30%) (Japanese Association of Healthcare Information Systems Industry, 2019).
However, 80–90% of newly opened clinics use the EMR system; in fact, in urban
areas, the usage rate is almost 100%. The reason for the delay in implementation in
small-scale hospitals is mainly financial. Small-scale hospitals cannot afford the cost
of implementing the EMR system (JPY 300,000–600,000 for 100 beds per year)
(Japan Hospital Association, 2017). Medical services in Japan are provided mainly
by the private sector under a social insurance system; 71% of hospitals and 83% of
clinics are private (Japan Ministry of Health, Labour and Welfare, n.d.), and a
significant number of private medical institutions are small to medium-sized. Each
institution decides whether to introduce an electronic medical record system; the
government cannot force them to adopt such systems. Some institutions oppose
medical information systems because of their high operating costs.
Regarding the penetration rate for the EMR system, it is still difficult to use ICT
for information sharing because of the low penetration rate in small hospitals and
clinics, which are intrinsic to the Community-based Integrated Care system. At
present, testing is ongoing in hospitals and clinics that are making advanced efforts.
Another factor is that many regional medical information cooperation networks
are not yet functioning sufficiently, and there is no mechanism in place to link a
patient’s ID or manage the viewing authority for medical records. Thus, such
deficiencies indicate that there is more work to be done to ensure the effectiveness
of these networks.
The framework for regional medical information cooperation networks began
with an attempt to share information in a large hospital focused on utilizing electronic records for medical cooperation in the community. Before the implementation
of the network, there were some attempts to share information using a common card
in the medical arena, but it was not practical. In addition, the government provided
subsidies to build a regional medical network from the perspective of reducing
medical expenses. A regional medical network was expected to improve efficiency
and reduce medical costs resulting from the duplication of tests and prescriptions,
support for interpretation, and so on.
In 2005, the retirement age of baby boomers was near, and awareness regarding
the situation emerged in 2025. At the same time, the training system for clinical
residents changed, effectively meaning that for 2 years, no doctors were supplied.
The shortage of doctors became a real problem, and the uneven distribution of
doctors was also evident. The number of university medical schools increased, and
medical care efficiency was improved by securing local doctors, sharing hospital
functions, and cooperating in providing regional medical care. Thus, it was necessary to ensure role sharing among hospitals and build a regional medical network.
Since 2009, financial backing has been obtained via a “fund to revitalize the
community health care” system five times (Fig. 4).
The regional medical information cooperation network was originally started
with the accumulation of centralized patient information for the cooperative sharing
of information along a disease-specific clinical pathway. With the consent of the
patient, medical information is registered and shared. The second-generation
regional medical information cooperation network is a resource for medical
Current Status and Issues with Japan’s Community-Based Integrated Care System:. . .
161
However, 80–90% of newly opened clinics use the EMR system; in fact, in urban
areas, the usage rate is almost 100%. The reason for the delay in implementation in
small-scale hospitals is mainly financial. Small-scale hospitals cannot afford the cost
of implementing the EMR system (JPY 300,000–600,000 for 100 beds per year)
(Japan Hospital Association, 2017). Medical services in Japan are provided mainly
by the private sector under a social insurance system; 71% of hospitals and 83% of
clinics are private (Japan Ministry of Health, Labour and Welfare, n.d.), and a
significant number of private medical institutions are small to medium-sized. Each
institution decides whether to introduce an electronic medical record system; the
government cannot force them to adopt such systems. Some institutions oppose
medical information systems because of their high operating costs.
Regarding the penetration rate for the EMR system, it is still difficult to use ICT
for information sharing because of the low penetration rate in small hospitals and
clinics, which are intrinsic to the Community-based Integrated Care system. At
present, testing is ongoing in hospitals and clinics that are making advanced efforts.
Another factor is that many regional medical information cooperation networks
are not yet functioning sufficiently, and there is no mechanism in place to link a
patient’s ID or manage the viewing authority for medical records. Thus, such
deficiencies indicate that there is more work to be done to ensure the effectiveness
of these networks.
The framework for regional medical information cooperation networks began
with an attempt to share information in a large hospital focused on utilizing electronic records for medical cooperation in the community. Before the implementation
of the network, there were some attempts to share information using a common card
in the medical arena, but it was not practical. In addition, the government provided
subsidies to build a regional medical network from the perspective of reducing
medical expenses. A regional medical network was expected to improve efficiency
and reduce medical costs resulting from the duplication of tests and prescriptions,
support for interpretation, and so on.
In 2005, the retirement age of baby boomers was near, and awareness regarding
the situation emerged in 2025. At the same time, the training system for clinical
residents changed, effectively meaning that for 2 years, no doctors were supplied.
The shortage of doctors became a real problem, and the uneven distribution of
doctors was also evident. The number of university medical schools increased, and
medical care efficiency was improved by securing local doctors, sharing hospital
functions, and cooperating in providing regional medical care. Thus, it was necessary to ensure role sharing among hospitals and build a regional medical network.
Since 2009, financial backing has been obtained via a “fund to revitalize the
community health care” system five times (Fig. 4).
The regional medical information cooperation network was originally started
with the accumulation of centralized patient information for the cooperative sharing
of information along a disease-specific clinical pathway. With the consent of the
patient, medical information is registered and shared. The second-generation
regional medical information cooperation network is a resource for medical
Current Status and Issues with Japan’s Community-Based Integrated Care System:. . .
161