Adopting EMRs and CPOE in Japan under a national strategy

The trends in EMR and CPOE adoption in Japan under the national strategy by Yuichi Yoshida, Takeshi Imai and Kazuhiko Ohe

Reading this article made me realize that even for Japan – a highly technological society would have the same issues as the Philippines in adoption of EMR and CPOE.  The efforts of the government covers all the all health facilities, however the efforts prioritized medium to large hospitals over small hospitals and clinics and this greatly affected the adoption rate among these healthcare facilities.

Just like here in the Philippines, their Ministry of Health, Labour and Welfare (MHLW) fix medical fee and controls medical institutions via administrative direction on a universal health insurance system.  Computerization of medical billing and CPOE was instroduced in the 1980’s.  However, EMRs was not legally accepted for a long time. Hospitals needed to prepare paper based medical records in accordance to the law even even with the use of EMR. In 1999, MHLW legally permitted the use of EMR.  And in 2001, MHLW published a national policy on the grand design for development of information systems in health care and medical fields. With this, the government set the policy target of increasing the adoption of EMR.   The Diagnostic Procedure Combination (DPC)  fwas introduced in 2003. It is a case-mix payment system.  Along with that submission of computerized medical record data  was required by government to get approved as a DPC hospital. Another factor that affected the adoption is the “The New IT Reform Strategy”, however the targets are medium to large hospitals, but for small medical institutions, the use of low-cost EMR was the goal.

The methodology used was a survey with 30 questions. It has base attributes such as hospital size, location, equipment, clinical specialities and implementation of surgery and tests.  Using this survey, relevant points were studied:  type of establishing organization, number of beds permitted, status of EMR adoption and status of CPOE adoption.

It was found that the rate of adoption is particularly high in medium and large hospital. This can be attributed to Japan’s policy in supporting health IT adoption targeted hospitals with 200 or more beds.  These health facilities were granted a subsidy, financial support. Which results to a relatively high adoption rate.

However, EMR adoption in small hospital remained relative low compared to the overall rate of adoption in hospitals.

Comparing adoption rate of CPOE to EMR, CPOE has higher adoption rate.  However, the government does not approve a subsidy for CPOE adoption only. This has made a condition a combined adoption with EMR and CPOE for financial report.  This was an effective means of raising the rate of EMR adoption.

Another factor why EMR adoption is behind CPOE adoption is that EMR was not legally accepted as official medical record earlier.  Moreover, DPC system implementation affected the adoption of HIS at hospitals.  Low adoption rate in clinics and small hospitals was affected by the government policy of the government focused in hospitals with atleast 200 beds.

Clinics  cited reasons for the low adoption rate. Reasons include, the “workload of doctors would increase”, “cost is high” and “we are used to paper system”.

Another survey was conducted and submitted to the Central Social Insurance Medical Council, the results say that the maintenance cost for health information system adoption per clinic is $20,000 even for facilities with no beds. On estimate clinics and small hospitals receive $440 as subsidy, which is roughly 4% of the maintenance cost of a electronic hospital information system.

However, the national government  of Japan abandoned the idea of complete online medical billing due to the lawsuit against the government by the Japan Medical Association and Japan Dental Association and Japan Pharmaceutical Association to nullify online billing.

 In conclusion, giving financial incentives gave effective means of raising EMR adoption rate. With this study, it was found that IT when used in the health care setting has the potential to improve medical quality and reduce medical costs for society as a whole.

Similary, only efforts lead by the national government can directly affect adoption smarter solutions such as Health Information Technology.  In the Philippines, setting a national standard and strategy in implementing HIT should pick up from knowing the roles of different stakeholders should be prioritized. f The government’s role  should be focused on policy making.  Additionally, incentives are good motivators in adopting fully health information systems.

Reference: The trends in EMR and CPOE adoption in Japan under the national strategy by Yuichi Yoshidaa, Takeshi Imai and Kazuhiko Ohec