫࢆ」ᩘࡢ࣮ࣘࢨ࡛┦஫࡟ඹ᭷ࡋ㸪పࢥࢫࢺ࡛฼⏝ࡍࡿሙྜ࡟ࡣ㸪ࢡࣛ࢘ࢻ࢔࣮࢟ࢸࢡࢳࣕࡀ᭱㐺ࡢᙧែ࡟࡞ࡿ㸬௨ୗ㸪ᮏ✏࡛ࡣ㸪ᆅᇦ㐃ᦠ་⒪ࡢศ㔝࡛≉࡟୰᰾⑓㝔ࢆ୰ᚰ࡜ࡋࡓ⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫ㸦ᐦ⤖ྜᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫ㸧࡟࠾ࡅࡿࢡࣛ࢘ࢻᆺ㝔ෆ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢࣔࢹࣝ໬ࢆ⾜࠺㸬3㸬ᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢศᯒ࡜ࣔࢹࣝ໬

࡝࡟࠾ࡅࡿ᝟ሗ⟶⌮ᴗົࡀᚲせ࡛࠶ࡿ㸬デ⒪ᡤ୺యࡢ⤂௓ඖ་⒪ᶵ㛵ࡣ㸪ձ⣬⤂௓ᆺ㹼ճ࣓࣮ࣝῧ௜⤂௓ᆺࡀᐇ⏝ẁ㝵࡛㸪մ㟁Ꮚ፹య⤂௓ᆺࡣ୍㒊ᆅᇦ㐃ᦠ࡛ᐇ⏝໬㸪յඹ᭷⤂௓ᆺࡣ◊✲ẁ㝵࡛࠶ࡿ㸬ᮏ✏࡛ࡣ㸪◊✲ẁ㝵࡛࠶ࡿյඹ᭷⤂௓ᆺࢆᑐ㇟࡜ࡍࡿ
⑓デ㐃ᦠᝈ⪅ࢧ࣮ࣅࢫࢆࣔࢹࣝ໬ࡍࡿ㸬
3.2. ᝈ⪅ࢧ࣮ࣅࢫࡢࣔࢹࣝ໬

୍⯡ⓗ࡟ᆅᇦࡢ୰᰾་⒪ᶵ㛵ࡣ㸪㧗ᗘ࡞་⒪ᶵჾࡀᩚഛࡉࢀ㸪㝔ෆࢿࢵࢺ࣮࣡ࢡ࡟ࡼࡾデ⒪⾜Ⅽࡸ་⒪஦ົࡢຠ⋡໬ࡀᅗࡽࢀ㸪ᩚഛ⤫ྜࡉࢀࡓHIS(HospitalInformation System)㸪RIS(Radiology InformationSystem)㸪PACS(Picture Archiving and CommunicationSystems)࡞࡝ࡢ་⒪᝟ሗࢩࢫࢸ࣒ࡢ࢖ࣥࣇࣛࡀᩚഛࡉࢀ࡚࠸ࡿ㸬ᝈ⪅⤂௓ᴗົࡶᆅᇦ㐃ᦠᐊࡀᑐᛂࡍࡿሙྜࡀከ࠸㸬ࡋ࠿ࡋ㸪ྛ་⒪ᶵ㛵ࡀࡍ࡛࡟ᑟධࡋ࡚࠸ࡿᵝࠎ࡞᝟ሗ࢖ࣥࣇࣛࡣ㸪࣓࣮࢝࡟ࡼࡾ௙ᵝࡀ␗࡞ࡾ㸪⤂௓≧࡟ࡼࡿᆅᇦ་⒪㐃ᦠࡢࢿࢵࢡ࡜࡞ࡿሙྜࡀ࠶ࡿ㸬ᮏ✏࡛ࡣ㸪ࡇࡢࡼ࠺࡞⤂௓ඛ་⒪ᶵ㛵ࡢᆅᇦ㐃ᦠᐊ࡛ࡢᝈ⪅⤂௓ᴗົ࡟ࡘ࠸࡚᪤Ꮡࡢ㝔ෆ་⒪᝟ሗࢩࢫࢸ࣒࡜
㐃ᦠࡍࡿᴗົࢆ᫂ࡽ࠿࡟ࡋ࡚㸪ᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫ㸦PSP㸧࡟ࡼࡿᝈ⪅ࢧ࣮ࣅࢫࡢࣔࢹࣝ໬ࢆᅗࡿ㸬Fig㸬4࡟ࢡࣛ࢘ࢻࢆ฼⏝ࡋ࡚ࣔࢹࣝ໬ࡋࡓ⤂௓≧ᝈ⪅ࢧ࣮ࣅࢫฎ⌮ࡢὶࢀࢆ♧ࡍ㸬
Hospital Information System: Patient Service Tasks
Medical Cost
Task Management
Prescription䠈Examination

3.1. ᝈ⪅ࢧ࣮ࣅࢫࣉࣟࢭࢫࡢᢳฟᝈ⪅⤂௓ࢧ࣮ࣅࢫ࡟ࡘ࠸࡚ඵ⋤Ꮚ⑓㝔࡟࠾࠸࡚⌧≧ࡢㄪᰝࢆᐇ᪋ࡋࡓ㸬ࡑࡢ⤖ᯝ㸪୍⯡ⓗ࡟⤂௓ඖ་⒪ᶵ㛵㸪
デ⒪ᡤ࡟࠾ࡅࡿᝈ⪅⤂௓ࢧ࣮ࣅࢫ᪉ᘧࡣᣢཧᆺ࡜㏦௜ᆺ㸪ඹ᭷ᆺ࡟ศ㢮ࡉࢀࡿ㸬ᣢཧᆺ࡟ࡣ㸪⣬፹య㸪㟁Ꮚ፹య㸦CD-ROM㸧ࡀ࠶ࡾ㸪㏦௜ᆺ࡟ࡣ㸪FAX㸪࣓࣮ࣝ࡞࡝ࡀ࠶ࡿ㸬ඹ᭷ᆺࡣ㸪࢖ࣥࢱ࣮ࢿࢵࢺࡸ࢖ࣥࢺࣛࢿࢵࢺ࡞࡝ࡢࢿࢵࢺ࣮࣡ࢡୖ࡛㟁Ꮚ⤂௓≧ࢆඹ᭷ࡍࡿ᪉ᘧ࡛࠶ࡿ㸬ཌ⏕ປാ┬ࡢࠕಖ೺་⒪ศ㔝ࡢ᝟ሗ໬࡟ࡴࡅ࡚ࡢࢢࣛࣥࢻࢹࢨ࢖࡛ࣥࠖࡣ㸪2006ᖺᗘࡲ࡛ࡢ㐩ᡂ┠ᶆ࡜ࡋ࡚㸪デ⒪ᡤ࡜
400ᗋ௨ୖࡢ⑓㝔ࡢ6๭௨ୖ࡟㟁Ꮚ࢝ࣝࢸࢆᑟධࡋ㸪⑓㝔ࣞࢭࣉࢺࡢ7๭௨ୖࢆ㟁⟬໬ࡍࡿࡇ࡜࡛࠶ࡗࡓࡀ㐩ᡂࡉࢀ࡚࠸࡞࠸㸬デ⒪ᡤࡣ㸪୰᰾⑓㝔࡜ẚ㍑ࡋ࡚㸪᝟ሗ࢖ࣥࣇࣛࡢᩚഛࡀᩚࡗ࡚࠸࡞࠸ࡓࡵ㸪⣬፹యࡀ୺࡛࠶ࡿ㸬᝟ሗ࢖ࣥࣇࣛࡢᩚࡗࡓ୰᰾⑓㝔ࡶ⣬ᆺࡸFAXᆺ࡞࡝࡟ᑐᛂ࡛ࡁ࡚࠸࡞࠸ࡓࡵ㸪ᡭື㸦ேᡭ㸧࡛ᑐᛂࡋ࡚࠸ࡿ㸬
Table1࡟ྛ᪉ᘧࡢẚ㍑ࢆ♧ࡍ㸬
Table1 Comparison of referral letters system

Type䐟 Paper
䐠 TEL䞉FAX
䐡 Mail attachment
䐢 Electric MediaMediaPaper
Analog Data
Electric Document
CD-ROM䚸DVD etc.

䐣 Online share

Electric Document

PSP

PS management task
Referral Task DB
Treatment Infomation䠈Application PSP
Referral Confirmation䠈Guidance
Collaboration Task
Regional Collaboration

Referral Task
PSP

EventFormat change

FAX

Letter A

Letter B

Paper

FAX

Letter CWeb

Original A

Original B

Original C

FirewallFig.4䠊Flow of Patient Service Process⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫฎ⌮࡟ඹ㏻ࡢࢱࢫࢡ
㸦Collaboration Task㸧ࡣ㸪ࢡࣛ࢘ࢻ㸦RegionalCollaboration㸧࡟ᐇ⿦ࡉࢀ㸪ྛᶵ㛵࠿ࡽࡢせồ㸦ReferralTask㸧ࢆ᪤Ꮡࡢ㝔ෆ་⒪᝟ሗࢩࢫࢸ࣒㸦Patient ServiceTasks㸧ᶵ⬟ࢆά⏝ࡋ࡚ᐇ⌧ࡍࡿ㸬ࡇࡢࡼ࠺࡞᪤Ꮡࡢ㝔ෆ
་⒪᝟ሗࢩࢫࢸ࣒ࢆ⏕࠿ࡍ࢔ࣉ࣮ࣟࢳࡣ㸪᝟ሗࢩࢫࢸ࣒
ࡢ࢖ࣥࣇࣛࡀᩚഛࡉࢀࡓ་⒪ᶵ㛵࡬ࡢ᪂ᶵ⬟ࢩࢫࢸ࣒ࡢᑟධࡀᅔ㞴࡞㝔ෆ㐃ᦠၥ㢟࡟ᑐࡋ࡚᭷ຠ࡛࠶ࡿ㸬ᝈ⪅⤂௓ᴗົ࡛ࡣ㸪⤂௓ඖ་⒪ᶵ㛵㸪⤂௓ඛ་⒪ᶵ㛵㸦་஦ㄢ㸪⤂௓ඛ་⒪ᶵ㛵࡛ࡣ㸪ᝈ⪅ࡉࢇࡢཷ௜ᴗົ࣭⤂௓ඖ་⒪ᶵ㛵࡜⤂௓ඛ་⒪ᶵ㛵ࡢྛデ⒪⛉࡜ࡢ㐃⤡ㄪᩚ㸪⤂௓ඖ་⒪ᶵ㛵࡬ࡢ㏉᭩㸦⤖ᯝሗ࿌㸧㸪⤒㐣ሗ࿌㸪㏫⤂௓࡞̿3 ̿− 49−

クラウド技術を用いた広域連携医療サービスモデルの提案

࣊ࢵࢲ࣮デ⒪⛉㸪ᆅᇦ㐃ᦠᐊ㸧ࡢ⤂௓≧࡟㛵ಀࡍࡿࠕデ⒪᝟ሗᥦ౪᭩ࠖ㸪ࠕデ⒪⏦㎸᭩ࠖࡸ㏉᭩࡟㛵ಀࡍࡿࠕࡈ⤂௓☜ㄆ᭩ࠖ㸪ࠕ᮶㝔ࡢࡈ᱌ෆࠖ࡞࡝ࡢධຊᙧᘧࢆ⤫୍ࡋ࡚ᢅ࠺ᚲせࡀ࠶ࡿ㸬ࡇࡢࡓࡵ㸪ඹ㏻࡞ࠕ⤂௓㐃ᦠࣇ࢛࣮࣒ࠖసᡂࢧ࣮ࣅࢫࢆᝈ⪅ࢧ࣮ࣅࢫෆ࡛ᥦ౪ࡍࡿᚲせࡀ࠶ࡿ㸬ࡇࡢࡼ࠺࡟」ᩘࡢ⤌⧊ࡀඹ㏻ࡢࢧ࣮ࣅࢫࢆඹ᭷ࡋ࡚฼⏝ࡍࡿࡓࡵ࡟᭱㐺ࡢᢏ⾡ࡀ㸪ࢡࣛ࢘ࢻᢏ⾡࡛࠶ࡿ㸬

SaaPS䠖Software as a Patient Service
Applications
Referral LetterSelf-government
LifeSaving

Medical Care

Nursing

Medical4㸬ࢡࣛ࢘ࢻᆺᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢᵓᡂ
4.1㸬㝔ෆ㐃ᦠ་⒪ࣉࣛ࢖࣮࣋ࢺࢡࣛ࢘ࢻࣔࢹࣝ

Vendor Framework
GoogleApp EngineAmazon
web service

Force.com
Platform

WindowsAzure

Visit Medical
Treatment

Home
Medical Care

MedicalCollaboration

Intra Hospital Collaboration
Cloud
3D referral letter

Hardware

Reverse Reference

Internet

3D DB

Central Hospital
Intra Hospital System

PACS
DoctorPreventivemedicine

GCM Framework
Attached Cloud
Image DB
Security

Network

Clustering DB
Middleware

Fig.6㸬Hierarchy of GCM cloud

Local Collaboration
Destination
Hospital

Examination

IaaPS䠖Infrastructure as a Patient Service
InfrastructureInternet Data Center

Local
ClinicHealth CenterPaaPS䠖Platform as a Patient Service
GCM Frameworkᮏ⠇࡛ࡣ㸪ᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࡢศ㔝࡛≉࡟୰᰾⑓㝔ࢆ୰ᚰ࡜ࡋࡓ⑓デ㐃ᦠ་⒪ࢧ࣮ࣅࢫ㸦ᐦ⤖ྜᆅᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫ㸧࡟࠾ࡅࡿ㝔ෆ㐃ᦠ་⒪ࢡࣛ࢘ࢻ࡟ࡘ࠸࡚
ㄽ㏙ࡍࡿ㸬ᮏࢡࣛ࢘ࢻࡣ㸪ᆅᇦ㐃ᦠᐊ࡟3D㟁Ꮚ⤂௓≧ࢆඹ᭷ࡉࡏࡿᝈ⪅⤂௓᪉ᘧ࡟ࡼࡾᝈ⪅⤂௓≧
PaaPS(Platform as a Patient Service)࡜ࡋ࡚఩⨨࡙ࡅࡿ㸬㐺⏝ࣔࢹࣝࡣ㸪5❶࡛㏙࡭ࡿ㸬
Fig.5࡟3D㟁Ꮚ⤂௓≧ᴗົࢆᥦ౪ࡍࡿ㝔ෆ㐃ᦠ་⒪ࣉ
ࣛ࢖࣮࣋ࢺࢡࣛ࢘ࢻࣔࢹࣝࢆ♧ࡍ㸬

Original
Hospital

GCM cloud

XaaPS 䠖Everything as a PatientHIS

RISIntranet

Fig.5䠊Patient Service Private Cloud Model

GCMࢡࣛ࢘ࢻࡢୖ఩ᴫᛕ࡜ࡋ࡚XaaPS(Everything as aPatient Service)ࢡࣛ࢘ࢻࡀ࠶ࡿ㸬ࢡࣛ࢘ࢻࡢ㝵ᒙᵓᡂ࡟ᛂࡌ࡚㸪ୖ఩࠿ࡽᝈ⪅ࢧ࣮ࣅࢫࢆᥦ౪ࡍࡿ SaaPS(Service as a Patient Service)㸪ࢧ࣮ࣅࢫࡢᇶ┙ࢆᥦ౪ࡍࡿPaaPS㸪ࢯࣇࢺ࢙࢘࢔࡜ࣁ࣮ࢻ࢙࢘࢔ࡢ࢖ࣥࣇࣛࢆ
ᥦ౪ࡍࡿIaaPS (Infrastructure as a Patient Service)࠿ࡽᵓᡂࡉࢀࡿ㸬SaaPS࢔ࣉࣜࢣ࣮ࢩࣙࣥࡣ㸪་⒪ᶵ㛵㐃ᦠ㸪⮬἞య㸪ಖ೺ᡤ࡟ࡘ࠸࡚ᒎ㛤ࡍࡿ㸬ࣉࣛࢵࢺ࣮࣒࣍PaaPS࡛ࡣ㸪GCMࣇ࣮࣒࣮ࣞ࣡ࢡ࡛ᵓ⠏ࡍࡿࡀ㸪࣋ࣥࢲࣇ࣮࣒࣮ࣞ࣡ࢡ࡜⑓デ㐃ᦠ࡞࡝࡛ࡣ㸪GCMᑓ⏝ࣇ࣮࣒࣮ࣞ࣡ࢡࡶྍ⬟࡛࠶ࡿ㸬5㸬ᗈᇦ㐃ᦠ་⒪ࢧ࣮ࣅࢫࣔࢹࣝ

ᮏࢡࣛ࢘ࢻࣔࢹ࡛ࣝࡣ㸪 3D⏬ീࣇ࢓࢖࡛ࣝᵓᡂࡉࢀࡿࢹ࣮ࢱ࣮࣋ࢫ㸦3D DB㸧ࡣ㸪᪤Ꮡࡢ㝔ෆ་⒪᝟ሗࢩࢫࢸ࣒
ࡢDBࢆࢹ࣮ࢱࢭࣥࢱ࡜ࡋ࡚ά⏝ࡍࡿ㸬࢖ࣥࢺࣛࢿࢵࢺ࡟᥋⥆ࡉࢀࡓ㝔ෆࢩࢫࢸ࣒ࡸ㸪デ⒪⛉㸪་ᖌ࡞࡝ࡣ㸪㝔ෆ࠿ࡽ㸪ᮏࢡࣛ࢘ࢻ་⒪ࢧ࣮ࣅࢫࢆ฼⏝ࡍࡿࡀ㸪⤂௓ඖ་⒪ᶵ㛵㸪ᅾᏯデ⒪㸪⥭ᛴデ⒪⎔ቃ࡛ࡣ㸪࢖ࣥࢱ࣮ࢿࢵࢺ
ࢆ௓ࡋ࡚デ⒪᝟ሗᥦ౪᭩ࡢ㟁Ꮚⓗ࡞సᡂ࣭㏦௜࣭⟶⌮ࢆ⾜࠺㸬
4.2㸬ᝈ⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻࡢ㝵ᒙࣔࢹࣝ໬

GCMࢡࣛ࢘ࢻࡀᥦ౪ࡍࡿࢧ࣮ࣅࢫࡣ㸪ᝈ⪅ࢧ࣮ࣅࢫࡀ୺య࡛࠶ࡿ㸬ᮏ⠇࡛ࡣ㸪3D㟁Ꮚ⤂௓≧࡜㟁Ꮚ࢝ࣝࢸ࠿ࡽᥦ
౪ࡉࢀࡿᝈ⪅デ⒪᝟ሗ࡟ࡼࡿデ᩿ᨭ᥼ 6)ࢆ୰ᚰ࡜ࡍࡿᝈ
⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻࡢ㝵ᒙࣔࢹࣝ㸦Fig. 6㸧ࢆᥦ᱌ࡍࡿ㸬̿4 ̿− 50−

5.1. 3D 㟁Ꮚ⤂௓≧ SaaPS，⌧≧㸪3❶ࡢTable 1࡛♧ࡋࡓ࡜࠾ࡾࠊ㟁Ꮚ⤂௓≧ࡣ㸪୺࡟༳ๅࡉࢀࡓ⣬፹యࡸCD-ROM࡞࡝ࡢ㟁Ꮚ፹య࡞࡝࡟ࡼࡾ㸪࢜ࣇࣛ࢖࡛ࣥ᝟ሗ஺᥮ࡉࢀ࡚࠸ࡿ㸬ᡃࠎࡣ㸪㟁Ꮚ⤂௓≧ࡢ࢜ࣥࣛ࢖ࣥࢡࣛ࢘ࢻ໬ࢆ┠ᣦࡋࠊඛ⾜◊✲P2Pᆺ3D⏬ീᨭ᥼௜ࡁ㟁Ꮚ⤂௓≧(3DERL: 3D electronic referralletters) 5)ࢆMicrosoft Accessࢆ⏝࠸࡚ᐇ⿦ࡋ㸪ᝈ⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻࣔࢹࣝࢆᐇ⌧ࡍࡿ㸬
㸦1㸧3Dࢯࣇࢺࡢ㑅ᢥᝈ⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻ࡛ࡣ㸪3D㟁Ꮚ⤂௓≧⟶⌮ᴗົࢆᥦ౪ࡍࡿ㸬3Dྜᡂࢯࣇࢺࡣ㸪ࢧ࢖ࣂࢿࢵࢺࢩࢫࢸ࣒(ᰴ) 7㸧
ࡢINTAGE ࢩ࣮ࣜࢬࡢࣜ࢔ࣜ࢔㸦Realia㸧ࢆ㸪Realia࡛ྜᡂࡉࢀࡿ3D⏬ീᙧᘧ࡟IVPᙧᘧࢆ᥇⏝ࡋࡓ㸬3D෌⏕࡟ࡣࣇ࣮ࣜࢯࣇࢺ࡛࠶ࡿIntageVP㸦Intage Volume Player㸧ࢆ野地保・荻野正࣊ࢵࢲ࣮㑅ᢥࡋࡓ㸬IVPࣇ࢓࢖ࣝࡣࢡࣛ࢘ࢻ࡛ඹ᭷ࡍࡿ᪉ᘧ࡜ࡍࡿ㸬
㸦2㸧3D⏬ീཧ↷ᶵ⬟௜㟁Ꮚ⤂௓≧SaaPS
3D⏬ീཧ↷ᶵ⬟௜ࡁ㟁Ꮚ⤂௓≧࡜ࡣ㸪㟁Ꮚ⤂௓≧࡟⏬
ീཧ↷ࢆࡍࡿࡓࡵࡢ3D࣎ࢱࣥࢆタࡅ㸪ࡇࡢ࣎ࢱࣥࢆ
IntageVP࡜ࣜࣥࢡࡉࡏ㸪㟁Ꮚ⤂௓≧ୖ࡛ᝈ⪅ࡢ3D⏬ീࢆ⾲♧ࡍࡿᶵ⬟࡛࠶ࡾ㸪SaaPS࡜ࡋ࡚ᐇ⿦ࡍࡿ㸬Fig.7࡟3D㟁Ꮚ⤂௓≧ SaaPSࣔࢹࣝ౛ࢆ♧ࡍ㸬
Realiasynthesis

IVP DB(IaaPS)

Save with IVP format
䝸䞁䜽

3D Image

3D Button
3DERL:3D electronic referral letters㸦SaaPS㸧IVP DBࡣࢡࣛ࢘ࢻ࡛ࡢࢹ࣮ࢱᐜ㔞ࡢ๐ῶࢆ┠ⓗ࡟3DERL
࡜ඹ᭷ࡉࡏࡿ᪉ᘧ࡜ࡋࡓ㸬 VONAVSᝈ⪅ࢧ࣮ࣅࢫDBMSࡣ㸪ᝈ⪅ࢧ࣮ࣅࢫࡢᒚṔ⟶⌮DB㸦CRDBMS㸧࡜3D㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒㸦KTDBMS㸧࡛ᵓᡂࡍࡿࣔࢹࣝ࡜ࡋࡓ㸬ᡃࠎࡣ㸪Microsoft Accessࢆ⏝࠸࡚KTDBMS࡜IVP DBࢆࣜࣥࢡࡉࡏ
ࡿࡇ࡜࡟ࡼࡾ㸪3Dᨭ᥼ྍ⬟࡞㟁Ꮚ࢝ࣝࢸࢡࣛ࢘ࢻࡢࣔࢹࣝ໬ࢆヨࡳࡓ㸬
IVP DBࡢタᐃ⟶⌮᪉ᘧ࡟ࡣ㸪ձSaaPS࡜ྠࡌࢡࣛ࢘ࢻୖ
࡟IaaPS࡜ࡋ࡚タᐃࡍࡿ᪉ᘧ㸪ղSaaPS࡜ࡣู࡞ᑓ⏝᱁⣡ᗜ౛࠼ࡤ㸪ࣃࣈࣜࢵࢡࢡࣛ࢘ࢻ࡟࠾ࡅࡿDC㸦 Internet datacenter㸧࡛ࡲ࡜ࡵ࡚⟶⌮ࡍࡿ᪉ᘧࡀ࠶ࡿ㸬᪉ᘧձࡢྠ୍ࢡࣛ࢘ࢻ࡛タᐃ⟶⌮ࡍࡿ᪉ᘧ࡛ࡣ㸪࣮ࣘࢨࡀࢹ࣮ࢱ◚ቯ㸪ᾘኻ࡞࡝࡟ᑐࡍࡿࢭ࢟ࣗࣜࢸ࢕㠃࡛ࡢಖ㞀ࢆ┤᥋⟶⌮࡛ࡁࡿ࣓ࣜࢵࢺࡣ࠶ࡿࡀ㸪୍᪉㸪ᑓ⏝ࡢࢹ࣮ࢱಖ⟶タഛ㸦DC࡞࡝㸧ࢆᚲせ࡜ࡍࡿ࡞࡝ࢥࢫࢺ㠃࡛ࡢㄢ㢟ࡀᏑᅾࡍࡿ㸬᪉ᘧղࡢDC࡛⟶⌮ࡍࡿ᪉ᘧ࡛ࡣࠊ࣮ࣘࢨࡀ┤᥋⟶⌮ಖ㞀࡛ࡁ࡞࠸᪉ᘧࡢࡓࡵࠊࢹ࣮ࢱ◚ቯ㸪ᾘኻ࡞࡝࡟ᑐࡍࡿࢭ࢟ࣗࣜࢸ࢕㠃࡛ࡢಖ㞀⟶⌮࡟ᑐࡍࡿㄢ㢟ࡀ࠶ࡿ㸬ᮏ◊✲࡛ࡣ㸪ᡃࠎ⮬㌟ࡢಖ㞀⟶⌮ࡀྍ⬟࡞⠊ᅖ࡛ࡢ◊✲ࢆ㐍ࡵࡿᚲせᛶ࠿ࡽࠊࢡࣛ࢘ࢻ㸦SaaPS㸪IaaPS㸧࡟タ⨨ࡍࡿࣔ，ࢹࣝ໬ࢆ᥇ࡗ࡚࠸ࡿ㸬Fig.7㸬Implementation of 3DERL SaaPS6㸬ホ౯࡜⪃ᐹ，IntageVPࡢᐇ⿦᪉ᘧ࡟ࡣࠊձ3DERL㸦SaaPS㸧ഃ࡟ᐇ⿦ࡍࡿ㸪ղIVP DB(IaaPS)ഃ࡟ᐇ⿦ࡍࡿ㸪ճ3DERL㸦SaaPS㸧
࡜IVP DB(IaaPS)௨እ࡛ඹ᭷ࡍࡿ㸪ࣔࢹࣝ໬᱌ࡀ࠶ࡿ㸬ᮏㄽᩥ࡛ࡣ㸪⡆༢࡟ᐇ⿦࡛ࡁࡿ᪉ᘧձࡢࣔࢹࣝ໬᱌ࢆ᥇⏝ࡋࡓ㸬㟁Ꮚ⤂௓≧࡟㏣ຍࡋࡓ3D ࣎ࢱࣥࢆࢡࣜࢵࢡࡍࡿࡇ࡜࡟ࡼࡾ㸪IVP DB(IaaPS)ෆ࡟࠶ࡿᝈ⪅ࡉࢇ࡟ᑐᛂࡋࡓ
Realia࡛ྜᡂࡉࢀࡓ3D⏬ീࡢIVPࣇ࢓࢖ࣝࢆIntageVP࡛⾲♧ࡍࡿ㸬㟁Ꮚ⤂௓≧ࡣ㸪㟁Ꮚ࢝ࣝࢸࡢᝈ⪅᝟ሗࢆཧ↷ࡍࡿࡓࡵ㸪㟁Ꮚ⤂௓≧ࢡࣛ࢘ࢻࡢ◊✲࡟ࡣ㸪㟁Ꮚ࢝ࣝࢸࢡࣛ࢘ࢻࣔࢹࣝࡀᚲせ࡜࡞ࡿ㸬5.2⠇࡛ヲ㏙ࡍࡿ㸬5.2. 3D 㟁Ꮚ࢝ࣝࢸ SaaPSᡃࠎࡣ㸪ඛ⾜◊✲┣┠⪅ࡢ⮬❧Ṍ⾜ࢆᨭ᥼ࡍࡿ┣┠⪅ᨭ᥼ࢼࣅࢩࢫࢸ࣒㸦VONAVS㸸Voice navigation system㸧8)ࡢ◊✲ࢆᇶᮏ࡟᪂ࡓ࡟㸪3D㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒㸦KTDBMS㸧㸪VONAVSᝈ⪅ࢧ࣮ࣅࢫDBMS㸦 VONAVS DBMS㸧ࢆࣔࢹࣝ໬ࡋࡓ㸬Fig.8࡟VONAVS 3D㟁Ꮚ࢝ࣝࢸ㸦SaaPS㸧ࣔࢹࣝ౛ࢆ♧ࡍ㸬

Patient Service DBMS

Patient CRDBMS㝔ෆ㐃ᦠ་⒪ࢡࣛ࢘ࢻ࡛ࡣ㸪ࢥࢫࢺ㠃࠿ࡽ3D⏬ീࢹ࣮ࢱࡢࢡࣛ࢘ࢻಖ⟶ᐜ㔞ࡢ๐ῶ࡜ᛶ⬟㠃࠿ࡽ㝔ෆࢩࢫࢸ࣒࡬ࡢࢺࣛࣇ࢕ࢵࢡ➇ྜࡀㄢ㢟࡛࠶ࡾ㸪IVPࣇ࢓࢖ࣝࡢᐜ㔞ࢆᑡ࡞ࡃࡍࡿࡇ࡜ࡀᚲせ᮲௳࡜࡞ࡿ㸬ࡑࡢࡓࡵ㸪ࣜ࢔ࣜ࢔࡛ྜᡂࡉࢀࡿ3D⏬ീࡢᅽ⦰⋡ࡢホ౯ࢆ⾜࠺㸬㸦1㸧ホ౯᪉ἲ࡜᮲௳ᝈ⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻ࡛ࡣ㸪3D⏬ീDB⟶⌮PaaPSࡸ3D⏬
ീᨭ᥼ࡢ㟁Ꮚ⤂௓≧㸪㟁Ꮚ࢝ࣝࢸࡢಖ⟶ࢧ࣮ࣅࢫ࡜⤂௓ඛ࡬ࡢ㌿㏦ࢧ࣮ࣅࢫࡀⓎ⏕ࡍࡿ㸬ᡃࠎࡣ㸪ࡇࢀࡲ࡛㸪
INTAGE ࢩ࣮ࣜࢬࣜ࢔ࣜ࢔࡛ྜᡂࡋࡓ3D⏬ീ(IVPࣇ࢓࢖ࣝ)ࢆ࢖ࣥࢱ࣮ࢿࢵࢺ㌿㏦ࡍࡿࡇ࡜ࢆ๓ᥦ࡟3D⏬ീ௜ࡁ㟁Ꮚ⤂௓≧㸦3DERL㸧࡜3D㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒㸦KTDBMS㸧
ࢆࣔࢹࣝ໬ࡋࡓ㸬3Dᵓᡂࡣᇶᮏⓗ࡟VR(Volume Rendering)࡜VE(Virtual Endoscopy)ࡀ㑅ᢥ࡛ࡁࡿ㸬ᮏ⠇࡛ࡣ㸪3Dྜ
ᡂ࡟ࡼࡿ⏬ീᅽ⦰⋡ࡢホ౯ࢆ⾜࠺㸬ホ౯ࢹ࣮ࢱࡢ✀㢮ࡣ㸪⮫ᗋ⌧ሙࡢ་ᖌࡸᢏᖌࡢࡈ༠ຊࢆᚓ࡚ࠊ㟁Ꮚ࢝ࣝࢸ࡛౑
⏝ࡉࢀࡿ3D⮫ᗋࢹ࣮ࢱࡢ୰࠿ࡽᶆ‽ⓗ࡞10✀㢮㸦Table 2㸧ࢆ㑅ᢥࡋࡓ㸬2Dࢹ࣮ࢱࢧ࢖ࢬࡣ㸪1.4MB㹼127MB࡛࠶ࡿ㸬
Fig.9࡟ホ౯ࡢᑐ㇟࡜ࡋࡓDICOMᙧᘧࡢX⥺CT⏬ീ࡜
Realia࡛ྜᡂࡋࡓ኱⭣㒊ࡢ3D⏬ീྜᡂẚ㍑౛ࢆ♧ࡍ㸬(b) 3D femur image(Volume Rendering)(a) CT femur image(DICOM)

Patient KTDBMS

synthesis

IVP DB䠄IaaPS䠅ྜᡂ๓ 1.4MB

ྜᡂᚋ 1.0MBFig.9 Comparison between 2D image and 3D image
Fig.9

Fig.8 Implementation of 3D image VONAVS SaaPS̿5 ̿− 51−

クラウド技術を用いた広域連携医療サービスモデルの提案

࣊ࢵࢲ࣮ホ౯᪉ἲࡣ㸪ࣜ࢔ࣜ࢔ࢆ⏝࠸࡚2D⏬ീ࠿ࡽ3D⏬ീ࡟ྜᡂࡋ࡚IVPࣇ࢓࢖ࣝࢧ࢖ࢬࢆồࡵ㸪ྜᡂ๓ࣇ࢓࢖ࣝࢧ࢖ࢬ
x࡜ྜᡂᚋࡢࣇ࢓࢖ࣝࢧ࢖ࢬyࡢẚ㍑࡟ࡼࡾ㸪ᅽ⦰⋡zࢆồࡵࡿ㸬z 1 y / x

7㸬ࡲ࡜ࡵ

㸦1㸧

3D⏬ീྜᡂホ౯㡯┠ࢆḟࡢ3Ⅼ࡜ࡍࡿ㸬ձ ྜᡂ๓࡜ྜᡂᚋࡢᅽ⦰⋡ࡢẚ㍑
ྜᡂᑐ㇟࡜࡞ࡿ2D⏬ീࡢ௵ពᯛᩘ㒊ศࢆྜᡂ⟠ᡤ࡜࿧ࡪ㸬ྜᡂࡍࡿ2D⏬ീࡢᯛᩘࡸྜᡂ⟠ᡤ࡟ࡣὀ┠ࡏࡎ㸪඲య࡜ࡋ࡚ࡢࢹ࣮ࢱࢧ࢖ࢬࡢᅽ⦰⋡࡟ὀ┠ࡋࡓẚ㍑㡯┠࡛࠶ࡿ㸬ղ ྜᡂᯛᩘࡢᅽ⦰⋡࡟୚࠼ࡿᙳ㡪ྜᡂࡍࡿ2D⏬ീࡢᯛᩘࢆ10ᯛ࠿ࡽጞࡵ10ᯛ༢఩࡛ቑࡸࡋ㸪100ᯛࡢྜᡂࡲ࡛⾜࠸㸪ᅽ⦰⋡ࡢኚ໬ࢆࡳࡿ㸬ճ ྜᡂ⟠ᡤ࡜ᅽ⦰⋡࡜ࡢ㛵ಀྜᡂ⟠ᡤࡣ᭱ప2ᯛࡢ2D⏬ീ࡛ᵓᡂࡉࢀࡿ㸬ྜᡂࡍࡿ2D⏬ീࡢᯛᩘࢆ1㹼2ᯛ┠㸪2㹼3ᯛ┠㸪࣭࣭࣭㸪10㹼11ᯛ┠࡜ྜᡂ⟠ᡤࢆ࣮࢜ࣂࢵࣛࣉࡉࡏ࡞ࡀࡽ2ᯛࡎࡘྜᡂࡍࡿࡇ࡜࡟ࡼࡾᅽ⦰⋡࡟ኚ໬ࡀฟࡿ࠿ࢆ☜ㄆࡍࡿ.
㸦2㸧ホ౯⤖ᯝ࡜⪃ᐹ
Table 2࡟ホ౯⤖ᯝࢆ♧ࡍ㸬
Table 2 Comparison of Compression ratioNO.
1ࢺࢲ࢘ࣥྍ⬟࡛࠶ࡾ㸪ᶵ⬟㏣ຍࡶᐜ࡛᫆࠶ࡿ㸬մ㠃ಽ࡞ࢩࢫࢸ࣒⟶⌮ࡸࢹ࣮ࢱ⟶⌮ࡀ୙せ࡛࠶ࡾ㸪་ᖌࡣᮏ᮶ࡢデ⒪࣭἞⒪ᴗົ࡟ᑓᛕ࡛ࡁࡿ㸬䝕䞊䝍ྡ๓䠄MB䠅 ᚋ䠄MB䠅
1. 0ᅽ⦰⋡኱⭣㒊

1.4

28.6

2

brain_surface

15.1

6.2

58.9

3

ṑ⛉⏝䝕䞊䝍

63.9

44. 0

31.1

4

Stomach

76.6

33.1

56.8

5

Broncho

127

59.8

52.9

6

CT Head

77

38.1

50.5

7

Ankle

64.4

21.1

67.2

8

Colon

63

28.6

54.6

9

Brain_nerve

33.8

20. 0

40.8

10

኱ື⬦⒗

64.5

18.6

71.2

ᮏㄽᩥ࡛ࡣ㸪ᗈᇦ㐃ᦠ་⒪࡟࠾ࡅࡿ3D㟁Ꮚ⤂௓≧࡟ࡼࡿᝈ⪅ࢧ࣮ࣅࢫPaaPS࡟ࡘ࠸࡚㸪ᆅᇦ་⒪ᶵ㛵㛫ࡢ㐃ᦠၥ㢟ࡸ㐲㝸デ⒪ࡸᩆᛴデ⒪㸪ᅾᏯデ⒪࡞࡝ࡢᝈ⪅ࢧ࣮ࣅࢫၥ㢟ࢆゎỴࡍࡿ㝔ෆ㐃ᦠᝈ⪅ࢧ࣮ࣅࢫࢡࣛ࢘ࢻࢆᥦ᱌ࡋࡓ㸬ࡲࡓ㸪ࡇࡢࢡࣛ࢘ࢻࡀᶵ⬟㠃࡜ᛶ⬟㠃࡟࠾࠸࡚ࡶᐇࢩࢫࢸ࣒࡜ࡋ࡚᭷ຠ࡛࠶ࡿࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓ㸬㝔ෆ㐃ᦠࢡࣛ࢘ࢻ࡟ࡼࡗ࡚㸪⌧≧ࡢྛデ⒪ᡤ࡛␗࡞ࡿ㸪ᣢཧᆺ㸪
FAXᆺ㸪Webᆺ࡞࡝ࡢࡍ࡭࡚ࡢᶵ⬟せ௳࡟ྜࢃࡏ࡚㸪⤂௓ඛ་⒪ᶵ㛵࡛ࡢᝈ⪅ࢧ࣮ࣅࢫࡢᥦ౪ࡀྍ⬟࡜࡞ࡿ㸬௒ᚋࡢㄢ㢟࡜ࡋ࡚ࡣ㸪GCMࢡࣛ࢘ࢻࡢᅾᏯ㐃ᦠ⠊ᅖᣑᙇࡀᣲࡆࡽࢀࡿ㸬GCMࣇ࣮࣒࣮ࣞ࣡ࢡࢆ࣋ࣥࢲࣇ࣮࣒࣮ࣞ࣡ࢡ࡛ᵓ⠏ࡍࡿࡇ࡜ࡀᮃࡲࢀࡿ㸬ㅰ㎡ከ኱࡞ࡿᚚᨭ᥼ࢆ㈷ࡗࡓᮾᾏ኱Ꮫ་Ꮫ㒊௜ᒓඵ⋤Ꮚ⑓㝔ࡢᇼ஭ᐇẶ࡜ࢧ࢖ࣂࢿࢵࢺࢩࢫࢸ࣒㸦ᰴ㸧ࡢ‶⏕ᗣ୍Ặ୪ࡧ࡟ᮾᾏ኱Ꮫ᝟ሗ㏻ಙᏛ㒊㔝ᆅ◊✲ᐊࡢⓙࡉࢇ≉࡟ఀ⸨ᾴ㤶ྩࡣ3Dホ౯ᐇ㦂ࢆᡭఏࡗ࡚㡬ࡁឤㅰࡢពࢆ⾲ࡋࡲࡍ㸬ཧ⪃ᩥ⊩ྜᡂࡍࡿ2D⏬ീࡢᯛᩘࡸྜᡂࡍࡿ⟠ᡤ࡟ࡣὀ┠ࡏࡎ㸪඲య࡜ࡋ࡚ࡢࢹ࣮ࢱࢧ࢖ࢬࡢᅽ⦰⋡ࢆẚ㍑ࡍࡿ㸬⤖ᯝ㸪ᅽ⦰⋡ࡣ28.8%㹼71.2%࡜⏬ീࢹ࣮ࢱ࡟ࡼࡗ࡚኱ࡁࡃᕪࡀฟ࡚࠸ࡿ㸬ྜᡂᯛᩘ10ᯛ࠿ࡽ100ᯛࡲ࡛ኚ໬ࡉࡏࡓ⤖ᯝ㸪ᅽ⦰⋡ࡣ㸪53.6%㹼57.2%࡜࡞ࡾ㸪ᕪࡀ⏕ࡌ࡞࠿ࡗࡓ㸬ྜᡂ⟠ᡤ࡜ᅽ⦰⋡࡜ࡢ㛵ಀࡶᕪࡀ⏕ࡌ࡞࠿ࡗࡓ㸬⤖ᯝ࠿ࡽ㸪
IVPࣇ࢓࢖ࣝࡣ㸪ᖹᆒ⣙50㸣ࡢᐜ㔞㍍ῶࡀྍ⬟࡛㸪ࢹ࣮ࢱ㌿㏦࡛ࡢࢺࣛࣇ࢕ࢵࢡ㔞ࡢ㍍ῶ࡟ຠᯝࡀᚓࡽࢀࡿࡇ࡜ࡀ
ศ࠿ࡗࡓ㸬(3)➨୕⪅᳨ドᶵ⬟㠃࡛ࡢ➨୕⪅᳨ド࡜ࡋ࡚㸪3D㟁Ꮚ࢝ࣝࢸࢩࢫࢸ࣒㸦KTDBMS㸧࡜3D㟁Ꮚ⤂௓≧㸦3DERL㸧ࢡࣛ࢘ࢻࡢヨ౑⏝ホ౯ࢆ᯾་ᖌ఍࡟࠾㢪࠸ࡋࡓ⤖ᯝ㸪௨ୗࡢ⪃ᐹࢆ㡬࠸ࡓ㸬ձࢩࢫࢸ࣒ࡢᏳ඲ᛶᑐ⟇࡜ࡋ࡚⿦⨨㸪ࢩࢫࢸ࣒ࡢศᩓࡀྍ⬟࡜࡞ࡿ㸬ղ኱㟈⅏࡛㸪ఫᇶࢿࢵࢺࡸࣞࢭࣉࢺࢹ࣮ࢱࡀኻࢃࢀࡿ≧ἣࢆ⪃࠼ࡿ࡜㸪ࢡࣛ࢘ࢻ࡟ࡼࡿࢹ࣮ࢱಖᏑࡢ㔜せᛶࡀᐇឤࡉࡏࡽࢀࡓ㸬ճ࢔ࣉࣜࢣ࣮ࢩࣙࣥ㸦SaaPS㸧ࡣᚑ㔞ㄢ㔠ไࡢ᥇⏝࡛ࢥࢫ̿
6 ̿− 52−1)ᗈᇦ㐃ᦠ་⒪ࢿࢵࢺ࣮࣡ࢡࢩࢫࢸ࣒㸦GCMNWS:Global Collaboration Medical Network System)㸧◊✲఍ࠖhttp://www.gcm-sso.jp/2)ಖ㝤་⒪ศ㔝ࡢ᝟ሗ໬࡟ྥࡅ࡚ࡢࢢࣛࣥࢻࢹ
ࢨ࢖ࣥࡢ⟇ᐃ࡟ࡘ࠸࡚
http://www.mhlw.go.jp/shingi/0112/s1226-1.html
3)㛗⃝஽㸪͇ ⩌㤿┴࡟࠾ࡅࡿ㟁Ꮚ࢝ࣝࢸࡢᑟධ
≧ἣㄪᰝ㸪͇➨25ᅇ་⒪᝟ሗ㐃ྜ኱఍ࣉࣟࢢ࣒࣭ࣛᢒ㘓
㞟,pp.128(2005)4)㕥ᮌᩪ⋤㸪Ⲩᮌ㈼஧㸪⬥ඖ┤ᙪ௚,͇ᐑᓮᆅᇦࡢ⌧≧࡜௒ᚋ㸦ࡣ࡟ࢃࢿࢵࢺ㸧㸪͇➨24ᅇ་⒪᝟ሗᏛ㐃ྜ኱఍ㄽᩥ㞟㸪pp.308-309(2004)5)㔝ᆅಖ㸪᭷㔝┿ྐ㸪࿘⸨Ᏻ㐀㸪͇3D⏬ീᨭ᥼ࡢP2Pᆺ་⒪㐃ᦠ࢔࣮࢟ࢸࢡࢳࣕࡢᵓ⠏࡜ホ౯㸪͇➨28ᅇ
JAMIT2009㸪OP6-08/JAMIT2009Proceedings㸪pp.1-10(2009)6)࿘⸨Ᏻ㐀㸪బࠎᮌோ㸪ᕝ஭㝯❶㸸⏬ീデ᩿ᨭ᥼ࢆ⪃៖ࡋࡓ㟁Ꮚ⤂௓≧࡟ࡼࡿデ⒪ᡤ㛫་⒪㐃ᦠࢩࢫࢸ࣒ࡢ㛤Ⓨ㸬་⒪᝟ሗᏛ27:483-489,20077)
ࢧ࢖ࣂࢿࢵࢺࢩࢫࢸ࣒ᰴᘧ఍♫࢔ࢻࣂࣥࢫࢻࢯ࣮ࣜࣗࢩࣙࣥ஦ᴗ㒊 ࣅࢪࣗ࢔ࣜࢮ࣮ࢩࣙࣥ㒊ࣜ࢔ࣜ࢔ࢧ࣏࣮ࢺhttp://www.kgt.cybernet.co.jp/8)
Juthamas Punwilai, Tamotsu Noji and Hiroyuki
Kitamura, ³The Design of a Voice Navigation System forthe blind in Negative Feelings Environment´㸪IEEE
ISCIT 2009㸪1B-6,pp53-58(2009)