Toward a clinical utopia

The potential of telemedicine in Japan

Text by Justin McCurry

There must be many urban residents of Japan who have arrived at a clinic or hospital and — recalling the crowded waiting areas, treatment rooms lacking privacy and consultations that seem to be over before they have even begun — thought twice about stepping through the doors.

Rural areas of the country face a more serious problem. Ageing communities are placing greater demands on already overstretched clinics, and this has prompted a rethink of medical practice provision and the role technology can play in delivering healthcare services remotely.

Part of the answer lies in telemedicine — the use of communications and information technology in medical diagnoses and treatments. The “tele-” prefix now accompanies a host of clinical fields, from cardiology and pathology to dentistry and psychiatry.

In August 2015, Japan’s government approved the use of telemedicine throughout the country, and not just on outlying islands and remote locations, as had been the case since 1997.

Now, hundreds of medical institutions routinely use online consultation. Yano Research Institute, a market research company, says Japan’s telemedicine market is expected to be worth ¥19.9 billion in fiscal year 2019, compared with ¥12.2 billion in fiscal 2015.

The benefits of telemedicine to both patients and doctors are self-evident. It allows health professionals to collaborate regardless of their location and gives patients a direct line to doctors regardless of where they are based, noted Jun Ito, a professor in the faculty of nursing at Hyogo University and the co-author of an October 2017 paper on the subject for the Journal of Telemedicine and Telecare.

While remote diagnosis and health monitoring are not new, technological advances are expected to further bridge the communication gap between patient and doctor, according to Ito.

“I expect to see improvements in wearable, remote devices to monitor things such as blood pressure, blood glucose, and oxygen saturation,” he said.

In Japan, cardiology and hypertension are major areas of clinical interest, according to Dr Sisira Edirippulige of the Centre for Online Health at the University of Queensland in Australia. But there are many others.

“Diabetes, heart failure, stroke and mental health are diseases that feature in telemedicine around the world and those are also the focus of Japanese telemedicine,” he said. “Geriatrics has also been featured for obvious reasons.”

Telemedicine is spreading to urban areas as well, where patients use smartphone apps that allow them to make appointments and enable them to talk with doctors in real time.

Experts believe telemedicine will help prevent lifestyle-related conditions and diseases such as high blood pressure and diabetes, increase efficiency and reduce the burden on family members who act as primary caregivers.

“The impact of telemedicine will not be limited to the ageing population, but to a whole spectrum of demographics and disease groups,” Edirippulige said.

In addition to more effective prognoses for patients, the nation-wide use of telemedicine in Japan has presented opportunities for Japanese and European companies with proven track records in telemedicine products and services.

Medtronic, one of the world’s largest medical technology, service and solutions firms, with headquarters in Ireland and the US, has developed a range of telemedicine products, including insertable cardiac monitoring systems.

“For people with chronic diseases like diabetes and heart conditions, managing their condition is a lifelong collaboration with healthcare teams,” said Ayako Ichimaru, a Tokyo-based spokesperson for Medtronic Japan. “We have made the process easier with our remote monitoring systems, which allow patients with certain insulin pumps and heart devices to download information captured by their device and transfer that data via a secure server to a website. This creates a seamless link so everyone has the information they need to make smart, timely healthcare decisions.”

The Swiss company Roche Diagnostics makes digital pathology products such as iScan HT, a whole image scanner; and Virtuoso, an image management system.

“There are not enough pathology specialists in Japan,” said Chiaki Kawasaki, senior manager of Marketing Tissue Diagnostics and Sequencing at Roche’s Japan unit. “Our digital pathology products enable professional consultation at many hospitals and clinics where there are no pathologists.”

Makoto Ogasawara, president and CEO of Roche Diagnostics in Japan, said the firm would invest heavily in the use of big data, artificial intelligence and the Internet of Things over the next decade to create a “clinical utopia”.

“I hope that Japan will become one of the leading countries in telemedicine, including teleconsultation, telepathology and telecare,” Ogasawara stated. “We need agility in government systems, regulatory systems; and to swiftly put these new changes into the system.”

The German medical technology firm Dräger has its expertise in the field of acute care.

“Telemedicine is helping in the monitoring of clinical outcomes and the success of rehabilitation after acute care treatment,” says Holger Klein, president and representative director of Dräger Medical Japan. “Dräger is not currently involved in the development of telemedicine, but we prepare our products to be part of a networked environment and are developing remote monitoring solutions, including tools for mobile devices in a hospital network.”

Data collected from acute care and from post-clinical observation helps clinicians improve operational processes and, in turn, the long-term outcome of clinical interventions.

“The combination of hospital monitoring and IT systems with remote medical technology via telemedicine will improve patient safety, medical outcomes and efficiency,” adds Klein.

However, there are some downsides to telemedicine. The cost of telecommunication and data management equipment, along with technical training for medical personnel, can be high. There is also evidence that some consultations carried out virtually can take significantly longer than face-to-face interactions. And the absence of a direct link between patient and doctor has prompted doctors in Japan to stress that telemedicine should complement conventional medical practice, not replace it.

Given its clear potential to improve efficiency, reduce costs and deliver better and safer health care, the response to telemedicine among Japan’s clinical sector has been largely positive, while patients are beginning to value the independence that technology can give them, according to Edirippulige.

“The use of mobile devices for providing care,” he said, “has great potential for empowering patients to take more control over their health.”  •