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HealthJuly 27, 2021

Kagoshima University Hospital increases UpToDate use through single sign-on

Kagoshima University Hospital, established in 1872 as the forerunner of the Shimazu domain medical school, is the only university hospital in the Kagoshima Prefecture. The Prefecture is comprised of many remote islands and remote areas and Kagoshima University Hospital provides advanced medical care so that people in all areas of the Prefecture can receive the best possible care. In April 2018, Kagoshima University Hospital introduced a single sign-on system to make the evidenced-based clinical information in UpToDate more accessible for all medical professionals within the hospital.

Kagoshima University Hospital integrates a clinical decision support resource into their hospital information system to deliver quality care

Kagoshima University Hospital has been building a comprehensive hospital information system for more than 30 years. To continually improve the efficiency and convenience of the entire medical information system, the hospital incorporated the clinical decision support resource UpToDate® into their workflow in 2018.

As the originator of the “ordering system,” Kagoshima University Hospital has been an early adopter of computerized IT systems. We interviewed Dr. Takashi Iwaanakuchi, Assistant Professor of the Medical Information Department, who has a background in nursing and is now responsible for the hospital’s information system, about the improved hospital system and how the integration of UpToDate has helped the medical staff deliver quality care.

How did the hospital "ordering system" come about?


Kagoshima University Hospital has been developing and managing Think(Total Hospital Information System of Kagoshima University), a comprehensive hospital information system that supports hospital operations, since 1984. The term "ordering system", which is now commonly used across Japan, originated from Think.

The Medical Information Department, to which I belong, has a Medical Information Management Section and a Physician Administrative Assistant Section. Both sections play a role in optimizing the flow of information within the hospital, from managing the accuracy of medical information to its utilization.

It is very convenient to be able to log in to UpToDate even from outside the hospital or university premises. In fact, after we introduced the single sign-on mechanism from Think, the use of UpToDate increased dramatically.
Dr. Takashi Iwaanakuchi, Assistant Professor, Department of Medical Informatics, Kagoshima University Hospital

How is UpToDate used in Kagoshima University Hospital?


Mainly, UpToDate is used by doctors, residents, and students in the medical department. Residents and students seem more likely to use it.

Many of them use it to search for literature on symptoms and diseases. Since Kagoshima University Hospital is the only university hospital in the prefecture and receives many patients with complex and rare diseases, it is often necessary to collect evidence-based information in a short period of time between consultations.

Not only are doctors are using UpToDate but pharmacists also. They use UpToDate to collect evidence-based drug and dosing information when the hospital’s Pharmaceutical Affairs Committee deliberates on advanced medical technologies that involve the off-label use of drugs.

Integration of electronic medical records and UpToDate with single sign-on to improve utilization


How does UpToDate work with the general hospital system Think during a consultation?

In general, hospital information systems are built in a closed network for security reasons. At our Hospital, we use the DenyAllow system (a system that allows only secure sites to be connected), and through this system, we allow Think to access UpToDate. In this way, we can keep the UpToDate screen open and search for clinical information at any time while entering data into the electronic medical record during a consultation on the same terminal.

In April 2018, Kagoshima University Hospital also introduced a system called single sign-on. To put it simply, when users log in to the electronic medical record, they can log in to UpToDate as well.

If you first log into the electronic medical record and then log into UpToDate with the same account from the portal screen, which is personalized for each user, you can open the personal page of UpToDate directly from Think the next time.

Once you have accessed UpToDate from the hospital or university campus, you can also log into UpToDate even from outside the hospital or university premises for a certain period of time, which is very convenient. In fact, after the introduction of the single sign-on system, UpToDate usage from off-campus and via the application increased significantly.

In university hospitals and medical offices, there are seniors and superiors who can ask questions immediately, but this is not possible outside. In such cases, clinicians can log into UpToDate from their smart phones and efficiently collect necessary and useful information. In the past, hospital information systems were generally not connected to the outside world, which was very inconvenient.

Although there are some restrictions, we can use UpToDate safely and conveniently by using devices such as the DenyAllow method and single sign-on. Also, the information system administrator can centrally manage the usage status of the various applications we use in the hospital, making it possible to optimize the IT budget for the entire medical information system.

Clinical decisions are often influenced by advice given by senior colleagues that may potentially be outdated, leading to inefficiency and even patient harm. UpToDate is a powerful reference tool which allows medical staff to re-consider their decisions based on evidence while saving time and effort as well as improving patient care. We want to create an environment where evidenced-based nursing (EBN) can be realized.
Dr. Takashi Iwaanakuchi, Assistant Professor, Department of Medical Informatics, Kagoshima University Hospital

Increasing UpToDate usage to better deliver evidence-based nursing

Do you think the content in UpToDate is valuable for nurses?


I am deeply involved with medical information in a large organization where IT is becoming increasingly popular. I also have experience as a nurse. As part of the activities of the Japan Society for Medical Informatics, I sometimes hold paper reading sessions with medical professionals from other universities and believe the content in UpToDate has a lot of useful information for nurses.

A big challenge for nurses is to balance between effectiveness and efficiency. With UpToDate, they can instantly search secondary information to find answers to their questions. Reliable content developed and reviewed by authors and editors around the world helps not only to enhance medical safety but also to make nursing care smarter and more efficient.

UpToDate can be searched in Japanese, but the text of clinical topics is displayed in English. Academic nurses have no problem reading in English if necessary, but we would like to create a system that makes it easy for our clinical nurses to use evidence-based medical information.

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