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

Tokushukai's transition to electronic medical records began in November 1997, when Yao Tokushukai General Hospital installed an order entry system from Software Service (SSI). Kishiwada Tokushukai Hospital followed in April of the next year with a Fujitsu order entry system.

The main aims were to shorten pharmacy waiting times and prevent missed charges. Deployment later extended to very large hospitals, including Shonan Kamakura General Hospital. A turning point came with the Ministry of Health, Labour and Welfare's grand design for healthcare information technology, announced on 26 December 2001. It set targets for EMR installation at at least one facility in every secondary medical area by fiscal 2004 and at more than 60% of hospitals with 400 or more beds by fiscal 2006. Eight Tokushukai hospitals consequently received installation subsidies.

Building the early EMR systems at Yao and Shonan Kamakura was extremely challenging. Today's systems can be built with less than half the cost, time and effort, but we must not forget the work of those who came before us.

Benefits for patients receiving care across several specialties

The eight hospitals introduced Fujitsu EMRs. When development was delayed, however, Chairman Torao Tokuda decided that Yao, which already used SSI order entry, should move to an SSI EMR. Both Fujitsu and SSI systems continued to be installed until Tokushukai Information System, Inc. (TIS) was established. With two separately managed systems, hospitals could not be networked effectively or statistical data managed centrally. TIS was therefore established to consolidate EMR suppliers and standardise codes across systems.

EMRs eliminate the space and work needed to manage paper charts and place test results in a database, benefiting patients seen by several specialties. Prescriptions can also be copied from the EMR, saving time and reducing errors.

It is often said that EMRs lead doctors to converse with a monitor instead of looking at the patient. Such comments seem less common now that doctors are accustomed to the systems, but it remains important to be mindful of this when working at a computer.

What would applying My Number to healthcare change?

On 24 May this year, the House of Councillors passed the My Number Act with majority support from the governing parties, the Democratic Party of Japan and others. If the system, intended to begin in January 2016, is applied to healthcare, records could be linked with institutions outside Tokushukai. Individual institutions currently manage EMRs, or Electronic Medical Records. The new system could enable nationwide sharing through EHRs, or Electronic Health Records. Individuals could then manage and use the medical and health information held in EMRs and EHRs as PHRs, or Personal Health Records, improving health awareness and understanding and helping prevent lifestyle-related diseases and their progression. People could also choose to use their information for second opinions or care in other specialties, improving care, including emergency treatment, and reducing unnecessary tests. The UK, US and Canada are already pursuing national EHR and PHR projects with budgets of ¥1–2 trillion.

In Japan, government-funded regional EHR projects are being attempted in dozens of locations, but few are being used effectively. Different company approaches have produced different networks, IDs and code linkages in each region, which I do not believe will provide a nationwide EHR infrastructure.

Tokushukai has standardised EMRs at 80% of its facilities, but our larger goal is to provide patients with their medical information. Our Chairman has used boundless imagination to make one seemingly impossible idea after another a reality. I believe this was possible because he was determined to see them through.

Let us work together, holding on to our dreams and the determination to fulfil them.

Source: Tokushukai Newspaper, 3 June 2013, No. 880