From Paper Letters to an Integrated Digital Workflow: Improving Efficiency, Reliability, and Engagement in Health Guidance
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Post-checkup health guidance in Japan has traditionally relied on paper-based communication and manual administrative processes. These workflows are time-consuming, prone to transcription errors, and can delay timely engagement with health guidance recipients.
Objective
To assess whether replacing a paper-based workflow with an integrated digital system using Microsoft Access, robotic process automation (RPA), and web-based responses could improve administrative efficiency, operational reliability, and engagement among health guidance recipients.
Methods
This single-site quality improvement initiative redesigned the existing letter-based workflow. Access served as a central interface for managing recipients and generating guidance letters. RPA (EzRobot) automated repetitive clerical and billing-related tasks. A web form accessed via a QR code enabled recipients to respond digitally. Outcomes included manual administrative handling time per case, occurrence of transcription-related errors, health guidance completion rate, and guidance duration distribution.
Results
Following implementation, staff active handling time per case decreased from approximately 10 minutes to less than 1 minute (approximately 30 seconds), while automated RPA execution typically required about 4–5 minutes per case without staff input. No transcription-related errors were detected during the post-implementation observation period. Health guidance completion rates improved from 28.3% to 39.2% (χ 2 test, P<0.01; R4 (FY2022) n=184, R5 (FY2023) n=536). Guidance duration distributions, calculated using the corrected method, shifted towards shorter durations: cases with ≥200 days decreased from 30.5% to 20.9% and cases with ≥240 days decreased from 13.6% to 8.9% (R4 n=59, R5 n=158).
Conclusion
An integrated Access–RPA–Web workflow was associated with improvements in administrative efficiency and operational reliability in post-checkup health guidance while retaining human verification and exception handling. This pragmatic, non-AI-dependent approach may offer a useful model for process-level improvement in preventive care settings.
Summary Box (Key Messages)
What is already known on this topic
Paper-based health guidance remains widely used in preventive care, but it involves multiple manual steps, increasing administrative burden, delays in follow-up, and transcription risks. Robotic process automation (RPA) has been applied to healthcare administration, particularly billing and data entry, yet integrated workflows linking health guidance delivery, recipient responses, and billing transfer have rarely been described.
What this study adds
This study describes a non-AI-dependent digital workflow using Microsoft Access, rule-based RPA, and an optional QR-linked web form to modernise letter-based health guidance while retaining human verification and exception handling. The approach reduced administrative handling, automated routine transcription steps in billing transfer, and supported more efficient workflow management in routine practice.
How this study might affect research, practice or policy
Pragmatic digital integration may support sustainable quality improvement in preventive health services without major infrastructure investment. These principles may be transferable to other settings where paper-based communication remains necessary.
