Empowered JAPAN Webinar Report

Empowered JAPAN Executive Steering Committee was established in 2018, “To realize a world where everyone canwork and learn, from anywhere, at anytime.” To promote the true value of workstyle innovation including telework, the committee has beencoordinating symposiums in both Tokyo and regional cities. And in collaboration with various local governments, Microsoft, and partners,
the committee has been serving as an advisor to provide telework training for both corporate and individuals. In response to the spread of
infection of corona virus (COVID-19) and the government announcement on February 25, 2020,

which included the request to citizens totelework, the steering committee made the decision to launch a series of free webinars starting from March 17, 2020, to provide practicalinformation for individuals and organizations across the nation, to telework and/or practice online education.
Category：Contents for government,

Possibility of telework for medical institutions:healthcare, and educational institutions.
Date：March, 30, 2020

Work and conference and research

Speaker：Kengo Miyo

Starting with the examination of more than 650 returnees from the city of Wuhan, the National

National Center for Global Health andMedicine/Director of Center for Medical
Informatics Intelligence/J-DREAMS information representative
Visiting Professor of the Tokyo universityof technology and Nagasaki university

Center for Global Medical Research (NCGM) is at the forefront of treatment and research on
COVID-19. The NCGM has many specialists for infectious diseases. Dr. Miyo, holds a PhD in
medicine and specializes in medical informatics. He is the Director of the Department of Medical
Informatics, which is the NCGM's medical information department. Through ICT, the department
supports organizations that are committed to the fight against COVID-19.
"We use teleconferencing for discussions with the World Health Organization (WHO), as well as
the NIH (National Institutes of Health) and CDC (Centers for Disease Control and Prevention),
both of which are located in the United States," says Dr. Miyo. "In addition, it is difficult to accessthe negative pressure treatment room which requires strict protective gear. We use Teams' split
screen for four people in order to communicate between the treatment room and the staff room.
"As a countermeasure against COVID-19, the NCGM is using Teams for the following kinds ofusage scenes, including the content discussed by Dr. Miyo after giving a lecture at Empowered
JAPAN.

Mr. Miyo was hired as an assistant in thecentral medical information departmentof the University of Tokyo Hospital in
1998. After that, he became vice directorof the department of medical
informatics, Kobe University Hospital,
then director of the University of Tokyo
Hospital Department of Planning
Information and Management, and now
he is chief medical informatics officer ofCenter for Medical Informatics
Intelligence. He has studied abroad atPeter L. Reichertz Institute for Medical
Informatics, Germany, and is familiar withthe medical information situation inEurope.
At Medical Information SystemDevelopment Center he is chairing theprivacy mark review board in the medical
field. He specializes in medical
informatics and doctor of medical
science.

Usage Scene
Communication
between medical
personnel inside andoutside of negative
pressure rooms where
critically ill patients arebeing treated
Communication
between hospitalized
patients with mild
symptoms andmedical staff

BeforePeople entering the room are required
to wear protective gear and take avariety of preventive measures against
COVID-19. Therefore, once entering
the room, it is difficult to exit, and it
was difficult to communicate with staff
on the outside
There was an increase in the use ofmasks and protective gear which haveto be worn each time to prevent
infection. This created concern aboutprocuring gear and managing
inventory

Committee for swift
decision-making andwidespreadcommunication

Because main hospital staff gatheredin the same conference room, there
was a risk that if even one of theattendees was found to be infectedwith COVID-19, all attendees would beclassified as being exposed to highrisk contacts, and would be suspended
from work

After
Utilizing Teams' web
conferencing made it possible toexchange necessary informationin real-time between medical
personnel inside and outside thenegative pressure room
Utilizing Teams' web
conferencing made it possible tocommunicate with patients
without actually entering/exit
hospital rooms, thus conserving
gear for protecting against
infection
Utilizing Teams' web
conferencing made it possible tobuild a decision-making system
which eliminates the need formain hospital staff to gather andavoids the three modes ofinfection

When thinking of telework by medical institutions, people immediately imagine on-line medical treatment and remote surgery. However, inreality, there is an enormous amount of various work, research, and conferences that accompany medical treatment. The efficiency of workthrough the use of ICT and telework is also an urgent issue. The NCGM is gradually starting to implement telework starting from staff forwhom telework is possible. According to Dr. Miyo, the foundation of starting telework is the implementation of ICT for the entire center,
which has been under way for five years.
The NCGM introduced Office 365 E1 in 2015 and provided accounts for all of its
approximately 3,000 employees. One year after the introduction, almost all
meetings are held in a paperless format.
"The number of conferences (at medical institutions) is almost unbelievable,"
exclaims Dr. Miyo. "Although medical institutions should spend more timeattending to patients than holding conferences, many of these conferences arerequired by laws and regulations. Since the number of meetings can't be reduced, Idecided that our only option is to improve efficiency."
In principle, NCGM staff do not print out meeting materials; instead, they uploadthem to SharePoint and they view them on a screen. Replacing materials is easy
and there is no need for reprinting, so the creation time is greatly reduced. Furthermore, the materials are automatically archived, so there
is no hassle associated with storage, organization, or searching. The NCGM has also created a conference room reservation system simply
by using the basic functions of Office 365. "We accomplished this by defining one conference room as one person and then sharing theconference room schedule with everyone," says Dr. Miyo.
Even staff outside of the NCGM or on an overseas business trip can check the meeting materials in real-time. Conference rooms can bereserved at anytime and from anywhere. In this sense, the NCGM has already succeeded in implementing part of telework.
Although paperless meetings and conference room reservation systems are already commonplace at large private companies, suchtechnology can be called an advanced effort in the case of medical institutions. Dr. Miyo says that there have been improvements insecurity, which is a more important issue at medical institutions than at companies. As opposed to paper materials which are difficult tomanage, it is easy to set restrictions on access, editing, downloading, and printing in the case of digitized materials.According to Dr. Miyo,the extent to which telework will progress at medical institutions depends on ensuring an appropriate level of security. An importantelement of security is multi-factor authentication (MFA), which is used when accessing information from outside of the NCGM. At theNCGM, each work smartphone requires an additional verification."We do this because anyone will notice if they lose their smartphone, butwon't notice if their password is stolen," explains Dr. Miyo. "In this way, we are visualizing risks."
If there is suspicious communication on a smartphone, it will be automatically blocked and a notification will be sent to the security
response team for Teams. Members of the team write their response status in Teams, and it is stored as a response record.
As a result of these efforts, the NCGM suffered no damage during the 2018 phishing e-mail incident, while many universities, etc., had
their IDs and passwords stolen. By reporting these results within the NCGM, Dr. Miyo and his colleagues have furthered increasedrecognition for the need of MFA and other technology within the organization.
Dr. Miyo points out that failure for an organization to implement ICT will lead to individual employees and departments using IT at theirown discretion—which actually increases risk. It is necessary to recognize that risks will always exist, to appropriately evaluate those risks,
and to implement responses."We define the rules (such as mandatory use of MFA) and then trust other parties to act appropriately,"
explains Dr. Miyo. "We expect people and departments throughout the NCGM to share the necessary information among themselves.
Teams is being used even more than we expected. I have even heard of nurses who ask to attend meetings from their homes via Teams."
ICT is increasingly used in research fields. A leading example is the Japan
Diabetes compREhensive database project based on an Advanced electronic
Medical record System (J-DREAMS), which is led by Dr. Miyo. A total of 55
medical institutions (including the NCGM) from throughout Japan participate inthis project. Data from the medical records of more than 60,000 patients isrendered anonymous and then shared among participants. J-DREAMS is used todevelop new drugs and identify risk factors for complications.
Dr. Miyo was appointed as Director of the Department of Medical Informatics inJanuary 2015. At that time, he did not have a single staff member; just a roomwith desks and chairs. There was not even a computer. The department had
almost no personnel or budget."Even so, as long as you have allies and ideas, you can always start from what is possible," says Dr. Miyo.
He started by cultivating like-minded individuals from within the NCGM. Specifically, he began by searching each department for staff who
are certified as Healthcare Information Technologists. He then asked the certified staff to take on the concurrent role of informationmanagers. Dr. Miyo gathered individuals who have always had a proactive mindset towards ICT and fostered a sense of fellowship. His
group has succeeded in contributing to the organization while keeping costs low, thus earning trust from colleagues and rising to theircurrent position.The NCGM originated from a provisional military hospital that was established in 1868. The NCGM has a long history. It stillretains medical records from the Spanish Flu, which raged across the globe about 100 years ago."The essence of medical care is information
sharing," says Dr. Miyo. "Even in the case of surgery, where techniques tend to be the focus of attention, the best surgeons excel atthoroughly gathering information in advance and making surgical plans. I believe that even better medical care can be achieved by writing
down information, and then saving that information to be shared and used in medical treatment."