A system that a ward cannot operate at three in the morning, two nurses short, is not finished, however well it performed in the supplier's demonstration. I would rather spend money on the hours when the record is missing or unfamiliar than on another feature for the hours when everything works. The clinical teams decide how patients are cared for; my job is to make sure the tools still serve them when conditions are at their worst.
Selected works
Decisions in context.
I
Choosing isolated backups and paper drills over a supplier's live replica
In late 2022, after several Japanese hospitals had suspended services for weeks following ransomware attacks, our board asked how long we could operate without the electronic record.
Moving three hospitals onto one standard record and removing valued screens
By 2021 our three hospitals ran three electronic records: two versions from one supplier, with support for the older ending in 2024, and a smaller supplier's product at the rehabilitation hospital.
Keeping reception staffed while patients moved to the My Number card
Medical institutions in Japan were required to confirm insurance eligibility online from 2023, and new paper insurance cards stopped being issued at the end of 2024.
I judge a hospital group's information systems by whether its nurses, pharmacists and reception staff can keep working safely on the day those systems fail or change.
I am chief information officer and an executive officer of Tsuyuhakai Medical Corporation, a not-for-profit medical corporation in northern Kanto. We run three hospitals with 771 beds between them, a 100-place geriatric health services facility, five home-visit nursing stations and a dialysis clinic. In the year to March 2026 the group recorded ¥34.6 billion of operating revenue, an operating surplus of ¥380 million and 2,940 employees. I lead 41 colleagues in the medical information department through four section heads, on an annual budget of ¥1.31 billion including depreciation. The physician chairman and the board of directors decide; I attend their meetings as an executive officer, without a directorship.
I came to hospitals from the supplier side. From April 1994 I built and installed order-entry and electronic medical record systems for Hakuzen Medical Systems, then spent five and a half years running the dispensing and claims systems of Kotohane Pharmacy, a chain in Kanto. Watching ward staff work around screens I had configured taught me a lesson I still apply to every contract and budget: the night shift is the real acceptance test.
The three decisions on this site each gave something up. I declined a supplier's live replica in favour of isolated backups and paper drills, which lengthened our worst-case recovery. I moved three hospitals onto one standard record and removed screens that rehabilitation therapists valued. I kept reception posts the budget had already removed while patients moved to the My Number health insurance card. None of these made our hospitals safe by itself. Each made a specific weakness visible to the people who must manage it.
A rehearsed restore instead of a mirrored data centre
We spent ¥84 million on isolated backups and a separate restore environment rather than ¥238 million on a live replica. Our 2024 rehearsal rebuilt the acute hospital's full record in 58 hours, inside the 72-hour assumption our wards plan around.
One record across three hospitals
Local customisations fell from 286 to 41 when the hospitals moved to one standard package between November 2023 and November 2024. The seven-year cost is now forecast at ¥1.51 billion, ¥50 million above the contract because of added training.
Reception kept staffed through the card transition
We deferred the removal of seven reception posts and forwent about ¥31 million in the year to March 2026. Claims returned to us for insurance-eligibility errors fell from 1,340 a year to 520 over the same period.
Current focus
I am reducing the separate log-ins and screens a ward nurse or care worker meets in one shift, and measuring where doctors' hours are lost to the record, so that our response to the 2024 limits on doctors' overtime rests on evidence rather than impressions.
Conversations I welcome
I would consider one outside directorship at a listed company in healthcare services or nursing care, with about twenty days a year, after our chairman's approval and a review of my supplier and pharmacy relationships.
The leadership record
Trusted with consequential decisions.
Formation
Bachelor of engineering in information engineeringKibiyama Institute of Technology · 1994
Naoki paid for the first drill's overtime only after I pushed him, and he said so to the board himself. Since then, our ward managers bring him problems before they become incidents.
Michiyo KanazashiDirector of nursing, Tsuyuhakai Medical CorporationThe full record ↗
Contact
I would consider one outside directorship at a listed company in healthcare services or nursing care, with about twenty days a year, after our chairman's approval and a review of my supplier and pharmacy relationships.
