[Hiroyuki Takao Column] What is needed first for future online medical care | Med IT Tech

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This time, Med IT Tech will publish a new column by Dr. Hiroyuki Takao, an associate professor at the Jikei University School of Medicine Advanced Medical Information Technology Research Department.

Professor Takao does not need to be introduced again, but he has made active policy proposals based on his own efforts related to digital health in Japan and his experience in the field of authentication processes as a medical technical officer. You are a leading authority in your field. It was announced the other day, but in 2018, while suffering from Guillain-Barré Syndrome, he is steadily making his way back. Unexpectedly, you have gained a professional perspective not only as a doctor and digital health expert, but also as a patient, and I believe that you have become even more unique. As a media company, we are very honored to be able to provide such a valuable platform for such a teacher.

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#1 The first thing you need for online medical care in the future

　This is Hiroyuki Takao. I would like to use the opportunity of Med IT Tech to share my thoughts. In August 2018, I suddenly lost consciousness and remained unconscious for 4 months. . Now I can remove the respirator and have a voice. I can now move my arms a little, so I can use an electric wheelchair. While normal progressive diseases get worse and worse, Guillain-Barré Syndrome starts bad and gets better. I think I'm in the middle of that process now. I've recovered a lot, but I think it's going to take a little more time to get back to normal.

　That's why I'm currently resuming various activities, and this column is one of them. While I was dead, due to the pandemic, several use cases for digital health, digital medical care, and digital treatment, including online medical consultations, began to emerge. However, it cannot be said that the spread is still progressing compared to other countries. I think there is still a lot of things to do and think about in order for patients and related medical staff to be happy.

　In that sense, the first thing I think is to expand the scope of online medical care, especially to promote online collaboration between "specialist doctors and family doctors". Currently, it seems that revisions to the guidelines regarding the lifting of the ban on online medical consultations from the first visit are underway, but in order to make it possible to "access appropriate medical care at the appropriate time", it is necessary to add expertise and support to primary care doctors. I think we need a system to evaluate the efforts of specialists to make it possible.

Specifically, at the time of online consultation, if necessary, a specialist doctor will participate at the same time in addition to the family doctor. Alternatively, the family doctor goes to the examination room (patient's home), and the specialist doctor connects to the doctor for online medical treatment. In this way, there are actually many cases of watching over patients with diseases that are difficult to follow up unless they are specialists, especially intractable diseases. Some university hospitals have set up specialized telemedicine departments, and are constantly working with villages without doctors or areas without specialists.

　Despite the fact that the initiative itself is being carried out in this way, there is almost no provision for the cost of collaboration with online medical consultations. As far as I know, the actual situation is that medical corporations that collaborate with each other form unions and create funds, and then share the costs, including with local governments, or apply for research and manage to cover the costs. In other words, we are currently struggling just to cover the actual costs, and there is no way we can guarantee sustainability. Despite the obvious benefits for patients.

　Online medical care is the only way to overcome distance barriers in a good way, and not only to provide medical care, but also to provide "appropriate medical care" including those with intractable diseases. In that sense, I feel that it is an urgent issue to develop a support system, including financial support, so that specialists can easily support primary care physicians.

　There is one more thing that I am thinking, or rather, I am worried about. In recent years, it has become commonplace for individuals to purchase mobile devices such as smartwatches and measure vital data such as heart rate and blood pressure. In recent years, the functions of devices such as the Apple Watch have been significantly enhanced, and the scene where the measurement data of these devices can be used for medical treatment is finally coming.

　The only thing we have to keep in mind here is whether the data can be properly imported and used, for example, when transcribing it to an electronic medical record or retrieving it for analysis by an external AI. If this is not guaranteed, device dependence will occur, and the compatibility of software and electronic medical record systems that are not linked can make medical care time-consuming. This is putting the cart before the horse, and we need a standard that allows data to be properly exchanged between any systems when needed.

Of course, this possibility is naturally recognized, and the medical information system used by medical institutions, the so-called electronic medical record, is required to establish standards for various records and comply with them. The Ministry of Economy, Trade and Industry has also set guidelines for health checkup data and some test data, among which it is required that data be stored according to standards such as HL7. However, companies that sell mobile devices are not included in this target business. Specifically, if a company that handles health checkup data separately handles mobile device data, it will be covered, but a company that does not do such business and only sells devices is not covered. is. In other words, the reality is that devices that are not covered by the guidelines occupy a large part of the market.

In addition, I wrote a column about this in the "Digital Health Commentary" recently opened by our research department, so please refer to that as well.

　Currently, most devices measure only "light" vital data such as heart rate and blood pressure from a medical point of view, so the impact is not yet significant, but the technology has progressed further in the last few years. It is certain that we will be able to measure data that is important in medical care, such as blood sugar levels and oxygen saturation levels. It will be too late once such devices have become widespread and the data has been accumulated. I think we need to demand preservation and have business operators guarantee compatibility.

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