K A ZU O N A K A M U R A

Ta l k W i t h

N AOTO I S H I DA

The Future of Healthcare Pioneeredby Elegant Ideas

Kazuo Nakamura
CMIC HOLDINGS Co., Ltd.
Representative Director and CEO

Naoto Ishida
Urawa Digital Planning Representative

Till now, healthcare systems have been built with a view of providing patients with medicalcare and medicinal treatment. However, the recent spread of the novel coronavirus haschanged how we see prevention, treatment, and other aspects of healthcare. There is ademand for healthcare systems to move closer to those who in need of care and to adjust
to fit into their daily life. What is needed to construct the framework for new healthcare
systems that adopt the perspective of those who receive care? CEO Nakamura spoke toNaoto Ishida, who has worked behind the scenes to help Japanese video games gamesucceed in the world and gained his view on the kind of reforms that is needed to revolutecurrent healthcare system.

The Future of Healthcare Pioneered by Elegant Ideas

KAZUO NAKAMURA

Talk With

NAOTO ISHIDA*1Managing the entire
process related to audioon the Super NintendoNakamura This time, I am visited byMr. Ishida, who has worked indevelopment since the dawn of thevideo game console age, and who hassupported the advancement ofJapanese consoles abroad.

At the time, people of my generation
perceived video games as mere toys,

but these games defied expectations,advancing internationally andachieving huge success. In addition,Sony’s Walkman succeeded globally at
almost the same time. Music wassomething that you listened to athome, but the Walkman created aculture where you could easily takemusic outside and enjoy it anytime,

anywhere. When talking about Japan’sstrengths, people tend to focus on

manufacturing and other “hard” areas.
However, Japan also has great powerin “soft” areas to encourage changes

from the start.

Ishida Nintendo also did not say “doomissions in managing medicine atMr. Ishida, what was the video gamechange the original design forthat did not do anything like creating athought it would be interesting toin people’s actions.

industry like when you began working?
Ishida I began working at Nintendo in

1988, which was the end of the periodof the Family Computer (nicknamed“Famicom”). At that time, Nintendo
was thinking of shifting to the next

machine soon. I had studied acoustic
physics at Kyushu University, soimmediately after joining thecompany, I was assigned to manage

sound design for the Super Nintendo.
As it was going to be a 16-bit

overseas rollout. As people atNintendo believe that if most of theend users liked it, it is a good product.
They never wavered in this conviction,
always starting by making whatever

the employees themselves found to bethe most interesting.

Interesting things are born“under the desk”

machine, its expressive power was like

Nakamura Today, I am also visited byNintendo was then still a small

electronic medicine notebook

a Cambrian explosion.

company, so it was normal for one
person to play many roles. Thus, I

managed the entire process related toMr. Fukushi, who conceived of the“harmo” during his time at Sony, andwho now is Head of CMIC Tech Lab.

audio: I worked on designing

What was the story behind thedevelopment of harmo*1 at Sony?

inbuilt synthesizer; I composed music; I

development, I myself became ill andspecifications for the game console’s

built the chip; and I even arranged thecircuits. There was no precedent forme to reference, so I did research on
my own and asked many

people a lot of questions. I
knew I wanted to use myabilities to make the bestthing possible. As I had justjoined my first company, I
didn’t know about othercompanies, so I thought thiswas a natural thing to do.
Nakamura Were you

thinking about advancing inoverseas markets from thestart?

Ishida At that time, allJapanese video games werecalled “Nintendo” overseas,
regardless of the actualmanufacturer, so of course
we were thinking about
KAZUO NAKAMURA

I think it was good that we didn’t

expanding overseas market

Fukushi Regarding harmo’s

was prescribed many medicines. I did
not know about the difference ofmedicines, and I made mistakes intaking them. I wondered whether
there might be an easy way tomanage prescription drug andinstruction data, and this became mymotivation for the development. In aflash of inspiration, I realized I could

apply the FeliCa technology Sony had
developed to achieve a completely

new method of managing prescriptionthis” or “do that”; it was a company
release plan for a video game andthen reflect that into the financial plan.
Motivated people work voluntarily

from the start, and when a task hasvaguely taken shape, they show it to

the division manager and ask for his or
her decision. If they receive a go sign,then they finally start to engage in it aswork. Ultimately, the company
president decides oncommercialization. In this world, wecan drive maybe 1 out of 100 video

games to commercialization, so we all
rack our brains because we need tothink of something that can get
approved.

Nakamura Now, with remote working
taking root due to the COVID-19

pandemic, new things are being born

through exchanges across companies,
but at the same time, I am afraid that
we will lose the feeling andopportunities to gather everyone

together and do something. I thinkthat places where everyone can gather
and rack our brains while we work arealso extremely important.

Three principles: “Do nothesitate; do not worry;enjoy”

drug and instruction data. However,

Nakamura When we could not decideassigned to me.

consulted with Mr. Ishida. What was

this was not a task that the company
Nakamura Did the company approveof you doing research anddevelopment outside of work?

Fukushi It was not approved officially,
but the culture was such that it was

natural to do research outside of work
using one’s free time, and this wascalled “under the desk.”

about the next move for harmo, I

your impression when you saw harmo?
Ishida I felt it was slightly formal. It isrelated to healthcare, so of course it
should not be too playful, but I had

the sense it is not something I would

see every day. To say it another way,

making it into something that I would
see every day might eliminate

crucial moments. For the next stage, Iposition it as an app that you would
inadvertently check even at times

completely unrelated to medicine.

Nakamura CMIC is a company that has

Electronic medicine notebook
service harmo
Using the contactless IC card technology
FeliCa, the electronic medicine notebook
service harmo empowers patients to centrally
manage their own medicine information in asimple, reliable way. Healthcare professionals
can also share and use this information. This
healthcare information integration system has
an electronic medicine notebook as its
foundation.

7,000 professionals involved in➡ For details, see p.16 to 18.

pharmaceutical industry andhealthcare. Here, a culture of doing

things based on the conventional flow
is deeply rooted, and it is natural tothink about work while complying withthe many various regulations.

developments using a Personal Health
Record.*2 However, when viewed frommight be different when considering

necessary to make it a tool for people

patients. At that time, I received themaking daily life more interesting.

not change it so that users will notFukushi I think that it is important tothese words, I felt the fog inside myplace. Harmo uses a contactless ICIshida Video games have a set of threewhen you touch the Suica IC card to ahesitate”; “do not make the player

situations where children find thethe player cannot stop.” Video games

card to the reader many times. Thus, Itime, so people will run away if games

it because they want to touch it.” At

principles. I also think that it is a good

because “it would not contribute tothe app.

Nakamura I greatly agree, though.

games recently, so there is a greater

Making fans in this area while working

not understand a minor thing, the appto breaking apart the sense of despair

However, I did think that something

the user’s perspective, I think it ismanufacturing from the viewpoint of

to enjoy content that they like, or forfollowing advice from Mr. Ishida: “WhyWhat do you think about this?

easily move away from harmo?” With

create fans starting from a familiar

head clear.

card. For example, a sound is madeprinciples: “do not allow the player topayment reader, and I have seenworry”; and “make it so enjoyable thatsound interesting and touch the Suicaare things that you do in your free

proposed a system where “people use

do not comply with these three

the time, this was flatly rejectedidea to put all of these elements intosales.” (laughter)

Fukushi There are many free video

Sensory enjoyment is important.

hurdle in this regard. If the user does

to realize the developments will be key

will be deleted immediately. So as youin Japan today.

said, Mr. Ishida, it is necessary to havea flow that does not allow for

hesitation, and to make it simple andattractive so that users cannot stop
once they start.

Nakamura Harmo goes beyond asimple medicine notebook; it is a toolwith which we can expect many new*2 Personal Health Record (PHR): A system for collecting and centrally storing data on a patient's healthcare, nursing care, and general health.

The Future of Healthcare Pioneered by Elegant Ideas

KAZUO NAKAMURA

things that you concentrate on whileinterest in health. People do notuse of the medicine.

people take the same medicinesomething happens while you leave

interesting, so I think it is necessary to

personally feel concerned, and I think I

Ishida For example, during

playing, but with idle games,

the game, and you can check the new

event when you come back and play. It
might be interesting if this sort ofsystem could be made in harmo, too.

Building a framework forhealth management fromthe perspective of those
who receive care
Ishida Recently, the number of jobs

related to healthcare and nursing care
has increased, but I have noticed thatthe shift to IT has been quite slow.
When people become ill, almost

everyone goes to see a doctor, but if

people could practice thorough care in
their daily lives, then they would only
need to make a comparison against
their baseline data and find thedifferences.

Nakamura This is precisely what weare interested in right now. Particularly
at present with COVID-19, people areminimizing their visits to hospitals, andhow one manages one’s own healthhas become extremely important. I

think we can learn many things fromvideo game development, but what doyou think?

Ishida Recently, the keyword “idle”
has become popular in the video

game industry. Until now, games were“Pokémon GO” serves as a reference.

If you make walking itself into a game,then people start walking.

Smartphones have a pedometer

function, so the issue becomes how tomake it interesting.

Fukushi Listening to what Mr. Ishidasaid, I remembered that I tried tomake a game called “Medicine

Notebook Battler” after taking a hintfrom “Barcode Battler”.*3 Barcode
Battler is a game in which you scanbarcodes to generate characters, andyou can make the characters fight eachother. I wondered whether I could

make a version of this with medicine. If
you could have the medicines you are
currently taking fight each other, you
would come to recognize those

medicines, and you would always

register new medicines when you getthem, so it would be really good. But
when I suggested this, I was scoldedwith the words “don’t be ridiculous!”(laughter)

Ishida No, I think that is interesting,without a doubt. I too think it would
be good to anthropomorphize
medicines.

Nakamura In the past, the only ideas
came from the viewpoint of people

providing healthcare, so perspective
was lacking in terms of blending
medicine and the healthcare

management system into each

person’s life to enable people to makemaximal use of them. Do you have any
ideas about this?
Gakuho Fukushi
Head of CMIC Tech Lab, Business Strategy Headquarters,

Fukushi I think that people in general,
including myself, do not have much

CMIC HOLDINGS Co., Ltd.
Conceived harmo.

*3 Barcode Battler is an electronic game console that was sold by Epoch in 1991.

usually do something if it is nothave a system which enables people to
do something enjoyable without

overexerting themselves, and thisstate actually helps with healthmanagement.

Ishida I think it may be good to

expand the functions of pharmacies sothat they become destinations. Now,
they are only places for getting

medicine, but they could becomebases for the neighborhood if they

have useful information for people andfunctions for encountering the new.

Also, if pharmacies become fun places,
the barrier to healthcare will belowered significantly, and perceptionsof health may change as well.

Nakamura COVID-19’s impact has put
healthcare systems at a crossroads.

Going forward, it will be necessary tobuild a new ecosystem related tohealthcare and health. As you pointedout, I think the position of pharmacies

will change under this new framework.
However, in reality, it is tough to train
staff to acquire new functions, and so

it would be good if harmo could assist
in that.

Going beyond a mere
medicine notebook tocreate new value
Nakamura One problem is that

medicine labels are hard for regularpeople to understand. Even if theylook at the list of adverse effects, itdoes not seem real. For example, if
there was site for facilitatingexchanges between people who takethe same medicine, I think they could
all support each other and manage

adverse effects in order to optimize

Ishida When I take medicine, I

would be encouraged just by knowingthat there are others taking the samething. For example, even if the records

Talk With

NAOTO ISHIDA

for many years.

disasters, it is important to knowwhat kind of medicines arefor people taking medicine werepresent in which locations. People
may find that a certain district orwould see such people taking thekind of medicine. This may allow

this may make them think that they

the medicine to others who have

Fukushi We are thinking precisely thealso be done by comprehensively“Several thousand harmo users areregistration and use.

create a sense of camaraderie because

ascertain where a certain type ofconnections between people, as we

It may be just a number, but I thinkentire production process could bea long time due to COVID-19. I hopethe medicine will change depending

possibility for revolutionizing supplysimply published anonymously, others

user group still has at least one

same medicine without forgetting, andpeople in that district to circulate

should work hard, too.

an urgent need for it. This could

same thing. For example, the message

gathering the status of medicine

taking this medicine now” by itself canNakamura If people could“so many others are taking it.”

medicine is and its expiry date, thethat one’s desire to continue taking

adjusted, so there is also theon the presence of this number.

chains.

Nakamura Through exchanges

between users, an optimal way to takethe medicine may emerge. For

example, with medicine taken aftereating, the timing differs if it is“immediately after eating” or “afterFor people to live lives intheir own ways in a
post-COVID-19 society

eating.” The former means within 5

Nakamura COVID-19 has significantly

means within 30 minutes of eating, but

think society will change in the future?

these two apart. People take moreage of more individual expression.

they may take all of their medicines

example, I think people who develop

split them up into the categories ofbeing significant medicine nerds. Inprinciple, medicines have an optimal

given about effects, but I think it

information exchange would be

more about their feelings regarding

Apart from this, there may be

development. Users can enjoy thisaccumulate data such as whether

harmo to include a space like this, too.

COVID-19, or what happens whenfor me to rediscover the importance ofminutes of eating, while the lattershaken up our values. How do you

regular people may not be able to tell

Ishida I think we will transition into an

medicines as they get older, and so

Regarding the topic at hand, fortogether because it is bothersome tomedicine have the characteristic of

before and after eating. However, inthe past, information has only been

way to be taken, so I think such

would be good for people to talkexcellent.

the medicine or stories from

unexpected discoveries if wecontent, so it might be good forpeople taking a certain medicine have

Fukushi This pandemic was a chance

NAOTO ISHIDA

have not been able to meet others forthat harmo will serve as a tool for
supporting these personalconnections. I felt I want to make it sothat people can communicate their
feelings through this tool. For

example, a grandson could receive amessage if his grandfather properly
takes his medicine every day.

Nakamura The COVID-19 pandemic
has led me to understand theimportance of each person living his or
her life based on something to live for,not just treating diseases. I think that
harmo will be an important tool for

supporting such efforts. Moving one

step forward, I want to make it into a
tool where people touch it

involuntarily because it is interesting,and through this process increase theirhealthcare literacy naturally. We wantto advance while racking our brains

together on how to achieve this, so I
would appreciate your assistance inthe future. Thank you for taking thetime to talk today.