Applying XML Web Services into Health Care Management

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1 Applying XML Web Services into Health Care Management Mayumi Hori¹& Masakazu Ohashi² ¹Graduate School & Faculty of Business Management, Hakuoh University ²Graduate School & Faculty of Policy Studies, Chuo University Abstract As Japan has become one of the fastest-aging societies in the world, it is important to improve the quality of our health maintenance management and preventive medical care to extend healthy life expectancy. We believe advanced implementation of Information and Communications Technologies (ICT) may improve the medical services and health maintenance management. In this paper, we discuss the potentialities and expansibility of the XML Web Services based on the Adaptive Collaboration (AC) to improve the quality of the Japanese medical services. By examining the experimental pilot studies on the XML Web Services, we would like to present ways of improving health maintenance service and regional medical services. In order to realize better health maintenance and prevention of disease, we would like to prove that incorporating medicine, life, and work through the XML Web Services is highly effectiveness. 1. Introduction The development of Information and Communications Technology (ICT) has drawn attention as it may bring a healthier and safer life to each and every individual in the country. The Japanese government announced the e- Japan Strategy II in July 2003 to promote more advanced implementation of ICT. In the strategy, medical service was identified as one of the seven areas to which advanced measures will be taken for the implementation. New medical policy was developed based on the viewpoint of citizens to improve the quality of medical services, and the following are stated in the strategy: 1) by 2005, develop the authentication infrastructure in the medical treatment field, enabling electronic medical charts to be transmitted through networks and safely stored outside the medical institutions, 2) disclose information of medical institutions to patients, which is evaluated by a third party, and 3) establish the online billing system of medical service fees in 2004, making this system available at all the medical institutions by Promoting ICT into the medical service field has drawn much interest as it may improve the quality and efficiency of medical service and health maintenance management for local residents, and some regions have already implemented ICT into their medical services. As Japan is one of the fastest-aging societies in the world, it is important to improve the quality of our health maintenance management and preventive medical care to extend healthy life expectancy. In this paper, we discuss the potentialities and expansibility of application of the XML Web Services based on the concept of the Adaptive Collaboration (AC) to improve the quality of the Japanese medical services. 1

2 Especially, by examining the experimental pilot studies on the XML Web Services, we would like to investigate how to improve the quality and efficiency of health maintenance service and regional medical service in the Ubiquitous Society. 2 Health Management and Medical Service in the Ubiquitous Society As the average Japanese life span increases, it is necessary to cultivate an economic and legal environment in which any individual is encourage to work healthy for a long time. In the e-japan Strategy II, establishing of the patient-oriented medical care system and improving the operational efficiency and services of medical institutions are the two main goals stated in the medical services field. Not only medical treatment for sick patients, but also establishing an ensuring health maintenance system for everyone is critical. According to the survey 1 on the medical reform of the city conducted by the metropolis of Tokyo in March 2004, accessible medical system (26.5 ), quality of doctors and medical education (26.1 ), and patientoriented medical service (19.0%) top the list for the category of the need of improvement in medical service system. In addition, cooperation among hospitals (4.5%) ranks sixth in the same category. For the category of information of medical institutions, accessibility of information on medical institutions (55.1%), ensuring information disclosure of medical institutions (19.8%), and accessibility to counseling and advice (11.8%) top the list. For the category of the relationship with medical service providers, providing medical records and treatment information (57.6%) took up the majority. The result of the survey above clearly shows that people want a patient-oriented medical system and medical information to be easily accessible. In the Ubiquitous Society, these requests may be easily satisfied with a comprehensive and efficient medical service system that suits to each individual s need with the computing network. The innovative possible health maintenance and medical service that may be provided in the Ubiquitous Society are the following: 1) mental and physical health maintenance counseling service including offering athome physical examination, exercise training, and dietary advice, 2) support service for the elders, caregivers, and patients including remotely monitoring physical status and providing medical support, 3) emergency care service including proving an emergency sensor and report system. The cordial, caring support is essential and fundamental for innovative medical service in the Ubiquitous Society. This illustrates a patient s medical record. Any data related to the patient s heath can be entered here hence it clearly shows the medical history of the patient s. (Fig. 1)This shows that a physician can be allowed to obtain latest medical information and learn treatment more easily. For patients, an appropriate diagnosis or treatment will be received in accordance with the patient s health and disease condition. According to the history of a patient s medical report in Figure 1, we suggest the four elements; on the vertical axis, home and hospital, on the horizontal axis, health and disease. For instance, by utilizing the XML Web services, for patients in serious conditions and needing hospitalization, a physician finds latest medical information and know hospital or medical treatment methods easily. And as patients burden of going to hospitals will become lighter, they can receive a suitable medical treatment while staying at home based on the best medical information. Figure1 The History of a patient s medical record Home medical treatment Disease hospital treatment Hospital Health medical inspection rehabilitation 1 The Tokyo Metropolitan Bureau of Citizens and Cultural Affairs, Survey Theme: Patient-Oriented Medical Service Necessary medical information for choosing medical institutions. Survey Purpose: As a guide for medical reform to achieve patient-oriented medical services. Survey Period: From February 27, 2004 to March 4, Survey Method: Internet. Number of participants: 500, Number of respondents: 488, Retrieval Rate: 97.6% 3 Applying the XML Web Services Based on the AC for Healthcare Management Conventional business models had built information systems that operated only within the organization, and interchangeability or interactivity was not particularly considered. However, the rapid development of ICT has encouraged the creation of a seamless networked environment regardless of organization s type and size. It has also encouraged the development of ubiquitous 2

3 environment where public institutions such as government and local governments can freely utilize each other s information and collaborate together without the boundary of time and space. Expansion of the versatility of ICT has facilitated many corporations and administrative agencies to merge and collaborate with each other and enabled them to enter into new business schemes. On the other hand, it has become extremely difficult to maintain the competitive advantage in the present market as the culture of sharing and collaboration prevailed. Furthermore, government and local governments have been urged to meet the diverse needs of the people while improving economic efficiency. In accordance with these situations, we would like to propose the Adaptive Collaboration (AC) as an essential concept for the new paradigm of knowledge integration and collaboration in the Ubiquitous Society. We define the AC as a new collaborative system utilizing the XML Web Services on the computer network infrastructure such as idc (internet Data Center). This system allows entities of different ontological level to be linked laterally therefore making it easier for them to appreciate each other s expertise, which essentially encourages further development and innovation. The AC also breaks the conventional relationships within and between organizations but instills and operates the horizontal and lateral business model. For medical services, the AC can be applied effectively for providing the horizontal, cooperative medical service, and for manipulating objects such as health maintenance service models and programs. In a broader sense, the XML Web Services collectively means any services involving the use of Web applications. However in this paper, we specifically use the term as the technology that integrates a numerous software applications online and automatically connects and conduct the operations on its own. The goal of the XML Web Services is not to make conventional services available online using Web applications. The XML Web Services is a method for collaboration between different systems which exchanges information written in XML and automatically processes the task on the network according to the object of each program. It is also possible to collaborate with the legacy system. The most innovative feature of this system is its compatibility with the Internet. The benefits of utilizing the XML Web Services are the following: 1) it is platform independent therefore it is usable regardless of the type of hardware and software, 2) the connection is highly flexible, collaborative, and compatible with other systems, 3) it avoids overlapping investments of the ICT utilization and development, 4) it enables the sharing of the ICT sources, and 5) it offers more flexibility in data process and exchange. These benefits improve the efficiency of B2B businesses and CRM, and produce new business opportunities Experimental Pilot Study on the AC and its Potentialities for Healthcare Implications of the study In the Ubiquitous Society, open networked information systems are vital which enable people to collaborate with others regardless of location and type of business. In that environment, we will experience shifts in our communications both in terms of quantity and quality. Not only Human-to-PC, but a new pattern of PC-to- PC would expand the dimension of communications. The information we share with others will include not only textual information but a disparate range of data and information, and even those knowledge that is essential for decision making. Therefore, we define the Adaptive Collaborative Work (ACW) as a system that efficiently relates, shares, and utilizes data, information, and knowledge in the Ubiquitous Society where the amount of information grows at an accelerated pace. The purpose of this pilot study is to demonstrate the effectiveness of application of the XML Web Services into the ACW from the perspective of users. It automatically sorts and relates different application systems and computing resources required to process the queries on the Internet regardless of the program format. Therefore, we believe that by applying this technology, users may be able to execute their process without having to worry about unfamiliar technologies and complicated procedures. Requirement and Purpose of the Study The essential requirements to realize the ACW are the following: 1) users must be geographically-dispersed and belong to different organization, and they are able to freely change off, 2) knowledge information must be easy to store and retrieve, and long-term information storage needs to be safe and sure. Knowledge information also needs be available for high-level statistical process and analysis, 3) it must operate uninterruptedly, and it needs to be low in cost and highly-reliable. The purpose of the study is to realize the real-time ACW environment through data sharing. For this purpose, we conducted the following experiments: 1) a demonstration experiment on the Storage Management which enables users to share information located in the idc storage, 2) a demonstration experiment on data management by applying the XML Web Services into the real-time collaborative work system through data sharing. (The Report of the Advanced Studies forthe Social Capital of e-society, The Society of the Basis for e Community, 2004,pp.55-pp.60) 3

4 Experimental Methods First, we examined the possibility of collaboration among corporations, universities, and research institutions by building an information sharing environment prior to applying the XML Web Services into the data management system which utilizes the information stored within the idc. Second, we examined the effectiveness of the data storage system and evaluated whether the external applications are capable of high-level utilization such as its proficiency of producing knowledge out of information, presenting data effectively, and storing know-how. (Knowledge-Based Collaborative Work, Report of Supplementary Budget Project of the Ministry of Post and Telecommunications,2003) The following criteria were examined by the demonstration experiment utilizing the collaborative work test bed. 1) The possibility of collaboratively creating digital visual image contents in the distributed environment. All the materials in the visual library were stored, managed, and safely backed-up in an integrated fashion without making duplications at organizations within in the distributed environment. 2) The potentialities of connecting different organizations through the idc with high-speed network and of building a system with which users can exchange large amount of data on-line and on-time. Its effectiveness of arousing academic curiosity for the further development of technology for high-speed, large capacity data and information exchange and sharing. 3) The capability of the idc and the proxy servers to operate interactive control functions even when clients and their servers are located in an IP unreachable area. 4) The efficiency of collaboratively developing educational materials, reducing the process dynamics before making it available to classes, and reducing the cost of security by examining the issues in operating with modified server applications to make them more suitable and useable within the idc. The operationality of the dynamic image archive. 5) The validity of the data structuralization, retrieval, extraction, supply, and utilization with XML in the knowledge management systems being developed in the platform. Especially, the capability of prompting the collaborative work while protecting the data privacy by allowing users to switch the collaborative workplaces according to their object where access is controlled by each organization so that only permitted group members have the authority to share data. 3-2 Results of the Experiment and Healthcare Management The demonstration experiment proved that real-time discussion with sharing data and resources among the geographically-dispersed teams was possible. Furthermore, we confirmed that it is possible to collaboratively edit and process image data between remote locations using high-speed network. As population is aging rapidly and healthcare cost is escalating dramatically, people are becoming more conscious of the quality of life than ever before. Conventional health maintenance system is no longer capable of handling the current spread of acute illnesses such as infectious diseases and chronic diseases such as lifestyle-related diseases. Hence, digitalization of health, medical, and social work services is critical agenda for the Ubiquitous Society. It is required to build a new system that is capable of dealing with and analyzing over the years of varied medical data, and providing appropriate advice on a broad range of life activities to each individual according to the analysis. In addition, the system needs to be patient-oriented and provides accessibility to medical institutions and doctors. Furthermore, applying ICT into regional medicine is highly promising as it has been experiencing a number of problems such as shortage of hospitals and doctors in under-populated area and difficulties in operating the distance medical service system that can be solved with the ICT. From the experiment, the following benefits of applying the XML Web Services were proved: 1) flexible cooperation and collaboration through sharing the ICT resources, 2) flexibility in data exchange, 3) automatic execution of modules, 4) applicability to existing internetbased technologies (vendor independent), 5) effective utilization of existing programs, and 6) low cost for implementation. By utilizing these benefits, the following health maintenance services can be provided: 1) routine checkup and automatic notifying service for at-home patients on blood pressure, pulse check, blood test, urine test, and blood-sugar monitoring, 2) advice and counseling on the health checkup results, 3) nursing care services, 3) distance health and medical counseling service, 4) emergency services and, 5) working environment monitoring for teleworkers such as checking the temperature and humidity. In addition, in terms of regional medicine, a variety of medical data such as medical records and letter of introduction by physicians can be safely shared across the medical institutions. Furthermore, more accurate and reliable medical services can be provided by building more accessible and cooperative relationship among the regional medical service providers, pharmacies, and patients. 4

5 Also the protection of personal data is especially important. Applying the AC into medical and healthcare services field upon incorporating highly reliable idc and the XML Web Services makes the system highly dependable and ensures the security on privacy issues. This figure (Fig. 2) represents a Web Services system which processes patient s medical record in conjunction with the system shown in figure 1. This system is especially useful to avoid overlapping prescription of drugs and side effects when patient is suffering several different illnesses or being treated concurrently by different doctors, such as by an internist and a dentist. Knowledge Management system is applied for the analysis of the information and data structures and relationship between terms delivered from different medical institutions. From the demonstration experiment, we proved the effectiveness of utilizing the adaptive collaboration into the bottom layer of data. We also examined the efficiency of incorporating knowledge management system into the adaptive collaboration. Figure2 Health Layer Model Adaptive Collaborative System with Web Services Patient 4 Conclusion Knowledge Management System Treatment Layer Diagnosis Layer Chart and Data Layer XML SOAP(HTTP,SMTP) As expressed in the survey of the metropolis of Tokyo, many people recognize the need of improving the quality and efficiency of health maintenance management. In order to improve the quality of the healthcare management system, sharing information among residents, patients, hospitals, clinics, medical institutes, and pharmacies is imperative. In the Ubiquitous Society, more accurate and prompt healthcare management and quality medical services are expected by utilizing advanced ICT. There needs to be a system that effectively make appropriate counseling and educational information more accessible for the people so as to prevent them from suffering mental and/or physical health problems that may affect their work and life. The XML Web Services into the AC enables many people to contact and stay in close touch with physicians and outside mental health professionals at any moment when necessary through network. Therefore, utilization of the XML Web Services would generate innovative ways for the people to maintain and improve their mental and physical health. In this paper, the demonstration experiment was conducted at a limited number of universities and research institutes as a pilot study. However, we could gain enough evidences to confirm the validity of realizing the ACW system.especially, it is helpful for telework that is utilized as the adaptive collaboration. It enables multiple people to work together on same projectby allowing them to exchange a massive amount of data. It also does not require them to possess the same terminology. Particularly, in order to promptly meet the medical needs of local residents, telelwork betweenneighboring medical care facilities should be encouraged, which would enhance the quality of medical services to the local residents and enablethe optimum allocation of management resources of medical care facilities. We believe that our proposal to apply the XML Web Services into the AC would make a substantial contribution to the healthcare and medical field to realize the patient-oriented services in the Ubiquitous Society. References [1] David Nicson, Suzy Siddons, Remote Working: Linking people and organization,butterworth-heinemann,2003. [2] Kaoru Sasaki & Masakazu Ohashi, Key Issues for the Next Generation Knowledge Management, Journal of Policy Studies, Vol.9. Chuo University, Tokyo, Japan, 2002 [3] Kimball Fisher Mareeen Duncan Fisher, The Distance Manager, McGraw-Hill,2001 [4] Masakazu Ohashi & Masatoshi Nagai, Internet Data Center Revolution, Impress, Tokyo, Japan, [5]]Masakazu Ohahi edi., Knowledge-Based Collaborative Work, Report of Supplementary Budget Project of the Ministry of Post and Telecommunications,2003 [6] Masakazu Ohashi, Public idc and c-society, Kogaku Tosho, Tokyo, Japan, [7] Masakazu Ohashi, Time Business, NTT Publication, Tokyo, Japan,2003. [8] Masakazu Ohashi & Kaoru Sasaki,On the Study of Knowledge Structuralization, Process Based on Project Based Learning, Journal of Policy Studies,Vol.10, Chuo University, Tokyo, Japan,2003. [9]Masakazu Ohashi, edi., Knowledge-Based Collaborative Work, Report of Supplementary Budget Project of the Ministry of Post and Telecommunications,2003 [10]Masakazu Ohashi edi.,the Report of Society for the Advance Study on e-society, The Society of the Basis for e- Community,2003,pp

6 [11]Masakazu Ohashi edi.,the Report of the Advanced Studies for the Social Capital of e-society, The Society of the Basis for e-community,2004 [12]Masakazu Ohashi,Sasaki Kaoru &Mayumi Hori,On the Study of Knowledge Structuralizing and Adaptive Process Based on Project Based Learning The Annual Bulletin of Institute of Policy and Cultural Studies Vol.7,,Japan,2004. [13]Mayumi Hori & Masakazu Ohashi, Adaptive Implementing Adaptive Collaborative Telework in Public Administration, Proceedings of echallenge e2004, European Commission,Vienna,Austria,2004 [14] Mayumi Hori & Masakazu Ohashi, Telework Changes Working Style for Japanese Women, Proceeding of AWEEB2004,International Workshop on Advanced Web Engineering For E-Business, Germany [15] Mayumi Hori& Masakazu Ohashi, Telework and Mental Health-Collaborative Work to Maintain and Manage the Mental Health, Proceedings of the Thirty-Seventh Annual Hawaii International Conference on System Sciences,HICSS37, 2004 [16] Mayumi Hori, The Development of IT and a New Work Format for Women in Japan, Proceedings of t-world 2001, Edi. Reima Suomi, Ministry of Labour Finland, [17] Mayumi Hori & Masakazu Ohashi, Information Technology and The Possibility of Women s Work: A New Work Format for Women in Japan, The 6 th International ITF Workshop and Business Conference Working in the New Economy, Amsterdam, [18] Mayumi Hori, The present Situation and Perspective of Women s Work: How does IT work Hakuoh Business Review Vol.11 No.1, Institute of Business Research Hakuoh University, [19] Mayumi Hori, Society of Telework and Working for Women, Publishers of Chuo University, Tokyo, Japan,2003. [20] Micheal M.Beyerlein, Sue Freedmau, Craig McGee & Linda Moran, Beyond Teams Building The Collaborative Organization, Jossey-bass/Pfeiffer,2003. [21] Viviane Illegems, Alain Verbeke, Moving Towards the Virtual Workplace: Managerial and Societal Perspectives on Telework, Edward Elgar Pub,2004. [22] White Paper on Information Technology Services Industry2003, Japan Information Technology Services Industry Association, May