Case Study Highlights

POINT 1: Post-Implementation Review
1. YUYAMA’s ease of use becomes increasingly apparent over time
2. A system that can flexibly accommodate a wide range of chief complaints
POINT 2: Post-Implementation Use and Benefits
1. Post-implementation use and benefits
2. Greater efficiency through access to relevant diagnoses from package inserts
3. Extensive use of previous medical records and the memo field in clinical practice
POINT 3: Why YUYAMA Stands Out
1. Comprehensive hands-on, in-person training during the clinic’s launch
2. Dedicated ongoing support that goes beyond the EMR system
3. Prompt remote support whenever issues arise

First, could you tell us a little about Yamaoka Dermatology Clinic?

Our clinic opened in September 2020. We primarily specialize in dermatology, while also offering allergy care, pediatric dermatology, cosmetic dermatology, and dermatologic surgery. We have a total of 11 full-time staff members: six administrative staff members, four nurses, and myself as the clinic’s sole physician. We have a relatively large staff for a clinic of this size, partly because our administrative staff and nurses conduct thorough pre-consultation patient interviews, but also because we want to reduce patient waiting times.

Could you also tell us about your professional background and why you chose dermatology?

I graduated from medical school in 2003. I was in the final graduating class before Japan’s mandatory postgraduate clinical rotation system was introduced, so I entered dermatology directly after graduation. I subsequently gained clinical experience at major hospitals and university hospitals. I chose dermatology because I was particularly drawn to the opportunity to treat patients across a wide range of age groups and to the fact that the specialty combines medical approaches with surgical procedures.

Could you tell us about the patients who visit Yamaoka Dermatology Clinic?

We see an extremely broad range of patients, from babies only a few weeks old to people over the age of 100. In summer, we see many young children with insect bites, molluscum contagiosum, and impetigo. In winter, we see an increase in older patients experiencing itching caused by dry skin. The conditions we treat therefore vary considerably with the seasons. In allergy care, atopic dermatitis is the main condition we treat.We see an average of 150 to 170 patients a day, and during the busy summer season, that number can exceed 200.

What do you keep in mind when seeing such a large number of patients each day?

I want to see every patient who comes to the clinic. We do not place a limit on the number of patients we see. If someone says, “I am willing to wait, so please see me,” I want to make sure that we do. I believe that this is how we can contribute to community healthcare. Dermatology also tends to generate lower average revenue per patient than other specialties, so we need to see a certain number of patients. Of course, we also have a policy of avoiding unnecessary tests and treatments to minimize the burden on our patients.

To realize your goal of seeing every patient and sustainably improve the clinic’s operations, the challenge is to provide care both quickly and attentively.

That is right. In dermatology, patients often present with several symptoms during a single visit, so pre-consultation patient interviews can sometimes take time. We have four consultation rooms, and our administrative staff and nurses generally conduct the pre-consultation patient interviews. I then move from one consultation room to the next as each interview is completed, which makes the examination process more efficient.We developed this approach to balance two objectives: allowing our staff to finish work on time and seeing patients without compromising the quality of care. It is still a work in progress, however.Hiring additional physicians is another option, but in dermatology, clinical assessments can vary from one physician to another, as can prescribing practices. From the patient’s perspective, being seen by the same physician every time provides the greatest reassurance. That is why we remain committed to operating with a single physician.

What other benefits have you noticed in your medical practice?

Data such as package inserts for pharmaceuticals is very easy to read. When explaining information that patients need to know, such as effects and side effects, we explain together on the monitor. This puts patients at ease, rather than having to read a book. We also make use of touchscreen monitors, so sometimes we explain by writing directly on the screen.
Another great feature is the “quote function,” which allows you to enter all the necessary test items and then provide a rough estimate of costs, including management fees. When performing multiple tests, it’s now easier to communicate to patients how much a day’s costs will be.
We’ve also had the system linked to another company’s filing system, which we introduced after being recommended by many parties, and so far it’s worked without any issues, which has been very helpful.

You introduced the BrainBox Cloud electronic medical record system when the clinic opened. Could you tell us what led to its introduction and how you have found using it?

At the hospitals and clinics where I previously worked, I used systems from other companies. When I opened this clinic, however, I decided to introduce YUYAMA’s EMR system at the suggestion of our clinic administrator at the time.Initially, there was a period when I felt that the previous system might be easier to use simply because I was more familiar with it. As I continued using YUYAMA’s system, however, I came to appreciate its strengths. Now that I am familiar with its operation, I find it extremely easy to use. Our nurses and administrative staff can also conduct thorough pre-consultation patient interviews and properly enter all the necessary information.

Which specific features do you find particularly easy to use?

The order set feature is probably the most useful. In dermatology, the prescriptions we commonly use tend to follow certain patterns depending on factors such as the patient’s age and the severity of the condition. For example, we can create an order set in advance for a condition such as acne and bring up the entire prescription on screen with a single click.This saves us from having to enter each prescription from scratch every time. Since we use multiple terminals throughout the clinic, it is also helpful that once we create an order set, we can easily copy it to the other terminals.

Are there any features you use to help improve the safety and quality of patient care?

We can access drug package inserts and other documents directly within the EMR. By clicking on a term in a document, we can quickly access information on the relevant diagnosis. This feature is extremely useful because it saves us the time and effort of checking whether a medication is indicated for a particular condition.Blood test and pathology test results are also automatically imported into the EMR through integration with our laboratory provider. We really have not experienced any inconvenience.

Many dermatology patients receive care over an extended period. Do you make use of the feature for referring back to previous medical records?

Yes, quite often. However, we do not have time to go back and review every previous medical record in detail. When referring to previous medical records, I therefore summarize critical information that must not be overlooked, such as pregnancy, drug allergies, and problems caused by medications used in the past, in the memo field at the top right of the screen.The memo field appears automatically whenever we open the patient’s medical record, making it less likely that we will overlook important information.

What kind of information do you enter in the memo field?

Administrative staff and nurses enter information in the memo field. They always include the patient’s medical history and other important information. When new information comes up during a consultation, I sometimes ask them to enter it in red.Staff members share this information with one another to ensure that details highlighted in red in previous medical records are carried forward to the current medical record at every visit. We pay close attention to this process because failing to carry over important information could lead to problems.

That is another way of ensuring that consultations are conducted safely and efficiently. How many EMR terminals do you currently have?

We have six terminals in total: two at reception and one in each of the four consultation rooms. In each consultation room, my terminal is linked to a desktop computer positioned next to me, allowing an administrative staff member to enter information into the EMR while I examine the patient.While I speak with the patient one-on-one and conduct the medical consultation, the administrative staff member follows our conversation and enters the relevant information. After each consultation, I provide feedback to ensure that no necessary information is missing and that the instructions regarding treatment duration, application site, and method of application are correct.Ultimately, I am the physician and the final responsibility rests with me. I therefore review the contents of the medical record carefully before moving on to the next consultation.

How was the training when the system was introduced?

When introducing a new system, it inevitably takes time before everything runs smoothly. During the first week after the system was introduced, however, a YUYAMA representative came to the clinic and provided hands-on, in-person training alongside us at reception and in the consultation rooms.Whenever an issue arose, the representative showed us how to address it while resolving the actual problem with us. That was extremely helpful.

How would you describe YUYAMA’s overall support?

In the early days, we experienced a few issues with the computers, but we have had no such problems at all over the past year or two. We have rarely needed anyone to visit the clinic in person.When a computer freezes, for example, the support team accesses the system through remote maintenance and quickly identifies the source of the problem. Our administrative staff call whenever they encounter an issue, and YUYAMA provides excellent support. We greatly appreciate being able to receive comprehensive assistance that goes beyond the EMR system itself.

Finally, could you tell us about your plans for the future and share a message for physicians considering an EMR system?

Going forward, I intend to continue seeing every patient who comes to the clinic without placing a limit on patient numbers. In dermatology, patients often present with multiple symptoms, but I believe YUYAMA’s EMR system can effectively accommodate a wide range of chief complaints.I would recommend it to physicians who want to provide attentive care to a large number of patients and effectively address multiple chief complaints.

Thank you very much for your time today.