Secom Science and Technology FoundationResearch Grant Report – Executive SummaryFY2010 to FY 2013	 Title：Introduction of a comprehensive home healthcare and welfare system and thedevelopment of a corresponding information system in the communityJune, 2014	 Department of Geriatric Medicine, The University of Tokyo, Professor,
Masahiro AkishitaSummaryJapan is experiencing rapid aging of its population at a pace unseen anywhere else inthe world. Urban areas in particular are experiencing unprecedented growth in thenumber of late elderly (75 years and older). Therefore, conventional medical carepolicies need to be reexamined, and comprehensive policies that include urban andother types of policies need to be developed.
Over the next 20 years, the population of late elderly in Japan is expected to increaserapidly, predominantly in urban areas, as is the proportion of people who die inhospitals, which is currently substantial. Conventional hospital-centered geriatricsmedical care will be unable to cope with the rising number of elderly requiring medicalcare.
Therefore, the widespread establishment of home healthcare is an indispensablenational issue in the future of Japan’s super-aging society. An information systemmodel that links relevant agencies and professional occupations will be key inestablishing and promoting home healthcare; however, hardly any empirical evidencehas been presented regarding the establishment and validation of such a system in thecommunity. We believe that if home healthcare can be popularized through thewidespread dissemination of practical research findings throughout Japan, it will greatlycontribute to relieving the anxieties of the Japanese people and society in relation to theimpending arrival of a super-aging society.
The purpose of this study was to develop a practical and versatile information systemthat will allow relevant home healthcare providers to share information during theprocess of introducing a home healthcare service model. An urban city in a metropolitanarea (Kashiwa city in Chiba Prefecture) and a district in a rural area (Sakai district[Sakai city and Awara city] in Fukui Prefecture) were chosen as fields for validation.
An initiative was carried out in Kashiwa city, Chiba Prefecture, which is expected toundergo rapid aging in the future, that aimed to develop a homecare system, whichincluded home healthcare, that would allow residents to enjoy good health as long aspossible and continue living in the comfort of their communities, even if their healthwere to deteriorate. In order to confirm the universality of our study findings, weconducted a study in conjunction with and using the methodology as that in Kashiwacity in the Sakai district of Fukui Prefecture as our rural area model.
The study results can be organized as follows: 1) Creating a model on how tocoordinate the establishment of a collaboration system for community-based integratedcare that includes home healthcare; and 2) Developing an information system thatsupports multidisciplinary collaboration and includes home healthcare. A briefsummary of the main findings is described as follows.
1) Creating a model on how to coordinate the establishment a collaboration system forcommunity- based integrated care that includes home healthcare.
To establish a framework of “multidisciplinary collaboration” for the effective care ofhome healthcare patients, we created case studies through i) the introduction of the“attending and associate attending physician” system to enhance the grouping ofindependent private physicians, and ii) collaboration between multidisciplinary homehealthcare professionals, including physicians. In conjunction with the establishment ofthe above framework, an information sharing system was developed to facilitate theexchange of information between various multidisciplinary healthcare professionals,including physicians. Then, to proceed further with the study through an investigationof actual cases, a trial run with case studies was carried out for a limited period.
Through this trial run, we repeated the cycle of trial and evaluation to establish rules formultidisciplinary collaboration. First, the process was self-evaluated usingmultidisciplinary trial case study. The home healthcare team was composed of attendingphysicians, associate attending physicians, and long-term care support specialists ascore members, as well as home visiting nurses, hospital social workers, and, if needed,pharmacists, dentists, and dental hygienists. The process of extracting rules for theseamless exchange of information between multidisciplinary home healthcareprofessionals, including physicians, was then repeated.
The rules were categorized according to the following five phases: 1) Between thefirst consultation regarding transition into home care and the medical conference; 2)Between the medical conference and hospital discharge; 3) During monitoring andevaluation (periodically); 4) During assessment after a patient’s condition changes (ondemand); and 5) Terminal phase (death, hospitalization, admitted into a facility). Overhalf of the rules were categorized between the first consultation regarding transition intohome care and hospital discharge. Therefore, for examination, the rules were furthercategorized as those before and after the time of hospital discharge.
By conducting self-evaluations based on specific case studies such as these, issuespertaining to multidisciplinary collaboration were discussed, and a rough draft of ruleswas created. Representatives from each professional organization were consulted toreexamine the rules and take part in a comprehensive discussion before reaching a finaldecision.
2) Developing an information system that supports multidisciplinary collaboration andincludes home healthcare.A service provision was used to configure the information sharing system throughcloud computing, and multiple data centers for cloud computing were used for theserver environment. Through the use of other data centers, uninterrupted servicesbecame possible in case of emergencies such as natural disasters. Initially, a tabletcomputer (iPad2) was used as the client terminal; however, a variety of other terminals,such as Windows for PC, Android tablets, Android smartphones, and iPhones, weresubsequently introduced to create a friendlier user environment.
In terms of physical security measures, user (patient) data was stored within a securedata center. A system was created whereby no data would remain in the client’sterminal as processing took place from the server side, and clients were limited tobrowsing and updating features only. Regarding the logical security measures, access topatient data was limited, with information sharing restricted to those personnel actuallyinvolved in the care of the patient.
Only two functions were developed: i) The “face sheet” containing the patient’s basicinformation, which was prepared based on the collaboration system used in ChibaPrefecture; and ii) the “care report” (electronic care notes) for information on dailychanges. At this point, the “care report” only had open text entry functions. Theinformation to be shared was separated into two broad categories: i) information thatseldom changes and ii) information that frequently changes.
In the past, a large number of documents needed to be completed formultidisciplinary data sharing; however, as stated above, this information system allowsthe entry of minimal data. In addition, by utilizing the accumulated data from casestudies, rules needed for smooth multidisciplinary collaboration, such as those related tosetting, considerations, and sender, were established, and an information sharing systembased on these rules was established. As a result, various healthcare professionals,including physicians, nurses, and care providers participating in the system, were able toshare home healthcare information in real time. This system gives multidisciplinary andmulti-corporate providers the opportunity to provide seamless services beyond theboundaries of health and long-term care insurance. Furthermore, the “attending andassociate attending physician system” was able to be utilized in medicalintraprofessional collaboration between physicians.