Better nursing care with networking: Fujisawa City, Kanagawa Prefecture 2

Sharing information on care activities across various professions

For provider of nursing care service rather than the person in need of the care or their families, the project installed a database system that allows various professions related to home medical care, such as nursing care staff, medical doctors, and nurses, to share information.

“For home nursing care of one individual, many people across various professions are involved. For example, there are many cases where a homecare worker provides a service once a week, and a visiting nurse comes once every two weeks. There are also cases where multiple helpers take turns in providing nursing care for one person. If there is no information sharing among these people, they might end up providing same meal every week, and it is not possible to obtain detailed information regarding physical and mental condition of the person being taken care of. Medical institutions that perform medical examinations intermittently are also in need of more detailed information regarding the patient. The law for nursing care insurance states that the involved individuals must hold joint meetings, but in reality, these meetings are seldom held. Quality of the nursing care service is also an important topic for the city, which pays the nursing care insurance fees.” says Uchiyama.

Biometrics is applied for the operation of this database, and user authentication and data encryption are performed in order to stop unauthorized person from accessing private information of the patient. However, from the experience of operating the database, Uchiyama notes that, “Since many homecare workers are also not familiar with the use of PC, even if the database is solid in terms of security, it will not be of any use to the workers if it is not easy to use. Many procedures such as asking for the cooperation of the people involved, and finding a method of keeping records for information sharing had to be done through trial and error.”

For homecare workers who are busy with their daily lives and have difficulty finding time to study nursing care, the project is providing video tutorial on the web which shows how to help the elderly take a bath in detail using multi-angle video.

Online class provided by e-care projectéÒ web site

IPv6 contributes to the security improvement

Network for this project connects following locations; “e-Care Studio” which was newly established as a base for the project and a place for related activities such as making video tutorials, homes of 25 families who participated in the project, 20 Wireless LAN hotspots placed mainly in public buildings around the city to obtain information from pedometers and other devices, and Fujisawa City’s Health Care Center. Fiber-optic cables have been installed in all of these places, and they are connected to each other by NTT East Japan’s Super-Wide LAN (Layer 2) at the speed of 100Mbps. This network is connected to the IPv4/IPv6 Internet through Keio University. All the terminals used in the present project have both global IPv6 addresses and private IPv4 addresses assigned.

The project’s network can also connect to community’s “disaster prevention network”, which had been established by Fujisawa City, via Health Care Center, and communicate with all the elementary schools and the public facilities in the city.

Broadband routers and multicast compliant switches have been installed in the homes of the participating families, but how to utilize these multicast compliant switches is still under planning.

When asked about the fact that this project is adopting IPv6 fully, Minami replied, “In order to achieve truly secure communication, the side that obtains information and the side that uses information must communicate in an end-to-end fashion. Hop-by-hop option can be useful, using destination option to authenticate small chunks of data might be especially useful, and we might be able to find a way to utilize flow-label, too. Protocol like IPv6 that provides new possibilities is well suited for making new communication system that must suit the needs of particular field.”


Providing services unrestricted by time or place

Professor Ota described her impression at this point about the project that has been going on since last fall. “I felt that the use of IT can greatly help us overcome the restriction of time and place that had been placed on the health care professionals and the people that receive the nursing care. Normally, when you want to see health care professionals you need to make an appointment and must go to a certain location. By utilizing IT, it is possible to obtain the necessary information anytime, at the location of your choice. Health care professionals can also obtain the information regarding the health condition of the person that needs nursing care at a convenient time. I’m hoping that IT would also change the way the individuals involved in the nursing care cooperate with each other and the scope of their connection.”

This project is running under a three-year plan. Fiscal year 2002 was the first year of the project, and it was spent on developing the information infrastructure. Since the project was new to everyone, it was also a year for those involved in the project to build cooperative environment and to share the experience. Finally, it was also a year for exploring on the details of research methods applied in the project.

From the second year on, they are planning to investigate specific problems that may come up when the government and companies start providing the service to the general public, and build new proposals regarding the project.

Minami says, “We would like to make second year the year for upgrading the experimental projects, by increasing the type of sensors, and connecting medical equipments to the network.” For example, in the “e-health-up” program, exercise bikes were connected to the network in the first year. For the second year, Minami would like to introduce equipments for muscle exercise, such as dumbbell, to monitor the movement of the muscle and measure the load.

For networking related area, QoS routing is another theme for the second year. For example, the project would like to assign different QoS for the control related and content related packets, to achieve high reliability even for emergency messages.

Also, during the first year, main participants were those in nursing care, but the project would like to get more active participation from medical doctors in the second year. In order to achieve this goal, it is necessary to overcome various challenges such as, dealing with various regulations, scheduling doctors’ appointments, filtering the collected information to make it easier to see, protecting private information, and improving the security function in order to prevent tampering of the information completely and obtain non-repudiation.

“In the third year, we would like to find a way of deploying the system to the real society. Using this entire project as a model case, we would like to show the whole country what are essential for network infrastructure for the nursing care, and how we can build them. In the end, we hope to come up with a policy proposal to the government. Dealing with various regulations is a big challenge. However, if we could build a good system that can bring clear benefits to the people, we might be able to move public opinion to our side. Ambiguity regarding the regulations should be resolved as we move along with the project.” (Minami)

Uchiyama shared her thought on the project’s future. “In the first year, how to run this project and what can be achieve by this project was still unknown, just like the development of the new devices used for this project. Since we asked help from people who were already involved in nursing care and working every day, we had put a lot of extra burden on those people. Also, they were probably confused on how they could contribute to the project. Bringing in various equipments to the participant’s house also caused many problems that we didn’t realize until we actually started doing them. In the following years, we would like to seek a way to provide these services through local governments, and also find a system that can bring benefits to all the participants.”

e-Care Town Fujisawa
http://www.e-care-project.jp/