Japan s Changing Medical Care Scene

Transcription

1 Japan s Changing Medical Care Scene Japan s medical care system is undergoing significant change due to the application of advanced information technology. There is a new trend toward the introduction of patient charts in electronic form as a means of increasing the quality of medical care while also improving efficiency. This report covers this new development in the medical care industry, where deregulation has now made it easier to apply IT methods and approaches. Access Your Own Medical Chart on the Internet Yoga Urban Clinic opened in December 2000 in a quiet residential section of Setagaya, Tokyo. This outpatient clinic has earned a reputation in the neighborhood as a clinic with a difference. The first things that catch your eye upon entering are the wooden table and chairs, while a sofa nearby adds to the at-home feel. Conspicuously absent is the typical disinfectant odor of a hospital. Clinic director Dr. Satoshi Nomaguchi and his staff of doctors all wear normal street clothes when examining patients. This clinic considers medical care as a service, placing a strong emphasis on patient satisfaction. Open weekdays from 8 a.m. to 7 p.m., the clinic s long consultation hours are further extended by the fact it does not follow the norm of closing for lunch. Its electronic patient chart system further sets this clinic apart, and patients can view their own charts online whenever they like. A specialist in neurosurgery, Dr. Nomaguchi explains, We use electronic charts to encourage information disclosure, in keeping with our goal of medical care that emphasizes communication with patients. We believe we can improve and deepen this communication by sharing with patients the information written in their charts. E-Charts Improve Efficiency The Japan Hospital Association conducted a survey of member hospitals on the use of electronic medical care information systems, and published its findings in In its survey of member hospitals, including national government hospitals, a mere 1.1% of 761 member facilities (729 general hospitals) had adopted e-chart systems, while 3.3% were in the development stage and 25.9% were under consideration. This means that around 30% of medical facilities were either using electronic charts, or were seriously considering their adoption. When combined with the 31.1% for order systems, used to convey information between doctors and medical staff, either in use, or in development or planning stages, information system usage amounts to 63.9%. Since electronic charts are a prerequisite for many hospitals considering the adoption of order systems, it can be concluded that, at this point four years after the survey, even more hospitals are moving toward e-chart systems. While Yoga Urban Clinic s Dr. Nomaguchi points to electronic charts as a tool for communication with patients, their benefit in boosting efficiency should not be overlooked, either. Doctors prepare charts almost instantly, entering data during examinations, while networking allows other medical and technical departments to check records. Updating information is faster than with

2 conventional paper charts, while searching is also easier, and physical storage isn t necessary. Naturally, many medical facilities take a positive attitude toward adopting electronic charts after assessing their cost reduction benefits. Medical Care Sector Part of e-japan Strategies Japan s national medical care costs totaled 31 trillion in fiscal 2002 (April 2002 to March 2003), with a rate of growth exceeding that of the national income. The phenomena of an aging population is behind this. As of October 2004, those 65 or older accounted for 19.5% of the overall population, with that ratio forecast to reach 26.0% by 2015 and 33.2% by Moreover, the cost of medical care is expected to further increase as the population continues to age. However, health insurance premiums, the primary source of revenue for medical care, have remained flat during the lengthy recession, and health insurance finances are in an extremely dire state. As such, the Japanese government has tried to hold down medical care costs on one hand while promoting a variety of reform measures to increase both quality and efficiency. One is promoting IT in medical care, one of the seven sectors covered in the e-japan strategy the Koizumi government has promoted under a five-year plan that began in Linking Regional Medical Care Facilities with IT Networks The Ministry of Economy, Trade and Industry also instituted a program in to promote the adoption of IT networks based on e-charts in 26 areas nationwide to gauge the feasibility of adopting advanced IT networks linking medical care facilities. Yoga Urban Clinic was one participant in this program. The system used in this experimental program linked data centers and web servers at individual medical care facilities via networks, enabling patients who have registered their IDs in advance to access servers over the Internet and view their own charts. The main functions to be achieved include: (1) the sharing of data between medical facilities, (2) data sharing with patients, and (3) quantitative analysis. The first function allows hospitals equipped with in-patient facilities to check the condition of patients introduced by facilities such as Yoga Urban Clinic that have no in-patient facilities, and to have image data sent when MRI or other tests are conducted at other hospitals. The second is a service that permits patients to see their medical charts over the Internet. Yoga Urban Clinic, for instance, ensures that the questions patients ask their doctors and the consultations given are recorded in e-charts in the system. The third is the creation of a database used to search for and analyze chart content, diagnostic images and clinical results in various ways. Linking multiple medical facilities has the advantage of increasing the amount of data accumulated. Security measures for personal patient data are also essential when using electronic medical charts. The manager of Yoga Urban Clinic, Shoichi Takada, explained their security policy. The original copy of the chart data is saved on our clinic s server and sent to a web server after removing data that could be used to identify the individual patients. Patients access via the Internet, using passwords for security. The data center s web server is monitored 24 hours a day and operated under strict supervision. The Ministry of Economy, Trade and Industry s networking promotion program mentioned above included a number of unique efforts. In one, over 40 hospitals, clinics and other medical facilities, as well as the fire department, participated in Toyoda, Aichi Prefecture. In another, medical welfare agencies in Tsuruoka, Yamagata Prefecture shared patients diagnostic data via Intranet links, as well as cooperated with the Shinjuku Medical Association in Tokyo a few hundred kilometers away in an effort to create charts that could contain the lifetime records of an individual patient. This experimental program took place during a one-year period between , with the final evaluation released in However, several facilities, such as the Yoga

3 Urban Clinic, have continued to use the test system. Increasing Corporate Participation Promotes Cost Reductions The follow-up report evaluating this program compliled the results of a written survey of all 610 medical facilities that participated. According to the survey, 76.0% of medical facilities cited high costs as a factor in hindering the adoption of IT in medical care. This response was followed, in order, by the 57.2% that noted a lack of standardization in medical jargon, 53.1% concerned about the confidentiality of personal data, and 44.2% the difficulty of acquiring medical personnel versed in IT. Regarding these points, Hiroyuki Kondo, deputy director of the Ministry of Economy, Trade and Industry s Commerce and Information Policy Bureau Medical and Assistive Device Industries Office, tentatively praised the benefits of electronic medical charts while pointing out that costs are an issue. Adopting electronic patient records will not only help medical facilities improve operational efficiency, but will also contribute to improvements in the quality of medical care, Mr. Kondo says. Duplicate exams and prescriptions can be avoided when multiple medical facilities share patient data via an electronic chart system. This will also undoubtedly contribute to curtailing medical care costs and reducing medical care error. However, implementation of this project increased awareness of higher costs. When we carried out the trial program in 2000 and 2001, a limited number of manufacturers participated because the market was not that large. The lack of compatibility between systems from computer manufacturers and software development companies was also a factor in higher costs. However, costs have subsequently become less of an issue. Yoga Urban Clinic s Manager Takada says, The number of companies developing electronic medical chart has increased by around 50 or 60, while prices have fallen. The Ministry of Economy, Trade and Industry has also indicated that it would welcome more companies entering the market. The ministry is currently drafting a database format to increase data compatibility, while also promoting basic development and test projects related to such things as the communication protocols required for exchanging data. Mr. Kondo notes that, as progress is made on this sort of standardization, It will become easier for companies to enter the market, while competition will serve to decrease prices. Deregulation Provides Boost The lack of medical personnel versed in IT has also been cited as a factor in the difficulty of promoting IT in medical care. The Ministry of Economy, Trade and Industry drew up an IT training program for medical care administrative staff in 2004 as a strategy to relieve the personnel shortage, and training programs began in Private sector efforts now underway include medical data technician training programs conducted by the Japan Association for Medical Informatics. IT personnel training services offered by computer manufacturers and software development companies are also conceivable in future. In the past, the medical care industry has been hindered by various regulations, but progress has been made in deregulation in recent years. For example, in a March 2002 bulletin regarding diagnostic record storage locations, the Ministry of Economy, Trade and Industry granted express permission for medical care facilities to store electronic records externally. System reforms have also allowed the online storage of receipts indicating medical care cost details. The corporate management of hospitals traditionally been restricted to those performing high level medical care not covered under the National Health System. However, this limitation was lifted in 2004, and in July 2005 the Kanagawa Biomedical Industry Zone was approved as the first special zone where corporate-managed hospitals could operate. Estimates are that new corporations will enter this market during Medical care IT systems, such as for electronic charts, will not produce profits themselves. Rather,

4 system reforms to enable a medical insurance point system as the basis for remuneration for treatment will likely be needed to further promote the adoption of electronic medical charts and other advanced IT in medical care. In an initiative known as the Grand Design for Information Processing in the Insured Medical Care Sector, the Ministry of Economy, Trade and Industry s medical insurance information systems advisory panel has set forth a nationwide goal for electronic medical data systems, calling for their adoption by more than 60% of hospitals with over 400 beds, and more than 60% of all clinics by In addition, there is also a need for the promotion and adoption of remote medical care support, computerized receipt processing, inventory, and individual identity verification systems. Demand is also expected to expand in peripheral sectors with comprehensive medical product networks that can quickly provide accurate pharmaceutical data, along with medical supply distribution systems that employ bar codes for greater efficiency. As the use of electronic chart systems begins to spread, companies in a wide range of industries, including computer manufacturers, software development companies and diagnostic testing firms, have identified business opportunities and have started entering the market. This major new trend toward the adoption of information technology marks the beginning of a new era in Japanese medicine.

5 References: Ministry of Economy, Trade and Industry Yoga Urban Clinic (Japanese only) Mediva Inc. (Japanese only) Japan Hospital Association (Japanese only) Japan Association for Medical Informatics