Many medical information standards are not widely used in Japan, and this hinders the promotion of the use of real-world data. However, the complex intertwining of many factors hindering the dissemination of medical information standards makes it difficult to solve this problem. This study analyzed and visualized relationships among factors that inhibit the dissemination of medical information standards. Five medical informatics experts affiliated with universities and hospitals were interviewed about the factors that hinder the dissemination of medical information standards in Japan. The presented factors were analyzed using the interpretive structural modeling (ISM) method and the decision-making trial and evaluation laboratory (DEMATEL) method. We found that "legislation" and "reliability" were important inhibiting factors for the dissemination of medical information standards in Japan. We also found a six-layered structure in which "reliability" was satisfied when "legislation" was in place and "expectations" and "personal information" were resolved. The DEMATEL analysis indicated the relationships and classifications of factors hindering the dissemination of medical information standards. Since the adoption of medical information standards does not directly lead to revenue for medical institutions, it is possible to meet the "expectation" of improving the quality of medical care by ensuring "legislation" and "reliability", that is, ensuring the dependability of medical treatment. The results of this study visually show the structure of the factors and will help solve the problems that hinder the effective and efficient spread of standards. Solving these problems may support the efficient use of real-world data.
Keywords: DEMATEL; ISM; inhabitant factor; real-world data (RWD); standards.