A pioneer at heart

For the last 10 years it has been a ritual of sorts. Every two weeks on a Saturday afternoon, Shinsuke Muto hops on the Shinkan-sen in Tokyo to travel to the coastal town of Ishinomaki for a three-day patient visit. Once he arrives, a car packed with essential medicines awaits him before he sets out to see patients at home. Without Muto and the support of his local clinic in the Miyagi Prefecture, which was hit by a devastating tsunami in 2011, many would struggle to get medical care.

One of them is Michiko Oshima, an 82-year-old patient with a long history of heart disease. “Tending to her is not just about providing the medical treatment she needs,” Muto says. “I also enjoy the contact with her,” as he does with all his other patients. As he leans over Ms. Oshima to take her pulse, the two interact like close friends or family members. One can sense the intimacy between doctor and patient and the solace Muto provides by just being there and enquiring how she is feeling today. Such patient interactions are part and parcel of Muto’s busy life. But they are more than just regular medical check-ups. They are powered by the latest digital technology that allows Muto and pharmaceutical companies such as Novartis to provide the best possible patient care.

Every two weeks, Dr. Shinsuke Muto embarks on a journey from Tokyo to Ishinomaki to visit patients in this city, which was ravaged by a tsunami in 2011.

A childhood dream For Muto, the founder of clinic network Tetsuyu Institute Medical Corporation, which consists of nine centers across Japan, and chairman of Integrity Health, one of the country’s leading telemedicine firms, the patient visits reflect his ideal of a compassionate medical practice. But more than that – and invisible to a chance onlooker – the personal exchanges are also testament to his ambition to change Japan’s healthcare system by wedding classic home care with digital technology. It is something he has dreamt of for a long time. “I was six years old when I realized that I wanted to become a physician,” Muto tells me during our first talk in August 2023. “I was mostly inspired by Hideyo Noguchi, a Japanese doctor, who was a pioneer and who traveled the world to understand diseases and find cures against them.” After high school, Muto decided to become a cardiologist. But once he started practice, his enthusiasm soon faded as he learned that the reality of being a doctor often reduced him to treat organs rather than caring for patients holistically, as his role model Noguchi did. “I really wanted to do more and still felt the inspiration of my younger self to save lives,” Muto says. “But initially I found little opportunity to do what I really wished, because the healthcare system was forcing doctors to focus less on personal care.” As he struggled to find his place, a colleague suggested that he join consultancy firm McKinsey, where he could have a bigger influence on healthcare. And while he initially cherished the time as a globetrotting adviser, he soon started to miss his real vocation. “What drove me to join McKinsey was the desire to gain a higher perspective on how to effect change on the ground,” Muto says of his motivation to leave medical practice. “But while I really enjoyed traveling and working as a consultant, I missed being with patients.” This is when he had the idea to set up his own shop and create a clinic network that would allow him to improve healthcare on a structural level as well as keep close contact to patients and follow his initial drive to save patient lives. Doctor in a digital country But that was not enough either. In 2009, leveraging the skills and experience he gathered at McKinsey, Muto helped set up Integrity Health, which has since become Japan’s leading telemedicine company catering to medical institutions across the country. Among the company’s services, Integrity Health has developed the YaDoc app, which allows for swift communication between doctors and patients through video, for example. Furthermore, the app provides solutions for efficient monitoring as well as collecting patient data.

“Our system allows us to capture patient data remotely and provide it to physicians in order to give them the most accurate and up-to-date picture of a patient,” Muto explains. “What is really a great add-on, is that they can also immediately interact with patients.” The fast growth of Integrity Health, which today provides services to more than 4000 medical institutions, reflects not only a growing patient need but also Japan’s traditional appetite for digital technologies in general. One of the reasons for this goes back more than a century to when Japan built its first robot, called Gakutensoku, which was a response to Karl Capek’s 1926 dystopian play R.U.R., in which android slaves stage an uprising against their creators and eventually destroy humanity. In contrast, Gakutensoku, which means “learning from the laws of nature,” is a helpful robot designed to support its creators and imbue them with hope for a better future. When shown to the Japanese public in 1928, audiences were captivated by the automaton. Ever since, Japan has embraced new technologies with a verve not seen elsewhere, be it Tamagotchis, which were all the craze a decade ago, or robots in restaurants and nursery homes, which are used with increasing frequency around the country.

Muto’s professional journey led to innovative digital solutions, like the YaDoc app, merging traditional home care with modern technology for enhanced patient experiences. It allows him to travel long distances without jeopardizing efficiency.

Against this cultural background, even elderly patients in Japan have little problem embracing new technologies – least of all healthcare apps, which help them get into contact with doctors and get the help they need, Muto says. “People are very open to using our services,” he adds. “It is a very efficient way of working with patients. It allows us to continue with our home care services, which are so important, especially when it comes to the care of elderly patients,” Muto explains. Cardio care As Muto continues to pursue his childhood dream and grow his network of clinics and app users, he is also always on the lookout to expand his activities and is ready to develop new practice approaches whenever possible to improve patient care. Among his many efforts is cardio care. After the Japanese government in 2018 launched a nationwide effort to improve heart health in the country, Muto started to work on new solutions to help improve monitoring. Among other things, Muto’s Integrity Health developed a clinical pathway for secondary cardio prevention, as well as a digital system that allows doctors to capture the cholesterol levels of patients and thus devise the best possible medical practice for them. Thanks to these steps, patients could now see the data and monitor cholesterol levels and other symptoms, with thresholds that alert them when they should see a doctor. Doctors, in turn, can see the test results and can make recommendations for each patient. “Here we were able to develop an extremely useful way to help doctors treat their patients both remotely and at home,” Muto says. “It is a system that creates a win-win-win situation for patients, doctors and the healthcare system itself.” The data system is currently being tested in Nagasaki. Chances are high that, once the test phase is completed, the system could be introduced in other parts of the country and rolled out across all of Japan in due course. Extending partnerships While Muto is excited about the early achievements of Integrity Health in Nagasaki, he is fully aware that transforming the health-care system is only possible through partnerships, be it in the field of medicine, technology or on the political level. “Partners are crucial to any such big endeavor, given that the healthcare system is fragmented on so many levels,” Muto says. “Without bringing everyone to the table, it is difficult to create a lasting impact.” One of the partners with which Muto is collaborating is Novartis, which has a long tradition in the cardiovascular space, having developed a series of medicines that have helped improve heart health.

The company’s earliest heart medicines date back to the 1930s, when Novartis predecessor company Sandoz worked with natural products and extracted the active ingredients from plants, such as digitalis, to develop heart medicines. Since then, Novartis has developed a series of drugs that help treat heart failure and hypertension, as well as manage high cholesterol levels, which is considered one of the key reasons for heart attacks and stroke. Trust is essential The partnership with Muto’s Integrity Health started several years back when Novartis was itself on the lookout for ways to improve heart health in Japan and wanted to support the government in its effort to reduce the healthcare burden in this domain. “Novartis has a strong legacy in heart health,” says Mei Haruya, who heads the partnership efforts in the cardio realm at Novartis in Japan. “But given the high healthcare burden, we are constantly on the lookout for new ways to improve the situation on the ground.” Besides “listening tours” to better understand the needs of healthcare specialists and patients, the company has also been busy connecting with policy makers and regulators to discuss the current framework and ways to overcome existing barriers. Among other things, the team in Japan was active at a recent G7 event and had a seat at the World Heart Summit. There, Novartis had the opportunity to explain some of its ideas and how it aims to improve secondary prevention through timely access to life-saving medicines. “Of course, this is a very complex and difficult road, but one that is worthwhile taking,” Haruya emphasizes. “We are willing to make this effort, because this is an investment in healthcare that will ultimately help people lead healthier and longer lives.” Collaborating with Dr. Muto is one key aspect of the company’s efforts in the country. “Dr. Muto has made great strides in the realm of telemedicine and can provide patients with the right medical and personal care – both remotely and at home. For us, supporting him in his efforts is a big win.” But the road ahead will not be an easy one. “This is really a long game, and one of the most important ingredients is mutual trust,” Haruya says. “Given our long collaboration, which stretches back many years, I am confident that we can have a big impact.” The best of two worlds Aware that digital solutions are essential to create scale effects and help millions of patients in Japan, Muto is also adamant in his belief that compassion and personal assistance are crucial to strengthening healthcare systems in the long run.

Dr. Muto envisions a healthcare landscape where compassion and digital precision seamlessly unite, promising a brighter and more connected future for healthcare in Japan.

“It’s intensive and it may not look efficient in the first place,” says Muto. “But providing home care – especially for the elderly in a rapidly ageing society like Japan – and backing it up with strong digital services is the way forward.” As he visits one patient after another during his stay in Ishinomaki, Muto seems invigorated by every contact as he instinctively feels that his presence is having a visible positive effect on his patients. This is also the case with 50-year-old Mitsue Kinoshita, who recently suffered bleeding on the brain and has difficulty moving her left hand. She is now taking pain killers three times a day to alleviate her condition. While she tells Muto that she currently has no pain attacks, he advises her only to take the pills when the pain returns in order not to strain her liver. Furthermore, as the summer heat still hangs over the city, Muto tells her to stay indoors and drink plenty of fluid to avoid a heat stroke. Muto also takes time for chitchat with his patients. When he meets 96-year-old Kahoru Imamiya, she removes her face mask for the first time since the outbreak of the coronavirus pandemic and Muto jokingly says that she is looking so young.

As Imamiya perks up, she also tells him about the day-care service she now uses twice a week. Asked what she is doing there all day long, she tells him that she is singing. Everybody has a good laugh. Before he bids her goodbye and takes the car to meet the next patient, Muto tells Imamiya that he will return on September 25 for another check-up and that she should continue taking her medicines regularly. “While my visits are important for keeping a check on the patients, one key aspect is the emotional closeness that I have with them,” Muto explains. “Sometimes, patients do not just want to talk about medical issues, they just want to feel a human connection.” In an ideal healthcare system, such as envisioned by Shinsuke Muto, human connection and digital precision go hand in hand.