Fujitsu Forum 2015 Tokyo, Fujitsu’s largest annual event, was held on May 14-15 at the Tokyo International Forum in Yurakucho. On the second day, three speakers discussed the challenges involved in implementing comprehensive community healthcare systems to address Japan's rapidly aging population. The guest speakers were:
- Mr. Yoshinori Kujirai, Secretariat and Counselor of the Ministry of Health, Labour and Welfare (MHLW);
- Mr. Junro Watanabe, Executive Director of the Beppu Medical Association; and
- Mr. Tatsuro Mikawa, Director of the Home Medical Care Department of the Sugiura Clinic.
Mr. Hironori Kimura, the Director of Internal Medicine at the NHO Nagasaki Kawatana Medical Center, also joined the discussion as panel moderator.
Taking the microphone in turn, our distinguished guests presented their expert opinions on the state of Japan’s regional healthcare and on the effective application of ICT.
Mr. Kujirai opened the discussion by explaining the current initiatives of the Japanese government. The MHLW is actively promoting the growth of regional healthcare networks, and its ultimate goal is high-quality, efficient healthcare.
According to a 2014 joint by the MHLW and Japan Medical Association, networks for sharing patient information among medical institutions currently connect 207 regions across Japan. However, Mr. Kujirai noted that, "even though participant numbers are steadily increasing, some areas have too few clinics and hospitals in their networks." He also noted that, ultimately, sustaining and improving healthcare networks rest on improving the interactivity of medical information to attract smaller medical institutions.
Here, Mr. Kujirai referred to Japan's new ID number system. The ministry hopes the new ID system, called "My Number," will make sharing patient information more efficient. More specifically, the MHLW hopes this will promote cooperation and medical follow-up over the long term among clinics and hospitals. However, the My Number system alone cannot accomplish this goal. The development of basic infrastructure and advanced analytical techniques is essential for the standardization of electronic medical information.
The ministry believes that Japan must develop standardized patient IDs and medical terminology codes along international standards. Mr. Kujirai said the government is currently discussing possible formats and codes for international standardization. In addition, he said there are moves toward expanding the use of ICT to nursing care.
Using leading edge clinical equipment for house calls
Mr. Mikawa addressed advances in “mobile clinics.” With recent advances, doctors can now take the latest medical equipment, including USB electrocardiographs or blood and biochemical analyzers, when visiting patients at home. The latest portable, high tech medical equipment allows doctors making house calls to perform examinations that were once limited to hospitals and clinics. They can even perform X-ray imaging using portable devices.
As the Sugiura Clinic pioneers the use of mobile clinics, it hopes cooperation among regional home care providers will be promoted by home nursing care workers. These personnel can now upload medical information garnered from home visits to a server. Doctors and cooperating medical institutions have built a system to share information with visiting nurses in realtime. They can even order prescriptions online. In the future, the government plans to build a system that will connect care managers and caregivers.
Easing patient concerns with networked diagnoses
Mr. Watanabe described the Yukemuri Medical Care Net created by Beppu city in 2010. Four key hospitals conduct examinations, provide treatment with advanced medical equipment and share information with clinic physicians. With patient consent, doctors can register hospital or clinic examinations, examination images, and prescribed medication. Both doctors at major hospitals and smaller clinics can access this regional healthcare network.
In this way, the Yukemuri Medical Care Net also promotes cooperation among doctors at clinics and home care nurses, forming the foundation of a home healthcare system. In this system, which forms a stepping stone to the delivery of comprehensive regional care, visiting nurses can enter patient information at the patient's home on tablets. The system even allows care providers to attach examination images to reports. Mr. Watanabe went on to explain the benefits of doctors being able to check in on patients for clinic visits and outpatient care.
Mr. Watanabe said, "Home care nurses can now file reports and get in touch with attending physicians immediately, which speeds up patient care and makes it easier to build relationships of trust with patients and their families."
Team medicine: using ICT in medical and nursing care
After each speaker gave a presentation, we held a panel discussion. As moderator, Mr. Kimura chose the following theme: adding value by using ICT in healthcare. Recounting an episode illustrating the effectiveness of the Yukemuri Medical Care Net, Mr. Watanabe described the power of sharing diagnosis: "I sent a patient with a serious illness to a major hospital with my letter of introduction as his family doctor. Surprised by the sudden diagnosis, the patient could not entirely comprehend the description the hospital doctor gave him. However, I was able to access the Yukemuri network, and query the diagnosis made at the major hospital. My being able to check the treatment calmed the patient down."
Mr. Mikawa described how home healthcare's ability to deliver on the spot diagnoses from examination results and images via PC provides a sense of security to patients. He expects information sharing between care managers and visiting caregivers to expand. "For example, nursing staff will be able to capture patient images and upload the data to the server. Being able to see how a patient moves or behaves in a relaxed state, or diagnose symptoms such as pressure ulcers* or edema at a glance, will greatly enhance care."
* Ulcers developing in bedridden patients from poor blood flow to parts of the body.
The next topic of discussion was securing and educating enough personnel to support home healthcare services. Mr. Kujirai said, "the Ministry of Health, Labor and Welfare is implementing a plan to reduce the burden on individual doctors by relaxing the requirements for home care assistance clinics to promote new entrants into this market." In addition, he laid out a path toward creating a system for evaluating the quality of nursing care providers to help nursing care personnel create a career.
Here the discussion turned once again to applications for the My Number system in healthcare. Recently, there is growing support for managing medical examination data through the My Number system so doctors and healthcare providers can keep the flow of information going, even when a patient’s coverage is transferred from one insurer to another insurer. He expects the scheme to make major contributions to healthcare, as medical examination data is invaluable for estimating when a patient first developed a disease. Mr. Kujirai believes the necessary infrastructure development needed to incorporate My Number into healthcare information sharing will be in place in 2018 at the earliest.
Wrapping up the extensive discussion, Mr. Kimura re-emphasized the progress made to date in applying ICT in the medical and nursing care fields. However, he noted that further debate is needed on how to deliver "team medicine" to solve the many outstanding issues.
Mr. Yoshinori Kujirai
Minister's Secretariat and Counselor (Information Policymaker), Ministry of Health, Labour and Welfare
Mr. Junro Watanabe
Executive Director, Beppu Medical Association
Mr. Tatsuro Mikawa
Home Medical Care Department Director, Sugiura Clinic
Mr. Hironori Kimura
Endocrinologist-in-Chief, Director of Internal Medicine,
NHO Nagasaki Kawatana Medical Center