E-health services in low-resource settings: Requirements and ITU role February 5, 2013 Session 4: Current Projects on e-Health The status quo and the future of e-Health Ikuyo Kaneko Keio University, Japan

Will show results from several projects on e-health in Japan (a) to identify major problems and barriers preventing efficient and effective e-health system building in Japan, (b) to explain some of the models leading to successful cases of e-health in Japan, aaa (c) to share experiences to show the importance of standardization.

PROBLEMS SOLUTIONS BARRIERS Use of database and telemedicine to share information and resources. PHR/EHR and other database systems lack standardization. Multi-investment on ICT systems due to lack of inter-operability. Uneven distribution of resources; severe shortage of doctors in many areas The elderly care and home care are not systematized and very much inefficient. Promote preventive medicine to reduce the total costs. Laws and regulations work as barriers. Many medical laws were made before internet. Policies to reimburse a part of ICT. The cost of health care for the aged is growing rapidly. Need to formulate proper policies to use tax money to induce incentives. Costs of PC and internet access cause a problem for the elderly. Employ “community model.”

PROBLEMS SOLUTIONS BARRIERS Use of database and telemedicine to share information and resources. PHR/EHR and other database systems lack standardization. Multi-investment on ICT systems due to lack of inter-operability. Uneven distribution of resources; severe shortage of doctors in many areas The elderly care and home care are not systematized and very much inefficient. Promote preventive medicine to reduce the total costs Laws and regulations work as barriers. Many medical laws were made before internet. Policies to reimburse a part of ICT costs. The cost of health care for the aged is growing rapidly. Need to formulate proper policies to use tax money to induce incentives. Costs of PC and internet access cause a problem for the elderly. Employ “community model.”

PROBLEMS SOLUTIONS BARRIERS Use of database and telemedicine to share information and resources. PHR/EHR and other database systems lack standardization. Multi-investment on ICT systems due to lack of inter-operability. Uneven distribution of resources; severe shortage of doctors in many areas The elderly care and home care are not systematized and very much inefficient. Promote preventive medicine to reduce total costs. Laws and regulations work as barriers. Many medical laws were made before internet. Policies to reimburse a part of ICT costs. The cost of health care for the aged is growing rapidly. Need to formulate proper policies to use tax money to induce incentives. Costs of PC and internet access cause a problem for the elderly. Employ “community model.”

telemedicine proved very effective as a preventive approach before　　　 after BMI highest blood pressure (mmHg) abdominal circumference（cm） total　A 　B 　 C　 D E 　 F G total　 A 　 B 　 C　 D 　 E 　F 　 G total　A 　B 　 C　 D 　E 　 F 　 G nuetral fat (mg.dl) lowest blood pressure (mmHg) HDL cholesterol （mg.dl) 　higher the better total　　A 　B 　C　 D 　 E 　 F 　G total　A 　 B 　 C　 D 　 E 　F 　 G total　　A 　B 　C　 D 　E 　 F 　G blood sugar (mg.dl) HbA1c(%) □marked improvement in most districts n = 75 total　　A 　B 　 C　 D 　 E 　 F 　 G total　A 　B 　C　 D 　 E 　 F 　G

long term effect of telemedicine proves good Transition of test scores in 4 years starting in 2008 ※# of risk factors among blood pressure, blood sugar, fat metabolism and lever functions # of low risk group increased 地区組織活動の具体的な例を紹介させていただきます。 まず、先に述べました長野県にある保健補導員制度がその典型例です。長野県の保健補導員は1945年、まだ日本が戦争中であった時代に、現在の須坂市で誕生しました。長野県はほぼ全域に保健補導員組織が設置され、2007年は約一万三千人の住民が保健補導員として活動しております。さらに、私の計算では、少なくともこの35年間で、長野県の住民の、実に５人に１人が保健補導員の経験者であると考えられます。現在、長野県は医療費が低く寿命が長い健康長寿の県として知られていますが、その背景には、この保健補導員が、地域の医師や保健師と一体となって、草の根的に地域の健康作りを推進したことが大きく関係していると考えられます。代表的なのが、1970年代の減塩運動です。 また、長野県以外でも、今回研究対象としました山形県にある大蔵村というところでも、保健衛生推進員という名称を持つ人たちが活動をしています。この大蔵村は、現在は健診を受けるのが当たり前という、大変住民の意識の高い村で、例えば2005年は、このように、基本健診や各種がん検診において、山形県平均よりもはるかにたかい受診率を誇っております。乳がん検診などは、県の21％に対して、実に61％です。山形県自体、検診に力を入れており、全国的にも高い健診受診率を誇るのですが、その県平均を大きく上回るのが大蔵村です。この大蔵村も、昔は医療過疎地域として医師も逃げ出すほどだったらしいのですが、保健衛生推進員制度を制定した以降、推進員たちの活動によって、住民の意識が徐々に変容していったとのことです。 # of high risk group decreased

out-patient group VS telemedicine group 　 out-patient group 〜　 ave. age = 54.8、13（male 11、female 2） 　　　telemedicine group 〜　 ave. age = 58.4、13（male 11、female 2） ・the same doctor for both groups ・test on 10 itmes （weitht、BMI、neutral fat、HDL cholesterol、blood sugar、HbA1c etc.） ・blood tests before and after ・compare the average scores of all the members in both groups results 　out-patient group　〜　# of improved items ＝ 0、# of worsened items ＝ 7 telemedicine group 〜　 # of improved items ＝　9、# of worsened items ＝１ 　　improvement telemedicine outpatients （*=P<0.05、**=P<0.01）。 worsening

PROBLEMS SOLUTIONS BARRIERS Use of database and telemedicine to share information and resources. PHR/EHR and other database systems lack standardization. Multi-investment on ICT systems due to lack of inter-operability. Uneven distribution of resources; severe shortage of doctors in many areas The elderly care and home care are not systematized and very much inefficient. Promote preventive medicine to reduce total costs. Laws and regulations work as barriers. Many medical laws were made before internet. Policies to reimburse a part of ICT costs. The cost of health care for the aged is growing rapidly. Need to formulate proper policies to use tax money to induce incentives. Costs of PC and internet access cause a problem for the elderly. Employ “community model.”

communities with high social capital leads to better results City of Okutama, Tokyo City of Kurihara, Miyagi 　　# of blood test scores improved % of the elderlys with ADL 11 or higher index of social capital index of social capital A community with high social capital is known to produce improvements in health conditions with low cots. The community model of telemedicine for preventive approaches: Participants get together at a local meeting place once a week or so to measure weight, blood pressure etc. and talk with a doctor or other staff person for health check and consultations. In the past several years, the continua standard has contributed considerable to lower cost of the community model of tele-medicine.

Community with high social capital Complete ennumeration of 14,781 persons older than 65 years of age in 6 districts in Kurihara City (160 wards in all) higher health index テレビ電話相談実施地区 higher social capital

PROBLEMS SOLUTIONS BARRIERS Use of database and telemedicine to share information and resources. PHR/EHR and other database systems lack standardization. Multi-investment on ICT systems due to lack of inter-operability. Uneven distribution of resources; severe shortage of doctors in many areas The elderly care and home care are not systematized and very much inefficient. Promote preventive medicine to reduce total costs. Laws and regulations work as barriers. Many medical laws were made before internet. Policies to reimburse a part of ICT costs. The cost of health care for the aged is growing rapidly. Need to formulate proper policies to use tax money to induce incentives. Costs of PC and internet access cause a problem for the elderly. Employ “community model.”

Information sharing “low cost” network connecting all related players in the City of Miyako drug stores hospital clinics patient ID certification of users Practical implementation to share basic information and to promote collaboration by many different players in the health field. information & resource sharing standar formalt DB general groupware care businesses dentists visiting nurses Back up of date data center at remote cite patients at home