Katsuhiko Ozaki, President and Representative Director, Tokushukai Information System, Inc. (TIS)

I joined Yao Tokushukai General Hospital as a pharmacist in 1980, immediately after graduating from university. My first experience of working life was helping the late Akira Nishimura with his campaign for mayor of Daito.

Work in the pharmacy ran from before 8 a.m. until 11 p.m., with hardly a chance to sit down, and I wanted to quit after three days. When I told my mother, she said, “Keep going for a week.” When I told a senior pharmacist that my legs hurt from standing, I was told, “You will get used to it in two weeks.” Thirty-two years have now passed.

When I joined, I wanted to study anticancer drugs, but I was assigned to drug inventory management. Every month I prepared inventory sheets and, after the physical stocktake, calculated the value of the stock. Doing these calculations alongside dispensing and other daily work took two to three weeks. As soon as I finished, it was time to prepare the next month's sheets.

Wondering whether I could make this work more efficient, I bought an NEC personal computer, which was a new product at the time, with my own money. I wrote a program by following books. Inventory calculations then took only two or three days, leaving time to study pharmacy, and I was able to present at a conference the following year.

I believe this was possible because I turned my wish to finish a demanding inventory task more quickly into a goal. That also required a concrete action plan and a deadline.

I later moved to Nozaki Tokushukai Hospital, where the hospital bought a computer for me for the first time, and I developed a full pharmacy inventory program. Ordering medicines from IHS, now Tokushukai Co., Ltd., was difficult because there was no network like those we have today. Eventually, however, an online medicine ordering system was completed. I then used that connection to build a daily reporting system, the predecessor of the current system.

Before each new system was finished, another development request would arrive, such as payroll calculations from general affairs or diabetes patient management from doctors. System development alongside my work as a pharmacist never seemed to end.

Organisations and systems must go beyond the status quo to keep developing

When I returned to Yao Hospital as head of pharmacy in 1989, I was asked to build an order entry system. Believing that electronic medical records would eventually become a reality, I pursued a joint EMR development project with Sony. We spent three years on it, but difficulties in building the medical billing system led to its failure.

Tokushukai later began installing systems from both Fujitsu and SSI (Software Service), but has now standardised on SSI. Meanwhile, I passed drug management and operational reporting systems on to the next generation. A third generation of successors is now preparing to build new systems.

Technology and infrastructure advance with time, so the whole system will become outdated unless we develop younger successors as early as possible. Those who take over must have the ideas and skills to move beyond the status quo.

Our company is now working to build tools that assess the quality of care against Tokushukai's philosophy and basic policies. Although we have consolidated our software vendors, standardising operating methods remains a major challenge. Tokushukai also participates in the national medical information database infrastructure project. We hope this will unify and standardise medical information nationwide so that patients can receive higher-quality care.

Chairman Torao Tokuda used to tell us, “The reward for work is more work.” I also believe that capable staff grow when given new responsibilities. He would also say, “Delegate what others can do.” We need to entrust younger staff with work early and help them set and pursue their next goals.

Healthcare professionals can now share medical information through EMR systems to improve efficiency and safety, but patients themselves cannot share that information. In other words, current systems still lack the patient's perspective. We need next-generation EMR systems that address this problem.

Systems are living things. By continuing to grow every day, they can endure without being replaced. The same applies to our organisation: growth is what enables continuity.

Creating an environment where care can continue during disasters

As we learned from the Great East Japan Earthquake, securing lifelines, especially electricity, is a hospital's most pressing concern. Some Tokushukai hospitals lack emergency server power or protection against ceiling leaks, so the Group's disaster system management arrangements are not yet adequate. The information systems committee is preparing improvements in three areas: hospital facilities, information communication and sharing, and preparedness for system outages. We are starting with the improvements that can be made now.

Ishinomaki Municipal Hospital lost its servers in the tsunami, but restored operations and its care arrangements in less than a month. Patient data survived because it had reciprocal backups with a hospital in Yamagata and stored routine backup tapes in a fireproof safe.

We recommend that every Tokushukai hospital store backup tapes in a fireproof safe. We must urgently establish an information system crisis management framework and an environment that allows rapid recovery after a disaster. The only way to achieve a large goal is to keep achieving smaller ones.

Every member of the Group should carry forward our philosophy and work towards a society in which anyone, anywhere, at any time can receive the best possible care with confidence. That is our shared goal.

Let us work towards it together.

Source: Tokushukai Newspaper, 19 March 2012, No. 817