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Mar. 10, 2015 - Updated 04:16 UTC

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Doctors on Call

Masami Ukon

Jul. 6, 2015

A new networking system is improving medical treatment in Japan by helping doctors share their knowledge and expertise. The mobile-based app called JOIN has been developed to address some of the challenges facing the medical field as demand increases for its services.

OECD data shows Japan has one of the lowest doctor-to-patient ratios of any advanced nation, and the number of doctors relative to the population is especially low in rural areas. Allocating limited healthcare resources is a key concern as Japan’s population ages, and hospitals are networking in an effort to provide better service.

Nothing is more important than speed and making the right decisions in a medical emergency. Saving lives and minimizing after-effects mean that every second counts. Communication is vital, and that is where JOIN steps in.

Tokyo’s Jikei University School of Medicine uses the app to enable doctors to share their knowledge. Custom software allows nearly 200 specialists at the hospital to stay in touch at all times. Team members can chat individually and in groups, and most importantly, they can share images and video. The network is on track to building 2,000 user accounts.

In one example, a physician in an affiliated hospital 20 kilometers away can report about a patient who is having difficulty moving one of her eyes. A specialist needs only a few minutes to diagnose it as an aneurysm and gives advice about how to give immediate care.

Until now, Japanese doctors have usually handled emergencies on their own. They use ordinary mobile phones and it can take time to put together a team of specialists.

The JOIN system can alert an entire team with a single message. Team members who are available reply, and patient treatment starts immediately. Surgical procedures and medical images can be streamed to users’ phones and specialists can organize additional care or give instructions remotely.

“One of the best things about this app is how it helps us avoid delays in treating patients,” says Dr Shougo Kaku of Jikei University School of Medicine’s Department of Neurosurgery.

JOIN has become indispensable for young doctors who use the app to consult senior colleagues: "Being able to send more detailed information makes it easier to consult with senior doctors. They respond to me very quickly, even after midnight,” says app user Dr Shota Sonoda.

The idea for the software came from Professor Yuichi Murayama, chairman of Jikei’s Department of Neurosurgery. Murayama is one of the world’s top neurosurgeons with extensive experience at university hospitals in Japan and the US. He is constantly on the phone dealing with difficult cases.

“When I was abroad, I really wanted to go straight back to Japan and help, but it was physically impossible. It was really stressful not to be able to see anything in real time,” says Murayama. “Of course doctors are human, too, and have families. They cannot be available 24 hours a day, 365 days a year, so I saw the need for an app like this.”

He developed the communication system with colleagues and private companies. It takes advantage of cloud servers and smart phones, and personal information supplied by patients is made anonymous and encrypted to protect personal privacy.

Authorized users have access to clear and high-quality medical images and the app enables hospitals to share data. Forty-five institutions across Japan now use JOIN and facilities in four other countries, including the US, have also adopted it.

Work continues to develop the app and specialists from six major Tokyo universities and hospitals met last week to discuss its use. Some suggested additional functions, such as allowing users to tag medical records or collaborate with emergency rescue teams. Others said JOIN could help make use of facilities that would otherwise be idle.

“We have our medical unit standing by, but on some days, we don’t have patients. It would be great if we could use this app to make better use of our facility,” says Dr Yuji Matsumaru, of Toranomon Hospital in central Tokyo.

The specialists also discussed privacy worries. “I’m concerned about the ethics in handling patient information,” says the Japanese Red Cross Medical Center’s Dr Ichiro Suzuki. “When we start hospital-to-hospital collaboration, we have to make sure who has access to the information.”

According to JOIN’s creator Murayama, the system has an important role to play in patient care. “Communication is important, not only in the neurosurgical field,” he says. “I think there are many cases where better communication could benefit patients. Japan’s medical insurance system is based on the concept of helping each other. In order to keep the system functioning, proper use of IT can solve many challenges we now face."

Murayama is leading the effort to help doctors make better use of IT tools to improve medical care and save lives.


Medical IT expert Dr Hiroshi Tanaka joined Aki Shibuya and Sho Beppu in the studio to discuss the benefits and use of networking systems like JOIN. Tanaka is the director of Japan’s Regional Healthcare and Welfare IT Consortium and he is also a professor at both Tohoku University and Tokyo Medical and Dental University.

Beppu: Do you know of any particular cases where the lives of patients could have been saved if there had been better communication?

Tanaka: Although there are no clear statistics on this, it is very likely that malpractice and treatment failures often occur because of poor communication or inability to find crucial information. With the advance of medical knowledge and therapeutic measures, clinical practice is now highly specialized. That means expert knowledge and experience is required to provide effective treatment. The kinds of risks I’m talking about often involve duty doctors in emergency wards. Because of the shortage of physicians, hospitals can’t allocate doctors to cover all fields.

Shibuya: What do you think is the significance of the JOIN project?

Tanaka: There are now many projects in which patient information is shared using smart phones or tablet PCs. This JOIN project is especially interesting, because brain surgeons proposed it based on actual needs in clinical practice. Surgeons from different hospitals are communicating and exchanging their opinions to make diagnoses based on a patient’s MRI. In Japan, the government established a policy to promote regional information-sharing of patient healthcare data. But one study found that only two percent of all such digitized data is actually shared. Laboratory tests or medical imaging like MRI are duplicated by different medical facilities. That’s a waste of time and resources. The accumulated patient data will result in healthcare “big data”. That could provide the basis for future R&D; breakthroughs.

Shibuya: But sharing information about patients raises privacy issues. What’s your take on that?

Tanaka: At present, sharing this kind of information is confined to emergency care. Personal information such as names and birthdays are left out. In addition, in most cases emergency patients are unable to give their consent for use of this data by doctors from other hospitals. But patient consent is necessary in non-emergency cases, especially when it comes to things such as sharing electronic medical records. The more widely patient information is shared, the more medical professionals can improve treatment.

Beppu: Japan’s healthcare system faces many challenges. How can IT meet those challenges?

Tanaka: The Japanese healthcare system was established during the period of high economic growth. It’s about to collapse, especially in rural areas. A new system should be based on sharing information about patients, and people managing their own health situation. That’s possible by using IT infrastructure such as using cloud-based mobile communications, fast and large-capacity wired communications and mass storage of medical big data. In the current situation, plans to use new IT technology cannot be realized or maintained due to financial concerns. To promote projects such as JOIN, the national health insurance system should include a digitization fee.