ehealth in japan

～ viewpoint from big data and service ～

2011.11(J E translation in 2012.3⇒ ）

■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

Business Opportunities with Healthcare ICT

Yasuji 　 Suda 　 [email protected]

■Characteristics of Healthcare Industry■

Expectations and policy trends about 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

◆◆Health in Japanese Laws◆◆

【 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

【 Medical Care Act Article 1-2 】 This Act ・・・ aims to contribute maintaining our citizens health by Protecting Interest of medical care recipient and trying to 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 　

※ 　 Describe Health as Wellness

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

source ： http://www.definitionofwellness.com 　

Distributed by Suda Yasuji, 2011 　　

Are these definitions conformant with Health that consumer think or

conscious nowadays ？

Are these definitions conformant with Health that consumer think or

conscious nowadays ？

Charles B. Corbin

This is not formal translation

Concept of healthcare field

Public Private Partnership

Consumer Goods& servicesSocial Security

Politically Concerned

Health

PubliclyCovered

Health

PersonallyConsuming

Care

Insured Health Health maintenance & self-care

1 　 Healthcare Field （ 1 ）

Healthcare means ・・・　

　　　　　　　 Health is contributed By Someone’s

CareBy 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 Necessity

Service is picked by user

？



Physiologically

Safety

Esteem

Love/Belonging

Self-Actualization

【 Service provided as SS 】Quality Of

LifeCommodity

Life Support

【 Service provided in Market 】Value For

LifeSpecialty

Life Design

PoliticallyConcerned

Publicly Covered

PersonallyConsuming

Insured Health

？Health

Maintenance & Self-care

Maslow’s Hierarchy

CareBy Professionals

Acute

Self-care

Proactive

Reactive ElectiveProcedure

Chronic

Elevated

Risk Factors

Fitness

Wellness

mng.Home care &Independent Living

Rehabilitation

Disease

Mng.AssistedLiving

ActiveHealth

Insured Health Health Maintenance& Self-care


Connected 　 by Home Appliances

（ Health Data Available ）？

Emergency Care

Elective Care

　　　　　 indicate

need of coordination

among care settings

source ： Technical Research Center of Finland ” Ecosystem of PHR based products and services”2009


■ Mapping Healthcare Categories

－ Relation among Health, Prevention &Medicine － time

Healthy

Superior Healthy

Pre-Onset

OnsetDiseases

ＡGo Severe

Ｂ

Ｃ

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

It is not generally speaking that increasing effect of medical costof Advancing New Medical Technology is Higher than that of Population Aging.

2 　 Healthcare Market Review （ 1 ）


●Disease Onset will Avoidable through Prevention ?

●Disease Advance will Preventivethrough Early Intervention ?

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 ）

Assuming Healthcare has Potentially High Growth &

Revenue Chances

But providing healthcare services as Public Service may leads to increase SS cost

Intrinsic Motivation to develop New Medical Technology

New Tech. based products & services are usually costly & uncovered by insurance

Managed Care Transferring cost to User

User may avoid using them if though they can get high utility

Insurance coverage alleviate high user cost & facilitate its useContaining SS budget growth

through effective & efficient services

People are Econs ?

Paradoxical Mechanism


Socialization of Medicine（ Black Hole ）


Think & Act with economic rationality, without emotions

Cutting Payment Price to

Providers

・ High Cost・ Duplicate・ Redundant

・ Increase OOP Payment・ Delist from Coverage

“something new for love/someone”

Visit

Repeated Use

Admin.Work

ClinicalWork

Admin.Work

PrescribingWork

OutcomeOccurs

●Studying Individual Behavior, Information &Monetary Flow in Healthcare Services are Needed

Daily LifeHealth Nudges

Info. Collection Consideration

Keep Daily Life

Health Conscious Behavior

3

Account

Default

Curative Healthcare

Self Medication

2 4

4 3

4 3

Focal Point

Repeated Use

Worsening Own Health by Self-Care

・ Low adherence to medical Instructions・ Inappropriate Usage

Back

●Non-Profitability is Required but it is also an Economic Activity

1 expectationChoice& Use

PurchaseKeep Rule BasedActions

OutcomeStables

OutcomeOccurs

UsageEat/Drink/Spread



expectation

expectation

Account

Account

Account

Account

Account

Account

Save Use

From Think to Act

Info. Collection & Consideration process are often cyclic

Health SystemCommunity

Policy & Resources

Medical Facilities (Providing Care Services)

Self-Management Support

Delivery System Design

Decision Support

Clinical Information Systems

Improved Outcomes

Ex. Wagner’s Chronic Diseases Care Model

Productive InteractionsInformed, Activated

Patient

Prepared,Proactive

Practice Team


■ Points of Coordinated/Seamless Care


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

◆Healthcare paradigm shift is enable to select sophisticating services in Cure & Care by User rather than moves from Cure to Care

◆Bridging Cure & Care needs creation of system which User & Provider can select either without any hassle


ICT Implementing Opportunity

Sophisticating

ICT（ Data Driven ）

Cure CarePalliativeSupportiveLess invasive

Responsive service in

critical times

Go Ambient

■ Coordinated/Seamless Care & ICT


Selective


■ Coordinated ＆ Seamless Care Modeling


Referenced HealthIT.gov, public comment for ACO et al.

patient （ 5,000 ～／year ）

+ Family

ACO

Incentives generated by

reduching expenses

P

P

Patientt

P

P

Participation for 3 year in a row

High Safety

Efficient and Effective CareCare

Facilities

NursingFacilities

Hospitals

Doctor

HealthCenter

Clinics

Managed Free Access Is Necessary or Achievable in Japan ？

EHR Tele Health

Remote Monitoring

Providing QualityAnd Price Info.

●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

－　 Accountable Care Organization （ ACO ）　－

Digitization in Healthcare

●Reform Priorities

●Reform Approachesdiscussions

Clinical

Front Stage Tasks Related to Clinical Procedure （ Diagnose, Test , Care & Operation ）

Administrative

Back Stage Tasks Related to Medical Claims Processing （ Check & Pay)

3 　 Health ICT （ 1 ）

HIT ： Healthcare Information Technology

(HICT means same)Digitization in Medicine

E-Health, Tele-Health

Health 2.0, m-Health

EMR, e-claims

Digital Health

HIEHIE

－ Top-down－ Bottom-up－ Module－ Building-blocks

Daily Life have so many touch points that can lead to good opportunities for healthcare intervention ?


■ Framework of HIT adaptation

EHR

PHR

EMR EMR

EMR

Managing Health Risks in daily life

Connected Health


■ Types of Digitized Health Info.

3 　 Health ICT （ 2 ）

Coordination among Care Settings

（ Cure ）

■Healthcare Policy Trend in Japan■


■Aspect of Social Security Reform

●Reform service provisioning systems to improve efficiency & effectiveness in accordance with character of each Local community introducing needed legislations


Source ： SS Reform HQ （ 2011/6/30 ）

● Reform health & long-term care insurance systems as safety net through strengthen payer’s roles

・ Rearrange hospital functions & create coordinated NW. among them

・ Reduce community & subjective clinical gaps

・ Improve home care services

・ Strength outpatient visit management

・ Reduce duplicate/avoidable visits, test, and over prescribing using ICT

・ Study about introducing a fixed amount OOP payment including low income households

・ Promote generic drug use

・ Increase OOP payment for prescribed drug

・ Reform senior health insurance system, a sub system of national health insurance system

Long term un-dissolved issue

without effective solutions

Need to set theme for Big Data analysis

・ Separation of drug coverage ？　（ Medicare part D in Japan ）・ Reference price/price capping

Formally proposed as exemption of a fixed amount

4 　 Health System Reform Trends in Japan （ 1 ）

Integrated Reform of SS & Taxation

【 evolution of openlabs.go.jp 】



●Japan Council for Quality Healthcare Released “Medical Accidents Annual Report 2010”

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

？？？

Representiveness

No. of Reported Accidents ： 2,182 （ Death182 ）No. of Participating Facilities ： 850 （ 2010.12 ）No. of Participating Facilities ： 1,015 （ 2010.12 ）No. of Reported Incidents ： 25,305

http://www.med-safe.jp/

≪Total No. of Facilities is over 100k≫

●Many Medical Accidents are broadcasting

Source:Fresheye News Clip

■How to Assess Quality of Medical Care

Systematic problems though, tend to consider as personal or organization’s partial matters.


A Medical Sponge had been left into Patient body for 22 years.

A Patient died after mis-diagnosis

A Medical malpractice caused brain death

New Growth Strategy⇒⇒Realizing New Growth Strategy in 2011

Green Innovation

Life Innovation

New Approachesto Asian Economy

Inbound Tourism coupling with Regional Vitalization

Advancing Science, Tech. & ICT

Employment & HR

Source ： New Growth Strategy

●Make medical, health & long term care industry driver of economic growth

●Promote R&D for Japan origin innovative drug & care tech.

●Strength care service infrastructure to support Healthy Long Life

●Promote barrier-free housing

●Progressive export to abroad


Finance

●Achieve safe senior life in local community

【 National Policy Unit’s Focus 】

・ Facilitate use of new medical technologies & services

・ Promote inbound medical & health tourism

Matter of deregulation

●Health Related Services　　 Market 　 \25billion　　 Employment 0.8million

●Medical & Care 　　 Market \78billion　　 Employment 201million

■Aspect of Economic Policy －①

New Businesses ？Price competition ？(Commoditization)



Life Innovation WGPoints of deregulation

●Dissolving man power inappropriate allocation & shortage, increase number of students constantly with projection of needed man power

●Redefine area of coverage which public insurance should cover including preventive care

●Improve quality and efficiency of medical care through information sharing & applying new technology in clinical setting

●Promote & support consensus for self- health management through empowerment

●Facilitate combination and coordination of medical care & non medical care services to create New Business Opportunities

Provider’s ViewAdding User’s View ・・・

Good service encounter and efficient back end process are key

Quantity is key for better quality

Financial constraint allow prevention with little evidence?

Evidence of prevention are able to accumulate ?Networking of

providers is essential

Co-creation process with User is important

Financial constraint shift cost & responsibility to one

Med/Health tourism is easy to make and grow well ?

Service process innovation is key

Creation of high User friendly interface is key

Secondary Use & Big Data may be Drivers to

Innovation

－ now －　－ future －　

Distributed by Suda Yasuji, 2011 　　Source ： Cabinet Office, Sub Committee about Deregulation

■Aspect of Economic Policy －②

Report about Deregulation （ 2011/7 ）




Healthcare Related Project Proposals in New Special Zone from 2011

Intl. Strategic Special Zone ／ Tsukuba City

TeleMedicine Special Zone ／ Iwate Pref.

Medical Care Service Community ／ Hinoemata

Villiage

Active Health Special Zone ／ Kamogawa City

Smart Wellness City ／ Niigata City, Gifu City et al.

Naturing Wellness Special Zone ／ Myoko City

Leading Edge Medicine Special Zone ／ Shizuoka

Pref.

Lifetime Health Record Special Zone ／ Nagahama

City

Intl. Medical Exchange Special Zone ／ Izumisano City

Healthy Long-Life Special Zone ／ Okayama City

Regionally Coordinated Care Special Zone

／ Onomichi

City

Integrated Regional Medical Service ／ Tokushima

Pref.

Medical & Wellness Service Special Zone ／ Kagawa Pref.

Health Promotion Town ／ Matsuyama City

Medical Valley Special Zone ／ Ooita & Miyazaki Pref.

Source ： Cabinet Office. List of Special Zone （ 2011/10 ）

Leading Edge Medical Industry Promotion ／ Kobe City →Continued Under Kobe Medical Industry Vision Clinical Internship Promotion ／ Odawara

City & Rumoi City

　 → Continued Medical & Welfare Industry Promotion

／ Ootawara

City

　 → Further Deregulation has executed to enable this promotion nationally Genesis of Medical Valley ／ Tsu City

　→ Continued Under Medical Valley Project Bio-Me Industry Promotion ／ Kanagawa

Pref.　→ Continued 1 Clinic to Provide Advancing Cosmetic Surgery

Healthcare related Projects under Special Zone Since 2004

Source ： Special Zone for Structural Reform

Many Bio-venture Companies are far below from expectations. Success? Failure?

●Will economic growth and job creation be promised success in New Special Zone?

■Aspect of Economic Policy －③



MIC

Aso Regimei-Japan Strategy

Hatoyama ・ Kan Regimes -New Development Strategy “Life Innovation”

Abe Regime-IT New Revolution Strategy-Innovation25

ICT supported Tele Medicine System

A Study Group of New Health Services applying PHR

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

JapanEHR

Fukuda Regime-IT Policy Road Maps

METI

Ubiquitous Special Zone

Info. Grand Voyage The Consortium for the Promotion ⇒ ⇒of Next Generation Personal Services

Local Info. Platform Initiatives

Health Related Services

Healthy Long Life

（ Residents Health Portals ）

Service Tourism／ Inbound Med & Sightseeing

・ Lifetime Health Management by oneself・ Citizens e-Private Box・ Social Security Card

5 　 Digital Health Approaches in Japan （ 1 ） ●So many initiatives but little advancement in

health info. digitizing strategies for 5 years.


・ Citizens ID Number・ Unique Number for SS & Taxation

Intl. Medical Partnership

Japan EHR Facilitation Program

Haraguchi vision （ EHR for All by 2015 ）

⇒ ⇒

⇒ ⇒ ⇒

■HIT 　 Policy Movements

⇒ ⇒ ⇒

Projects for Infrastructure of Health Related Info. Usage

Source ： IT HQ ・ Healthcare TF


Drug e-Hand Book

■4 Major Categories of HIT

Completing Vision of “Virtually Replicated My Clinical Setting”

Completing Vision of Seamless Coordinated Medical Care in Regions

Toward More Efficient Medical Care Analyzing Claim Data

Facilitating Safer Medication By Using Drug DB

○Studying Architecture of Virtual My Hospital○Facilitating medical/health Info. digitization

○Model Network Development, Execution and Assessment

○Trial Use of providing data to 3rd Parties○Development of Data Use Technologies

IT HQ’s IT Strategy in Medicine is consisted in 4 CategoriesBut it lacks user (patient) perspective

10million Patients

○Advancing Medical Database Infrastructure

Development Program

Individually participating diseasemanagement services are still conceptual. There are No descriptions what value patient get & What valueco-creation process between patientand provider are required.

5 　 Digital Health Approaches in Japan （ 2 ）

1

2

3

4


Drug e-hand book & Opt in Type Disease Management Service are Newly Added in Updated Road Maps.

Former Planned Services are

giving patients more clinical &

administrative info. to Empower.

changed


5 　 Digital Health Approaches in Japan （ 2 ） a

Source ： IT HQ （ 2011/8 ）

IT 　 HQ ： The New Strategy in Info. & Communications Technology Road Maps （ Updated ）

New

Implementing Virtually replicated My Clinical Setting 　 (Dokodemo 　 My Hospital ）

Virtually

ReplicatedMy Clinical Setting

Drug

Info.

SpecificClaim Info.DischargeSummary

Health CheckInfo.

Test Result

Daily Health

Info.

Schedule Changed

Phase1Drug e-hand book

New

Phase2-2e-Discharge Summary

e-image report

Phase2-1Opt-in type Disease

Mgmt. Service

METI MIC

Data Exchange Standardization

METI MHLW

METIUse Case pilot testUse Case

pilot test

MIC

MHLW

METI

Use Case pilot test

Cab. Office MHLW METI MIC

In case that clinically duplicate/redundant medical tests but patient still want todo them, Whether Withdraw or Execute those

tests lead to better healthcare service for patient ？



5 　 Digital Health Approaches in Japan （ 2 ） b


IT 　 HQ ： The New Strategy in Info. & Communications Technology Road Maps （ Updated ）Establishing Seamless, Coordinated Community Based Medical Care

Tele Medicine

Incentives

E-Care

Autopsy Imaging

METI

MHLW

MHLW

MHLW

METI

METI

Cab. Office

Cab. Office

MIC

METI MICMIC

MHLW

MICMETIMIC

MICMIC

Cab. Office

Cab. Office Cab. Office Cab. Office

RegionalMedical Care NW

Inter-RegionalMedical Care NW

Cab. Office

Continuing Financial Support

Dissemination of Tele Medicine

Establishing Coordinated Medical & Long-term Home Care Model

Establishing ・ Coordinated Medical Care Models for Targeted Diseases・ Seamless, Coordinated Community Based Medical Care NW

Implement

Studying E-Prescription

METI MHLW MIC

Use Case pilot test

Studying Disaster Proof Health Info.NW

MHLW METI MIC

Use Case pilot test

MHLW

MHLW

MIC MHLW METI

Use Case pilot test

MHLW

MHLWDeveloping Guideline

MHLWFinancial Support

MHLW

Cab. Office

MHLW

MIC

METIUse Case pilot test



5 　 Digital Health Approaches in Japan （ 2 ） cIT 　 HQ ： The New Strategy in Info. & Communications Technology

Road Maps （ Updated ）


Usage

Provision

Types of Info.

DPC

Claims

Data

HospitalClinicalInfo. &Medical expense

Added

Improving Efficiency of Medical Care Using Medical Claims Data etc.

MHLW

MHLW

MHLW

MHLW Cab. OfficeMETI

Clinical & Admin. Efficiency

・ Provider Use

・ Payer Use

Use for Improving Efficiency

MHLW

MHLW

MHLW

・ Use Case Pilot Testing

・ Business Model Exam. 　 IncludingLegal aspects

Expertise Panel

Research & Study about Medical Claim Data Use for improving Medical Care Efficiency

National average data of Insurers expenses & clinical data of medical facilities are added in updated road maps. On the other, integrated usage among secondary Data Base is deleted.

METI MHLW

・ Studying Published Data Anonymization・ Reviewing Data Security Technology・ Developing Analytic Technology for Big Data

• Claim Data• Health Check• Coding Data

DPC DataPharmacoEpidemic Data

Other ValuableData

Hospital& PayerData

Exam. About Providing of national average data

ここを変更する！


Promotion of Medical Drug & Device Safety Assurance Initiatives Using Drug Info. DB

Types of Info.

Drug Research

Drug Research

Usage

Provision

Claim DataE-Clinical DataDPC Data

Other valuableData

MHLW

MHLW

MHLW

MHLW Cab. Office

MHLWResearch on usage by pharmaceutical companies

MHLW

Creation of NetworkAccumulating High Volume Data

Platform Development Project for DBof Medical Info.

MHLWMHLW

MHLW

Phase 1 Phase 2

MHLW

Rules for use of e-clinical data

MHLW

MHLW

Drug Adverse Info. Collection & Review

Exam. For DB Architecture

MHLWStudy of Provision Framework

IT 　 HQ ： The New Strategy in Info. & Communications Technology Road Maps （ Updated ）

・ Tohoku Univ. Hospital・ Chiba Univ. Hospital・ Tokyo Univ. Hospital・ Hamamatsu Med. Univ. Hospital・ Kagawa Univ. Hospital・ Kyushu Univ. Hospital・ Saga Univ. Hospital・ Kitasato Univ. Hospitals

・ NTT Hospitals・ Tokushukai Hospitals

10 million Patient Info. Repository

Distributed by Suda Yasuji, 2011 　　Source ： IT HQ （ 2011/8 ）

5 　 Digital Health Approaches in Japan （ 2 ） d


Community based Health Info. Platform

Broad Band

Health Check DB

Clinical DB

Long term Care DB

Record, Store & Retrieve

Community Based Coordinated Care Unit

Pharmacy Clinic

Nursing Care Facility

Home MedicalCare

Local-Hub Hospital

Tele-consul.

Health Coaching

SpecialistUniv.

Hospital

Other Communities in same Prefecturepatient

Municipal health staff

Network of networks

standards based interoperablenetwork

Local Network A

separated from each other

Local Network B Local Network C

A National Approach about “Network of networks”

was to set at last !

Source ： MIC, Action Plan 2012

？●Adding to IT HQ’s Open Network Initiative, MIC is planning to develop Japan EHR Network as Closed Network Initiative.⇒Will they interact effectively ？

Source ： IT HQ Healthcare TF （ 2011.5 ）


Applications Development

on Local Gov. Info. NW

Applications Development on Exclusive Health

Info. NW

5 　 Digital Health Approaches in Japan （ 3 ）■Pilot Programs for Inter-Regional HIE ①ｰ

Prescribed Info. Coordination

Region 2 ： Kagawa Pref.（ Takamatsu, Miki & Sanuki ）

Region 3 ： Hiroshima Pref.（ Onomichi. Fukuyama & Mihara ）

Medical & Nursing Care Coordination

Open Patient Card & Emergency Care

Coordination

Region 1 ： Shimane Pref.（ Izumo, Oota & Hikawa ）

Source ： MIC Outline of Japan EHRDistributed by Suda Yasuji, 2011 　　

Whether These 3 Applications

Should Run on One Common

Platform or Multi-Platforms is not

Clear

■Pilot Programs for Inter-Regional HIE ②ｰJapan EHR Developing Program （ a part of health info. Coordination Infrastructure Deployment ）


Issue3 ： Incentives to slow disease advancement using HIT

Source ： IT Strategic HQ ・ Healthcare TF

Year 1 Year 2 Year 3 Year 4

pilot project phase

In case of operation stops by financial shortage

implement cost running cost

assigned budget

required budget

actions for budget

Specify Benefits of Information Sharing

Measure & Analyze ROI

●Issue 3 ： Incentives to slow disease advancement using HITPast pilot HIT programs to create regional coordinated care often failed because they can’t get sound finance after governmentgrants period ended. Therefore, it may be necessary to provide service providers with financial incentives for continuing business.


■Concerns about HIT Business Model

Re-defining Profitability of

Healthcare Business Is Essential

(For profit Not for profit No profit)

●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.

Financial Incentive isn’t enough

Information Nudging (Information Design)

is also needed



Requiring non-profitable insured care but vague, abstractive words onlegislation & rules

■Fragile Insist of “Implementation of HIT should Do”

2011.3.11 Catastrophic Disaster in East Coast JapanPaper 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 PHRcould be useful in case of these urgent situations.


☆IT Strategic HQ ・ Healthcare TF☆EHR enterprise facilitation committee

Switch & Execute Alternative Logistic Systems Smoothly to Supply Medical Stuff & Staff in Emergency Is further important

Than Digitizing Patient

Information.

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


Tohoku Univ.

Medical Mega Bank

・ digital health・ tele medicine・ health info. NW

LocalCompanies

LocalColleges

Alliance National centersNational Univ.etc.

Health Mgmt. for Victims

Reconstruct Medical Care Systems

Tohoku Region

Create New Medical Businesses

Contribute to develop solutions for scarce medical resources

Medical Innovation facilitating disaster

recovery

Next Gen.

medical researchNext Gen.

Bio-med informatics

interaction

Ex. Tohoku Medical Megabank


Healthy

DiseaseOnset

NormalCondition

time

Insured Clinical Care

Insured Clinical Care

Operation&Rehabilitation

②Customized Services responding Personal needs

③Services for prevention of readmission & disease advance

①Services for health maintenance

④Services for Terminal carein home

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 .


6 　 Healthcare Service Policy Frame in Japan （ 1 ）■Services as Life-Medical Industry

Applying to the chart of P5

HealthySuperiorHealthy

Pre-onset

Disease

Onset

ＡGo Severe

Ｂ

Ｃ

④

②③①

source ： METIthis isn’t formal translation


■Services as Smart SystemStrategy for Smart Convergence

Smart Healthcare （ System ）

Combination pulling patient to Japan and pushing out Japanese medical

service system to abroad

Revitalize healthcare industry through developing international seamless medical care NW.

●OECD’s Medical Tourism ： Treatments, Markets and Health System Implications ： A scoping review （ 2011 ） pointed.

●Vague strategy for Medical/Health tourismJapanese Government has no numerical targets.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

Be Cautious !

http:www.oecd.org/dataoecd/51/11/48723982.pdf

6 　 Healthcare Service Policy Frame in Japan （ 2 ）

“During the 20th century, wealthy people from less developed areas of the world travelled to developed nations to access better facilities and highly trained medics”

http://www.dbj.jp/ja/topics/report/2010/files/0000004549_file2.pdf

Inbound

Outbound

Leading Edge MedicalServices for

foreign patients

Export Medical Care System(facility, equipment, ICT)

Create Offshore COE

• coordination with Inbound

• Health Information Exchange

• Tele-Medicine

source ： METIthis isn’t formal translation

【 Point 】 CSF of Medical Tourism is Low Price.

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


6 　 Healthcare Service Policy Frame in Japan （ 3 ）

Can Japan Create New Niche Market?

■Healthcare Policy Trends in English Spoken Countries■


United StatesUnited Kingdom （ England &

Scotland)AustraliaNew Zealand


●2004.4 　 E.O.13335 ： “EHR for All Americans by 2014”

7 　 Digital Health Approaches in US（ 1 ）


· 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.

NHIN ・ Direct Push Type

· Pilot Testing in 9 Areas

NHIN ・ Exchange

· Reference from Provider A to Provider B.

If Provider B have referenced Data of Patient X is confirmed, Provider A can Retrieve the Data

· 20 Organizations Joined ( 2011/10 )

Pull Type

NHIN ・ Connect

· Open Source initiative to develop and provide Direct Exchange Software.

· Ver. 3.2.1 is publishing ( 2011/10 )

· VLER ： Virtual Lifetime Electric Record

( DoD & VA )· Patient Summary ( SSA )· Bio Surveillance ( CDC )

－ On Going Effort to create Health Data distribution system 　－

■ Nationwide Health Information Network ： NHIN

Distributed by Suda Yasuji, 2011 　　source ： Federal HIT Strategic Plan

2011-2015

Dissemination of ＥＨＲ

（ 1）（ 2）

（ 3）（ 4）（ 5）

●Coined New Phrase to get More

Consumer Attraction and InvolvementToward “The learning health system”Huge Volume of digitized Health Related Data　　　　⇒ Collect and Analyze 　　　　　　⇒　 Create New Clinical Knowledge & Insight　　　　　　　　　　　　⇒　 Apply them in Clinical Setting ASAP

■ Federal HIT Strategy Map


● Using Blue Button, Medicare beneficiaries of DoD and VA can easily Down Load Own Medical Record for Self Control/Management of them


【 Blue Button Initiative 】

http://medgadget.com/2011/09/why-blue-button-data-is-a-big-deal.htmlhttp://www.ihealthbeat.org/articles/2011/10/11/hhs-more-than-430k-vets-using-blue-button-to-access-health-data.aspx

●PR Portal Site has opened （ http://www.bluebuttondata.org/）

● Over 430,000 beneficiaries use Blue Button since 2010/10 against projected number of 25,000.

Medicare

ＶＡ・myheatlhevet

DoD ・TRICARE

Aetna ・PHR

Relayhealth ・PHR

MS ・Healthvault

For iphone and ipod

use

ASCII Text Format

Iatric Systems ・

Patient Portal

A Condition to get

Meaningful Use Bonus

7 　 Digital Health Approaches in US（ 3 ）■ Empowering People Providing Rich Info.

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-data.aspx

http://www.bluebuttondata.org/

●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.


http://medlineplus.gov/connect

Service Provider （ including IT ）

Patient

Patient Portal （ EHR ／ PHR ）

MedlinePlus

①Input Code ・ Clinical ・ Drug ・ Test

② Pick up and Send Automatically

④Reference

③Repository

Generally, Patient have to search information by oneself

Clinical Code response Data

Test Code response Data

Drug Code response Data

【 MedlinePlus Connect 】

■ Empowering People Providing Rich Info.


●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

－　 Accountable Care Organization （ ACO ）　－


Referenced HealthIT.gov, public comment for ACO et al.

patient （ 5,000 ～／year ）

+ Family

ACO

Incentives generated by

reduching expenses

P

P

Patientt

P

P

Participation for 3 year in a row

High Safety

Efficient and Effective CareCare

Facilities

NursingFacilities

Hospitals

Doctor

HealthCenter

Clinics

■ Modeling Coordinated Healthcare Services


EHR Tele Health

Remote Monitoring

Providing QualityAnd Price Info.

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.

●NHS Evidence, a web portal of evidence information about health and medical care, is introduced to support more informed choice.

●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.

http://www.evidebce.nhs.uk/


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 information accessible while out of business hour are 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.

scheduled to start in 2014

8 　 Digital Health Approaches in UK(2)

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 ～


Growing its ecosystem through PC to mobile.

Shift its focus to Home Care Market ？

Microsoft・ Health Vault

10 　 PHR/PHI Market Movements （ 1 ）


Google・GoogleHealth

Challenged to establish health info. sharing,

but will stop it by the end of 2011 （ data

transition available through 2012 ）●Only few innovative customer used (not scale out ）●Accumulation⇒Big data⇒Value creation is hard

to achieve

Consortium growth is very slow and number of

implementation of this service in consortium

member looks stagnant.

Dossia

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

Recommended transfer alternative

●Hospital review on Google map looks same situation (a few posted ）

Reasons

Government pilot projects （ Japan ）

Health Service Industry （ 2004 ）

Local Community Revitalize （ 2008 ）

PHR ／ PHIDigitally Archived Personal Health, Beauty

and Wellness Data


Failure will replicate

Still there will any chances for success Or alternative ？

input process outcome

Service Industry （ 2006

）

Regional health integrated service industry （ 2009 ）

Deregulation （ 2010 ～）

Data accumulation grows though valuable outcome generation stumbles.

● Any Lessons from Past (Failed) Projects ？● Small Investment isn’t cause of Failure ？

● Vast Invested US Health ICT initiatives are really Successful ？

Value chain innovation is needed.

Claims Data

■ Quest for Data Driven Healthcare

≪not interoperable≫

Health Industry Platform（ 2011 ～）


chasm

Almost same projects continued with different names

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


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

really matched ？

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

almost

never

partly

But it may not good in User’s Emotional & Instinct Level

●Technological solution (Single Sign On) has 1st priority ？

Easy accessibility is a key

Alternative User Research Methods such as Ethnographic approach are Required

■ Designing information －①


Traditional Research based conclusion may ・・・


●Even local government sites change their design , much of healthcare service sites keep almost same looking (user interface) more than a year.

※a very few sites introduced tag cloud

2011.10

2010.7

Could you find any effort

improving GUI ？namely user Experience

■ Designing information ②ｰ


Lack of design thinking

Unchanged Design & Continuity is most important CSF ？

■ select suitable health & prevention plans, set the goals, then execute

Tried to provide PHR to consumer ・・・

■ results are e-mailed weekly

■ applying wisdom of crowd （ user feedback ）


http://info.keas.com/employee-wellness-tin

2010

Shift to gamified healthcare solution for company use

2011

■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 approach per

companyICT Social

game× ×

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


Withings

“From Parasite to Co-creation”

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


■ Quest for healthcare ecosystem


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

Distributed by Suda Yasuji, 2011 　　source ： companies HP

Blood pressure monitor

Weight/BMI scale

pedometer Activity monitor

【 case A 】Omron Healthcare

BMI scale

pedometer Blood pressure monitor

【 case B 】Tanita

Data link with digital TV (Sony) is available in Japan

【 case C 】NTT docomo

Link with “eatsmart”

DiscussionsDiscussions

synergy ？

Platform Owner

PlayerProvider of measure devices

Publish APIOf Health Planet


Publishing Real Magazine

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

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

Deep communication（ coaching ・・・）

Improving program adherence both short & long term

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



Actions for sophisticated use of digital data are accelerating

Society gradually wear more healthy taste

AccumulatedInfo.

Info. use Info. use

AccumulatedInfo.

AccumulatedInfo.

AccumulatedInfo.

Info. use

Info.use


To the letterBig Data

11 　 Healthcare Big Data approach （ 1 ）

Open Innovation comes popular in Healthcare ICT apps. development as well as product development.Many Governments start to support Open data initiatives.

Advanced analytical technologies with low cost computing power (cloud) bring opportunities to analyze larger data set and get valuable insights.

Ｂｉｇ ( Ｄｉｇｉｔａｌ ) Ｄａｔａ

http://www.hhs.gov/open/ 　


●Open Government Data Initiatives related to health & medicine 　 “ liberate data and catalyze innovation”

●“HHS Open Government Plan ver.1.1” an explanation material

http://www.data.gov/health

http://www.flu.gov/

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 ？

【 focused area 】

【 US ・ HHS 】


Advancing Open Innovation － 1

mHealth initiative

Health Data Initiative

Startup America

HHSinnovates

Challenges & Competitions


【 US ・ HHS （ continue ）】

イギリス・ HHS

【 UK ・ DOH 】

Healthcare Web Application Developer Online Community

was held for 6weeks from2011/8/22

http://departmentofhealth.ideascale.com/

http://mapsandapps.dh.gov.uk/

＜ Total Number of posted ＞

http://challenge.gov/search?cat=25&org=5



・ Ready-made apps assessment・ New apps idea contest


Asthmapolis ：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.

Ｃ ommunity Commons ：Providing free supportive tools of healthcare services use combining GIS data & free portal as learning & exchanging place.

Daily Feats ：Providing health related tips useful for better quality of life.User can get points making actions through using tips as they combined with point program.

My Dietary Supplements ：Mobile application for recording, managing & Cecking Information about Using Supplements.Providing English version & Spanish version.

source ： http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/HealthData/List%20of%20Featured%20Apps.pdf

IMPAct ：Providing health check information based on age & sex. Enabling appointment of healthcheck on Google Calendar.

SleepBot ：Mobile application for recordingsleep time & providing insufficient sleep related hazardous data.

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


http://profiles.communitycommons.org/site/#

http://asthmapolis.com/

http://ods.od.nih.gov/about/mobile/aboutmyds.aspx

http://www.dailyfeats.com/


● Japan is still in experimental phase compared to other governments.

● Furthermore, activity are temporally stalled.

New Strategy for Innovation of Information &Economy (2010/6)

People Seems to have great interesting about Open Government Movement(128p)

We will develop platform based on Idea Box (above)

to collect & share citizen’s voices then combining them

with policy making & executing processes(129p)

http://openlabs.go.jp/ 　

（ accessed 11/7/2011 ）


Source ： METI Medical Claims Data Processing Infrastructure Developing Project(2011)



Payer

Provider

ClaimData

HealthRecord

Mega Data1.8B/year

StrictManagement

Anonymization

Use Anonymized ID

EpidemiologyPharmacology

Research Institute

Applying Cloud Source in Medical Field High

Security

Resume date is unreleased

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


Many governments start to support open data initiatives

Advanced analytical technologies with low cost computing power (cloud) make opportunities to analyze larger data set and get valuable insights

Ｂｉｇ ( Ｄｉｇｉｔａｌ ) Ｄａｔａ

In Japan ， Consensus about non-profitability of health/medical care is essential. Worldwide dissemination of FREE health ICT applications is critical as well


Recap11

What can be connected to application X ？Who pay the bill ？ When and How ?


■ Healthcare As Services ■

Many sectors of society become somewhat Healthy.Medicalization of Society will be stimulated.

Medicine Exercise & Play

PHR

healthy ／medical XX


Though, many business players stick in enclosing information as value source.

～ stumbling information sharing ～～ product prior to service ～

Closed System or Open System

12 　 Healthcare as services （ 1 ）





OccupationSupplement

FashionDiet


Healthcare ICT Service Ecosystem

http://sph.continuaalliance.org/docs/SPH_D6.1_Final_Report.pdfsource ： smart personal health final repot ,deliverable 6.1 (2011 ）

Agreed in Meta-Concept

Implementations are 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.


11 posted from user in 2011

http://www.kao.co.jp/healthya/

Own products user only

Community Approach

Without Digital Health

Data Handling Ability

http://www.movescount.com/

https://www.polarpersonaltrainer.com/




Patient Community Sites are Goal of Health 2.0 ？


Provide Learning Opportunity

Health & Medical Info.

Clinical Financial

UGM ？Enhancing

Information AccessibilityEnhancing

Information Sharing

Mitigate・ time & spatial

barrier・ expertise barrier

Affection for service purchasing behavior

PreventionTrend reducinggross volume of med. service

・ Request for quality・ Cost Effectiveness

Supplement（ experience）

PHR

？

search

(Web）

community

Facing Trade-Off between medical care with insurance & preventive care without Insurance

Regimen, medication adherence


What types of recommendations

could motivate patient/user to

take action ?

？？ Health Risk Communication without obsessive phrase & word is valid ?≪Ethnographic Approach≫



Healthcare Could ／ Should be experience goods ？

Health Games,Game for Health (Robert Wood Johnson Foundation)

4 basic patterns of play

Agon(competition)

Alea(gambling)

Mimicry

Ilinx(dizziness)

soloo ｒ

combined

B.J.Pine , J.H.Gilmore Experience EconomyⅡ～ X-tainment view ～～ UX view ～

Esthetic Escapist

Entertainment Education

Healthcare as Services

C.Lovelock et al. 　 Service Theatre model～ Scheme view ～

Front stage （ touch point ） Back stage

SupportProcess mng.／ Customization

Customer Staff StaffService

Co-creation

Beyond Evidence Based Healthcare

which simply combined with

Narrative Based Healthcare

・ should charge user directly ？revenue ＝ unit price× frequency

・　 cognitive and emotionally effective response model ?

R.Caillois 　 Les Jeux et les Hommes


Procrastination Anomaly

Reversals of preference



Bad conditions Healthy conditions

“the more , the better”“higher, much better”

“less than more”

nervous to intervention’s quality

nervous to intervention itself

Trying to change “the more, the better”

into “Less than more”

(less care, better outcome?)

user’sperception

addressing issue by policy maker

&provider

Collecting earlierIntervention evidence for

Health/Stopping to develop sick &diseases

and 　・・・

user mind-sets are different

contain cost&

shift cost

CRFWith/without

user perception shift

value co-creation(user commitment)

（ mind-set A ）

（ mind-set B ） burdensome

irrelevantHelp!

value co-creation(user commitment)

Quest for cognitive and emotionally effective modelfocusing not only Clinical Health, but also Nonclinical Health


Metaphor for Healthcare Services


source ： Japan Cloud Consortium, 　 health ・ med cloud WG

http://www.japan-cloud.org/

Will this whole service scheme bring user happy ever after ？

“not Cure but Care one”

“One fits All” 　　　　

≪cognitive and emotionally effective models≫≪consensus for implementation of concept≫

healthy

http://colopl.co.jp

Deemed exercises may have similar health effect ？


(Non Health centric web service)

Health & Medical Care CloudServices Services

Senior (age 70-89)Pre Life Style Related Diseases

Population (age 40-69)

Assisted Living Service

Home/Tele Medicine

Home 　 Care Service

Life Style Improving Program Monitoring Service

Local Coordination

Metal Health Care

Prediction Program

Adherence Support

Local Coordination

Implicitly be-spoken

Explicitly be-spoken


MassCustomization

aggregated

digital data

Personalization

Peerization

YOU MAY

Those just like YOU

JUST FOR YOU

Prescribed Recommendations

processing

There is always an answer

“the more input, the better output”

～ fine-tuned ～

He/She can tell you concretelyabout own healthcare needs with one’s words.

He/She cannot tell you concretelywhat healthcare needs he/she has.What healthcare wants He/She does have are faint. By whomWh

atWhen

How

Where


source ： Cloud Computing and Competitiveness of Japan meeting　　　 3rd material 2 　 slide15


How could we define value of healthcare ？（ lessons from Google health 、 Keas ・・・）

value integration


User really want service models just like department store and shopping mall?


providers collaborationnew value creationconglomeration

Healthcare Value Chain are Fragmented An image of Customer Value Integration in Healthcare

SupplementsProducers

Home Health Appliances

Fitness Studios Health Exams

PharmaciesMedical Care Providers

User

Divided

Divided

Divided Divided

Divided

Fitness Studios

SupplementsProducers

Pharmacies

Medical Care Providers

Health Exams

Home Health Appliances

Servicer

Personalized Care Support

User

Aggregated Personal Data

Devices

• Training Record • Supplements Use• Vital Data Record• Health Exams

Record• Medical History• Drug Use

【 Now 】 Value proposition is divided into each provider.【 Future 】 Value chain integration may generate new customer value

such as one stop service.

Optimized Value will provide to every unique person everywhere, anytime.

New population health strategies (UK, US)adept information nudging approaches combined with financial incentives.

“nudging people in the right direction rather than banning or significantly restricting their choices” Ｐ 30 　 2010/10 　※ 1

※1 　 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf

※2 　 http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf　Distributed by Suda Yasuji, 2011 　　

Abandon Rational patients ／ health consumer model

METI sticks to financial incentives heavily


※1 　 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf

※2 　 http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf　

“individuals’ decisions are influenced by how environments are designed and how choices are presented”Ｐ 22 　 2011/6 　※ 2

But Some Consideration in New National Health

Promotion Strategy under developing

Japan

citizen

provider 1provider 2

financial incentivefor alliance

financial Incentiveto motivate citizen use

medical care

preventive services

life care health support

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf

http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_127424.pdf

http://www.healthcare.gov/center/councils/nphpphc/strategy/report.pdf

National interventions are welcomed in terms of socio-economic points



Health-related services tend to be freemium by

governments

The Last 1 mile

How to cope with those freemium-made serives ？

What will happen beyond open innovation ？Ecosystem : Connection to

application XPayment : When, for whom, how much?

[email protected]

Paradox Dominate the Market in Healthcare