1 - ITU

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
1
Will show results from several projects on
e-health in Japan
a
(a) to identify major problems and barriers
preventing efficient and effective e-health
system building in Japan,
a
(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.
2
PROBLEMS
Uneven
distribution of
resources; severe
shortage of doctors
in many areas
The elderly care
and home care are
not systematized
and very much
inefficient.
The cost of health
care for the aged is
growing rapidly.
Costs of PC and
internet access
cause a problem
for the elderly.
SOLUTIONS
Use of database
and telemedicine
to share
information and
resources.
Promote preventive
medicine to reduce
the total costs.
Policies to
reimburse a part of
ICT.
Employ
“community
model.”
BARRIERS
PHR/EHR and
other database
systems lack
standardization.
Multi-investment
on ICT systems
due to lack of
inter-operability.
Laws and
regulations work
as barriers.
Many medical
laws were made
before internet.
Need to
formulate proper
policies to use tax
money to induce
incentives.
PROBLEMS
Uneven
distribution of
resources; severe
shortage of doctors
in many areas
The elderly care
and home care are
not systematized
and very much
inefficient.
The cost of health
care for the aged is
growing rapidly.
Costs of PC and
internet access
cause a problem
for the elderly.
SOLUTIONS
Use of database
and telemedicine
to share
information and
resources.
Promote preventive
medicine to reduce
the total costs
Policies to
reimburse a part of
ICT costs.
Employ
“community
model.”
BARRIERS
PHR/EHR and
other database
systems lack
standardization.
Multi-investment
on ICT systems
due to lack of
inter-operability.
Laws and
regulations work
as barriers.
Many medical
laws were made
before internet.
Need to
formulate proper
policies to use tax
money to induce
incentives.
PROBLEMS
Uneven
distribution of
resources; severe
shortage of doctors
in many areas
The elderly care
and home care are
not systematized
and very much
inefficient.
The cost of health
care for the aged is
growing rapidly.
Costs of PC and
internet access
cause a problem
for the elderly.
SOLUTIONS
Use of database
and telemedicine
to share
information and
resources.
Promote preventive
medicine to reduce
total costs.
Policies to
reimburse a part of
ICT costs.
Employ
“community
model.”
BARRIERS
PHR/EHR and
other database
systems lack
standardization.
Multi-investment
on ICT systems
due to lack of
inter-operability.
Laws and
regulations work
as barriers.
Many medical
laws were made
before internet.
Need to
formulate proper
policies to use tax
money to induce
incentives.
telemedicine proved very effective as a preventive approach
before
after
BMI
abdominal circumference（cm）
highest blood pressure (mmHg)
25.0
95.0
24.5
90.0
24.0
160.0
155.0
150.0
145.0
140.0
135.0
130.0
125.0
120.0
23.5
85.0
23.0
80.0
22.5
22.0
75.0
21.5
21.0
70.0
total A
B
C
D E
F
total A
G
B
C
D
E
F G
nuetral fat (mg.dl)
lowest
blood pressure (mmHg)
105.0
B
C
D
E
F
G
HDL cholesterol （mg.dl) higher the better
250.0
60.0
55.0
200.0
95.0
total A
50.0
150.0
85.0
45.0
40.0
100.0
75.0
35.0
50.0
65.0
total
A B C
D
E
F
G
blood
sugar (mg.dl)
180.0
30.0
total
A B C D
E
F
G
total A
B
C
D
E
F
G
HbA1c(%)
160.0
140.0
5.6
□marked
120.0
5.4
improvement in
most districts
5.2
n = 75
100.0
80.0
5.0
60.0
total
A B
C D
E
F
G
total A B C
D
E
F
G
6
long term effect of telemedicine proves good
Transition of test scores in 4 years starting in 2008
参加者のリスクの変化（リスク保持数の変化）
100%
3
1
3
90%
2
1
3
1
4
2
6
80%
9
16
70%
12
16
23
#
of
low
risk
group
increased
21
13
60%
50%
12
15
40%
30%
19
11
17
13
12
20%
# of high risk group decreased
10%
4
5
6
5
5
9
7
4
0%
2
①200811実施 ②200903実施 ③200909実施 ④200912実施 ⑤20100３実施 ⑥201005実施 ⑦201009実施 ⑧201101実施
リスク保持数４
リスク保持数３
リスク保持数２
リスク保持数１
リスク保持数０
※# of risk factors
among blood
pressure, blood
sugar, fat
metabolism and
lever functions
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
worsening
（*=P<0.05、**=P<0.01）。
8
PROBLEMS
Uneven
distribution of
resources; severe
shortage of doctors
in many areas
The elderly care
and home care are
not systematized
and very much
inefficient.
The cost of health
care for the aged is
growing rapidly.
Costs of PC and
internet access
cause a problem
for the elderly.
SOLUTIONS
Use of database
and telemedicine
to share
information and
resources.
Promote preventive
medicine to reduce
total costs.
Policies to
reimburse a part of
ICT costs.
Employ
“community
model.”
BARRIERS
PHR/EHR and
other database
systems lack
standardization.
Multi-investment
on ICT systems
due to lack of
inter-operability.
Laws and
regulations work
as barriers.
Many medical
laws were made
before internet.
Need to
formulate proper
policies to use tax
money to induce
incentives.
communities with high social capital leads to better results
City of Kurihara, Miyagi
City of Okutama, Tokyo
A
F
8
7
G
改
善 6
項
目 5
数
4
K
E
B
11
I
C
J
H
y = 4.7416x - 11.169
R² = 0.6249
3
2
3.0
3.2
3.4
3.6
3.8
ソーシャル・キャピタル指標
% of the elderlys with
ADL
or higher
# of blood test
scores
improved
100.0%
9
4.0
人口集積地
平野部
中山間地域
山間地域
90.0%
80.0%
Ａ
Ｄ
Ｌ
が
１
１
点
以
上
の
割
合
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
つきあいの人数（「ある程度の人との面識・交流がある」以上の割合）
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.
10
Community with high social capital
Complete ennumeration of 14,781 persons older than 65 years
of age in 6 districts行政区別地域特性（６地区全体）
in Kurihara City (160 wards in all)
3.00
higher health index
若柳
栗駒
高清水
金成
志波姫
花山
2.00
テレビ電話相談実施地区
1.00
0.00
-3.00
-2.00
-1.00
0.00
1.00
2.00
3.00
-1.00
-2.00
-3.00
higher social capital
11
PROBLEMS
Uneven
distribution of
resources; severe
shortage of doctors
in many areas
The elderly care
and home care are
not systematized
and very much
inefficient.
The cost of health
care for the aged is
growing rapidly.
Costs of PC and
internet access
cause a problem
for the elderly.
SOLUTIONS
Use of database
and telemedicine
to share
information and
resources.
Promote preventive
medicine to reduce
total costs.
Policies to
reimburse a part of
ICT costs.
Employ
“community
model.”
BARRIERS
PHR/EHR and
other database
systems lack
standardization.
Multi-investment
on ICT systems
due to lack of
inter-operability.
Laws and
regulations work
as barriers.
Many medical
laws were made
before internet.
Need to
formulate proper
policies to use tax
money to induce
incentives.
Information sharing “low cost” network connecting all related players
in the City of Miyako
drug stores
hospital
clinics
patient ID
certification of
users
information & resource
sharing
care businesses
standar
formalt DB
general
groupware
Practical implementation
to share basic information
and to promote
collaboration by many
different players in the
health field.
dentists
visiting nurses
patients at home
Back up of date
data center
at remote cite

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