As Japan’s society grows even older, extending the healthy lives of the Japanese people and optimizing medical and nursing care benefit expenses have become critical policy issues for the Japanese government. To address these issues, local governments are being called upon not only to provide members of the community with services that support them in their lives, but also to effectively use the massive amounts of medical, nursing care, and other data the local governments have accrued to formulate new measures and evaluate those measures. However, many local governments face the problems of not being able to utilize data across the board or being too busy with their day-to-day duties to focus their efforts on proposing new measures. In this issue, we introduce ALWAYS ICC, the integrated community care solution from Toshiba Digital Solutions that uses data to support effective measure deliberation and improve operational efficiency.

The Ministry of Health, Labour and Welfare is aiming for individual municipalities and prefectures to create integrated community care systems tailored to the characteristics of their respective communities by 2025, when every member of the Japanese baby boom generation will be 75 or older. Integrated community care consists of providing integrated support and services, such as housing, medical care, nursing care, prevention, and lifestyle support and services, so that people, even if they require intensive nursing care, can continue to live their lives as much as possible the way they are accustomed to in the communities of which they are members. *1

The Japanese government also promotes evidence-based policy making (EBPM). EBPM refers to clarifying policy objectives and basing policy planning on evidence, rather than relying on mere experience or examples seen and heard on the spot. It also states that the outcomes of those policies should be measured by utilizing data such as information and statistics that have important relevance. *2

*1 Reference: Ministry of Health, Labour and Welfare - Integrated Community Care Systems
*2 Reference: Cabinet Office - EBPM Measures by the Cabinet Office

In other words, local governments are being called on to build integrated community care systems, to prevent the community members from falling ill or becoming severe conditions, and to promote cross-sectional nursing and medical care -- and to do so through EBPM.

However, for many local governments, the data that is collected, such as nursing care data, medical care data, and medical checkup data, is stored on independent and isolated information systems, so the governments are in no position to apply a cross-sectional approach to data usage. Some information that is on paper has yet to even be digitized.

In addition, at a good number of local governments, day-to-day operations are largely performed by hand. These include responding to inquiries, collecting and processing data, performing analysis, and preparing materials for conferences and meetings. The personnel that handle this work often have to devote all of their effort to it, making it difficult for them to dedicate attention to deliberating more effective potential measures. Quite a few local governments face both system and personnel challenges.

In the future, what will be important for local governments will be to prepare data utilization platforms that bring together the data they have accrued, tabulate and analyze it, and effectively leverage it. Realizing this kind of platform will make it possible for local governments to use data to determine current conditions (Check). They can then identify issues based on the results (Act), deliberate regarding future measures (Plan), and then implement and evaluate those measures (Do). Through this operation cycle, local governments will be able to efficiently conduct the regional management operations involved in integrated community care so that they can prevent people from contracting illnesses or becoming more severe, and promote cross-sectional nursing and medical care.

For local governments, this process will also be one of creating integrated community care systems through EBPM, and it will contribute to extending the healthy lives of the Japanese people and optimizing medical and nursing care benefit expenses, which local governments are being called on to do by the national government (Fig. 1).

Toshiba Digital Solutions is implementing measures aimed at supporting the management operations of local governments as they implement integrated community care.

The first is data management. Medical and nursing care data, which local governments have stored in separate systems, making it hard to utilize, is matched to individual elderly residents and stored in the cloud as senior citizen integrated ledgers, which are centrally managed. Next, to use this data, Toshiba has created a data utilization platform for aggregating data from individual ledgers, extracting and analyzing necessary data, visualizing data, and creating data-driven materials.

This makes it possible to analyze and visualize changes in the physical and mental states of individual elderly residents. Furthermore, cross-sectional data analysis enables local governments to develop proposals and evaluate the effectiveness of measures in each of the health stages of elderly residents, which change depending on their physical and mental states -- the stages of "disease prevention," "nursing care prevention," "nursing care," and "at-home medical care." This helps the local governments identify which measures are effective. The data can also be used to compare regions and identify changes over time. The data utilization platform improves the efficiency of day-to-day operations, which until now have had to be performed manually, allowing personnel to focus their efforts on improving integrated community care and implementing reforms.

The system that provides this support is offered through our ALWAYS ICC integrated community care solution (Fig. 2).

While talking about data utilization may be easy, actually doing it is not. Collecting, analyzing, and processing data requires a range of expertise.

We have long years of experience with building all kinds of systems for the medical and welfare fields, such as systems for the Ministry of Health, Labour and Welfare. Through this, we have accrued a great deal of expertise and knowledge regarding data cleansing and other operations. The ALWAYS ICC solution is continuing to evolve as we add the new knowledge that we are accruing through the deployment of the solution by local governments.

The ALWAYS ICC solution is made possible by leveraging data, such as by visualizing changes in the mental or physical states of elderly residents and their usage histories for individual services, identifying people who are at risk of contracting diseases or having their diseases become more severe, determining actual conditions on a region-specific or service provider-specific basis, and evaluating the effectiveness of measures.

Specifically, it makes it possible to identify elderly residents who match specified criteria and to observe how their mental and physical states, nursing care service usage, and participation in community exercise and recreation activities change over time. ALWAYS ICC visualizes information regarding specific services and activities that are expected to help improve people's mental and physical states. That makes it possible to better utilize the information in future plans and to make recommendations to other elderly residents with similar mental and physical states. The effectiveness of services and activities can therefore be verified not only for individual elderly residents but for numerous people, and those services and activities can be better leveraged.

Nursing care usage conditions and information about the mental and physical states of users can be tabulated and compared on a per-region or per-service provider basis, which makes it possible to identify regional trends and disparities. Measures that are frequently used and which often produce improvements in the mental and physical states of users can be rolled out to other service providers' facilities, helping improve outcomes for the entire community.

Furthermore, when investigating whether care plans*3 are appropriate, ALWAYS ICC can be used for the operations involved in selecting care managers as inspection candidates and to improve operational efficiency and quality by applying it to measures such as frailty prevention measures, which seek to delay the inevitable mental and physical weakness that comes with aging (Fig. 3).

*3 Care plan: Nursing care service plans created by care managers (nursing care support specialists) for people who require nursing care. Reference: Ministry of Health, Labour and Welfare "Nursing Care Service Plans (Care Plans)"

Conducting studies and deliberations using reliable evidence and data helps local governments implement the evidence-based policy making (EBPM).

EBPM -- using data to formulate and evaluate evidence-based project plans -- leads to greater trust being vested in local governments and improves their effectiveness. Extending it to numerous local government programs, based on integrated community care experience, has the potential to help solve various problems and to address them from a wider range of perspectives. Toshiba Digital Solutions will continue to refine ALWAYS ICC and contribute to integrated community care management tailored to actual local conditions.