The Development of Japanese Hospital

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Technical Report 2001-05
††††††††††††††††††††† 
 
 
 
The Development of Japanese Hospital
Information Reference Enterprise Model V-1.0
in Terms of RM-ODP Enterprise Language
 
(The deliverable of Healthcare Enterprise Model Development Joint Project)
 
 
 
 
 
 
March 19, 2001
Systems Technology Division
Japanese Association of Healthcare Information Systems Industry

Preface

The Japanese Hospital Information Reference Enterprise Model was developed by The
Healthcare Enterprise Model Development Joint Project consisting of JAHIS, INTAP
and MEDIS.

The report was originally submitted by Technologic Arts Incorporated.


JAHIS: Japanese Association of Healthcare Information Systems Industry
INTAP: Interoperability Technology Association for Information Processing, Japan
MEDIS: The Medical Information System Development Center 
 

1. Introduction
1.1 Background
1.2 Objectives

2. About the Hospital Information System
2.1 Assumptions
2.1.1 Assumptions of the hospital to be modeled
2.1.2 Assumptions of the model
2.1.3 Introducing the ODP system in REM

2.2 Scenarios for hospital information systems
2.2.1 Initial visit (outpatient)
2.2.2 Ambulatory care (outpatient)
2.2.3 Hospital admission (treatment)
2.2.4 Hospital change (discharge)

3. Hospital Information Reference Enterprise Model in Japan
3.1 Definitions of Enterprise Objects
3.2 Definitions of Roles
3.3 Association Between Hospital Community and External Communities
3.4 Hospital Community and Sub-communities
3.5 Communities, Enterprise Objects, and Roles
3.6 Definition of Each Community
3.6.1 Hospital Community
3.6.2 Patient Care Community
3.6.2.1 Outpatient Community
3.6.2.2 Inpatient Community
3.6.3 Clinical Laboratory Community
3.6.4 Radiological Community
3.6.5 Pharmaceutical Community
3.6.6 Administration Community
3.6.6.1 Reception Community
3.6.6.2 Medical Accounting Community

4. Reference Materials
I. RM-ODP overview
II. UML overview
III. UML terminology
IV. Assumptions of the hospital

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1. Introduction
The hospital information reference enterprise model, which is a generic enterprise model
for typical Japanese major local hospital, has been developed by a joint project team
comprising of experts from JAHIS, INTAP, MEDIS-DC and CBOP, and with the
background and objectives described below.

1.1 Background
As information systems become more and more sophisticated and complex, it becomes
quite difficult to understand, manage, and enhance these systems. In addition, there are
considerable difficulties in integrating systems whose components have been constructed
based on different architectures. The issue here is that no general method has yet been
established to overcome these problems. Therefore it is necessary to develop and apply
standard method to model those systems based on a systematic framework and
re-examine existing systems from the viewpoint of this standard model.

RM-ODP (Open Distributed Processing - Reference Model), which is a family of
standards from ISO/IEC JTC1 and ITU-T, is one of the techniques that is effective for
applying to modeling of complicated systems, in addition to clearly defining the
requirements. Although this standard has been applied to, e.g., geographical distributed
information system, federated healthcare record management system, and general ledger
system in Europe, but cases were limited, and appropriateness and effectiveness of
RM-ODP have not yet been widely recognized.

To make the open distributed processing technique accepted as one of best practices,
which is applicable for wide range of applications and systems, we believe many more
case studies in actual practice must be conducted. Hospital information systems are very
good cases for applying RM-ODP, since it is one of areas where advanced research,
including application of object-oriented technique, has already been conducted.

1.2 Objectives
The hospital information reference enterprise model will be developed using the
RM-ODP standards with a view toward advancing Japanese /hospital information
systems and promoting the open distributed processing standards. Expected usage of this
reference enterprise model follows.
(1) The Reference Enterprise Model is used as the basis for 1) the development of
Japanese standards related to healthcare information and information processing,
and 2) creating proposals regarding international and domestic standardization
related to healthcare information such as ISO TC215.
(2) The Reference Enterprise Model is used to assess the effectiveness and collect
issues when RM-ODP Enterprise Viewpoint is used for modeling the social system.
(3) Although RM-ODP defines what should be described in each viewpoint, the
resulting descriptions or specifications are not sufficient from software
development/engineering point of view. To compensate for this limitation, the
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modeling language UML is introduced and used in combination. The Reference
Enterprise Model in this document is defined taking advantage of both RM-ODP
and UML.
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2. About the Hospital Information System
2.1 Assumptions of the hospital model
2.1.1 Assumptions of the scenario
• It is a major local hospital with approximately 300 beds.
Note 1: It is not a postgraduate educational institution (i.e., there is no resident physicians on staff)
Note 2: It does not provide advanced specialty care such as that offered at university hospitals
* Advanced specialty care includes renal dialysis, radiotherapy, etc.
Note 3: It is a general hospital
• It is a healthcare institution.
• It does not have a dental department (i.e., there is no dentists on staff).
• It is not involved in clinical trials.
• This preliminary model does not deal with a surgery department, an emergency
department, or a nutrition department.

(Note) Some hospitals may have a pathology department, rehabilitation medicine department,
dialysis department, obstetrics department, health examination department, radiotherapy
department, intensive care department (ICU, CCU, NICU, etc.), visiting care department,
dentistry department (ward/beds), psychiatry department (ward/beds) ,tuberculosis
department (ward/beds), infectious disease department (beds), long-term care department
(ward/beds), palliative care department (ward/beds), or community Healthcare training center.
However, this model does not deal with these departments.


2.1.2 Assumptions of the model
• Healthcare records and other care-related information are stored on online
electronic media.

Note 1: One of the advantages of applying the ODP system to a hospital information system is that the
users can easily retrieve patient care information from the system even if they do not know the
locations of the applications or data.
(If the care information is not stored on online electronic media, introduction of the ODP
system is virtually meaningless.)
Note 2: It is generally known that the notification issued by the directors of the three bureaus of the
Ministry of Health and Welfare in April 1999 permits the storing of patient care information
(except for prescriptions and irradiation records) on electronic media.
Note 3: The ODP system can help ensure the proper design and management of future general
hospital information systems by demonstrating that it is advantageous to implement a system
in which patient care information is stored on online electronic media.

2.1.3 Introducing ODP system in Reference Enterprise Model
In this model, an ODP system is introduced as a model element but the functions of
the ODP system are intentionally not analyzed in detail, because of the focus on the
Enterprise Viewpoint (objective, scope, and policy) specification. However, from
the viewpoint that the minimum association between the Enterprise Model and the
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ODP system should be described, the ODP system is described when the ODP
system is definitely associated with the Enterprise Model.

2.2 Scenarios for hospital information systems
In the development of this hospital information reference enterprise model, the
following scenarios were used as a first step to define the model elements, including
enterprise objects, roles, and processes. The processes in each community of the
enterprise model were generated referring to these scenarios as trial cases.

2.2.1 Initial visit (outpatient)
Outline: Scenario of the course in which a patient visits the hospital for the first time
with a referral letter from a clinic physician and signs in, receives
consultation from a physician, receives tests, and pays the fee at the casher,
and preparation of statements for healthcare reimbursement.

2.2.2 Ambulatory care (outpatient)
Outline: Scenario of the course in which an outpatient with an appointment visits
the hospital, signs in, receives consultation, and undergoes tests according
to orders and in which the physician decides whether or not the patient
needs to be admitted to the hospital.

2.2.3 Hospital admission (treatment)
Outline: ♦ The day of admission...
Scenario of the course in which a patient who is scheduled to be admitted
visits the hospital, signs in, and receives various instruction and
explanations regarding the treatment schedule, present situation, etc.
♦ Xth day in the hospital...
Scenario of the course in which the previous day's work in each
department, such as label printing, preparation of drug envelopes, and
disbursement, are performed; the scheduled treatment, tests, and patient
compliance instructions are conducted and confirmed for an inpatient;
and additional orders are made.
♦ Ward change (department change)...
Scenario of the course in which the physician approves transfer of the
patient to another ward, the nurses of the sending ward and the accepting
ward exchange information regarding the patient, and the physician of
the accepting department examines the patient.
♦ Other...
Scenario of reception of visitors and settlement of monthly hospital
charges.

2.2.4 Hospital change (discharge)
Outline: ♦ Hospital change (discharge) planning...
Scenario of the course in which the physician suggests hospital change
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(discharge) planning to each section, revises the nursing care plan,
charges the patient's family with the hospital fee, and provides patient
guidance regarding hospital change (discharge).
♦ Yth day in the hospital...
Scenario of the course in which the previous day's work in each
department, such as label printing, preparation of drug envelopes, and
disbursement, are performed and the scheduled treatment, tests, and
patient compliance instructions are conducted and confirmed for an
inpatient.
♦ The day of hospital change (discharge)...
Scenario of the course in which the physician examines the patient and
makes final confirmation of hospital change (discharge), creates a
nursing summary, and prepares a referral letter to the physician at the
accepting hospital.
♦ Other...
Scenario of discharge summary entry and preparation of statements for
healthcare reimbursement.

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3. Hospital Information Reference Enterprise Model in Japan
(using the RM-ODP Enterprise Language)

(Note 1) The community definition items are described in the following order.
• Scope
• Objectives
• Enterprise Objectives
• Roles
• Process
• Policies

(Note 2) The predicates (languages) that can be used for the Policy of RM-ODP are "obligation",
"prohibition", "permission", and "authorization". In this model representation, Policy is
represented as "Policy or Policies".
However, policies of a process include the preconditions for the process.
"Policies" of a community can include a policy that shall be limited to an individual element of
the community. Such policies are expected to be clarified in the future.

3.1 Definitions of Enterprise Objects
♦ Hospital administrator
Person who supervises and runs a hospital.
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Director of a hospital.
♦ System administrator
Person who supervises and runs the system and also performs processing and
maintenance of the system.
♦ Physician
Person who has a license as defined by the Medical Practitioners Law and provides
healthcare services to patients with injuries and diseases.
♦ Patient
Person who needs healthcare services.
♦ Staff
Personnel involved with duties in the hospital
♦ Nurse
Person who is a qualified nurse as defined by the Public Health Nurse, Midwife,
and Nurse's Law, assists physicians in providing healthcare services, and provides
nursing care to patients.
♦ Clinical technologist
Person who is qualified as a clinical technologist or hygienic technologist as
defined by the Clinical Technologist Law and performs laboratory tests under the
direction and supervision of a physician.
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1
"Hospital" indicates a hospital as defined by the Medical Service Law (An institution providing accommodations
for 20 or more patients where physicians practice medicine for the general public or a specified population.)
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♦ Radiological technologist
Person who is qualified as a medical radiological technologist as defined by the
Medical Radiological Technologist Law and performs radiological examinations
under the direction and supervision of a physician.
♦ Pharmacist
Person who is qualified as a pharmacist as defined by the Pharmacist Law;
dispenses, manufactures, and supplies drugs; and is engaged in other
pharmaceutical-related work.
♦ Visitor
Person who visits the hospital for the purpose of seeing an inpatient.
♦ Hospital Information ODP System
A system comprising hardware and software systems that is designed to assist the
duties of the hospital staff or to perform duties by itself.
The ODP system is a system that implements distributed processing, irrespective of
differences in technology, organization, etc.
♦ Family
A group of persons including relatives of the patient.
♦ Healthcare professional
Persons engaged in medical care. Generic term for hospital administrators,
physicians, healthcare staff members, nurses, clinical technologists, radiological
technologists, and pharmacists.

(Note 1) It is expected that the future full-scale hospital model will also include the following enterprise
objects as medically qualified professionals: Dentists, dietitians, physiotherapists,
occupational therapists, dental hygienists, dental technicians, orthoptists, prosthetists, social
welfare counselors, welfare caretakers, speech/hearing therapists, sanitary engineers,
osteopaths/chiropractors, traditional massage therapists, massage therapists, acupressure
therapists, acupuncture and moxibustion therapists, midwives, public health nurses, care
information administrators, mental health welfare counselors, medical social workers (MSW),
etc.

(Note 2) It is expected that the future full-scale hospital model will include article objects in addition to
human objects. The article objects may include medical records, drugs, medical equipment,
medical materials, irradiation records, films, beds, etc.

3.2 Definitions of Roles
♦ Outpatient
Patient who visits the hospital for healthcare services
♦ Inpatient
Patient who resides in the hospital for treatment
♦ Administrator of the administration department
Administrator who is in charge of the clerical department
♦ Outpatient reception staff
Staff in charge of outpatient reception
♦ Admission and discharge clerical staff
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Staff in charge of clerical procedures related to inpatients
♦ Visitor reception staff
Staff in charge of visitor reception
♦ Accounting staff
Staff in charge of accounting
♦ Medical reimbursement statements staff
Staff in charge of statements for medical reimbursement
♦ Clinical laboratory nurse
Nurse in charge of clinical tests in the clinical laboratory department
♦ Clinical laboratory staff
Staff assigned to the clinical laboratory department
♦ Administrator of the clinical laboratory department
Administrator who is in charge of the clinical laboratory department
♦ Pharmaceutical staff
Staff assigned to the pharmaceutical department
♦ Administrator of the pharmaceutical department
Administrator who is in charge of the pharmaceutical department
♦ Radiology staff
Staff assigned to the radiological department
♦ Radiologist
Physician in charge of image reading
♦ Administrator of the radiology department
Administrator who is in charge of the radiology department
♦ Ward nurse
Nurse assigned to the ward
♦ Bed management nurse
Nurse who controls beds
♦ Ward physician
Physician in charge of the ward
♦ Sending physician
Physician who sends the patient
♦ Accepting physician
Physician who accepts the patient
♦ Sending nurse
Nurse who sends the patient
♦ Accepting nurse
Nurse who accepts the patient
♦ Ward visitor reception staff
Staff in charge of visitor reception in the ward
♦ Outpatient staff
Staff in charge of outpatients
♦ Outpatient physician
Physician who cares for outpatients
♦ Outpatient nurse
Nurse who cares for outpatients
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3.3 Association Between Hospital Community and External Communities


Strong connection
(high connection frequency in medical care)
Medium connection
(medium connection frequency in medical
care, or high connection frequency outside
medical care)
Weak connection
(connected only in special cases)
Judicial circles
Insurer
Mass media
Self-help patient group
System vender institution
Medical association
Academic association
Administration
(
national and local
g
overnments
)

Medical education and research
i t
i
t
t
i

H e a l t hc a r e c e n te r
Midwifery center
Fire department
Welfare nursing care facility
Healthcare facility for the elderly
Advanced medical institution
Pharmacy
Clinic
Examination institution
(
e.
g
.
,
ima
g
e readin
g
center
)

Pharmaceutical company
Inspection and payment organization
Supplier
(
medicines
,
medical materials
,
etc.
)

Police
Hospital Community
Physical examination institution




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3.4 Hospital Community and Sub-communities
• Hospital Community (3.6.1)
• Patient Care Community (3.6.2)
• Outpatient Community (3.6.2.1)
• Ward Community (3.6.2.2)
• Clinical Laboratory Community (3.6.3)
• Radiological Community (3.6.4)
• Pharmaceutical Community (3.6.5)
• Administration Community (3.6.6)
• Reception Community (3.6.6.1)
• Medical Accounting Community (3.6.6.2)
Other (not defined in this revision)
Surgery department, emergency department, materials control department,
nutrition department, etc.


Patient Car Community

e




Outpatient Community


Inpatient Community


Clinical Laboratory Community


Radiological Community


Pharmaceutical Community




Reception Community


Medical Accounting Community
 
Administration Community

Hospital Community
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3.5 Communities, Enterprise Objects, and Roles

Hospital Community
Hospital administrator
System administrator
Hospital information
DODP system
Associated with
every community
Staff

Healthcare
professional
Clinical technologist
Radiological technologist
Physician

Pharmacist

Nurse

Hospital administrator
Inpatient Community
Outpatient Community
Patient Care Community
Ward visitor reception staff

Bed management nurse

Ward nurse

Sending nurse

Inpatient

House physician

Sending physician

Accepting physician

Accepting nurse

Administrator of the
patient care department

Outpatient staff

Outpatient nurse

Outpatient

Outpatient physician

Clinical Laboratory Community
Clinical laboratory staff
Clinical laboratory nurse
Outpatient
Inpatient
Manager of clinical laboratory department
Clinical technologist
Visitor
Radiological community
Radiological staff
Manager of radiology department

Outpatient
Inpatient
Radiologist
Pharmacist
Pharmaceutical Community
Pharmaceutical staff
Administrator of pharmaceutical
Radiological technologist
Reception Community
Outpatient reception staff
Admission staff
Outpatient
Inpatient
Visitor reception staff
Medical Accounting Community

Accounting staff
Medical reimbursement staff
Outpatient
Inpatient
Family
Administrator of
administration department
Physician
Patient
Nurse
Staff
Administration Community




: Enterprise Object

: Role

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3.6 Definition of Each Community
3.6.1 Hospital Community
3.6.1.A Scope
♦ Supports patients physically and mentally and treats diseases.
♦ Receives reimbursement according to the prescriptions as defined by the
health insurance system.
♦ Manages patients' medical records and provides data for local and national
statistics on diseases as required by law.

3.6.1.B Objective
♦ Works with local clinics and accepts patients.

♦ Performs appropriate examinations to establish a precise diagnosis of the
patient's disease.

♦ Appropriately manages the data obtained by examining the patient.

♦ Diagnoses the patient's disease promptly and precisely based on appropriate
information.

♦ Explains the patient's condition and treatment options to the patient and his or
her family, establishes the optimal treatment plan together with the patient, and
provides treatment.

♦ Writes prescriptions as required for outpatients or home-bound patients.

♦ Supplies a bed and provides treatment to patients who require hospitalization.

♦ Maintains proper medical records when caring for the patient. Manages the
records properly for the specified period as required by law.

♦ Provides patients receiving treatment at home with appropriate advice
regarding lifestyle. In the case where liaison with a clinic is necessary,
provides the clinic with the appropriate information.

♦ If necessary, reports the disease to an appropriate facility as required by law.

♦ Accepts visitors in compliance with the request of the patient or his or her
family.

♦ In compliance with the request of the insurer, calculates the expenses
associated with care. Also requests the patient to bear a part of the expenses.
Reports expenses to the insurer and arranges for assessment by the inspection
and payment organization.
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♦ If the patient dies, promptly notifies an appropriate facility as required by law.

♦ The hospital manager establishes an environment in which the hospital staff
can work comfortably. The hospital administrator also controls the hospital
property, articles, etc. appropriately.

♦ The hospital administrator maintains appropriate contact with the
organizations that are involved in running the hospital properly.

♦ The hospital administrator selects appropriate service providers and supervises
the services to ensure that the hospital runs smoothly.

3.6.1.C Enterprise Objects
♦ Hospital administrator
♦ System administrator
<Policy>
The system administrator shall have the authorization to exercise the hospital
manager's authority to the extent necessary to control the operation of the
hospital information ODP system.
♦ Hospital information ODP system

3.6.1.D Policies
♦ The hospital administrator is obligated to establish rules regarding the
operation of the hospital information ODP system and to ensure that the
operating rules are clearly understood by all hospital staff in order to maintain
proper operation of the hospital information ODP system.

♦ The hospital administrator is obligated to establish committees that handle the
matters dealt with in the hospital. The committees are as follows:
• Electronic archival system committee
(Management and operation of the hospital information ODP system)
• Nosocomial infection prevention task force
(Planning of nosocomial infection prevention and establishment of the
systems required for this purpose)
• Pharmaceutical committee
(Management of purchase of drugs, medical materials, etc.)
• Medical reimbursement review committee
(Review and notification for proper medical remuneration claims)

♦ The hospital administrator is obligated to apply for notifications,
authorizations, certifications, etc. as defined by the Medical Service Law.

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♦ The hospital administrator is obligated to respond to health statistical surveys
(Patient Surveys, Surveys of Medical Care Institutes, Hospital Reports,
Statistical Reports on Public Health Administration, Local Health Service
Reports, Reports on Health Services for the Elderly, Statistical Reports on the
Protection of Maternal Health) conducted by the Ministry of Health, Labor,
and Welfare according to the Statistics Law.

♦ The hospital administrator must be a physician. (Medical Service Law)

♦ The hospital administrator is obligated to post the name of the hospital
administrator, physicians' names, and office days and hours at a prominent
place in the hospital. (Medical Service Law)

♦ The hospital administrator is obligated to supervise the hospital staff so that
they do not encounter difficulties in job performance. (Medical Service Law)

♦ The hospital administrator is obligated to schedule physicians for night duty.
(Medical Service Law)

♦ The hospital is obligated to ensure that personnel (physicians, nurses, etc.) and
facilities (consultation rooms, operating rooms, clinical laboratories, X-ray
systems, etc.) conform with the Medical Service Law and is also obligated to
keep records.

♦ The hospital administrator is obligated to maintain the information that is
required by law to be included in the medical record for five years. (Medical
Service Law)

♦ The system administrator is obligated to maintain the hospital information
ODP system to ensure that the hospital runs smoothly.

♦ The system administrator is obligated to improve the environment so that the
hospital information ODP system for the electronic archival of medical records
can be operated without problems.

♦ The system administrator is obligated to educate and train users to ensure that
the hospital information ODP system is operated correctly.

♦ The system administrator is obligated to establish a framework to maintain and
operate the hospital information ODP system to ensure that the hospital runs
smoothly.

♦ The system administrator is obligated to establish measures to be taken in the
case of system failure and to ensure that the hospital staff understands these
measures.
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♦ The system administrator is obligated to upgrade the hospital information ODP
system in order to improve the operational efficiency of the hospital staff and
the quality of patient care.

♦ The system administrator is obligated to manage the hospital information ODP
system to ensure that the electronically archived information can be used even
after the hardware or software of the hospital information ODP system has
been changed.

♦ The hospital information ODP system is obligated to control the registration of
users and registration information to control access in order to prevent
unauthorized use.

♦ The system administrator is obligated to ensure that the specifications of the
hospital information ODP system meet the three conditions
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for the electrical
archival of medical records: authentication, display, and conservation. The
system administrator is also obligated to report to the hospital manager the
management rules to cover areas where the three conditions cannot be ensured
by the use of the system.

♦ Each healthcare professional (including clerical staff) is obligated to protect
any personal information he or she obtains in the course of his or her work.

♦ When a healthcare professional plans to use clinical data for a patient for a
purpose other than patient care with the patient's consent, the healthcare
professional is obligated to delete any information that could allow the patient
to be identified.

♦ The chairman of each committee shall have obtained authorization to exercise
the hospital administrator's authority in their operations associated with the
committee.

††††††††††††
 
2
Official notice "Archival of medical records etc. in electronic media" issued on April 22, 1999, by the Ministry of
Health and Welfare
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3.6.2 Patient Care Community
3.6.2.A Scope
♦ Sum of patient care departments
♦ Sum of nursing departments

3.6.2.B Objective
♦ Executing patient care activities as a sub-community of the Hospital
Community

3.6.2.C Enterprise Objects
♦ Patient
♦ Nurse
<Policy>
When instructed to perform care by a physician, the nurse obtains
authorization with regard to the care provided.
♦ Physician
♦ Visitor
♦ Staff
♦ System administrator
♦ Hospital administrator

3.6.2.D Policies
♦ The hospital administrator is obligated to classify the healthcare professionals
and the care information recorded in the hospital information ODP system
from the viewpoint of "protection of personal information" and "need to know",
to define the qualifications for care information retrieval according to the
classification, and to ensure that the hospital staff understands these
qualifications.

♦ The administrator of each patient care department shall have obtained
authorization to exercise the hospital manager's authority to the extent
necessary to execute and control the work of the department.

♦ The administrator of each nursing department shall have obtained
authorization to exercise the hospital manager's authority to the extent
necessary to execute and control the work of the department.

♦ When consultation for a patient is completed, the physician is obligated to
enter a medical record covering the items listed below regarding the patient
into the hospital information ODP system without delay.
(1) Findings obtained during consultation with the patient
(2) Patient care orders that the physician has issued to other healthcare staff
(3) Medical practices that the physician has performed for the patient and the
contents of explanations provided to the patient by the physician
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(4) Results of the tests performed regarding the patient's physical (mental)
condition and assessment of the results
(5) Results of the medical practices that the physician or other healthcare staff
has performed for the patient

♦ When the physician has entered the care-related record into the hospital
information ODP system, the physician is obligated to add information that
identifies himself or herself and to finalize the information. The hospital
information ODP system is obligated to save the entered information,
associating it with the information identifying the person who made the entry
and the entry time.

♦ If the physician finds an error in a medical record after he or she has entered it
into the hospital information ODP system and performed finalization, the
physician is obligated to enter corrective information into the hospital
information ODP system and to finalize the corrective data without delay. The
hospital information ODP system is obligated to associate the corrective data
with the data before correction and to record it so that the corrective data is
displayed or printed together with the data before correction when the data
before correction is retrieved.

♦ When the patient requests disclosure of his or her care information, the
physician is obligated to disclose the information to the patient unless there is
sufficient reason to reject the patient's request.

♦ When the physician issues a prescription order, the physician is obligated to
issue the order electronically using the hospital information ODP system and
to sign the printed prescription.

♦ The physician is obligated to give serious consideration to the patient's wishes
in determining the optimal treatment plan and to proceed with treatment.
*Patient's wishes: painless, rapid, inexpensive, disclosure of disease name,
etc.

♦ The physician is obligated to disclose and explain the contents of treatment and
the treatment plan to the patient and the patient's family in terms that they can
understand.

♦ The physician is obligated to record the healthcare record correctly and
without delay.

♦ The physician is obligated to manage and maintain the care information in a
form that allows the information to contribute to improvements in the quality
of patient care.

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♦ The nurse is obligated to confirm the orders (procedures, injections, specimen
collection, etc.) issued by the physician and to request the physician who
issued the orders to clarify the orders if he or she has any doubts regarding the
contents of the orders. In this case, the nurse is prohibited from conducting
treatment intervention until the physician responds to the query and the orders
have been clarified. (Treatment intervention includes injections, procedures,
medications, etc.)

♦ The nurse is prohibited from conducting any treatment intervention for the
patient without receiving orders from the physician.

♦ The hospital information ODP system is obligated to store the entered medical
records in a manner that permits qualified persons to retrieve them without
difficulty for a period not less than that required by the law.

♦ The hospital information ODP system is obligated to reject access by
unauthorized persons who attempt to retrieve specific care information stored
in the system.

♦ The hospital information ODP system is obligated to determine whether or not
the person operating the ODP system in an attempt to retrieve specific care
information is qualified to retrieve the information and to ensure that
displaying, copying, transmission, deletion, alteration, or printing of the
information is not possible unless the person is authorized.

♦ If a side effect of a drug or a problem with medical equipment is found, the
physician is obligated to report it to the Ministry of Health, Labor, and Welfare.
("Drug Safety Information Reporting System" (notification issued in 1997))

♦ When the physician performs care for a patient with an infectious disease
specified in the Infectious Disease Law, the physician is obligated to report it
to the public health center.

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3.6.2.1 Outpatient Community
3.6.2.1.A Scope
♦ Examines outpatients.

3.6.2.1.B Objective
♦ Executing consultation activities as a sub-community of the Hospital
Community

3.6.2.1.C Enterprise Objects
♦ Patient
♦ Staff
♦ Physician
♦ Nurse
♦ System administrator

3.6.2.1.D Roles
♦ Outpatient
♦ Outpatient staff
♦ Outpatient physician
♦ Outpatient nurse

3.6.2.1.E Process
♦ Reception of a first-visit outpatient before consultation
<Policy>
• Reception of the new patient shall have been completed.
<Description>

Goes to the window of the
appropriate outpatient care
department
Staff/Outpatient staff
Receives the patient
Patient/Outpatient












20 

♦ Consultation for a first-visit outpatient and registration of test orders
<Policy>
• Pre-consultation reception for the patient shall have been completed and
the patient shall be ready for consultation.
• The patient shall bring a referral letter.
<Description>

Calls the patient
Patient/Outpatient
Physician/Outpatient physician
Confirms the contents of the
referral letter
Enters the consultation data
and test orders
Performs consultation
Enters the consultation room
and hands the referral letter
to the physician















♦ Post-test consultation for a first-visit patient and registration of test orders
(appointment)
<Policy>
• The patient shall have undergone the tests ordered by the physician and the
test results shall be available.
<Description>

Physician/Outpatient physician
Patient/Outpatient
Checks the results of the test
orders, results of specimen
tests, image reading reports,
and X-ray images
Calls the patient and explains
the results
Enters the consultation data,
prescription orders, test
orders (appointment), and
care appointment
Returns to the appropriate
care de
p
artment
















21 

♦ Giving third-party prescriptions to a first-visit patient
<Policy>
• The third-party prescriptions ordered by the physician shall be available.
<Description>

Physician/Outpatient physician
Patient/Outpatient
Receives the third-party
prescriptions
Places his/her seal of approval
on the third-party prescriptions










♦ Consultation for a non-first-visit patient
<Policy>
• The pre-consultation tests for the next visit shall have been ordered at the
time of the previous consultation.
• The pre-consultation tests shall have been completed.
• The specimen test results shall be available.
<Description>

Physician/Outpatient physician
Patient/Outpatient
Checks the results of the test
orders, results of specimen
tests, image reading reports,
and X-ray images (acquired at
the time of the
p
revious visit
)

[The patient does not
need to be hospitalized]
[The patient needs
to be hospitalized]
Checks with the
ward to determine
whether the patient
can be admitted on
that da
y


Enters the
consultation
data
To the process for
checking with the ward
to determine whether
the patient can be
admitted on that day
Calls the patient and explains
the results
Returns to the appropriate
care de
p
artment

























22 

♦ Check with the ward for an unoccupied bed and a decision on admission
<Policy>
• This process shall be performed when the physician has decided that the
outpatient he or she has consulted with needs to be hospitalized.
• The physician/outpatient physician shall have instructed the nurse
(ward)/bed management nurse to check the status of unoccupied beds.
<Description>

Physician/Outpatient physician
Enters the consultation data
Receives information
re
g
ardin
g
unoccu
p
ied beds
[There are no beds
available]
[There is an
available bed]
Issues an
admission
instruction
Refers and sends
the patient to
another hospital y
















[To hospital
change]

[To admission]



3.6.2.1.F Policies
♦ The outpatient nurse is permitted to administer first aid to the patient by
himself or herself to the extent allowed by law before he or she contacts the
responsible physician if the patient's condition changes suddenly and it is
obvious that first aid is required.
23 

3.6.2.2 Inpatient Community
(Note 1) In the future, it is expected that the Ward Community will be divided into sub-communities for
each care department, in the full-scale hospital model.

(Note 2) Care departments include: internal medicine department, respiratory department,
gastrointestinal department, cardiovascular department, pediatrics department, psychiatry
department, neurosurgery department, neurology department, psychosomatic medicine
department, allergy department, rheumatology department, surgical department, orthopedics
department, plastic surgery department, cosmetic surgery department, respiratory surgery
department, cardiovascular surgery department, pediatric surgery department, obstetrics and
gynecology department (obstetrics department and gynecology department), ophthalmology
department, otolaryngology department, bronchoesophagology department, dermatology
department, urology department, venereology department, proctology department,
rehabilitation department, radiological department, anesthesiology department, dentistry
department, orthodontic dentistry department, pediatric dentistry department, and oral
surgery department.

3.6.2.2.A Scope
♦ Treats the inpatient.
♦ Provides nursing care for the inpatient.

3.6.2.2.B Objective
♦ Executing nursing activities and care in the ward as a sub-community of the
Hospital Community

3.6.2.2.C Enterprise Objects
♦ Patient
♦ Nurse
♦ Physician
♦ Visitor
♦ Staff

3.6.2.2.D Roles
♦ Inpatient
♦ Ward nurse
♦ Bed management nurse
<Policy>
• The bed management nurse shall be working at the ward.
♦ Ward physician
• The ward physician shall be working at the ward.
♦ Sending physician
<Policy>
• The sending physician shall be the physician who is currently in charge of
the patient.
24 

♦ Accepting physician
<Policy>
• The accepting physician shall be the physician who will take charge of the
patient.
♦ Sending nurse
<Policy>
• The sending nurse shall be the nurse who is currently in charge of the
patient.
• The sending nurse shall be on duty on the day the patient is sent out.
♦ Accepting nurse
<Policy>
• The accepting nurse shall be the nurse who will take charge of the patient.
• The accepting nurse shall be on duty on the day the patient arrives.
♦ Ward visitor reception staff

3.6.2.2.E Process
♦ Escorting the patient to be admitted to the bed
<Policy>
• It shall be on the day the patient is admitted.
• The patient shall have an appointment for admission.
• The patient's basic information shall have been registered by the staff
(medical accounting)/admission staff.
• The patient shall have been escorted to the ward by the nurse
(outpatient)/outpatient nurse.
<Description>

Nurse/Ward nurse
Accepts the patient
Patient/Inpatient
Assigns a bed
Informs the medical accounting
staff of the bed number
Nurse/Bed management nurse
Goes to the ward










♦ Guidance on the day of admission
<Policy>
• It shall be the day of admission.
• The patient shall have an appointment for admission.
• The nursing-related information shall have been registered by the staff
(medical accounting)/admission staff.
• A bed shall have been assigned to the patient.
• This process shall be performed in parallel with bed assignment by the staff
(medical accounting)/admission staff.
25 

<Description>

Physician/Ward physician
Visits the patient.
Explains the patient's current
condition, planned treatment,
contents of tests, etc. to the patient
Explains the treatment course,
tests to be performed, and
treatment schedule to the patient
Issues additional orders as
re
q
uired
Receives the patient and the
nursing interview sheet from the
outpatient nurse, interviews the

patient, and provides guidance
to the
p
atient.
Prints the critical path for the

p
atient
Nurse/Ward nurse
























♦ Output of nursing worksheet
<Policy>
• The nursing-related information has been registered.
<Description>

Outputs the nursing
worksheet information
Nurse/Ward nurse









26 

♦ Confirmation of nursing orders for an inpatient
<Policy>
• The nursing worksheet information has been output.
• The patient is hospitalized.
<Description>

[Orders for blood
sample collection]
[Orders for radiographic
examinations]
[Orders for
medications]

Confirms the orders
Nurse/Ward nurse











[To the "Medication"
process]
[To the "Blood
sample collection"
process]
[To radiographic
examination]



♦ Blood sample collection
<Policy>
• Clinical tests have been ordered for the patient.
• The patient is hospitalized.
<Description>

Collects the patient's blood sample
Goes to the patient's room.
Nurse/Ward nurse









27 

♦ Medication
<Policy>
• Medication has been ordered.
• The patient is hospitalized.
<Description>











Patient/Inpatient
Nurse/Ward nurse
Administers the oral
medication for the
day to the patient
Administers the scheduled
in
j
ection to the
p
atient
[Order for injection]
[Order for oral
administration]
Takes the prescribed medicine




♦ Check after test/medication
<Policy>
• The tests have been completed and the medicines have been administered.
• The patient is hospitalized.
<Description>

[If an abnormality is found]

Informs the physician
Checks the results
[The scheduled tests
have been
completed and the
medications have
been administered.]

[Other tests have not yet been completed and othe
r
medications have not yet been administered]
To the "Confirmation o
f
nursing orders for an
inpatient" process
Confirms that the scheduled tests

have been completed and that the
medications have been
administered to the patient
Nurse/Ward nurse


















♦ Confirmation of ward change
28 

<Policy>
• Ward change has been decided for the patient.
<Description>

Nurse/Sending nurse
Physician/Sending physician
Confirms the ward change
with the accepting ward
Confirms that the ward is ready
to accept the patient and informs
the sendin
g
ward
Nurse/Accepting nurse
Visits the patient and issues final
authorization for ward change
Refers to the latest care
information, confirms the
nursing plan, etc.















♦ Ward change
<Policy>
•  Confirmation of ward change shall have been completed.
•  This process shall be performed in parallel with the "Registration of a
ward-changed patient" process.
<Description>

Escorts the patient to the
accepting ward
Patient/Inpatient
Goes to the new ward
Nurse/Sending nurse
Informs the accepting nurse
of the nursing information for
the patient.













29 

♦ Registration of a ward-changed patient
<Policy>
•  Confirmation of ward change shall have been completed.
•  This process shall be performed in parallel with the "Ward change"
process.
<Description>

Registers the patient as a
ward-changed patient
(makes a bed available and
assigns it to the patient)
Nurse/Accepting nurse










♦ Work after ward change
<Policy>
•  Ward change has been completed without problems.
<Description>

Registers the additional
nursing-related information
Physician/Accepting physician
Issues additional orders as
required
Nurse/Accepting nurse
Confirms the care schedule
table (critical path for the
patient) and disease information
to be ex
p
lained to the
p
atient
Visits the patient (in an
interview room) and explains
e patient's current conditio
d the treatments and tests t
e
p
erformed for the
p
atient

th n
an o

b
Receives the nursing
information for the patient
and interviews the patient























30 

♦ Visitor reception at the ward
<Policy>
•  It shall be during visiting hours.
<Description>

Staff/Ward visitor reception staff
Visitor
[Goes to the ward station]
Visits the hospital
[Goes to the hospital
reception desk]
To the "Visitor reception"
process for the Clerical
Community
Receives the visitor













♦ Registration of the discharge plan
<Policy>
•  The patient shall have been hospitalized and the treatment results shall
have been output, and the physician shall have decided that the patient can
be discharged.
<Description>

Nurse/Ward nurse
Physician/Ward physician
Corrects the nursing plan and
nursing orders
Enters the change to the bed
occupation schedule
Nurse/Bed management nurse
Registers the schedule as to
when the bed will become vacant
Advises the departments
concerned to implement the
discharge plan
















31 

♦ Discharge guidance
<Policy>
•  The patient shall have been hospitalized and the treatment results shall
have been output, and the physician shall have decided that the patient can
be discharged.
•  The preparations for discharge, including issuance of a discharge plan and
a tentative bill, shall have been completed.
<Description>

Refers, corrects, and prints the

contents of discharge guidance,
explains the discharge plan,
and gives discharge guidance
to the
p
atient
Physician/Ward physician










♦ Examination before hospital change (discharge) and preparation for hospital
change (discharge)
<Policy>
•  It shall be on the day the patient is to be discharged.
<Description>

Nurse/Ward nurse
Physician/Ward physician
Enters the prescription orders
for discharge
Receives the hospital change
(discharge) notice for the patient
Performs final confirmation o
f
hospital change (discharge)
Examines the patient















32 

♦ Creation of the nursing summary
<Policy>
•  It shall be on the day the patient is to be discharged.
•  The final confirmation for the discharge shall have been completed.
•  This process shall be performed in parallel with the "Issuance of a
provisional bill" process for the Medical Accounting Community.
•  The nursing summary and a referral letter to the patient's personal
physician are required for discharge.
<Description>

Physician/Ward physician
Nurse/Ward nurse
Creates the nursing
ummary for the nursing staf
the
p
atient's new hos
p
it
f
al
Refers to the care
information for the patient
each de
from
p
artm
ent
Creates a referral letter to the
patient's personal physician
s
at













♦ Discharge of the inpatient
<Policy>
•  It shall be on the day the patient is to be discharged.
•  A referral letter to the patient's personal physician shall have been written.
•  The referral letter shall be handed to the patient in parallel with this
process.
<Description>

Physician/Ward physician
Patient/Inpatient
Receives permission for
discharge and is discharged
from the hospital
Explains the medications
after discharge to the patient












33 

♦ Creation of the discharge summary
<Policy>
•  It shall have been decided to discharge the patient.
<Description>

Enters the discharge summary
Physician/Ward physician








♦ Confirmation of vacant beds
<Policy>
•  The bed management nurse shall have been requested to confirm the vacant
beds by the outpatient physician.
<Description>

Checks the vacant beds and
patient information, confirms that

a bed suitable for the patient is
available, and informs the
out
p
atient
p
h
y
sician of this fact
Nurse/Bed management nurse











3.6.2.2.F Policies
♦ If the ward nurse has any doubts or finds missing information in the contents of
the nursing-related information for the new inpatient, the ward nurse is
obligated to submit an inquiry to the responsible inpatient nurse or medical
accounting staff to eliminate the doubts or obtain the missing information.

♦ The ward nurse is obligated to enter the nursing record for the patients for
whom he or she is responsible, covering the following items, into the hospital
information ODP system so that the information can be shared by other
nursing staff.
(1) Findings obtained by observing the patient
(2) Nursing care he or she performed for the patient
(3) Assessment of the nursing care he or she performed for the patient
(4) Orders received from the physician and their implementation

34 

♦ The ward nurse is permitted to administer first aid to the patient by himself or
herself to the extent allowed by law before he or she contacts the responsible
physician if the patient's condition changes suddenly and it is obvious that first
aid is required.

♦ The pharmacist is obligated to give patient compliance instructions to the
patient in a manner that the patient can understand.

♦ The pharmacist is obligated to monitor the inpatients taking drugs for the
appearance of side effects and to record the side effects. (Reimbursement)

♦ The pharmacist is obligated to give patient compliance instructions to the
patient when the patient is to be discharged. (Reimbursement)

3.6.3 Clinical Laboratory Community
3.6.3.A Scope
♦ Performs laboratory tests.

3.6.3.B Objective
♦ Executing laboratory testing activities as a sub-community of the Hospital
Community

3.6.3.C Enterprise Objects
♦ Patient
♦ Nurse
♦ Clinical technologist
♦ Staff
♦ System administrator
♦ Hospital information ODP system

3.6.3.D Roles
♦ Outpatient
♦ Inpatient
♦ Clinical laboratory nurse
<Policy>
• The clinical laboratory nurse shall have obtained authorization from the
physician to obtain a blood sample.
♦ Clinical laboratory staff
♦ Administrator of the clinical laboratory department
<Policy>
• The administrator of the clinical laboratory department shall have obtained
authorization to exercise the hospital administrator's authority to the extent
necessary to execute and control the test activities.

35 

3.6.3.E Process
♦ Reception of a clinical test on that day
<Policy>
<Description>
























Patient/Outpatient
Goes to the test room
Nurse/Clinical laboratory nurse
Clinical technologist
Hospital information ODP system

Provides notification of the
arrival of the patient
Checks the label against the
patient
Prepares containers for
collecting specimens
Collects blood samples
[Items to be tested at an
external laboratory]
[Items to be
tested in house]

Performs testing
Confirms (receives and
inspects) the test results
To the test center
Receives the patient
Outputs the collection label
Goes to the window of the
radiology department
The physician or outpatient
physician shall have entered
the order for the test.

♦ Reception and inspection of results of tests performed at an external laboratory
<Description>

Confirms (receives and
inspects) the test results
Clinical technologist
The results of the tests ordered to
be performed at an external
laboratory shall have been output.










Continue to Second or subsequent visit



36 

♦ Reception of clinical tests for the next day or later
<Description>

























Patient/Outpatient
Goes to the examination room
Nurse/Clinical laboratory nurse
Clinical technologist
Hospital information ODP system

Provides notification of the
arrival of the patient
The outpatient physician
confirms the results
Checks the label against the
patient
Prepares containers for
collecting specimens
Collects blood samples

Performs testing

Enters and confirms (receives
and ins
p
ects
)
the test results
Receives the patient
Outputs the collection label
Goes to the window of the
radiology department
• The pre-consultation tests for the next visit shall have
been ordered at the time of the previous consultation.
• The patient is visiting the hospital.
• It is not the first visit for the patient.


♦ Regular work on the day before the day of admission
<Description>

Perform preparations for
printing of labels etc. on the
previous evening
Staff/Clinical laboratory staff
• It shall be the day before the date on which
the patient is to be tested.
• Tests shall have been ordered for the patient.
• The patient's condition shall allowing testing.












37 

♦ Reception of a non-scheduled clinical test
<Description>

Enters the implementation of

the specimen test
Performs testing
Receives the specimen
Laboratory technologist/
Clinical laboratory technologist
Non-scheduled clinical tests are
assumed not to be sent out to a
test center.
















3.6.3.F Policies
♦ If the clinical technologist has any doubts regarding the contents of a test order,
the clinical technologist is obligated to submit an inquiry to the physician who
issued the test order to eliminate the doubts.

♦ The clinical technologist is obligated to perform tests without delay according
to the type of the physician's request (urgent, routine, etc.).

♦ The clinical technologist is obligated to check the correctness of the test results
for the patient specimen and to finalize the results in the hospital information
ODP system so that the test results can be used at the requesting department
without delay. (It is assumed that the clinical test system is included in the
hospital information ODP system.)

♦ The clinical technologist is obligated to perform auditing to verify that the test
results are correct regardless of the testing method, and if there are any doubts
regarding the correctness of the results, to perform the test again.

♦ When a patient's specimen is to be sent out to an external laboratory for testing,
the clinical technologist is obligated to store the specimen under the specified
storage conditions until it is sent to the test center.

♦ The clinical technologist is obligated to maintain the test equipment used for
laboratory tests to ensure that the equipment meets its specified performance
when testing specimens and to record the results. The clinical technologist is
also obligated to replenish and manage the required reagents etc.

38 

♦ The clinical technologist is obligated to preserve the required amount of the
tested specimen in an appropriate environment for the required period to
permit re-testing etc. as required.

♦ The clinical technologist is obligated to dispose of the used test tubes and
waste fluids according to the specified procedures.

♦ The clinical technologist is obligated to protect all of the patient's personal
information he or she obtains in the course of his or her work.

♦ The nurse or clinical technologist in charge of collecting specimens is
obligated to collect the amount of specimen required for the test according to
the test order information without subjecting the patient to unreasonable
discomfort or anxiety.

♦ The hospital information ODP system is obligated to save the entered test
results electronically as original data.

♦ The hospital information ODP system is obligated to transmit the entered test
results to the requesting department without delay.
39 

3.6.4 Radiological Community
3.6.4.A Scope
♦ Performs radiography.
♦ Reads images and prepares reports.
♦ Manages images.
♦ Does not perform treatment.

3.6.4.B Objectives
♦ Executing radiographic examination activities as a sub-community of the
Hospital Community

3.6.4.C Enterprise Objects
♦ Patient
♦ Staff
♦ Radiological technologist
♦ Physician
♦ Hospital information ODP system
♦ System administrator

3.6.4.D Roles
♦ Outpatient
♦ Inpatient
♦ Radiology staff
♦ Image reading physician
♦ Administrator of the radiological department
<Policy>
The administrator of the radiological department shall have obtained
authorization to exercise the hospital manager's authority to the extent
necessary to execute and control radiological department activities.

40 

3.6.4.E Process
♦ On-the-day radiographic examination
<Description>

























Patient/Outpatient
Staff/Radiological staff
Radiological technologist
Hospital information ODP system
Outputs the radiography

prescription
Returns to the appropriate
care department
Performs plain radiography
Enters the implementation
information (exposure
conditions and materials used
)
Receives the patient
Goes to the window of
the radiology department
Physician/Radiologist
[When an image interpretation
report is to be entered]
Enters the implementation
information into the bill
Retrieves the medical record
and enters the image
interpretation report
• It shall be on the day a first-visit patien
t
visits the hospital.
• An on-the-day radiographic
examination shall have been ordered.

♦ Work on the day before regular radiographic examinations
<Policy>
• It shall be regular work on the day before the day of "radiographic
examination on the following day or later".
• It shall be the patient's Yth day in the hospital.
<Description>

Outputs the appointment list

and makes preparations for
the examination on the
previous evening.
Staff/Radiology staff










41 

♦ Radiographic examination on the following day or later
<Policy>
• An appointment for radiographic examination shall have been made.
<Description>























Patient/Inpatient
Staff/Radiology staff
Radiological technologist
Hospital information ODP system
Outputs the radiography

prescription
Returns to the appropriate
care department
Performs plain radiography
Enters the implementation
information (exposure
conditions and materials used
)
Receives the patient
Goes to the window of
the radiology department
Physician/Image reading physician
[When an image reading
report is to be entered]
Enters the implementation
information into the bill
Retrieves the medical
record and enters the
image reading report


3.6.4.F Policies
♦ The administrator of the radiological department is obligated to record the
radiography implementation information as an irradiation record and to
maintain the record for five years. (The obligation to archive medical records
as defined in the Medical Practitioners Law is applicable.)

♦ The manager of the radiological department is obligated to maintain the
radiographs for two years. (Medical Radiological Technologists Law)

♦ If the radiological technologist has any doubts regarding the contents of a
radiography order, the radiological technologist is required to submit an
inquiry to the physician who issued the radiography order to eliminate the
doubts.

♦ The radiological technologist is obligated to perform radiography quickly
without subjecting the patient to unreasonable discomfort or anxiety.

42 

♦ The radiological technologist is obligated to understand the intent of the
physician and to perform radiographic examination in a manner that satisfies
the physician's intent.

♦ The radiological technologist is obligated to perform radiography without
delay according to the type of the physician's request (urgent, routine, etc.) and
to report the radiographic results (including film delivery) to the physician.

♦ The radiological technologist is obligated to notify the Medical Accounting
Community of the accounting information related to the radiographic process
without delay.

♦ The radiological technologist is obligated to maintain the equipment used for
radiography so that the equipment meets its performance specifications. The
clinical technologist is also obligated to appropriately replenish and manage
the films, agents, etc. required for radiography.

♦ The radiological technologist is obligated to protect all of the patient's personal
information he or she obtains in the course of his or her work.

♦ The radiologist is obligated to submit the image reading report to the physician
without delay according to the type of the physician's request (degree of
urgency, reason for radiography, etc.).

♦ The physician who ordered the radiographic examination is obligated to sign
the irradiation record.

♦ Only physicians and radiographic technologists are permitted to expose a
human body to radiation. (Medical Radiological Technologists Law)

♦ The hospital information ODP system is obligated to electronically archive the
medical images used for diagnosis as "original images". Images acquired but
not used for diagnosis need not be archived. (Here, the hospital information
ODP system is assumed to include the image management system.)

43 

3.6.5 Pharmaceutical Community
3.6.5.A Scope
♦ Dispenses and checks prescriptions.
♦ Controls stocks of drugs.
♦ Controls the drug information (provides side effect information).
(If the Materials Control Community is taken into consideration, this shall be
included in the scope of the Materials Control Community.)
♦ Gives patient compliance instructions.

3.6.5.B Objective
♦ Executing the dispensing and prescription check activities as a sub-community
of the Hospital Community

3.6.5.C Enterprise Objects
♦ Pharmacist
♦ Staff
♦ System administrator

3.6.5.D Roles
♦ Pharmaceutical staff
♦ Administrator of the pharmaceutical department
<Policy>
• The administrator of the pharmaceutical department shall have obtained
authorization to exercise the hospital manager's authority to the extent
necessary to execute and control pharmaceutical department activities.

3.6.5.E Process
♦ Third-party prescription check
<Policy>
• The patient shall have been examined and the prescription written by the
physician shall have been delivered to the pharmaceutical department.
<Description>

Outputs the third-party
prescription
Displays the contents of the
care and test results, and
enters the check results
Checks the third-party
prescription
Pharmacist











44 

♦ Regular work on the day before the date of prescription
<Policy>
• It shall be the regular work on the day before the date on which the
prescription is to be dispensed for the patient.
• It shall be the patient's Yth day in the hospital.
• The prescription written by the physician shall have been delivered to the
pharmaceutical department.
<Description>

Staff/Pharmaceutical staff
Requests output of the
prescription, medicine bags, etc.
in the afternoon of the day before

the regular prescr iption day
Confirms the contents of care
Performs prescription check
Prepares the medication
Checks the prepared medication

Outputs the prescription
Hospital information ODP system

















♦ Prescription check at the time of patient discharge (hospital change)
<Policy>
• It shall be on the day the patient is to be discharged.
• The physician or the ward physician shall have created the discharge
prescription order.
• Patient compliance instructions after discharge shall be given by the
physician or ward physician.
<Description>

Pharmacist
Confirms the contents of care
Checks the prescription
Dispenses the medication
Checks the dispensed medication
Outputs the discharge prescription

Hospital information ODP system












45 

3.6.5.F Policies
♦ The administrator of the pharmaceutical department is obligated to control the
narcotics used in the hospital. (Narcotic and Psychotropic Control Law)

♦ The administrator of the pharmaceutical department is obligated to retain the
prescriptions for three years. (Pharmacist Law)

♦ The pharmacist is obligated to check the third-party prescriptions ordered by
the physician, and if there are any doubts concerning the prescription, to
submit an inquiry to the ordering physician and, if necessary, request the
physician for an order change.

♦ The pharmacist is obligated to check the third-party prescriptions ordered by
the physician, and if there are any doubts concerning the prescriptions, to
submit an inquiry to the ordering physician. In this case, dispensing of the
prescription is prohibited until the physician replies to the inquiry and the
doubts are eliminated.

♦ The pharmacist is prohibited from changing the medicines shown in the
prescription written by the physician without the physician's consent and is
also prohibited from dispensing a changed prescription.

♦ The pharmacist is obligated to verify that the medications are dispensed as
instructed in the prescription and to affix a stamp of approval when there is no
doubt with regard to dispensing.

♦ In the case of a prescription for narcotics, the pharmacist is obligated to verify
that it was written by a physician who is authorized to prescribe narcotics and
also to verify that the prescription is written using the specified form.

♦ When handing the medications to an outpatient, the pharmacist is obligated to
confirm the identity of the patient.

♦ The pharmacist is obligated to examine the prescription to confirm the
physician's signature and the contents of the prescription before handing the
medications to an outpatient.

♦ The pharmacist is obligated to provide an explanation concerning the
medication and how to take the medication to the outpatient (in the case of
non-third-party dispensing) or the patient's attendant in a manner that the
outpatient or attendant can understand.

♦ The pharmacist is obligated to enter the implementation and the contents of the
dispensing and the patient compliance instructions into the hospital
information ODP system.
46 

♦ For each prescription, the pharmacist is obligated to enter the information that
should be recorded in the prescription journal into the hospital information
ODP system, confirm the entered information, and then finalize it.

♦ The pharmacist must check the prescription written by the physician for drug
interactions etc. before dispensing. At this time, the pharmacist is obligated to
record the date of dispensing, record that the prescription has been dispensed,
and write his or her name and place his or her seal or place his or her signature
on the prescription. (Pharmacist Law)

♦ The pharmacist is obligated to monitor the side effects that have occurred in
the hospital, communicate the side effect information throughout the hospital,
and report it to the Ministry of Health, Labor, and Welfare.

♦ The pharmacist is obligated to collect safety information, including side
effects, to assist physicians in writing prescriptions and to provide the safety
information that has been gathered to physicians.

♦ The pharmacist is obligated to periodically control the medications (quantities
stored, expiration dates, deterioration, etc.) in the hospital, including the wards,
to ensure that healthcare practices run smoothly.

♦ When the pharmacist plans to replenish medications in automated equipment
(e.g., a tablet dispensing and wrapping machine), the pharmacist is obligated to
confirm that the proper medication is replenished.

♦ The pharmacist is obligated to maintain the automated equipment so that it
operates normally.

♦ The pharmacist is obligated to control the blood products (not applicable if the
hospital has a transfusion department) and toxins used in the hospital.

♦ In the case of health insurance care, the physician is prohibited from
prescribing medications not covered by health insurance and the pharmacist is
prohibited from dispensing medications not covered by health insurance.

♦ The hospital information ODP system is obligated to store the entered
implementation and contents of prescriptions, dispensing, and patient
compliance instructions in online electronic media.

♦ Regardless of prescription or dispensing, the hospital information ODP system
is obligated to transfer the prescription implementation information to the
ordering physician and the Accounting Community without delay.

47 

♦ The pharmacist is obligated to submit a report to the Ministry of Health, Labor,
and Welfare if any side effects of drugs or problems with medical equipment
are recognized. ("Drug Safety Information Reporting System" (notification
issued in 1997)

3.6.6 Administration Community
33

3.6.6.A Scope
♦ Superintending execution of clerical activities and medical accounting

3.6.6.B Objective
♦ Management of execution of clerical activities and medical accounting as a
sub-community of the Hospital Community

3.6.6.C Enterprise Objects
♦ Staff

3.6.6.D Roles
♦ Administrator of the clerical department
<Policy>
The administrator of the administration department shall have obtained
authorization to exercise the hospital administrator's authority to the extent
necessary to execute and control medical accounting and reception activities.


3.6.6.1 Reception Community
3.6.6.1.A Scope
♦ Receives outpatients
♦ Obtains basic information regarding patients
♦ Receives visitors

3.6.6.1.B Objectives
♦ Executing clerical and reception activities as a sub-community of the Hospital
Community

3.6.6.1.C Enterprise Objects
♦ Patient
♦ Staff
♦ Hospital information ODP system
♦ Visitor
††††††††††††
 
3
In this model, the Clerical Community is included as a conceptual community combining the Reception
Community and the Medical Accounting Community. It is expected that this community will also include the
human resources department, accounting department, medical record management department, materials
control department, general affairs department, etc.
48 

3.6.6.1.D Roles
♦ Outpatient
♦ Inpatient
♦ Outpatient reception staff
♦ Admission staff
♦ Visitor reception staff

3.6.6.1.E Process
♦ Reception of a new patient
<Policy>
• The patient shall have a referral letter written by his or her personal
physician to the hospital to which he or she is being referred.
• It shall be the patient's first visit.
<Description>












• When a first-visit outpatient visits the hospital, the outpatient reception staff is
obligated to ask the patient or the patient's attendant why the patient is visiting
the hospital, to obtain, if necessary, a physician's or nurse's advice as to
whether or not the department the patient requests is appropriate, and to escort
the patient to the appropriate department.

• When a first-visit outpatient visits the hospital, the outpatient reception staff is
obligated to check the items listed below and to enter the basic patient
information and the reason why the patient is visiting the hospital into the
hospital information ODP system to notify the outpatient department without
delay to ensure that the care and medical remuneration certificate preparation
processes can be performed efficiently.
∙ Patient name
∙ Age
∙ Gender
∙ Address
∙ Occupation
∙ Whether or not the patient has visited the hospital in the past
∙ Whether or not the patient has a health insurance ID card and whether or not
the health insurance ID card is valid
Patient/Outpatient
Visits the hospital
Goes to the reception
window of the appropriate
outpatient department
Staff/Outpatient reception staff
Receives the new patient
Provides notification of the
arrival of the patient
Hospital information ODP system


49 

♦ Reception of a non-first-visit patient
<Policy>
• The patient shall have an appointment for care.
• It shall be the patient's second or subsequent visit.
• The next pre-consultation tests shall have been ordered at the time of the
previous visit.
<Description>












• When a non-first-visit outpatient visits the hospital, the outpatient reception
staff is obligated to enter the patient's visit into the hospital information ODP
system in order to notify the outpatient department and to escort the patient to
the specified department.

• When a non-first-visit outpatient visits the hospital, the outpatient reception staff
is obligated to confirm the appointment information and to determine the order in
which the patient is to be examined to meet the order of appointments as far as
possible.

• If a non-first-visit patient visits the hospital for several days extending into the
following month, the outpatient reception staff is obligated to ask the patient to
show a health insurance ID card at the first visit on the following month and to
confirm the validity of the card.

• When a non-first-visit outpatient visits the hospital, the outpatient reception staff
is obligated to confirm the appointment information and, if an appointment for a
pre-consultation test has been made, to escort the patient to the examination
room.

• The outpatient reception staff is obligated to check the patient's condition, and, if
necessary, change the order of consultation for the patient, escort the patient to
the emergency department, secure a place where the patient can wait before
consultation (to prevent the spread of infection to other patients), or take other
appropriate measures after examination by a physician or nurse.
Patient/Outpatient
Visits the hospital
Staff/Outpatient reception staff
Receives the patient
Provides notification that the

patient is visiting the
examination room
Goes to the examination room
Hospital information ODP system


50 

♦ Reception of a patient scheduled for admission
<Policy>
∙ It shall be the day of admission.
∙ The patient shall have made an appointment for admission.
<Description>

Patient/Inpatient
Staff/Admission staff
Enters the information related
to nursing
Provides the admission
appointment information
Confirms the admission
appointment (order)
Receives the patient
Hospital information ODP system

Visits the hospital













♦ Reception of visitors at the administration department
• It shall be during visiting hours.
<Description>

Visitor
Visits the hospital
[Goes to the
ward station]

To the process "Reception
of visitors at the ward" for
Staff (ward)/Ward visitor
reception staff
[Goes to the hospital
reception desk]
Receives the visitor
Staff/Visitor reception staff















When a visitor visits the hospital to see a patient, the visitor
reception staff is obligated to confirm whether or not the visitor
can see the patient and the visiting hours and, if there are any
special prohibitions, to instruct the visitor to observe them.

51 

3.6.6.2 Medical Accounting Community
3.6.6.2.A Scope
♦ Performs accounting procedures (charges and receives a portion of the medical
expense to be paid by the patient)
♦ Sends claims for medical remuneration to inspection and payment
organizations and receives medical reimbursement (claims based on
certificates for medical remuneration)

3.6.6.2.B Objective
♦ Executing medical accounting activities as a sub-community of the Hospital
Community

3.6.6.2.C Enterprise Objects
♦ Patient
♦ Staff
♦ Family
♦ System administrator

3.6.6.2.D Roles
♦ Outpatient
♦ Inpatient
♦ Medical accounting staff
♦ Medical reimbursement certificates staff

3.6.6.2.E Process
♦ Accounting of outpatient care payment
<Policy>
• The care (tests, procedures, etc.) for the patient shall have been completed.
<Description>

Patient/Outpatient
Staff/Medical accounting staff
Receives a receipt and an
appointment card and goes
to an external pharmacy
Issues a receipt and
appointment card
Goes to the medical
accounting window
Outputs the bill
Enters the accounting
information
Makes payment
Enters the payment-received

information
Hospital information ODP system
















52 

♦ Preparation of certificates for medical reimbursement
<Policy>
• The statements for medical reimbursement shall be prepared before the
deadline specified by the inspection and payment organization.
• The patient shall be covered by health insurance.
<Description>

Creates a summary table
Checks the medical record
Confirms the matter with the
physician
[The disease is not found in the list o
f
diseases covered by insurance]
Staff/Certificates for medical
remuneration staff















♦ Periodic accounting of hospital charges
<Policy>
• Periodic accounting of hospital charges shall be performed before the
deadline defined by the Health Insurance Society
<Description>

Patient/Outpatient
Goes to the medical
accounting window

Makes payment
Receives a receipt
Enters the payment-received

information
Enters the accounting
information

Issues a receipt
Staff/Medical accounting staff













53 

♦ Accounting of hospital charges at the time of discharge
<Policy>
• It shall be the day the patient is discharged.
• Accounting shall be performed after the nurse receives the instruction to