Local Medical Associations in Japan The Development of Networks through Various Activities by the Ehime Medical Association JMAJ 52(3): 198–200, 2009 Goro HISANO*1 Ehime Pop. 1.5mil. Stretching lengthwise east and west, Ehime pre- Area 5,700km2 fecture is divided into three regions: the central commercial district centered on the prefectural capital Matsuyama, the east with a large manu- facturing sector producing paper, ships, towels and other goods, and the southern region of primary industry. The population of 1,450,000 is Tokyo in slight decline outside the center, where it is holding steady. Its Seto location has made Ehime prefecture a trading hub since early in Japan’s history. Perhaps due to the long-standing fame of the Dogo hot springs, Ehime prefecture was also a stopover to the Korean peninsula. As Nukata no Okimi wrote in the Manyoshu, the ancient A membership status and 77% of those eligible anthology of Japanese poetry, “At Nigitatsu we for B membership status are members of our waited for the moon before boarding our boat; Association. Although the municipal mergers now the tide is in at last—come, let’s get to row- of recent decades have brought a variety of ing.” During the Tokugawa period (1603–1867) problems, the forward-looking efforts of those Ehime prefecture was governed by successive involved at one point led to wide-area medical generations of the Hisamatsu clan, one of the associations spanning multiple municipalities, Tokugawa collaterals. In the subsequent modern but elsewhere resulted in medical association period, Ehime prefecture has produced such boundaries matching administrative jurisdictions literary luminaries as Masaoka Shiki, Takahama and it is hoped that it will lead to smooth coordi- Kyoshi and Kawahigashi Hekigoto, and is associ- nation with administrative bodies in the future. ated with Natsume Soseki, renowned author of Ehime prefecture had previously fallen behind the novel “Botchan.” Nobel laureate Kenzaburo in medical information, but has made dramatic Oe is a native of Ose in nearby Uchiko. The progress since hosting the national conference on Akiyama brothers, protagonists of Ryotaro Shiba’s medical information systems communications in “Saka no Ue no Kumo,” are leading figures in 1995. In a first effort among prefectural medical Japan’s victory over Russia in their 1904–05 war associations, EMAin December 1995 installed an as officers in the Imperial army and navy, and Internet server in a closed environment within the have recently been in the spotlight again. office building to operate a medical association As of 1 August 2007, the Ehime Medical intranet called Ehime Medical Association Medi- Association (EMA) has a total membership of cal Information Network, or the EMA Network. 2,899, including 1,109 A members and 1,790 B Functioning as a mechanism for the exchange of members. Over 99% of physicians eligible for information among medical association members, *1 President, Ehime Medical Association, Ehime, Japan ([email protected]). This article is a revised English version of a paper originally published in the Journal of the Japan Medical Association (Vol.136, No.11, 2008, pages 2228–2229). 198 JMAJ, May/June 2009 — Vol. 52, No. 3 THE DEVELOPMENT OF NETWORKS THROUGH VARIOUS ACTIVITIES BY THE EHIME MEDICAL ASSOCIATION the EMA Network also has the purpose of serv- training session and plan to offer workshops con- ing in practical medical activities as hospital- sisting primarily of practical training through clinic collaboration. conflict management seminars. With over 1,000 users currently registered, the In 2006, EMA began offering public lectures use of VPN connections to provide a secure envi- for prefecture residents. The first featured a talk ronment over the Internet now permits access on the medical system by Dr. Hiroshi Murakami, from the in-house networks of core hospitals, and a director in charge of general affairs for the we consider the number of potential physician Matsuyama City Medical Association, and users within Ehime prefecture to exceed 2,000. Rakucho Tatekawa, who is both a physician and The EMA Network is comprised of a closed a rakugo comic storyteller, entertained the large intranet zone accessed via VPN and an open zone audience and drew them to think about health- accessible over the Internet. The policy we are care with a mix of healthcare issues and comic looking at moving forward will take into con- tales. The second session, in 2007, featured a talk sideration the convenience of the membership. on healthcare issues by Dr. Hiroshi Honda of the For the public zone, the information provided by Saitama Prefecture Saiseikai Kurihashi Hospital, the medical association is to be specialized, and who more passionately than anyone laments the for the intranet zone, we are to specialized the state of the healthcare theater, and a talk by Dr. operating of a medical information system han- Jinro Itami, who engaged passionately with the dling patient records that require security mea- subject of motivational treatments. Relating how sures in view of recent circumstances that attach he climbed Mont Blanc in the European Alps great importance to coordination in community together with a group of cancer patients and also healthcare. EMA employs WebLi (a system for a climb of Mt. Fuji with American and Japanese exchanging medical records and graphics) as its cancer patients, he made a powerful case for the system for handling patient records. positive effect a sense of achievement has on life Municipal medical associations enthusiastic expectancy, illustrating the point with immuno- about network architecture are currently actively competence test results. The third speaker was working to expand it, and at the district level it Dr. Hiroshi Inoue, chairman of the Japan Society continues to spread gradually. For the future we for Laughter and Humor Studies, who discussed are considering further improvements with the learning on laughter and untold stories behind goal of expanding the network to all districts in jokes. He engaged the audience with pieces of the prefecture. humor, successfully cajoling them towards an As drastic systemic reform continues apace appreciation of the essence of healthcare and the throughout the field of healthcare, and if means contradictions it currently faces. are available for members to use the network An issue that arose in Ehime prefecture that in routine consultations and medical practice has drawn national attention is that of renal management, we will take a positive attitude to transplants. The Uwajima Municipal Hospital has deploying such systems. long actively performed renal transplants and The medical disputes settlement committee was the national leader in their number. An has been taking an interest recently in the Medi- investigation initiated due to monetary involve- cal Alternative Dispute Resolution (ADR), a ment in organ donation spread more widely to scheme for seeking out-of-court settlements for include questions of the transplant of diseased medical accidents and disputes. The dialog-form kidneys. What may have complicated the issue is of ADR between practitioners and complainants that while the law has always covered cadaveric is positioned as essential in the design of the renal transplants, it made no provision for living scheme in order to improve healthcare theater. renal transplants. It is a requirement of medical Medical mediators are knowledgeable experts service fees that transplants be of healthy kidneys, who resolve disputes between practitioners and but they are silent on what qualifies as a healthy their patients through dialog. In Ehime prefec- kidney. With this and many other issues tangled ture we are nurturing their role in coordination together, the investigation remains underway. with the center and consider it necessary to estab- The position of the local medical association is to lish a locus for individuals to interact more fully. uphold the cause and look forward to a judgment We have completed the first conflict management that does not set back community healthcare. JMAJ, May/June 2009 — Vol. 52, No. 3 199 Hisano G EMA publishes the academic journal Ehime afternoons as non-consultation hours. Therefore, Igaku (“Ehime Medicine”) as a forum for Ehime the executive board, regular board, and the various universities and physicians in the prefecture to committee (including the external ones) meetings report their research findings. The publication tend to cluster on Thursday afternoons so that became an online journal two years ago and is now directorial duties interfere as little as possible available in print only by special request. This has with consulting duties. We hope this will lead to brought the benefits of extensive cost savings, greater participation by eager young directors. practicality in its availability to the membership The final item on the agenda of every meeting by download at all times and has resolved con- of the regular board addresses the affairs of cerns of whether it did indeed have a future. municipal medical associations, cycling among Lastly, I would like to touch on medical asso- them two at a time to take up the issues they raise ciation management. It goes without saying that and sharing their problems. the board of directors is the ultimate decision- We hope to continue to work actively to play making body, but in a prefecture that stretches our role as the lubricant between municipal so far lengthwise as Ehime prefecture does it is medical associations and the Japan Medical difficult to set times for the board to meet. Many Association, between the membership and local directors are required to work forty-hour weeks government, and between prefecture residents and have Thursday (or in some cases Wednesday) and association members. 200 JMAJ, May/June 2009 — Vol. 52, No. 3.