Table Speech

Health Care Innovation in the Super-Aging Society

June 8, 2016

Dr. Shinsuke Muto
President, Tetsuyu Institute Medical Corporation

 I started my medical career as a cardiologist and performed cardiac catheterization at hospitals. I found my work rewarding as I shared the joy of overcoming the disease with my patients and their families after completing the treatment. My next assignment was to serve as a court physician to the Emperor and Empress for about three years. I felt deeply honored to have such a life-changing experience which exposed me to a new world and inspired me to address challenging social issues as a physician. I resolved to become a home medical care specialist and provide support and services in this super-aging society, especially for the elderly who had difficulties visiting clinics and hospitals. I joined a business management consulting firm McKinsey & Company to develop my problem-solving abilities and established You Home Clinic in 2010 to provide specialized and systematized home medical care.

 Japan has a rapidly aging population and the number of deaths per year totals 1.3 million. It is estimated to increase up to 1.6 million. Medical and nursing care benefit expenditure weighs heavily on the national budget and is projected to total 74 trillion yen by 2025. Home medical care presents a solution to curb social security costs. For example, monthly medical expenses for a hospitalized patient average 500,000 yen on top of medication and clinical test fees, while home medical care cost per month stays about 160,000 yen. Survey results show that over 70% of the elderly in Japan felt uneasy about their future, with health issues being their major source of concern While 60% of the respondents wished to receive medical treatment at home in their terminal stage, in reality more than 80% of deaths occur in hospitals today.

 Against such backdrop, the Japanese government is promoting home medical care. Its concept was institutionalized about 10 years ago to provide comprehensive support to patients’ recuperation period by ensuring well-planned, consistent medical control as well as follow-up treatment. Physicians make regular visits (at least twice per month) to patients’ home as well as make emergency interventions on a 24/7 basis.

 We currently operate four You Home Clinics, three in Tokyo and one in Ishinomaki, Miyagi Prefecture. In total 30 physicians visit about 900 patients and provide home care services. We have constructed a cloud-based leading-edge home care structure that makes full use of information technology to optimize operation and to reduce the burden of physicians. We developed and utilize four systems; electric health records that allow easy access from anywhere; medical clerk center for centralized management to improve efficiency; contact center where nurses serve as contact points and forward messages to physicians if necessary; and home medical cloud to manage physicians’ schedule and to create home visit routes for efficient operation.

 We have also been working to facilitate information sharing between home medical and nursing care personnel and facilities, including physicians, visiting nurses, care managers, pharmacists and day service centers. We had to reach a common understanding among experts from different fields, on the terms we communicate through and standpoint we base our operation on. For example, staff members of our clinic in Ishinomaki utilize cloud computing to share their schedule, messages and home-visiting records. We are excited that this system has developed into a de facto standard for information sharing among home medical and nursing care fields in Japan, through our collaboration with the Cabinet Secretariat and other ministries and agencies.

 The Great East Japan Earthquake caused devastating damages to medical facilities as well as public transport and deprived the elderly of access to these facilities and services. I established our clinic in Miyagi Prefecture to provide home medical care, especially to the so-called “in-home disaster sufferers” who had chosen to stay at their partially-damaged home and therefore, failed to receive adequate assistance from local municipalities. I launched the “Health and Life Revival Council in Ishinomaki District” and conducted a fact-finding survey to nearly 20,000 households on their life as well as health and mental state. We succeeded in compiling survey results in the database and identifying necessary assistance for different groups of people with specific needs. Thanks to the collaboration by many, we could share information through cloud computing and dispatch medical teams for continuous support.

 These initiatives motivated me to expand my scope of activities overseas and to see how feasible it is to export such software-based systems. I chose to study at INSEAD Executive MBA in Singapore, a country which also undergoes rapid aging of the population. I collaborated with my Singaporean classmates from INSEAD to launch a home medical and visiting care company in August 2015. It also undertakes ICT system operations, based on the “” cloud computing platform which facilitates communication between patients and physicians and enables sending alert or reminder messages. We are happy to have received high evaluation from the Ministry of Health Singapore and to get wider network of system users. I have an even larger ambition to construct a model that enables physicians and nurses to collaborate with robots and electrical sensors. I hope to expand it across countries in Asia, above all here in Japan.