Japan Medical Network Association

By visualising the flow of enquiries across multiple organisations, we were able to improve operational efficiency. In addition, the system enables efficient history management and response to requests for improvement, which were required before the system was put into operation.

Kyoto, Japan http://www.ehr.or.jp/

Successfully visualising workflows across multiple organisations


In December 2020, a paper was published in the Journal of the Japanese Telemedicine and Telecare Association detailing how the Japan Medical Network Association (JMSN) is using Questetra to improve the efficiency of its enquiry handling operations. In December 2020, the details of this work were published in a paper in the Japanese Telemedicine and Telecare Association, which is of great interest to anyone working to improve their work. This article presents the content of the paper in a more accessible form.

About the paper

  • Title
    • Improving the Efficiency of Inquiry Handling for a Nationwide Medical Information Sharing Service for Patients by Designing and Operating a Multi-Layered Helpdesk Using a Business Process Management Tool (CiNii)
  • Authors
    • Naoto Kumeke (Department of EHR Research, Graduate School of Medicine, Kyoto University)
    • Kenta HORI (Department of Medical Informatics, Hyogo Medical College)
    • Kenji Araki (Department of Hospital IR, Miyazaki University Hospital)

Requirements for Inquiry Handling Services

The Japan Medical Network Association has been conducting a research project on the collection and use of health and medical information. Within this project, the aim is to develop and provide a system (Sennen-Karte EHR) that enables patients themselves to access their medical record information easily and safely across regions, as opposed to the patient record information that is dispersed in medical information centres in each region.

As of January 2020, 115 medical facilities and related institutions are participating in the Millennium Medical Record EHR.

As Sennen Medical Record EHR provides a nationwide service, user support must also be provided on a nationwide scale. The support needs to be provided by the central (Sennen Karte EHR) office (help desk department) and several regional medical cooperation offices, depending on the nature of the enquiry.

In order to establish a nationwide helpdesk system, three requirements were set to achieve operational efficiency.

  1. Visualisation and efficiency improvement of workflows across multiple organisations
  2. Efficient inquiry history management
  3. Systems that can respond to requests for business improvement

To meet these requirements, Questetra was chosen to provide an efficient business execution environment through the visualisation of workflows.

Structuring of the enquiry handling process

The helpdesk department of the EHR, the regional office(s) and the system vendor will handle the enquiries of the EHR. Some enquiries from users reach the helpdesk department and some reach the regional office. In order to ensure consistent responses throughout, the regional office(s) will not respond directly, but will be coordinated by the helpdesk department.

Once the query has been collected by the helpdesk department, the regional office or the system vendor will be asked to investigate or carry out work depending on the nature of the query. After the investigation or work has been completed, the helpdesk department will send a response to the patient. In some cases the response is sent to the patient without a request to the regional office or the system vendor.

This kind of business flow is drawn in a workflow diagram on Questetra, and we can see what kind of data is handled and who will handle which process. With the appropriate settings a mechanism to carry out enquiry response tasks will be constructed.

The helpdesk department and the regional office(s) have Questetra user accounts. Therefore, the transfer of work between these two organizations can be easily achieved. On the other hand, the system vendor does not have an account. However, Questetra has a function for operating a process without having an account; the [Receive Task (Form)]. By using this function we can transfer the work between the three parties. (Requirement: visualization and efficiency improvements of workflow across multiple organizations.)

In order to achieve one of the requirements, efficient inquiry history management, the title of the query case is automatically set with key information that leads to the identification of the enquirer. This means that when an enquiry is received, a list of previous enquiries can be quickly extracted using the search function.

Operation of the enquiry handling service and the effectiveness of the system

In the 18 months of operation, from 7 December 2017 to 9 May 2019, the number of enquirers was 70 and the number of queries was 120.

During this period, the transfer of work between the three organisations proceeded smoothly. Communication between the staff was completed on the system, which significantly reduced the amount of communication.

From the point of view of the third requirement, a system that can respond to requests for business improvements, we responded to requests for business improvements that arose in the course of operation by improving the workflow as follows

  • Adding a new flow
    • The receptionist’s only job was to enter the information for the enquiry. At some point, the number of questions that could be answered by the receptionist increased, so the workflow was changed to allow the receptionist to answer questions at the same time as entering the information.
  • Addition of a new process (and flow at the same time)
    • Previously, there was a separate contact point for new user registration applications. However, as many enquiries are also related to new user registration, the user registration process was incorporated into the enquiry flow.
    • In the past, the work carried out by the system vendor was broadly requested as “system work”. However, the authentication unlocking process was included because it is one of the most frequently occurring tasks.

In this way, we were able to respond to requests for improvements as they arose through the operation of the business. Furthermore, this does not affect the ongoing enquiries which allows the staff to concentrate on their work.


We were able to meet all three of the requirements set for our enquiry handling operations: visualisation and efficiency of workflows across multiple organisations, efficient enquiry history management, and a system that can respond to requests for business improvement.

By continuing to use Questetra for helpdesk operation, we expect that it will become easier to create answers based on the response history data, rather than relying on the memory of the person in charge, and that more efficient operation will become possible.

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