Challenges and Potential in Healthcare IT

In June 2023, we invited to two outside medical experts, Mr. Oguchi and Mr. Miyachi, to participate in a stakeholder dialogue. The aim of the dialogue was to explore the potential for applying the Group's IT capabilities, intellectual property, and know-how in the field of healthcare IT. After explaining our business situation and Group strengths, we received objective and frank opinions from Mr. Oguchi and Mr. Miyachi regarding the challenges and potential of applying IT to healthcare.

Date: Friday, June 30, 2023
Attendees:
[Outside experts]
Mr. Masahiko Oguchi (Advisor and Director of Medical Informatics Department , Cancer Institute Hospital of JFCR)
Mr.Hiroki Miyachi (Director, Kakegawa Higashi Hospital of Medical Corporation RYOUWAKAI)
[TIS Inc.]
Masakazu Kawamura (Executive Officer, Division Manager of Corporate Planning SBU/Corporate Sustainability Promotion Officer)
Hirohito Yoshida (Executive Fellow, Healthcare Services Unit)
[INTEC Inc.]
Koumei Yamaguchi (Managing Executive Officer, General Manager in charge of Social Infrastructure Business Division)
[Facilitator]
Tomohiko Yamaguchi (Consultant, Cre-en Inc.)

Attendees

Masahiko Oguchi
Advisor and Director of Medical Informatics Department , Cancer Institute Hospital of JFCR
2009 : Director; Radiation Oncology Department, Cancer Institute Hospital of JFCR; 2012: Junior Hospital Director; same hospital;  2018: Deputy Hospital Director; 2023: Appointed to current position. Radiation oncologist for malignant lymphoma, breast cancer, rectal cancer, etc. Currently, he is engaged in developing an integrated cancer care support system (integrated cancer clinical database) using AI and deploying that system to create an Innovative AI Hospital System to provide precision cancer care.
Board certificated Radiation Oncologist; member of the Japanese Society for Radiation Oncology and the Japan Radiological Society.

Hiroki Miyachi
Director, Kakegawa Higashi Hospital of Medical Corporation RYOUWAKAI.
Became a doctor in 2004 after working part-time at a tavern and backpacking abroad. After working as a surgeon for 10 years, Mr. Miyachi became a home healthcare physician to support those who cannot go to a hospital. Currently, he is taking medical tours around the world to find solutions to the current situation in Japan, which has one of the world's most aging populations, and is seeking new forms of medical care through the exchange of knowledge. He assumed his current position in 2019.
Doctor of Medicine specializing in general medicine and surgery.

Masakazu Kawamura
Executive Officer, Division Manager of Corporate Planning SBU, Corporate Sustainability Promotion Officer, TIS Inc.
After working in the Financial Industry SBU and other sections, Mr. Kawamura became General Manager of the Corporate Management Department in 2017 and Executive Officer and Deputy General Manager of the Corporate Planning SBU in 2020. He assumed his current position in 2021. He is also in charge of corporate sustainability, corporate planning, finance and accounting, IR/SR, corporate governance, and IP legal affairs.

Hirohito Yoshida
Executive Fellow, Healthcare Services Unit, TIS Inc.
Mr. Yoshida joined TIS after supporting various corporate transformations, centered on management and operational strategies, at a foreign-affiliated consulting firm, then working as a representative of a foreign brand in Japan and CSO of a venture company. In addition to consulting, he is in charge of conceptualizing and launching new in-house services.

Koumei Yamaguchi
Managing Executive Officer, General Manager in charge of Social Infrastructure Business Division, INTEC Inc.
After working in the Public Utilities Promotion Office and the Public Utilities Sales Department, Mr. Yamaguchi became Healthcare Sales Manager in 2017 and General Manager of the Metropolitan Social Infrastructure Headquarters in 2018. He assumed his current position in April 2019.

[Facilitator]
Tomohiko Yamaguchi
Consultant, Cre-en Inc.

Introduction: Our Strengths and Approaches to Solving Social Issues

Kawamura: The TIS INTEC Group provides optimal one-stop support for all aspects of its clients' system lifecycles and IT-related operations, from consulting services to system development, IT infrastructure, and outsourcing. The financial sector, which includes credit card companies, accounts for 36% of our net sales, while the manufacturing, distribution, services, and the public sectors (including healthcare) together also represent a broad client base. Previously, the business structure for our system integrators was centered on contracted development. In addition to this, we have been promoting a Groupwide shift in our business structure to provide systems and operations as a service-style business. Here,

we deploy the know-how and expertise we have cultivated through contracted development to anticipate and address issues faced by our customers and the industry as a whole. Aiming to resolve social issues through our business, we have identified four social issues to be addressed: financial inclusion, health concerns, urban concentration/rural decline, and low-carbon/decarbonized society. At this point, our focus is on financial inclusion, where we utilize our expertise and knowledge about payment services, but we are also pursuing impactful initiatives to address health concerns.
The subject of today's dialogue is "IT x Healthcare." Here, we will talk about using our healthcare platform business as a foothold to provide both social and economic value using our IT capabilities, including in data utilization, to resolve health issues. Through this dialogue, we hope to gain insights into the role that companies can play in using "IT x Healthcare" to resolve health issues while exploring the possibility of addressing broader social issues both in Japan and around the world.

Challenges facing Japan's healthcare system

Miyachi: I think the aging population is Japan's biggest social problem. As you know, Japan is the world leader when it comes to aging, and soon people aged 65 and over will reach 30% of the total population. Here, we face two specific challenges. The first is the fact that elderly people must live with chronic diseases for a long time, and second is the need for long-term care (where people remain alive even after surpassing their healthy life expectancy). These two challenges will require considerable medical expenditures and manpower. With the ever-increasing number of elderly people, it is becoming more and more difficult to cover all medical costs through social security.

On a related note, promoting informal care^*1 is a national challenge. Back in the 1950s, each elderly person was supported by an average of 12 people, but the average will fall to 1.3 people by 2050. Simply shifting long-term care to community-driven care may not be sustainable, as it would be exhausting for the community carers. The problem is that nobody has identified who will be responsible for dealing with long-term care and chronic illness in the future.

Oguchi: I work at a Tokyo-based hospital specializing in cancer and we are seeing many patients in their 80s and 90s, which reflects our aging society. Looking ahead, the number of patients undergoing cancer treatment with chronic diseases will also increase, and various cancer treatments will be developed to meet their needs. In many cases, the key to treatment lies in the meticulous judgments and moderate approach of physicians. This takes into account the chronic disease and lifestyle habits of each patient and cannot be handled using standardized guidelines. Here, the lack of information-sharing is a problem.
Cancer is a common disease experienced by one out of every two Japanese people, and around 60% of cases are cured. This means that the number of cancer survivors will continue increasing in our aging society. More and more people are returning to society with long-term side effects of treatment and damage caused by the disease. Our society needs to create a support system for survivors. Hospitals alone cannot provide the required follow-up manpower and systems, making the situation unsustainable.

H. Yamaguchi: The last three years of COVID-19 have highlighted the challenges of our healthcare delivery system. By institutional design, a healthcare system may work optimally in normal times, but end up dysfunctional in times of emergency, such as a pandemic. While there are challenges with digitization, evidenced by Japan's My Number Card, the lack of a command center for healthcare delivery has been a challenge.
In some regions, we have seen successful cases of division of labor by local medical institutions. I attribute this to the active leadership of medical institutions and the segregation of relevant stakeholders, enabling them to fulfill their respective roles in providing services.

*1. Informal care: Informal support provided by family members, relatives and friends, local residents, NPOs, volunteers, and the like as opposed to support provided under official entities, such as local governments and professional organizations.

Challenges in utilizing healthcare information and the role of companies

H. Yamaguchi: For example, why is there no progress in the sharing of specialized information on cancer cases and sites? What about sharing of specific information related to patients, which is held by pathologists who are unevenly distributed throughout Japan? Also, what breakthroughs are needed to achieve this progress?

Miyachi: We are seeing progress with registration of disease-related data through academic societies, as well as with consolidation of information on surgical outcomes. However, it is difficult to effectively access medical record information as a database due to rules on protection of personal information, which discourages parties to share such information.
In one case overseas, a nation established a universal database linking all its medical records, from university hospitals to clinics, in one year. In Japan, before we talk about an integration format, we need to address the current situation, where there is almost no horizontal or vertical connection between medical institutions. Right now, therefore, it is quite difficult to unify information.

Oguchi: The format of information in electronic medical records differs slightly from hospital to hospital. This makes it difficult to standardize even electronic medical records from the same company. Another factor preventing unification of medical information in Japan is the customization of electronic medical records from hospital to hospital. We have epidemiological data, which may make it possible to create unified databases only for specific diseases such as cancer. However, we have not made much progress with unifying information on the details of each treatment, the specific situation of each patient, and how data will be used for prevention in the future. With this in mind, our hospital developed an integrated cancer clinical database.

that can be used with any electronic medical record. I think we need to create a system to collect data in cooperation with patients, enabling them to manage their medical information in relation to their own personal health records (PHRs^*2). Rather than leaving this solely to the government, which would be difficult, we need to forge ahead together with business associations and other stakeholders.

Miyachi: Companies are quite adept at accelerating the sharing of information. When information is pooled, however, it is difficult for one company or federation of companies to ensure effective control of security. In Estonia and elsewhere, national governments are leading the way. I hope we can find clear ways to encourage companies to participate, including by using receipt data to create and monetize services that help in prevention. There are several reasons why it is difficult to address the aging of society. First, local governments will not initiate any action unless they can see proven track records, such as reduced social security costs due to the introduction of digital technology. Also, companies will not make upfront investments in something that has no prospect of monetization. I think it's a structural problem where the issue of addressing our aging society is beyond the purview of both business and local government.

Yoshida: It is difficult for regular companies to become providers of nursing care or medical care itself. In our conversations with various corporate groups, however, we have found that insurance companies, health food companies, and other companies are very interested in healthcare. If such companies feel they can do something to help the community or their own business by getting involved in healthcare, they may be willing to spend money.
However, it is also difficult for companies to handle personal information and other data entrusted to them. If an infrastructure for the safe use of such data is in place, digital technology can help individuals feel confident about passing information about themselves and using it for a variety of things. I hope that companies can take the lead in creating a network that goes beyond current medical professionals to reach a far broader spectrum that brings people, goods, and money together.

*2. Personal health record (PHR): A lifelong electronic health record that collects and stores information on an individual's health in one place. That information can be freely accessed by the individual and used to promote health and improve quality life.

Direction of problem-solving in healthcare for the elderly

Miyachi: The concept of a community-based integrated care system ^*3 has been cited as a way to address the healthcare challenges of the elderly, specifically chronic disease and long-term care. Here, the manner in which we deploy social capital to reduce the burden of medical care is key. However, the level of medical care has increased as the nuclear family has become more commonplace, and people generally think that if something goes wrong, they can just go to a hospital. Therefore, it is difficult to build a community care system even if people are asked to return to the community and cooperate with their neighbors. On the corporate side, by contrast, the healthcare market is expanding due to the aging population, so there are great opportunities to for us to play a role. Therefore, I think we must think about resolving social issues in connection with various stakeholders, without relying on social security from the beginning.
On the government side, municipalities with large populations are too fragmented in terms of authority and responsibility, which can reduce their ability to take comprehensive action. Cities of about 100,000 people, such as Kakegawa City where my hospital is located, are not highly functionally differentiated, so issues are easier to grasp than in larger cities, and if several key persons raise their hands, they can move ahead as one. I came to Kakegawa City because I felt we should address this issue at the regional level, as the consequences of an aging population will be most noticeable in regional areas at first.

Yoshida: On the subject of reducing medical costs, I believe we should invest more in cancer treatment and advanced medical care. At the same time, we can reduce the burden of investment in this area by promoting the prevention of lifestyle-related diseases. As we move forward with regional medical coordination and PHRs, we are told that diabetes and stroke patients return once every three years, so tertiary prevention^*4 is extremely important, as is preventing people from getting the disease in the first place. The key to staying healthy is to not only obtain information from hospitals but also take early measures by cooperating with family doctors on the situation at home, as well as raise the health literacy of the citizens themselves.
In addition, data will lose its usefulness unless it is complemented and updated. Therefore, we need to have at least some IT literacy when we ourselves become old, so we should start absorbing such data now. We need to forge ahead while considering not only current objectives but also markets that will evolve in the future, and the cooperation of volunteers among our various stakeholders is essential for this purpose.

H. Yamaguchi: For patients returning from large hospitals to community hospitals, we need a mechanism to track their entire lifelogs as they move between facilities and progress from the acute phase to the convalescent phase and then to the chronic phase. However, patient data is scattered across multiple facilities and locations, as the owners of the information include hospitals, clinics, nursing homes, and special care facilities. There are various methodologies to address this, such as having someone unify and manage the information or keeping the information in different places and then gathering it on a blockchain. However, nobody seems to be following up on these methodologies, so relevant parties need to engage in advocacy activities such as policy proposals.

*3. Community-based integrated care system: System under which, in various fields of social welfare, treatment of patients is handled in the community as much as possible rather than in special facilities.

*4. Tertiary prevention: Rehabilitation and prevention of recurrence after a disease has run its course, to help patients recover and maintain functions that enable social reintegration.

Potential for the Group to address healthcare issues

Miyachi: When I visited Kenya, I noticed a remittance service called M-Pesa^*5, which enables poor people to store virtual currency in their cell phones to access various services, even if they are unable to save physical money. I think TIS has the potential to leverage its strengths and assets in finance to deliver innovations in healthcare, including by improving quality of life and encouraging the provision of services to various people. For example, the use of virtual currency to create a system in which non-medical stakeholders become potential care givers can change the very shape of healthcare itself, even if done is small amounts, such as hospital tokens and local currencies.

Yoshida: Looking at future healthcare, there are still many areas for which no uniform rules have been set and the difference between right has wrong has not yet been determined. Nevertheless, we should not just wait for the situation to improve. Even if we cannot expect immediate monetization, we should co-create with like-minded stakeholders and produce success stories.

*5. M-Pesa: A service offered by Safaricom and Vodacom (telecommunications companies of Kenya and South Africa, respectively) that provides contactless payments, remittances, microfinance, and other functions using cell phones.