Regional Collaboration and Standards

A regional healthcare cooperation information system enables hospitals, clinics, and other institutions in a region to view and share patients' clinical information with one another, supporting community-based care through referrals, counter-referrals, and regional cooperation pathways. Cooperation between departments within a hospital is the role of the hospital information system, and payroll or advertising is not a purpose.

The distributed model is an architecture in which each facility keeps its own data and facilities cross-reference each other when needed. Aggregating information into a data center is the cloud (centralized) model, and the two differ in how data is held. Mailing paper charts is wrong as a description of an information system architecture.

A regional healthcare information cooperation network is a mechanism in which regional hospitals, clinics, pharmacies, and long-term care facilities participate and can view the clinical information of patients who have consented, helping with referrals, counter-referrals, and reducing duplicate tests. Connecting departments inside a hospital is a matter of hospital information system architecture; information is not shared for all citizens without consent; and exchanging ordering information is a pharmaceutical distribution system.

Unlike hospitals, clinics have few central clinical service departments, so they have few departmental systems, and configurations integrating or closely linking the claims computer and the electronic medical record are common. Because it is hard to assign dedicated IT staff, keeping the operational burden low matters, and claims computers are in fact widely used in clinics.

The Japan Medical Association standard claims software (Nichi-rese, ORCA) is claims computer software developed and provided by the Japan Medical Association (日本医師会) and is widely used, mainly in clinics. The Japan Pharmaceutical Association, the Japanese Nursing Association, and the Japan Hospital Association are not its developers or providers.

For regional healthcare cooperation information systems, the cited challenges include sustaining the program after construction subsidies end (bearing the operating costs), ensuring that users at participating facilities follow the operating rules, use in home care, and support for wide-area use. Sharing clinical information itself is done with proper consent and safeguards and is not completely prohibited by law. More participating facilities actually makes coordination more complex.

Beyond mutual viewing of clinical information, regional healthcare cooperation information systems provide functions such as creating and sending referral letters (clinical information letters), booking appointments at partner institutions, and regional cooperation pathways that share the care plan from the acute phase through recovery to the family doctor. Shift scheduling belongs to nursing management systems, and pharmaceutical manufacturing and life insurance management are not cooperation functions.

In online eligibility verification, the patient holds the My Number card over a face-recognition card reader, and identity and eligibility are verified using the electronic certificate in the IC chip. Institutions do not handle the 12-digit My Number itself. Eligibility information is queried against the online eligibility verification system run by the Payment Fund and the National Health Insurance central federation, and it is used across medical, dental, and pharmacy settings.

Through the online eligibility verification system, when the patient consents, healthcare institutions and pharmacies can view medication information, specific health checkup information, and the like, and use them in care and medication counseling. Bank balances, tax payments, and educational history are not covered by this mechanism and fall outside its purpose of insurance eligibility verification and use in care.

Issuance of new conventional health insurance cards ended in December 2024; people without a Myna insurance card (a My Number card registered for health insurance use) are issued an eligibility certificate by their insurer, which is used to verify eligibility at visits. Online eligibility verification has been mandatory in principle for insurance-covered institutions and pharmacies since April 2023, so it is not optional.

Electronic prescriptions exchange prescription and dispensing information through the electronic prescription management service run by the Payment Fund and the National Health Insurance central federation; the mechanism is based on the online eligibility verification system and can use recent prescription and dispensing information spanning multiple institutions and pharmacies to check for duplicate medications and contraindicated combinations. It is not run per prefecture and nothing is mailed. Patients can choose electronic or paper.

HPKI (Healthcare PKI) is the public key infrastructure for the health, medical, and welfare fields; it can electronically certify national qualifications such as physician licenses and is used for digital signatures when issuing electronic prescriptions. PACS is the medical image management system, DICOM is the standard for medical images, and DWH is a data warehouse; none of them is a public key infrastructure certifying qualifications.

Telemedicine is classified by who is connected: D to P connects a Doctor and a Patient directly, with online consultations and remote monitoring as representative examples. D to D connects physicians with each other, as in teleradiology and telepathology. Forms mediated by a nurse are called D to N to P. B to B and P to P are not telemedicine classification terms.

Teleradiology is D to D telemedicine in which radiological images such as CT and MRI are sent over communication lines and a remote radiologist reads and diagnoses them, supporting facilities that lack reading physicians. Measuring blood pressure at home relates to remote monitoring, receiving prescriptions electronically is the electronic prescription system, and care planning belongs to long-term care systems.

Telepathology is D to D telemedicine in which images of pathology specimens are sent over communication lines for a remote pathologist to diagnose; a representative use is intraoperative rapid diagnosis during surgery at facilities without a full-time pathologist. Ambulance tracking, automatic drug ordering, and waiting-count displays are not examples of remote pathological diagnosis.

The electronic medication notebook is a mechanism by which patients electronically manage their own dispensing information and medication history, for example with a smartphone app; it can consolidate information from multiple pharmacies and institutions and is a representative example of a PHR. It is not a staffing or wholesale price comparison system, nor does it restrict physicians' prescribing rights.

The powder medicine verification system checks, when dispensing powdered drugs, that the weighed drug and its amount match the prescription, preventing dispensing errors. The automatic tablet packaging machine packages tablets into single-dose packs per administration time and does not interpret test results. The electronic medication history system manages medication counseling records, and bed management is a hospital information system function.

Checkups differ from clinical care in that the same test items are performed on many examinees in a short time; a checkup system supports everything from booking and reception through testing, result management and grading, and report generation, and year-over-year management of results and use in follow-up guidance are important. Inpatient records belong to the hospital information system, and descriptions of discarding results or lacking booking functions are wrong.

Long-term care information systems divide into insurer-side and provider-side systems: the insurer (municipal) side supports eligibility management, care-need certification, and benefit management, while the provider side supports care plan creation and long-term care fee claims. Claims go to the National Health Insurance Federations, not the Japan Pension Service. Care planning is a representative provider-side function, and systems are in fact spreading in long-term care.

Because test centers receive specimens from many healthcare institutions, correctly linking each received specimen with its test request information using barcodes — matching specimens with information — is the heart of the work. A wrong link means reporting another patient's results, with serious consequences. Standardizing equipment brands, sorting specimens, and publishing results are unrelated to this concept.

DICOM (Digital Imaging and Communications in Medicine) is the standard for medical images and their communication, covering connections between modalities and PACS, portable media, the grayscale standard display function (GSDF), and more. SS-MIX2 is standardized storage for clinical information, JLAC10 is the clinical laboratory test item code, and HL7 FHIR is a Web-technology exchange standard, not a medical imaging standard.

HL7 V2 is a healthcare information exchange standard that exchanges basic patient information, orders, test results, and so on in message form, and is widely used to link hospital information systems with departmental systems. DICOM covers medical images, ICD-10 is a disease classification, and the HOT code is a standard drug code, none of which is a message exchange standard.

HL7 FHIR (Fast Healthcare Interoperability Resources) defines information such as patients and test results in units of "resources" and exchanges them with Web technologies such as REST APIs and JSON; its ease of implementation has driven adoption, and description specifications based on FHIR have been adopted as MHLW standards in Japan. Display tone scales are DICOM's GSDF, and drug codes describe HOT.

SS-MIX2 is the standardized storage specification that accumulates clinical information such as prescriptions, test results, and disease names in standard formats like HL7 messages; it also defines extended storage for non-standard data, and is used for inter-facility cooperation and disaster backup. DICOM is the medical imaging standard, IHE is an initiative defining how to use existing standards, and JLAC10 is the clinical laboratory test item code.

ICD-10 is the 10th revision of the WHO's International Classification of Diseases, a code system for classifying diseases and causes of death. In Japan it underlies the ICD-10-based standard disease name master used to code diagnoses, and it also relates to statistics and DPC. It is not an image compression method; classifying laboratory test items is JLAC10's role, and drug identification is the HOT code's.

JLAC10 is the clinical laboratory test item classification code established by the Japanese Society of Laboratory Medicine; it identifies test items systematically and enables exchange and comparison of test results between facilities. The HOT code is a standard code identifying drugs, ICD-10 is a disease classification, and DICOM is the medical imaging standard; none is a laboratory test item code.

The HOT code is the code of the standard pharmaceutical master; it uniquely identifies drugs at the level of brand name and package unit and is used to link drug information between systems. JLAC10 is the laboratory test item classification code, SS-MIX2 is the standardized storage specification for clinical information, and IHE is an initiative defining how to operate existing standards; none is a drug identification code.

IHE does not create new standards; it is an international initiative that defines, as integration profiles for each workflow scenario, how existing standards such as DICOM and HL7 should be combined and used, publishing them as technical frameworks. It is not a developer of proprietary communication standards, a drug-pricing body, or a screen design standard.

The MHLW standards are a set of standards designated by the Japanese government to advance the standardization of health information, chosen from standards adopted by the HELICS council (the Health Information and Communication Standards Board). They include SS-MIX2, DICOM, the ICD-10-based standard disease name master, JLAC10, and the HOT code, and description specifications based on HL7 FHIR have also been adopted. They are not in-house rules or product lists, and they are used in health information exchange within Japan.

The electronic claims processing system codes are the codes for medical procedures, drugs, specified devices, and so on used in electronic claims, so that pairing is correct. DICOM's subject is medical images and their communication, SS-MIX2 is standardized storage for clinical information, and JLAC10 is the laboratory test item classification code; each of the others mixes up its subject.