Ehealth in japan

Business Opportunities
with Healthcare ICT
～ viewpoint from big data and service ～

■characteristics of healthcare industry
■healthcare policy trends in Japan
■healthcare policy trends in EU and
pan-pacific countries
■healthcare ICT trends in private sector
■healthcare as services

2011.11(J⇒E translation in 2012.3）

Yasuji Suda sudays17@gmail.com

Expectations and policy trends about healthcare industry

■Characteristics of Healthcare
Industry■

0 What is health？
◆◆Definition of WHO◆◆
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity.
The Definition has not been amended since 1948.
source：ＷＨＯ charter
Are these definitions
◆◆Health in Japanese Laws◆◆ conformant with Health
【Medical Care Act Article 1-2 】 This Act・・・aims to contribute maintaining
that consumer think or
our citizens health by Protecting Interest of medical care recipient and trying to
conscious nowadays？
keep hold system that provide better quality and appropriate care efficiently
【Medical Care Act Article 1】 Medical Care・・・should be consisted not only
from Disease Care but also from preventive care and rehabilitative care with
better quality and appropriateness
【Health Promotion Act Article 2】 Citizen should pay more
attention and understanding to importance of healthy life
styles, and also percept own health conditions and try
health promotion through their life This is not formal translation
※ Describe Health as Wellness
source：
http://www.definitionofwellness.com
Wellness is a multidimensional state of being
describing the existence of positive health in
an individual as exemplified by QOL and a
sense of well-being Charles B. Corbin
Distributed by Suda Yasuji, 2011

1 Healthcare Field（1）

Healthcare means・・・ By Someone’s Care
Health is contributed
By Self-Care

Concept of healthcare field

Politically Publicly Personally
Concerned Covered Consuming
Health Health Care
Public Private Consumer Goods
Social Security
Partnership & services
Insured Health Health maintenance
& self-care

There is no universally accepted policy to determine how
medical care should be provided as a part of publicly
funded healthcare.


As socio-economy matured, bi-
polarization of healthcare needs happens

Service is picked by
user Health
Personally
【Service provided in Self- ？ Maintenance
Market】 Actualization & Self-care Consuming
Value For Life
Specialty
Life Design Esteem
Publicly
Love/Belonging Covered

Service is Necessity Safety Insured
？ H e a l t h
【Service provided as Politically
SS】 Physiologically
Quality Of Life Concerned
Commodity
Life Support
Maslow’s Hierarchy


■ Mapping Healthcare Categories

Reactive Elective Elective Care
Acute Procedure
Rehabilitation indicate need
Emergency Chronic of coordination among
Care care settings
Disease Mng.
Assisted Elevated Risk
Living Factors

Home care & Wellness mng.
Active
Independent Health Fitness
Proactive Living

Care
Self-care
By Professionals

source：Technical Research Center of Finland ” Ecosystem of PHR based products and
services”2009
Connected by Home
Health Maintenance
Insured Health Appliances
& Self-care
（Health Data
Available）？


2 Healthcare Market Review
（ 1 ）
It is not generally speaking that increasing effect of medical cost
of Advancing New Medical Technology is Higher than that of
Population Aging.
Medical Expenditure is Most Highest in age group of 75-79
and a share of Total medical cost per person over age 80 is
about 25% in Japan. （National Statistic of 2009）
●Disease Onset will Avoidable
through Prevention ? Ａ
Go Severe
Onset ●Disease Advance will Preventive
Diseases through Early Intervention ?
Ｂ

Pre-Onset Ｃ

Healthy
Superior
Healthy
time
－Relation among Health, Prevention &Medicine－

■Using new technology including drug are very expensive
■Even if medicine advances, still, disease will have chances to surviv
■Think as social cost；patient & family satisfaction (process or outco

（ 2 ）
P a r a d o x i c a l M e c h a n i s m
Assuming Healthcare has Intrinsic Motivation to develop
Potentially High Growth & New Medical Technology
Revenue Chances “something new for love/someone”

New Tech. based products &
services are usually costly &
uncovered by insurance
Socialization of Medicine
（Black Hole） User may avoid using them if
But providing healthcare though they can get high utility
services as Public Service may
leads to increase SS cost
Insurance coverage alleviate high
Containing SS budget growth user cost & facilitate its use
through effective & efficient services

Cutting Managed Care Transferring cost to People are Econs ?
Payment ・High Cost User Think & Act with
Price to ・Duplicate ・Increase OOP Payment economic rationality,
Providers ・Redundant ・Delist from Coverage without emotions

（ ●Studying Individual Behavior, ）
3 Information &Monetary Flow in
Healthcare Services are Needed
●Non-Profitability is Required but it is also an Economic Activity

1 2 3 4
expectation
Health Focal Point Info. Choice
Daily Life Consideration
Nudges From Think Collection & Use
to Act
Account Account

expectation Info. Collection &
Back
Account Consideration
Repeated process are often
Keep Rule Use
Outcome Outcome Usage cyclic
Based Eat/Drink Purchase
Actions Stables Occurs /Spread
Account
Self Medication Account
Worsening Own Health Save Use
4 3
by Self-Care Health Keep
Conscious 4 3
・Low adherence to medical Instructions Behavior Daily Life
Account
・Inappropriate Usage

Outcome Prescribing Admin. Clinical Admin. Visit Curative Healthcare
Occurs Work Work Work Work
Repeated Use Account

Default
expectation

（ ■ Points of Coordinated/Seamless Care
4 ）
Ex. Wagner’s Chronic Diseases Care Model

Community
Health System
Medical Facilities (Providing Care Services)
Policy & Resources
Self- Delivery Decision Clinical
Management System Support Information
Support Design Systems

Informed, Prepared,
Activated Productive Interactions Proactive
Patient Practice Team

Improved Outcomes
http://clearinghouse.adma.org.au/home/evaluation-tool-framework/microsoft-word-the-wagner-chronic-care-model-with-an-equity-lens/view.html


（ ■ Coordinated/Seamless Care & ICT ）
5
◆Healthcare paradigm shift is enable to
select sophisticating services in Cure &
Care by User rather than moves from Cure ICT
to Care Implementing
◆Bridging Cure & Care needs creation of Opportunity
system which User & Provider can select
either without any hassle
Selective

ICT
（Data
Driven）
Palliative
Cure Care Supportive
Less
invasive

Responsive
service in Sophisticating Go Ambient
critical
times

（ ■ Coordinated ＆6 Seamless Care Modeling
）
－ Accountable Care Organization（ACO）－
●Same Concept of Medical Home, providing integrated and
customized care service experiences to patients.
●Scheduled to start in 2012 as an initiative of Medicare Service
Reform Activities

ACO

Incentives
Participation for 3 year generated by patient（5,000～／
in a row reduching expenses year）
Hospitals Patientt
Doctor P
Nursing
Facilities High Safety
Efficient and P + Family
Care Health Effective Care
Facilities Center
EHR Tele Health P
Clinics P
Remote Monitoring
Providing Quality
Referenced HealthIT.gov, public
And Price Info. comment for ACO et al.

Managed Free Access Is Necessary or Achievable in Japan？

3 Health ICT（1）
■ Framework of HIT adaptation HIT：Healthcare Information
Technology
D i g i t i z a t i o n i n(HICT means same)
M e d i c i n e
Clinical Administrative

Front Stage Tasks Related H I E
HIE Back Stage Tasks Related
to Clinical Procedure to Medical Claims
（Diagnose, Test , Care Processing（Check &
& Operation） EMR, e-claims Pay)

E-Health, Tele-Health

Health 2.0, m-Health
Digital Health
Digitization in Healthcare

Daily Life have so many touch points that can lead to
good opportunities for healthcare intervention ?
●Reform Priorities
discussions
●Reform Approaches －Top-down
－Bottom-up
－Module
－Building-blocks

3 Health ICT（2）
■ Types of Digitized Health Info.

EMR
Coordination among
Care Settings
（Cure）

EHR
EMR EMR

Connected Health

Managing Health
Risks in daily life

PHR



■Healthcare Policy Trend in
Japan■

4 Health System Reform Trends in Japan（1）
■Aspect of Social Security Reform
Integrated Reform of SS & Taxation
●Reform service provisioning systems to improve efficiency &
effectiveness in accordance with character of each Local
community introducing needed legislations
・Rearrange hospital functions & create
coordinated NW. among them Long term un-dissolved issue
・Reduce community & subjective clinical without effective solutions
gaps
・Improve home care services
Need to set theme for Big
・Strength outpatient visit management Data analysis
・Reduce duplicate/avoidable visits, test, and 【evolution of openlabs.go.jp】
over prescribing using ICT
● Reform health & long-term care insurance systems as
safety net through strengthen payer’s roles
Formally proposed as
・Study about introducing a fixed amount OOP
exemption of a fixed amount
payment including low income households
・Promote generic drug use
・Separation of drug coverage？
・Increase OOP payment for prescribed drug
（Medicare part D in Japan）
・Reform senior health insurance system, a sub
・Reference price/price capping
system of national health insurance system
Source：SS Reform HQ（2011/6/30）
Distributed by Suda Yasuji, 2011 This is not formal translation

■How to Assess Quality of Medical Care

Data Collection is too little to use statistic analysis.
Tragic Episodes tend to overwhelm statistical facts.

●Japan Council for Quality Healthcare Released “Medical Accidents Annual Report 2010”
No. of Reported Accidents：2,182（Death182） of Participating Facilities： 850 （20
No.
No. of Reported Incidents ： 25,305 No. of Participating Facilities： 1,015 （20
≪Total No. of Facilities is over
100k≫
●Many Medical Accidents are broadcasting

A Medical malpractice caused
brain death A Medical Sponge had been left into
Patient body for 22 years.

Representivenes
http://www.med-safe.jp/ A Patient died after mis-diagnosis
s

Systematic problems though, ？
？？
tend to consider as
personal or
organization’s partial Source:Fresheye News Clip

■Aspect of Economic Policy－①
New Growth Strategy⇒⇒Realizing New Growth Strategy in 2011
●Make medical, health & long term
Green Innovation care industry driver of economic ●Medical & Care
growth Market 78billion
●Promote R&D for Japan origin Employment
Life Innovation 201million
innovative drug & care tech. ●Health Related Services
●Progressive export to abroad Market 25billion
New Approaches Employment
to Asian Economy ●Promote barrier-free housing 0.8million
●Strength care service infrastructure
Inbound Tourism coupling to support Healthy Long Life
with Regional Vitalization
●Achieve safe senior life in local
Advancing Science, community Matter of
Tech. & ICT deregulation
【National Policy Unit’s
Employment & HR Focus】
・Facilitate use of new medical
technologies & services
New Businesses？
Finance ・Promote inbound medical & health Price
tourism competition？
(Commoditization
Source：New Growth Strategy )
This is not formal translation


■Aspect of Economic Policy－②
Report about Deregulation
（2011/7）
－now－－future－
Life Innovation WG Adding User’s
Points of deregulation Provider’s View
View・・・
●Dissolving man power inappropriate allocation Good service
Quantity is key for
& shortage, increase number of students
better quality encounter and
constantly with projection of needed man power efficient back end
●Redefine area of coverage which public Financial constraint process are key
Evidence of
insurance should cover including preventive allow prevention with
prevention are able
care little evidence?
to accumulate ?
●Improve quality and efficiency of medical care Networking of Co-creation process
through information sharing & applying new providers is essential with User is
technology in clinical setting important
Financial constraint
Service process
●Promote & support consensus for self- health shift cost &
innovation is key
management through empowerment responsibility to one
●Facilitate combination and coordination of Med/Health tourism Creation of high
medical care & non medical care services to is easy to make and User friendly
create New Business Opportunities grow well ? interface is key

Secondary Use & Big Data
may be Drivers to
Innovation
Source：Cabinet Office, Sub Committee about
Deregulation
Distributed by Suda Yasuji, 2011 This is not formal translation

■Aspect of Economic Policy－③ ●Will economic growth and job creation be
promised success in New Special Zone?
Healthcare related Projects under Special Zone Healthcare Related Project Proposals in New Special
Since 2004 Zone from 2011

Leading Edge Medical Industry Promotion Intl. Strategic Special Zone／Tsukuba City
／ Kobe City TeleMedicine Special Zone／Iwate Pref.
→Continued Under Kobe Medical Industry Medical Care Service Community／Hinoemata Villiage
Vision
Active Health Special Zone／Kamogawa City
Clinical Internship Promotion／Odawara City
& Rumoi City Smart Wellness City ／Niigata City, Gifu City et al.
→Continued Naturing Wellness Special Zone／Myoko City
Medical & Welfare Industry Promotion Leading Edge Medicine Special Zone／Shizuoka Pref.
／Ootawara City Lifetime Health Record Special Zone／Nagahama City
→Further Deregulation has executed to
Intl. Medical Exchange Special Zone／Izumisano City
enable this promotion nationally
Genesis of Medical Valley／Tsu City Healthy Long-Life Special Zone／Okayama City
→Continued Under Medical Valley Project Regionally Coordinated Care Special Zone
Bio-Me Industry Promotion／Kanagawa Pref. ／Onomichi City
→Continued 1 Clinic to Provide Advancing Integrated Regional Medical Service／Tokushima Pref.
Cosmetic Surgery
Medical & Wellness Service Special Zone
／Kagawa Pref.
Source：Special Zone for Structural Reform
Health Promotion Town ／Matsuyama City

Many Bio-venture Companies are far below Medical Valley Special Zone／Ooita & Miyazaki Pref.
from expectations. Success? Failure?
Source：Cabinet Office. List of Special Zone
（2011/10） This is not formal translation

5 Digital Health Approaches in Japan
（ ■HIT Policy Movements 1 ●So many initiatives but little advancement in
）
health info. digitizing strategies for 5 years.
Abe Regime
-IT New Revolution Strategy ・Lifetime Health Management by
-Innovation25 oneself
・Citizens ID Number
Fukuda Regime ・Citizens e-Private Box
-IT Policy Road Maps ・Unique Number for
・Social Security Card SS & Taxation
Aso Regime
i-Japan Strategy Japan Service Tourism
EHR Intl. Medical Partnership
／Inbound Med & Sightseeing
Health Related Healthy Long Life
Services
Hatoyama・Kan Regimes
-New Development Strategy “Life Innovation”
ICT supported Tele Medicine System
MIC Ubiquitous Special Zone
Local Info. Platform Initiatives Japan EHR Facilitation Program
（Residents Health Portals）
Projects for
Haraguchi vision （EHR for All by 2015）
Infrastructure
METI A Study Group of New Health Services applying PHR ⇒ ⇒ ⇒ of Health
Info. Grand Voyage ⇒ ⇒ The Consortium for the Promotion Related Info.
of Next Generation Personal Services ⇒ ⇒ Usage

Standardization and Pilot Projects for Infrastructure ⇒⇒⇒
of Health Related Info. Usage

（ ■4 Major Categories of 2
HIT ）

IT HQ’s IT Strategy in Medicine is consisted in 4 Categories
But it lacks user (patient) perspective
Individually participating
disease
Completing Vision of ○Studying Architecture of Virtual still
management services are My Hospital
1 conceptual.
“Virtually Replicated My Clinical Setting” ○Facilitating medical/health Info. digitization
There are No descriptions what
value patient get Drug e-Hand Book
& What value
co-creation process between
patient
Completing Vision of Seamless Coordinated ○Model and provider are required.
Network Development, Execution
2
Medical Care in Regions and Assessment

Toward More Efficient Medical Care ○Trial Use of providing data to 3rd Parties
3
Analyzing Claim Data ○Development of Data Use Technologies

○Advancing Medical Database Infrastructure
Facilitating Safer Medication
4
By Using Drug DB Development Program 10million Patients

Source：IT HQ・Healthcare TF

（ IT HQ：The New Strategy in Info. & Communications Technology
2 ） a Road Maps
（Updated）
Implementing Virtually replicated My Clinical Setting (Dokodemo My Hospital）

Use Case pilot test
Cab. Office MHLW METI MIC Drug e-hand book & Opt in Type
Disease Management Service are
Virtually
Newly Added in Updated Road
Replicated
My Clinical Maps.
Setting Former Planned Services are
METI MIC
giving patients more clinical &
MIC administrative info. to Empower.
Use Case MHLW Use Case pilot test
pilot test METI
METI

New
Drug
In case that clinically duplicate/ Phase1
Info. redundant medical tests but patient still want Drug e-hand book
to
Schedule
Specific do them, Whether Withdraw or Execute those
Changed
Claim Info.
Phase2-2
Discharge
Summary
tests lead to better healthcare service
New
e-Discharge Summary
e-image report
Health Check for patient？
Info. changed
Test Result Phase2-1
Opt-in type Disease
METI MHLW Mgmt. Service
Daily Health
Data Exchange
Info.
Standardization
Distributed by Suda Yasuji, 2011 Source：IT HQ（2011/8） is not formal translation
This

2 ） b Road Maps
（Updated）
Establishing Seamless, Coordinated Community Based Medical Care

Cab. Office Cab. Office Cab. Office

Establishing
Regional Use Case pilot test ・Coordinated Medical Care Models
Medical METI MHLW MIC for Targeted Diseases
Care NW Cab. Office MHLW ・Seamless, Coordinated Community
METI MIC Based Medical Care NW
Studying Disaster Proof Health Info.NW
MIC
Inter-
Regional
Use Case pilot test
Medical
Care NW Cab. Office MHLW METI MIC

Incentives Cab. Office MHLW
MIC Implement MHLW METI MIC
METI

MHLW

Use Case pilot test Establishing Coordinated Medical
& Long-term Home Care Model
Cab. Office MHLW MIC MHLW METI
E-Care METI MIC
MHLW METI MIC

Use Case pilot test MHLW METI
MIC Cab. Office
Tele
Medicine Studying E-Prescription MHLW MIC Dissemination of Tele Medicine

MHLW
Developing
Autopsy Guideline MHLW
Continuing Financial Support
Imaging
Financial Support MHLW
Distributed by Suda Yasuji, 2011 Source：IT HQ（2011/8） This is not formal translation

2 ） c Road Maps
（Updated）
Improving Efficiency of Medical Care Using Medical Claims Data etc.

•Claim Data Hospital& DPC Data Other Valuable
Types of Info. •Health Check Payer Pharmaco Data
•Coding Data Data Epidemic Data

Provision MHLW MHLW
Expertise Panel
Claims ・Use Case Pilot Testing Use for Improving Efficiency
Data ・Business Model Exam. Including
Legal aspects Clinical & Admin. Efficiency
MHLW MHLW ・Provider Use
・Payer Use
DPC
MHLW
ここを変更する！
National average data of Insurers
Hospital
expenses & clinical data of
Clinical Exam. About medical facilities are added in
Info. & Providing of national
Added average data
updated road maps. On the other,
Medical
expense integrated usage among
MHLW
secondary Data Base is deleted.
・Studying Published Data Anonymization
・Reviewing Data Security Technology
・Developing Analytic Technology for Big Data
Usage METI MHLW
Research & Study about Medical
Claim Data Use for improving
Medical Care Efficiency
MHLW METI Cab. Office
Source：IT HQ（2011/8） is not formal translation
This

2 ） d Road Maps
（Updated）
Promotion of Medical Drug & Device Safety Assurance Initiatives Using Drug Info. DB

E-Clinical Data Other valuable
Types of Info. Claim Data
DPC Data Data

Study of Provision Framework ・Tohoku Univ. Hospital
MHLW ・Chiba Univ. Hospital
MHLW
・Tokyo Univ. Hospital
・Hamamatsu Med. Univ.
Provision Hospital
MHLW MHLW
・Kagawa Univ. Hospital
Rules for use of e-clinical data
MHLW ・Kyushu Univ. Hospital
Drug Drug Adverse Info. Collection & Review ・Saga Univ. Hospital
Research MHLW ・Kitasato Univ. Hospitals
MHLW ・NTT Hospitals
Platform Development Project for DB ・Tokushukai Hospitals
Creation of Network
of Medical Info. Accumulating
Phase 1 Phase 2 High Volume Data 10 million Patient
MHLW MHLW MHLW Info. Repository
Exam. For DB Architecture
MHLW Cab. Office

Usage

Drug
MHLW
Research
Research on usage by pharmaceutical companies
MHLW

Distributed by Suda Yasuji, 2011 Source：IT HQ（2011/8） is not formal translation
This

（ ■Pilot Programs for Inter-Regional HIEｰ①
3 ）
A National Approach about “Network of networks”
was to set at last !
Network of networks

standards based
interoperable
network

Local Network A Local Network B Local Network C
separated from each other

Applications Development
on Exclusive Health Info.
NW Check Clinical Long term Care
Source：IT HQ Healthcare TF （2011.5）
Health
DB DB DB

●Adding to IT HQ’s Open Network ？ Community based Health Info. Platform

Record, Store & Retrieve Broad Band
Initiative, MIC is planning to develop Applications Development
Community Based Local-Hub
Japan EHR Network as Closed
Network Initiative. onCoordinated Gov. Info. NW Tele-consul.
Local Hospital Home
Care Unit
Medical
⇒Will they interact effectively？ Care
Pharmacy Clinic Univ.
Specialist Hospital
Source：MIC, Action Plan 2012 Nursing Care Municipal Other Communities
Facility patient health staff in same Prefecture
Health Coaching

（ ■Pilot Programs for Inter-Regional HIEｰ②
4 ）
Japan EHR Developing Program（a part of health info. Coordination Infrastructure
Deployment） Open Patient Card & Emergency
Care Coordination

Whether These 3 Applications
Should 1：Shimane Pref.
Region Run on One Common
Platform orOota & Hikawa） is not
（Izumo, Multi-Platforms
Prescribed Info. Coordination Clear Medical & Nursing Care
Coordination

Region 2：Kagawa Pref. Region 3：Hiroshima Pref.
（Takamatsu, Miki & Sanuki）（Onomichi. Fukuyama &
Mihara）
Source：MIC Outline of Japan EHR

（ ■Concerns about HIT Business Model
5 ）
●Issue 3：Incentives to slow disease advancement using HIT
Past pilot HIT programs to create regional coordinated care
often failed because they can’t get sound finance after government
Requiring non-profitable
grants period ended. insured care but vague,
Therefore, it may be necessary to provide service providers with
financial incentives for continuing business. abstractive words on
Issue3：Incentives to slow disease advancement using HIT legislation & rules

implement cost running cost actions for budget

Specify Benefits of Information Sharing
assigned budget

required budget

Measure & Analyze ROI
Year 1 Year 2 Year 3 Year 4

pilot project phase

In case of operation stops by financial shortage

Source：IT Strategic HQ・Healthcare TF

●METI・Interim Report （2011/6）
Financial Incentives such as Long-term care insurance premium
discount & point programs might effective to motivate Patients/
Users purchasing preventive care services.

（ ■Fragile Insist of “Implementation of HIT should Do”
6 ）
2011.3.11 Catastrophic Disaster in East Coast Japan
Paper based Patient Information are heavily Lost as well as
Hurricane Katrina, Great Earthquake in Haiti and so on.
Same Phenomenon already happened in 2004 Chuetsu Earthquake .
Proposals for Digitized Medical Information such as EHR and PHR
could be useful in case of these urgent situations.
☆IT Strategic HQ・Healthcare TF
☆EHR enterprise facilitation committee
Switch & Execute
Alternative Logistic Ex. Tohoku Medical Megabank
Health Mgmt. for Victims
Systems Smoothly to Alliance Tohoku Region
Local Reconstruct Medical Care Systems
Supply Medical StuffNational Tohoku Univ. Companies
centers Create New Medical Businesses
& Staff in EmergencyNational Medical Mega Bank Local
Univ. ・digital health
Colleges
Is further importantetc. ・tele medicine Contribute to develop
solutions for scarce
・health info. NW
Than Digitizing Patient medical resources

interaction
Information. Next Gen. Next Gen.
Medical Innovation
facilitating disaster
medical research Bio-med informatics recovery

Source：medical innovation council
http://www.kantei.go.jp/jp/singi/iryou/dai2/siryou5.pdf


6 Healthcare Service Policy Frame in Japan
（ ■Services as Life-Medical Industry
1 ）
Life-Medical Industry will be emerging as domination of
chronic diseases advance.
This service industry should facilitate by redefining health/
medical service field, especially public health insurance .
③Services for
prevention of Insured
Healthy
①Services for readmission & Clinical Care
health maintenance disease advance time
Normal
Condition

Applying to the chart of P5
④Services for
Terminal care
Operation& in home
Rehabilitation
Disease ②Customized Services
Onset Insured responding Personal Go Ａ
Clinical Care Disease Severe ④
needs
Onset
source：METI Ｂ
this isn’t formal translation

Pre-onset Ｃ ②
① ③
Healthy
Superior
Healthy

（ ■Services as Smart System 2 ）
Strategy for Smart Convergence
Leading Edge Medical Smart Healthcare （System）
Create Offshore COE Services for
Inbound foreign patients Revitalize healthcare industry
• coordination with Inbound
• Health Information Exchange through developing international
• Tele-Medicine seamless medical care NW.

Combination pulling patient to Japan
and pushing out Japanese medical
Export Medical Care System service system to abroad
(facility, equipment, ICT)

Outbound
Be Cautious !
source：METI
this isn’t formal translation

●OECD’s Medical Tourism：Treatments, Markets and “During the 20th century, wealthy
Health System Implications：A scoping review（2011） people from less developed areas of
pointed. the world travelled to developed
nations to access better facilities and
●Vague strategy for Medical/Health tourism highly trained medics”
Japanese Government has no numerical targets.
http:www.oecd.org/dataoecd/51/11/48723982.pdf
Instead, Development Bank of Japan’s estimation of
inbound medical tourist in 2020. ※both potential
-Total Number of tourists：0.425 millions
-Total Revenue ：￥168 billions
http://www.dbj.jp/ja/topics/report/2010/files/0000004549_file2.pdf

（ 3
【Point】 CSF of Medical Tourism is Low Price. ）

source：OECD Medical Tourism：Treatments, Markets and Health
System Implications：A scoping review（2011）

Can Japan Create New Niche Market?


■Healthcare Policy Trends in English
Spoken Countries■
United States
United Kingdom（England & Scotland)
Australia
New Zealand


7 Digital Health Approaches in US（1）
■ Nationwide Health Information Network：NHIN
●2004.4 “EHR for All Americans by 2014”
E.O.13335 ：
－ On Going Effort to create Health Data distribution system －
NHIN・Direct Push Type
If Provider A have Data of Patient X, He/She
can encrypt data and send it Directly to
Provider B who know each other and keep
trusted condition.
Alternative to FAX, mail and e-mail. Pilot Testing in 9 Areas

NHIN・Exchange Pull Type
VLER：Virtual Lifetime
Reference from Provider A to Provider B. Electric Record
If Provider B have referenced Data of ( DoD & VA )
Patient X is confirmed, Provider A can Patient Summary
Retrieve the Data ( SSA )
20 Organizations Joined ( 2011/10 ) Bio Surveillance
( CDC )
NHIN・Connect
Open Source initiative to develop and
provide Direct Exchange Software.
Ver. 3.2.1 is publishing ( 2011/10 )

■ Federal HIT Strategy Map

（1
）
（2
）
Disseminatio
（3
n of ＥＨＲ
）
（4
）
（5
）
●Coined New Phrase to get More
Toward “The learning health system” Consumer Attraction and Involvement
Huge Volume of digitized Health Related Data
⇒ Collect and Analyze
⇒ Create New Clinical Knowledge & Insight
⇒ Apply them in Clinical Setting
source：Federal HIT Strategic Plan 2011-
ASAP
Distributed by Suda Yasuji, 2011 2015

■ Empowering People Providing Rich Info. 【Blue Button
● Using Blue Button, Medicare beneficiaries of DoD
Initiative】
and VA can easily Down Load Own Medical Record for A Condition to get
Self Control/Management of them Meaningful Use Bonus
● Over 430,000 beneficiaries use Blue Button
since 2010/10 against projected number of 25,000.
http://medgadget.com/2011/09/why-blue-button-data-is-a-big-deal.html
http://www.ihealthbeat.org/articles/2011/10/11/hhs-more-than-430k-vets-using-blue-button-to-access-health-d

Medicare MS・Healthvault

ＶＡ・myheatlhevet Relayhealth・
PHR
ASCII Text Format

DoD・TRICARE Aetna・PHR
For iphone
and ipod use Iatric
Systems・
Patient
Portal
●PR Portal Site has opened
（http://www.bluebuttondata.org/）


■ Empowering People Providing Rich Info. 【MedlinePlus
Connect】
●Specified disease related information is provided from
MedlinePlus Library .
●Implementation is mandatory condition to get Meaningful
Use Bonus.
●A Type of Push Media to omit patient burdensome process
to get assured information.
Service Provider（including IT）
Clinical Code response Data

Patient Portal（EHR／PHR）

③Repository
①Input Code ④
・Clinical Reference
・Drug ② Pick up and
・Test Send Automatically
http://medlineplus.gov/connect
Generally, Patient have to Patient
MedlinePlus
search information by oneself

Drug Code response Data
Test Code response Data


■ Modeling Coordinated Healthcare Services
－ Accountable Care Organization（ACO）－
●Same Concept of Medical Home, providing integrated and customized
care service experiences to patients.
●Scheduled to start in 2012 as an initiative of Medicare Service Reform
Activities

ACO

Incentives
Participation for 3 year generated by patient（5,000～／
in a row reduching expenses year）
Hospitals Patientt
Doctor P
Nursing
Facilities High Safety
Efficient and P + Family
Care Health Effective Care
Facilities Center
EHR Tele Health P
Clinics P
Remote Monitoring
Providing Quality
Referenced HealthIT.gov, public
And Price Info. comment for ACO et al.

Managed Free Access Is Necessary or Achievable in Japan？

8 Digital Health Approaches in UK(1)
England

●Reviewing National Program for IT（NPfIT）, Program
scheme will be changed to more local NHS has responsibility
and budget control aiming to improve efficiency of the program.

●DOH will develop strategy for HIT market expansion allied
with industrial society, Intellect.

●Pilot testing Personal Health Budget in 42 areas aiming to
improve VFM through visualizing medical expense per person
and active choice of services.
Opt-in is required to use.

●NHS Evidence, a web portal of
evidence information about health and
medical care, is introduced to support
more informed choice.
http://www.evidebce.nhs.uk/


8 Digital Health Approaches in UK(2)
Scotland

● As following 3-year Strategy（2008-2011）, Developed 6-year
Strategy（2011-2017） targeted to digitize multiple data set .
・CHI ：Unique Patient ID, already applied
・PCR（Pharmacy Care Record）：Pharmacist use to support
appropriate medication for Chronic Patient who need medication for a
long period.
・ECS（Emergency Care Summary）：Prescribed medicine and
allergy information. 2010, 2.5 million summary are used.
・PCS（Palliative Care Summary）：Palliative Care related
scheduled to
information accessible while out of business hour are
start in 2014
added as new version of ECS.
・KIS（Key Information Summary）：Information consisted
from ECS, PCS and Care Plans are accessible
in any case.
Quality assured general portal
about health and medical info.
http://www.nhsinform.co.uk/

Portal about self-care info.
http://www.nhs24.com/
⇒Access via DirectScot, a Scottish
Government Portal, is plannned.


9 Digital Health Approaches in Oceanic Countries

Australia

●Patient Unique ID（14 digit）which is
necessary for HIE started 2010/7.
Total number of annual DL is over 24
millions and more than 1,180,000 are
activated.
●12 e-health pilot areas are selected.
● PCEHR（user must opt-in）will set to
start 2012/7.
● PCEHR Bill was introduced.

New Zealand

● Clinical Challenge, request ideas and concepts about
health ICT and select items to develop by IT vender, was held.
【finalist in 2011】
- Early warning scoring system
- Language interpreter for simple communication
- e-Referral to medical officers of health



■Healthcare ICT Trends in Private Sector■
～Information Design and Big Data～

10 PHR/PHI Market Movements（1）

Microsoft Growing its ecosystem through PC to mobile.
・Health Vault Shift its focus to Home Care Market ？

Recommended transfer alternative

Google Challenged to establish health info. sharing, but
・GoogleHealth
will stop it by the end of 2011（data transition
available through 2012）
Reasons ●Only few innovative customer used (not scale out）
●Accumulation⇒Big data⇒Value creation is hard to
achieve
●Hospital review on Google map looks same situation (a few
posted ）

Dossia Consortium growth is very slow and number of
implementation of this service in consortium member
looks stagnant.

Allied with Near Field Communication Forum and EU
Continua
Number of Consortium member is 264 as of 2011/10.
Microsoft joined at last.


■ Quest for Data Driven Healthcare

PHR／PHI
Digitally Archived Personal Health,
Beauty
and Wellness Data
≪not Data accumulation
Claims Data chasm interoperable≫ grows though valuable
outcome generation
stumbles.
input process outcome Value chain
Service Industry innovation is needed.
（2006）

Almost same projects
Government pilot projects （Japan） continued
with different names
Local Community
Health Industry Platform
Health ServiceRevitalize（2008） Deregulation（2010～）（2011～）
Industry （2004）
Regional health integrated
service industry（2009） Failure will
● Any Lessons from Past (Failed) Projects？ replicate
● Small Investment isn’t cause of Failure ？ Still there will any
chances for success
● Vast Invested US Health ICT initiatives are really
Successful ？ Or alternative ？

■ Designing information－①
●Technological solution (Single Sign On) has 1st priority？

User Provider
“I want (want to “User must want
see) these info.” (want to see)
these info.”

really matched？

Traditional Research
based conclusion
may・・・
almost
Easy
accessibility
is a key

http://www.karada.ft.nttcloud.net/
partly

But it may not good
in User’s Emotional
& Instinct Level
never
Alternative User Research Methods
such as Ethnographic approach are
Distributed by Suda Yasuji,
Required
2011

■ Designing informationｰ②
●Even local government sites change their
design , much of healthcare service sites
keep almost same looking (user interface)
Lack of design thinking
more than a year.
※a veryUnchanged Design &cloud
few sites introduced tag
2010.7 Continuity is most
important CSF ？

2011.10

Could you find any
effort improving
GUI？
namely user Experience


■ Designing informationｰ③ ●This leads to business model shift in Keas

Tried to provide PHR to consumer・・・ 2010

■ select suitable health & prevention plans,
set the goals, then execute
■ results are e-mailed weekly
■ applying wisdom of crowd（user feedback）

Shift to gamified healthcare 2011
solution for company use
■measuring health data will not create good
market（people don’t want to measure their
health） is the answer through 2010 trial.
■gamification will the CSF and company on the
target
■improving employee’s health status(phisycally
and mentally) leads to high productivity and high
ES
■Free to end user

Population
Social
approach per × ICT ×
http://info.keas.com/employee-wellness-tin game
company


■ Quest for healthcare ecosystem“From Parasite to Co-creation”

Withings

Data link with digital TV
(Panasonic)
is available in north American
region


●Health ICT ecosystem such as Withigs and healthvault are
Discussions not created in Japan. Is this a strategic decision ?
●Is it able to scale out in fragmented healthcare field ?

pedometer Activity monitor pedometer Blood pressure monitor

Player
Provider of measure
devices
【case A】【case B】
Omron Healthcare Tanita
Platform Owner
BMI scale
Publish API
【case C】
Of Health Planet
NTT docomo
Weight/BMI scale Blood pressure
monitor
synergy？
Data link with digital TV
(Sony) is available in Japan

Publishing Real Magazine

Link with
“eatsmart”
source：companies HP

Adding to LM,
Chronic disease management,
Cardio vascular diseases prevention,
Screening tests and Early diagnosis
Are focused categories.

Lifestyle management programs are process of
co-creation toward individual well-being

Improving program
Deep communication
adherence both short
（coaching ・・・）
& long term

source：Philips European Affairs Office”Active and Healthy Ageing – a Long-term View uo to 2050”
(2011/1/31) P7

11 Healthcare Big Data approach（1）
Actions for sophisticated use of digital data are accelerating

Info.
use Info. use Info. use
Info. use
Accumulated Accumulated Accumulated Accumulated
To the
Info. Info. Info.
Info. letter
Big Data

Open Innovation comes popular in
Healthcare ICT apps. development as well
as product development.
Many Governments start to support Open data Ｂｉｇ
initiatives. (Ｄｉｇｉ
ｔａｌ)
Ｄａｔａ
Advanced analytical technologies with low
cost computing power (cloud) bring
opportunities to analyze larger data set
and get valuable insights.

Advancing Open Innovation－1
【US・HHS】
●Open Government Data Initiatives related to health &
medicine “liberate data and catalyze innovation”

●“HHS Open Government Plan ver.1.1” an explanation
material
【focused area】 http://www.hhs.gov/open/
 mHealth initiative
 Health Data Initiative
 Startup America
 HHSinnovates
 Challenges & Competitions
http://www.data.gov/health

Since 2009, HHS has been providing
searchable Flu vaccination information on
google map (mashed up)
⇒MHLW of Japan doesn’t do this service
⇒What is the Reason？ Little demands？

http://www.flu.go
Distributed by Suda Yasuji, 2011 v/

【US・HHS（continue）】

【UK・DOH】 http://mapsandapps.dh.gov.uk/

http://challenge.gov/search?cat=25&org=5
イギリス・HHS

Healthcare Web Application
Developer Online Community
was held for 6weeks
from2011/8/22
・Ready-made apps assessment
・New apps idea contest
＜Total Number of posted＞

http://departmentofhealth.ideascale.com/


●Some applications picked up in Health Data Initiative Forum （2011.6）

Asthmapolis：http://asthmapolis.com
Enabling real/time monitoring of asthma
patients who use inhaler with sensors.
Analyzing monitoring data then send info.
about self-care to patients’ mobile devices.

Ｃommunity Commons：
Providing free supportive tools of healthcare services
use combining GIS data & free portal as learning &
exchanging place.
http://profiles.communitycommons.org/sit
e/#
Daily Feats：http://www.dailyfeats.com SleepBot：
/
Providing health related tips useful Mobile application for recording
for better quality of life. sleep time & providing insufficient
User can get points making actions sleep related hazardous data.
through using tips as they combined
with point program.

My Dietary Supplements： IMPAct：
Mobile application for recording, managing & Providing health check information based on
Cecking Information about Using Supplements. age & sex. Enabling appointment of health
Providing English version & Spanish version. check on Google Calendar.
http://ods.od.nih.gov/about/mobile/aboutmyds
.aspx
source：http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthData/List%20of%20Featured%20App


Advancing Open Innovation－4 ● Japan is still in experimental phase compared
to other governments.
http://openlabs.go.jp/
● Furthermore, activity are temporally stalled.
（accessed 11/7/2011）

Resume date is unreleased

Applying Cloud Source
in Medical Field High
New Strategy for Innovation of Information & Security
Payer Research Institute
Economy (2010/6) Anonymization
Claim Epidemiology
 People Seems to have great interesting about Data Mega Data Pharmacology
Open Government Movement(128p) Provider 1.8B/year
 We will develop platform based on Idea Box (above) Health
Record Strict Use
to collect & share citizen’s voices then combining them Management Anonymized ID
with policy making & executing processes(129p)
Source：METI Medical Claims Data Processing Infrastructure
Developing Project(2011)

R e c a p 1 1

Open Innovation comes popular in
Healthcare IT application development
as well as product development

Ｂｉｇ
Many governments start to support
(Ｄｉｇｉ
open data initiatives ｔａｌ)
Ｄａｔａ
Advanced analytical technologies with low
cost computing power (cloud) make
opportunities to analyze larger data set
and get valuable insights

In Japan，Consensus about non-profitability of
health/medical care is essential. Worldwide
dissemination of FREE health ICT applications
is critical as well
What can be connected to application
X？
Distributed by
Who pay the bill？ When and How ?
Suda Yasuji, 2011


■ Healthcare As Services ■

12 Healthcare as services （ 1）
Many sectors of society become somewhat Healthy.
Medicalization of Society will be stimulated.

Medicine Exercise & Play

healthy／
medical XX
healthy／
medical XX

Supplement PHR Occupation

healthy／ healthy／
medical XX medical XX

Diet Fashion
healthy／
medical XX

Though, many business players stick in
enclosing information as value source.
Closed System
～stumbling information sharing～
or Open System
～product prior to service～


Healthcare ICT Service Ecosystem Agreed in Meta-
Concept

Implementations are source：smart personal health final repot ,deliverable 6.1 (2011
http://sph.continuaalliance.org/docs/SPH_D6.1_Final_Report.
varied

【Case Study】 Digitizing personal exercise and health
data is already in place in Sports and Food Industry, but
there are no data platform across industry.

Own products user only
https://www.polarpersonaltrainer.com/

11 posted from user in 2011
http://www.movescount.com/
http://www.kao.co.jp/healthya/

https://www.polarpersonaltrainer.com/

Community Approach
Without Digital Health https://www.polarpersonaltrainer.com/
Data Handling Ability


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