Japan's First 'Station Platform Clinic': Aiming for a New Medical Platform
In this note, JR-EAST is promoting the background, process, and philosophy of the urban development called "TAKANAWA GATEWAY CITY" centered around Takanawa Gateway Station.
This time, we’d like to introduce the "Smart Health Station '' which opened on the platform of Nishi-Kokubunji Station in 2022. It has later on expanded to Asagaya Station, Tokyo Station, and Ueno Station, and is scheduled to open at Sendai Station this summer. Why does JR-EAST create clinics on station premises? And what is the new form of healthcare that JR-EAST aims to spread throughout Japan, using TAKANAWA GATEWAY CITY as a hub? Dr. Taro Kuwai, the director of Aoi Medical Clinic, which operates the Smart Health Stations at Nishi-Kokubunji Station and Asagaya Station, along with Nana Maruyama from JR-EAST, will provide insights.
Why Are There No Hospitals on the First Floor of Station Buildings?
─First of all, please give us an overview of the Smart Health Station.
Maruyama：Beyond the traditional role as transportation hubs, stations are evolving into platforms that serve as the starting point for people's lives, adding functions that support people's lives in a multifaceted way. Under the "Beyond Stations" concept advocated by JR-EAST, the attempt to implement medical functions is the "Smart Health Station."
In addition to conventional face-to-face consultations, the Smart Health Station is a hybrid clinic where comprehensive medical care from multiple specialties can be received online through online booths installed within the clinic.
─I believe there have been clinics attached to station building facilities in the past, but what are the differences in the concept?
Maruyama：The most significant difference lies in the idea of implementing medical functions as close as possible to the flow of everyday life. That's why at Nishi-Kokubunji Station and the upcoming summer opening of Sendai Station, clinics were established inside the ticket gates, and at Asagaya Station, the clinic was opened next to the ticket gates.
Maruyama：Until now, functions other than transportation at stations have tended to be commercially focused. Commercial facilities emphasize pedestrian flow, and medical institutions are typically located on higher floors because customers usually actively seek them out when symptoms arise. Therefore, it's natural for commercial spaces to occupy lower floors while clinics are often positioned on relatively higher floors. The Aoi Clinic at Nishi-Kokubunji Station was originally located where a convenience store was situated.
─However, it's not enough to just focus on commercial aspects to become a "platform for everyday life."
Maruyama：Indeed. When we thought about providing medical care in a way that truly meets the needs of our customers, leveraging the strengths of JR East, the answer was clinics located in station premises, easily accessible along the flow of daily life, where patients can receive prompt care without compromising quality.
The Extraordinary Demand for Medical Services at Station Premises
─ What kind of patients do you see after you actually start operating the clinic?
Kuwai：Certainly, there is an exceptionally high demand among working individuals aged from their 20s to their 60s. Among them, the demand for acute care and preventive services is particularly high. For example, the number of patients during the year-end period ranges from 3,000 to 3,500 per month, which is nearly three times the number of visits to internal medicine clinics in Tokyo. The number of influenza vaccine recipients from October to December is approximately 4,500 at the clinics operated by our medical corporation in Asagaya Station and Nishi-Kokubunji Station alone. Our main clinic in Yoyogi-Uehara, although a significantly large clinic in Shibuya Ward as a standalone medical institution, has only around 1,000 recipients for influenza vaccinations.
─That is an extraordinarily large number.
Kuwai：The key concept of the Smart Health Station is to provide medical care quickly to working individuals who may not have the opportunity to visit medical facilities during weekday daytime hours, even though they require appropriate medical attention. This market is generally not targeted by internal medicine clinics because they often cater to an older demographic. However, there is indeed a significant demand for such services. Essentially, the issue lies in the lack of time to visit clinics.
Maruyama：When getting the influenza vaccine at the Smart Health Station, the average time from entering the clinic to completing the payment process is approximately 15 minutes. Since there is approximately one train every 10 minutes on the Musashino Line at Nishi-Kokubunji Station, skipping just one transfer between the Chuo Line and the Musashino Line is enough. While we had considered a certain level of demand due to this convenience, we were surprised by the sheer number of people seeking medical care along their daily routes, especially considering the need to avoid interruptions in treatment and prescription medication.
A Hybrid Comprehensive Clinic Combining Real and Virtual Services.
─What is the uniqueness of Smart Health Station's online clinic?
Kuwai：One key feature is the ability to provide medical equipment that cannot be typically offered in standard online consultations conducted from patients' homes or other locations, within the online booths. For example, in dermatology consultations, patients can use a dermatoscope provided in the booth to capture images of their skin as needed. Physicians can then examine these images to obtain more detailed information about the condition. This enhances the accuracy of non-verbal information received by the physician through the use of such tools.
Kuwai：The significance of our online consultations lies in the presence of multiple physicians with different specialties in both the real and virtual space of a single clinic. Within the limited space of the station premises, we can accommodate various medical specialties such as internal medicine, dermatology, otolaryngology, and surgery. What we aim for is a "hybrid comprehensive clinic" that integrates online and offline medical care.
One significant advantage of digitizing and creating a comprehensive clinic is the ability to share patient records (medical charts). Typically, in online consultations where only a brief questionnaire is conducted, different physicians from different clinics usually create separate medical records each time, leading to potential ambiguity in management. This can result in difficulties coordinating medical records between different physicians for subsequent consultations. However, at Nishi-Kokubunji and Asagaya, external physicians participating in consultations remotely contribute to the electronic medical records installed within the clinic, enabling centralized management of patient records. This ensures smooth coordination of medical care within the clinic.
Another distinctive feature here is the ability to perform "tests" that are typically not possible in regular online consultations. For instance, if a dermatologist conducting a remote consultation determines that blood tests are necessary, they can request the resident internal medicine physician, based on the shared medical records, to perform the tests within the same clinic. This allows for blood collection and testing to be carried out in the same clinic, and the results can be shared for the next online consultation. Moreover, there is no need to move between departments like in a typical general hospital, thus eliminating the need for long waiting times each time. We consider these aspects to be excellent examples of the integration of online and offline services, transforming a small clinic into a comprehensive clinic.
Aiming for Centralized Management of Medical Records
─Are you also considering mechanisms for data integration that extend beyond individual clinics and medical institutions?
Maruyama：Through system integration at each Smart Health Station, we aim to build a "Chuo Line version PHR (Personal Health Record*)" that shares patients' health information in accordance with regulations. In the future, with the patient's consent as a prerequisite, any medical institution will be able to instantly access cloud-based medical information and utilize it for treatment. This will lead to increased accuracy of information, allowing for consistent medical care regardless of location. This is the vision we envision for healthcare.
*Personal Health Record (PHR): An electronically stored record that integrates information about an individual's health, medical, and caregiving, allowing for centralized storage and a mechanism for individuals and their families to accurately understand the information. It is sometimes referred to as a lifelong electronic medical record.
─There is a movement in Japan to introduce PHRs, but it has not progressed very far, has it? From your point of view, what do you think are the reasons for this?
Kuwai：One major reason is the fragmented nature of electronic medical record (EMR) platforms across different medical institutions. At the Smart Health Stations in Nishi-Kokubunji and Asagaya Station, we aim to establish a platform and system for centralized management of information. This will enable sharing of information among medical institutions, allowing patients' test results, medical procedures, and prescriptions to be seamlessly shared across stations. Our goal is to ensure smooth and high-quality medical treatment and prescriptions at any medical institution within the station premises.
We also collaborate with core hospitals such as JR Tokyo General Hospital to fulfill roles such as providing specialized and advanced medical care based on patients' symptoms, aiming for a division of roles between regional medical care and comprehensive hospitals. The coordination of medical data is crucial for such collaboration between regional medical care and comprehensive hospitals. Furthermore, as the physicians from JR Tokyo General Hospital who join the Smart Health Stations to provide specialized medical care are considered our staff, they naturally have access to medical records. Currently, there are various hurdles to overcome regarding the sharing of medical records due to the legal duty of confidentiality imposed on physicians. However, we are continuously experimenting and addressing these challenges.
Reforming Physician Work Styles and Eliminating Medical Disparities
─The mission of the Smart Health Station is to reform the way doctors work and to eliminate disparities in medical care between urban centers and other parts of Japan. How do you think you can contribute to solving these social issues?
Kuwai：The 2024 problem, which is being taken seriously in the logistics industry, is also a serious issue in the medical industry. In many cases, we doctors continue to work in a harsh working environment under the responsibility of treating people's health and lives, as well as for self-improvement. Looking back on my career, I sometimes worked more than 200 hours of overtime per month when I was in the emergency department.
─Wow....
Kuwai：However, as the reform of physicians' working conditions progresses, it becomes increasingly clear that the total working hours of physicians dedicated to medical care are insufficient. Additionally, there is a problem where female physicians tend to interrupt their careers on the front lines due to childbirth and child-rearing responsibilities. There are currently many cases where a certain number of female physicians retire semi-actively. In such cases, it is necessary to consider complementing the establishment of environments where physicians can thrive further, by utilizing digital technology. Online consultations do not require commuting, and physicians can work flexibly in short hours, making it possible for physicians who are raising children to participate in online consultations. The demand for utilizing medical resources through online consultations is expected to increase significantly from the medical side as well.
─What exactly is the issue of the disparity in medical care between various parts of Japan and urban centers?
Kuwai：The decisive issue regarding healthcare disparities between urban and rural areas lies in the unequal distribution of physicians and advanced medical technology. Rural areas have fewer physicians, and consequently, fewer physicians with specialized medical expertise. Why is this the case? While it's true that the number of medical cases increases in proportion to the population size, resulting in fewer cases of rare diseases in rural areas, the concentration of such cases in urban areas leads to physicians with advanced treatment skills seeking to concentrate their expertise and gain experience in urban areas.
Kuwai：To address this, we must focus on transferring knowledge and skills. While many treatments can be performed based on systematic and manualized knowledge, the final adjustments, based on experience, are often crucial. For instance, even if one knows that a certain medication works for a particular illness, determining whether to administer 1g or 1.1g depends on the patient's condition, which is guided by experience.
Moreover, rural areas often lack comprehensive coverage of all medical specialties. For example, the accuracy of diagnosing skin diseases can vary significantly between a dermatologist with 20 years of experience and a general practitioner. Such differences in accuracy, tips, and experiential knowledge cannot be obtained from textbooks alone. Therefore, in the past, physicians had to physically travel to these areas to convey such knowledge, but this proved to be quite challenging.
─Why is that?
Kuwai：Physicians can enhance the accuracy and experiential knowledge of their treatments by having access to a large number of cases, which are more readily available in urban areas with many large hospitals like university hospitals. This is why connecting through online platforms holds significant value. For example, if physicians in rural areas can digitally access treatments from experienced specialists handling rare diseases, knowledge and skills can spread from metropolitan areas to rural areas. As a result, the level of treatment for complex diseases in non-urban areas can improve, potentially leading to a significant reduction in healthcare disparities.
Changing the Very Nature of Healthcare
─I understand that you are considering introducing it into TAKANAWA GATEWAY CITY and expanding it to various parts of Japan, using it as a hub. Could you please tell me about the specific future prospects?
Maruyama：Not only hybrid clinics but also standalone booth-type online consultations* will be expanded in both urban and rural areas.
*Expansion is made possible by the revision of the "Guidelines for the Appropriate Implementation of Online Consultations.
─It seems that JR aims to expand nationwide with a concept similar to "STATION BOOTH", a private booth-type shared office space centered around train stations.
Maruyama：Yes, that's correct. It's not easy to find suitable spaces for opening clinics in station premises, even if they are small. It takes time and incurs costs. With standalone booths, however, we can expand our services even in limited spaces. We are considering deploying online consultations in places like unmanned stations in rural areas or locations where there is a shortage of physicians to provide sufficient medical care. Additionally, we also want to offer services in the preventive healthcare domain, such as health consultations and minor health management.
Maruyama：Therefore, it is necessary to implement and conduct experiments, verification, and improvements in new towns. TAKANAWA GATEWAY CITY is positioned as a business creation space that advocates for "an experimental site where we create ways to lead a fulfilled life a century into the future." This initiative also started at Nishi-Kokubunji Station with the idea of "A city that encourages you to try something new and watch it succeed" using our company's assets.
Furthermore, TAKANAWA GATEWAY CITY collaborates with the University of Tokyo to research specialized areas such as advanced medical care and sleep-related preventive healthcare. Through the network of Smart Health Stations, we aim to deliver this new approach to healthcare, including cutting-edge medical care, to various parts of the country. We aspire to realize such a future.
Kuwai：If the city is aiming for the next 100 years, then healthcare also needs to be created with a vision for the next century. There are two approaches to "new healthcare." One is to discover new treatment methods and medical technologies. We are collaborating with university hospitals and research institutions, including the University of Tokyo, which has campuses at TAKANAWA GATEWAY CITY, to pursue this avenue. The other approach is to create the future of healthcare itself. This involves various aspects such as service delivery methods, operations, work styles, systems, and ecosystems. I believe that influencing the very essence of healthcare is one of the significant roles of TAKANAWA GATEWAY CITY as an experimental site.
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