Development of the electronic patient record system based on problem oriented system.
In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called "e-kanja recording system". On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.
Department of Medical Informatics, Graduate School of Medical and Dental Sciences, Kagoshima University.
Yumiko
Y
Uto
Takashi
T
Iwaanakuchi
Fuminori
F
Muranaga
Ichiro
I
Kumamoto
D055991:Health Records, Personal; D007564:Japan; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008498:Medical Record Linkage / Q000379:methods*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D008501:Medical Records, Problem-Oriented; D012984:Software; D012985:Software Design; D014584:User-Computer Interface