Kyoto Smart city Expo.
2016.06.01

Kyoto University
University of Miyazaki

gEHR Project:
Nation-wide EHR Implementationin JAPAN
YOSHIHARA Hiroyuki, MD/Ph.DEmeritus professor ofKyoto University and University of Miyazaki
謝辞
本研究は国立研究開発法人日本医療研究開発機構（AMED）臨床研究等ICT基盤構築研究事業の支援を受けた“ 大規模健康・診療データ収集・利活用に関する研究 “Acknowledgement
This research is supported by "Clinical Study Oriented ICT Infrastructure Development Project - Sustainable
Massive Health and Clinical Data Repository for Secondary Use" from Japan Agency for Medical Research andDevelopment, AMED (15lk1010001h0001).

EHR Research Unit
• 5 years project, since 2013.04• Original members come from• Kyoto University Hospital• Staff• Naoto KUME (Associate Prof.)• Shinji KOBAYASHI (Lecturer)• Lab belongs to• Graduate School of Informatics
Social Informatics
Design school unit
• Graduate School of Medicine• Research collaboration with 5 companies• Pharmaceutical company• Lab test company• SIer company• Healthcare service company

Computerization in medicine (in Japan)
1999 Electric insurance claim submission• DPC; Diagnosis Procedure Combination• Japanese DRG• Inclusive payment, based on primary disease name,per a day2003 EMR installation in hospitals
Electric insurance claim

EMR

Hospitals ( >600 beds)

96%

70%

Clinics (GPs)

96%

30%

“Kokumin-eisei no doukou”, Health, Labour and Welfare Statistics Association, 2012

EMR: Hospital domestic HIS
EHR: Regional medical information sharing system

Medical Accounting System and EMR
Pay by fundCharge to patients

HIS

30%

RecordEMR+ 70%

Accounting

Electronic Medical Record
since 2003

Reimbursement$275 billion USD¥ 33,000 billion JPY

OrdersPrescription,
Lab test

Test order
Test result

Medical accounting systemsince 1997

Receipt(Bill)
Insurance Payment fund

Test Lab

Health insurance society

What is EHR; Electronic Health Record?
• EMR• Electronic Medical Record• Record is secured in aninstitute• Belongs to an institute• EHR• Electronic Health Record• Record is shared in a region• Belongs to a patientpatientlife• Risk• Multiple prescriptions• Overlapped lab test
• Difficulties on HTA• Health technology
Assessment• Risk• Access violation• Reference responsibility• Social consensus

Sustainable EHR-centered Ecosystem
Agreement
Approval, audit

requestDisaster

Web server
Authorization server

Healthcare info

ISO13606 + extended
Archetypes

Administration
Named-dataregisterIndividuals(PC, mobile phones)

EHR CloudAnonymization

Anonymization

CSV, XMLResearch

CSV, XMLUniversity,
Pharmaceutical,
lab test, medical
equipments
Healthcare domain
Company (food,healthcare）
Care givers

Medicalorganization
Univ. hospital
Public hospital
Private hospital
Clinics, dentist

Healthcareorganization
Pharmacy
Medical examination

Data center (current state)

4 iDolphin
2013

Kyoto Maiko-net

3500 users; 5% of patient of two univ. hospitals, Opt-in

Document list

Lab test result list

【拡大表示】

iPad, iPhone viewer for Patients

Document lists• Progress course• Prescription• Lab test result• Summary• Reports

Lab test result and graph view(cabinet document)
Health/Medical Strategy Head quarter by law
Health/Medical strategy Head quarter
専門的調査

政策的助言

Chief ：

Drug design support network

Vice-chief：

Chief cabinet secretary,
Health/Medical strategy minister

H/M strategy board members
Chairman: H/M strategy minister
Co-chair:H/M strategy office chief

Next generation
medical equipments

Next Generation
Medical ICT
board

Healthcare, medicalfunding

Advisory board: Cabinet secretariat office

Next generation
Healthcare industries

医療実・ 分
施医 野の療 の推分 研
進野 究に研 開
関究 発す開 にる発 関
調推 す
査進 る・計 専
検画 ⾨
討の 家作で成構及成び

Strategy expert board

Advisory board

産・・ 業
等 医健 界に 療康 ・関 分・ 医す 野医 療
る の療 関専 研分 係⾨ 究野 機的 開の 関助 発成 等
⾔ の⻑ の出戦 有
⼝略 識
戦 者略

Prime minister

International extensionof Japanese
medical services

Next generation Medical ICT infrastructure project
Users

Company A

Company B

Hospitals
Patients

Company C
PHR ?

National EHR Trials in The World• Canada• USA• UK• Finland• Estonia• Singapore• Australia• New Zealand• Russia (Moscow)How much should EHR investment cost?

@2010

NationBudgetPopulation

Budget/person

Singapore

280 million USD

5 million

56 USD

Canada2 billion USD

33 million

60 USD

U.S.A

20 billion USD

300 million

66 USDAs running 5 to 10 year

60 USD/person would be requiredExpectationJapan

7.8 billion USD

130 million

60 USDIn 2015, 6 million USD is funded by the Cabinet
for EHR establishment for one year project.

EHR-centered Medical Information Circulation Model
USE③Research

Secondary Use
Companies

University, Lab,
Pharmaceutical company,Medical Equipments

USE④

Healthcare
industries

Ｓｔｅｐ２：Anonymous data
management
Anonymous data
management company

Information request
Approval

Anonymous
secondaryuse

Named data
management company

ü Preservation ofanonymousinformation
ü Statistic
processing・・・

Information request
Approval, audit

Ｓｔｅｐ３：Named data
management

Named
secondaryuse

Ｓｔｅｐ１：ＥＨＲü

EHR DB

Medical information
standardization andanonymisation

EHR cloudNPOüü

個人同意契約管理
閲覧者の認証Contract delegation company
依頼（同意）
閲覧

診療情報

閲覧

健康情報

診療情報
閲覧

Clinics
Hospital

USE①

Patients

USE②・・・

Load map;
Working groups, management company setups
20142016

20152017
EHR運営・データソース拡充

EHR implementation

EHR
Secondary use

Secondary use
company setup

NPO setup

2018

Secondary use
To Nationwide EHR

EHR working
groupspreparationDefinition of standards

EHR Operation

Management company setup

Operating management company

初期ソース

EHR
managementcompany

宮崎
京都

Data sources
宮崎Data sources

別府

京都市町村

宮崎

別府

京都

琉球

市町村

Data sources
全国市町村

等

Secondary use boardmembers

User propagation

preparationSecondary use
managementcompany

Company setup

Running company

Self sustainable management

Requirement survey

Secondary use DBsetup

Secondary use DB Operation
二次利用者確保

京都⼤

宮崎⼤

GSK

BAYER等

京都⼤

宮崎⼤

GSK

BAYER

等

東九州メディカルバレー※

二次利用者確保

京都⼤

宮崎⼤

京都⼤

宮崎⼤

GSK

BAYER

GSK

BAYER

東九州メディカルバレー

東九州メディカルバレー

医療関連産業等

医療関連産業（※）記名データの本格運用、及びそれに向けた機関・システム整備については、匿名化データの本格運用以降、将来的に検討・整備する。

等

ISO13606/MML endorsement plan

ISO13606(OpenEHR)

International standard

MML

Domestic standard※ MML = Medical Markup Language

ISO13606

Localized ISO13606
archetypes

MML
Few extension

ISO13606 original+Localized archetypes

2015 plan

EHR-centered Medical Information Circulation Model
USE③

Research

Secondary Use

University, Lab,
Pharmaceutical company,
Medical Equipments

USE④

Healthcareindustries

Ｓｔｅｐ２：Anonymous data
management
Anonymous data
management company

Information request
Approval

Anonymous
secondaryuse

Named data
management company

ü Preservation ofanonymousinformation
ü Statistic
processing・・・

Information request
Approval, audit

Ｓｔｅｐ３：Named data
management

Named
secondaryuse

Ｓｔｅｐ１：ＥＨＲü

EHR DB

Medical information
standardization andanonymisation

EHR cloudüü

個人同意契約管理
閲覧者の認証Contract delegation company
依頼（同意）
閲覧

診療情報

閲覧

健康情報

診療情報
閲覧

Clinics

Hospital

USE①

Patients

USE②＜Participant organizations＞
Connected: 12 hospitals, Scheduled: 48 hospitals, Total Beds: 31,036・・・

Conclusion• Without a viewpoint of cost and efficiency, Healthcare cannot
be sustained• Data source, EHR, Secondary Use••••

Insurance claim information
Clinical information
Genome information
Lifestyle healthcare information• EHR ecosystem: financially sustainable system• Enforcement of secondary use• EHR is an infrastructure, so that strong governance is required••••BudgetSpecialized Organization
National unique ID
Legislation of personal information handling policy