Clinical Supporting System in Large-scaled General Hospital with Customized Interface Layer between Electronic Patient Record System and Filemaker Pro

摘要

Introduction; Clinical supporting system (CSS) is the utility software such as the cancer patient database or bedsore patient database designed by hospital staffs. Clinical supporting system is usually constructed and operated separately from electronic patient record (EPR) system, because clinical supporting system needs a flexible formation to fulfill the user's requests which is impossible by using the stiff vender-made EPR system. We had been using clinical supporting database system made by FileMaker Pro server-client system since 1998. This system included the scheduling system of surgical operations, bedsore record, surgical site infection record, and catheter infection record. On April 2006, we introduced the EPR system and developed the clinical supporting system connected to the main EPR system. Method; We developed "Card-type EPR system" by adding customized interface layer made by FileMaker Pro on the vender-made EPR system, EG-MainEX (Fujitsu Co. ltd.). In this card-type system, the input-output layouts can be modified easily as user need, and several functions which were not provided by the main system, can be introduced very easily. We have been used this EPR system in out-patient consultation in Departments of Medicine, Cardiology, and Obstetrics since April 2000. When the main EPR system was renewed to EG-Main EX Ver.6 on April 2006, the interface layer was newly customized not only for doctors of all Departments but also for medical social workers and clinical psychologists to use the clinical supporting system. We also unified the clinical supporting system already existed to the EPR System. In addition to the database of medical patient record for general doctors, the database of bedsore record, surgical site infection record, palliative care record, and cancer treatment record were implemented for infection nurses, psychologists and oncologists, respectively. These systems were designed not only as easy as to entry the data but also as to create effective database. Survey about clinical requirement for the database and the system was performed for six month before the introduction of the EPR system. We checked carefully the layouts and the function of the EPR system to keep the uniformity of them. Results; The new EPR systems designed to be used by all Departments were put into practice on April 2006. The doctors of Departments of Ophthalmology, Otorhinolaryngology or obstetrics are using the EPR system, even though these Departments need special layouts of patient record. Practical usage started smoothly, because the EPR layouts are not very different from the form of ordinary patient record in paper. The input layouts of clinical supporting system in the new EPR system are the same as those used before. Some records including clinical supporting data are transferred to FileMaker Pro server, and when browsing, the layouts are same as those used to input the data. This is very helpful for end-user to find out where is the data searching, and how to search them. Conclusions; Our system is so flexible that we can easily customize all the layouts as requested by any Department of a large-scaled general hospital and those of clinical supporting system. In addition to the flexibility of the interface layer, it is another benefit of our system that FileMaker layer can be used as the viewer of multi-vender system. Various data such as patient records, cardiotocogram (feto-maternal monitor) records, surgical operation records, admission summary and bedsore records are indicated shortly on the main layout of the EPR system, and easily transferred to user's files by clicking the indicator. Furthermore, basic EPR system guarantees the access speed, stability and detailed log recording which lack in FileMaker Pro server database. New or breakthrough work to be presented; We developed "Card-type EPR system" by adding interface layer made by FileMaker Pro on the vender-made EPR system. This is the first EPR system which fulfils the requests from all Departments of a large-scale general hospital in Japan. Our EPR system also includes the clinical supporting system. Reference database supported by FileMaker Pro is very easy to use. Some major weak points of FileMaker Pro database are complemented by conjugating it with the vender-made EPR system.