Ehealth in japan
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policy and business trend in ehealth in Japan, especially in terms of service....

policy and business trend in ehealth in Japan, especially in terms of service.
translation of 2011 Japanese version.

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  • 1. 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
  • 2. Expectations and policy trends about healthcare industry ■Characteristics of Healthcare Industry■
  • 3. 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
  • 4. 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. Distributed by Suda Yasuji, 2011
  • 5. 1 Healthcare Field(2) As socio-economy matured, bi- polarization of healthcare needs happensService is picked byuser 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 Distributed by Suda Yasuji, 2011
  • 6. 1 Healthcare Field(3) ■ 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) ? Distributed by Suda Yasuji, 2011
  • 7. 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 Distributed by Suda Yasuji, 2011
  • 8. 2 Healthcare Market Review( 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 Distributed by Suda Yasuji, 2011
  • 9. 2 Healthcare Market Review( ●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 Distributed by Suda Yasuji, 2011
  • 10. 2 Healthcare Market Review( ■ 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 Distributed by Suda Yasuji, 2011
  • 11. 2 Healthcare Market Review( ■ 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 Distributed by Suda Yasuji, 2011
  • 12. 2 Healthcare Market Review( ■ 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? Distributed by Suda Yasuji, 2011
  • 13. 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 Distributed by Suda Yasuji, 2011
  • 14. 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 Distributed by Suda Yasuji, 2011
  • 15. Expectations and policy trends about healthcare industry ■Healthcare Policy Trend in Japan■
  • 16. 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
  • 17. 4 Health System Reform Trends in Japan(2) ■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 Distributed by Suda Yasuji, 2011
  • 18. 4 Health System Reform Trends in Japan(3) ■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 Distributed by Suda Yasuji, 2011
  • 19. 4 Health System Reform Trends in Japan(4) ■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
  • 20. 4 Health System Reform Trends in Japan(5) ■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 SpecialSince 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 Distributed by Suda Yasuji, 2011
  • 21. 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 Distributed by Suda Yasuji, 2011
  • 22. 5 Digital Health Approaches in Japan( ■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 Hospital1 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, Execution2 Medical Care in Regions and Assessment Toward More Efficient Medical Care ○Trial Use of providing data to 3rd Parties3 Analyzing Claim Data ○Development of Data Use Technologies ○Advancing Medical Database Infrastructure Facilitating Safer Medication4 By Using Drug DB Development Program 10million Patients Source:IT HQ・Healthcare TF This is not formal translation Distributed by Suda Yasuji, 2011
  • 23. 5 Digital Health Approaches in Japan( 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 areVirtually Newly Added in Updated RoadReplicatedMy 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
  • 24. 5 Digital Health Approaches in Japan( IT HQ:The New Strategy in Info. & Communications Technology 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. OfficeTeleMedicine Studying E-Prescription MHLW MIC Dissemination of Tele Medicine MHLW DevelopingAutopsy Guideline MHLW Continuing Financial SupportImaging Financial Support MHLW Distributed by Suda Yasuji, 2011 Source:IT HQ(2011/8) This is not formal translation
  • 25. 5 Digital Health Approaches in Japan( IT HQ:The New Strategy in Info. & Communications Technology 2 ) c Road Maps (Updated) Improving Efficiency of Medical Care Using Medical Claims Data etc. •Claim Data Hospital& DPC Data Other ValuableTypes of Info. •Health Check Payer Pharmaco Data •Coding Data Data Epidemic DataProvision 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 Distributed by Suda Yasuji, 2011
  • 26. 5 Digital Health Approaches in Japan ( IT HQ:The New Strategy in Info. & Communications Technology 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
  • 27. 5 Digital Health Approaches in Japan( ■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 Distributed by Suda Yasuji, 2011
  • 28. 5 Digital Health Approaches in Japan( ■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 Distributed by Suda Yasuji, 2011
  • 29. 5 Digital Health Approaches in Japan( ■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. This is not formal translation Distributed by Suda Yasuji, 2011
  • 30. 5 Digital Health Approaches in Japan( ■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 This is not formal translation Distributed by Suda Yasuji, 2011
  • 31. 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 InsuredHealthy ①Services for readmission & Clinical Care health maintenance disease advance timeNormalCondition Applying to the chart of P5 ④Services for Terminal care Operation& in home RehabilitationDisease ②Customized ServicesOnset 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 Distributed by Suda Yasuji, 2011
  • 32. 6 Healthcare Service Policy Frame in Japan( ■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, wealthyHealth System Implications:A scoping review(2011) people from less developed areas ofpointed. 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.pdfInstead, Development Bank of Japan’s estimation ofinbound 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 Distributed by Suda Yasuji, 2011
  • 33. 6 Healthcare Service Policy Frame in Japan( 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? Distributed by Suda Yasuji, 2011
  • 34. Expectations and policy trends about healthcare industry ■Healthcare Policy Trends in English Spoken Countries■ United States United Kingdom(England & Scotland) Australia New Zealand Distributed by Suda Yasuji, 2011
  • 35. 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 ) Distributed by Suda Yasuji, 2011
  • 36. 7 Digital Health Approaches in US(2) ■ 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
  • 37. 7 Digital Health Approaches in US(3) ■ 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 iphoneand ipod use Iatric Systems・ Patient Portal ●PR Portal Site has opened (http://www.bluebuttondata.org/) Distributed by Suda Yasuji, 2011
  • 38. 7 Digital Health Approaches in US(4) ■ 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 Distributed by Suda Yasuji, 2011
  • 39. 7 Digital Health Approaches in US(5) ■ 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? Distributed by Suda Yasuji, 2011
  • 40. 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/ Distributed by Suda Yasuji, 2011
  • 41. 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. Distributed by Suda Yasuji, 2011
  • 42. 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 Distributed by Suda Yasuji, 2011
  • 43. Expectations and policy trends about healthcare industry ■Healthcare ICT Trends in Private Sector■ ~Information Design and Big Data~
  • 44. 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. Distributed by Suda Yasuji, 2011
  • 45. 10 PHR/PHI Market Movements(2) ■ 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 PlatformHealth 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 ? Distributed by Suda Yasuji, 2011
  • 46. 10 PHR/PHI Market Movements(3) ■ 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
  • 47. 10 PHR/PHI Market Movements(4) ■ 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 tag2010.7 Continuity is most important CSF ?2011.10 Could you find any effort improving GUI? namely user Experience Distributed by Suda Yasuji, 2011
  • 48. 10 PHR/PHI Market Movements(5) ■ 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 Distributed by Suda Yasuji, 2011
  • 49. 10 PHR/PHI Market Movements(6) ■ Quest for healthcare ecosystem“From Parasite to Co-creation” Withings Data link with digital TV (Panasonic) is available in north American region Distributed by Suda Yasuji, 2011
  • 50. 10 PHR/PHI Market Movements(7) ●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 docomoWeight/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 Distributed by Suda Yasuji, 2011
  • 51. 10 PHR/PHI Market Movements(8) 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 Distributed by Suda Yasuji, 2011
  • 52. 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. Distributed by Suda Yasuji, 2011
  • 53. 11 Healthcare Big Data approach(2) 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/
  • 54. 11 Healthcare Big Data approach(3) Advancing Open Innovation-2 【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/ Distributed by Suda Yasuji, 2011
  • 55. 11 Healthcare Big Data approach(4) Advancing Open Innovation-3 ●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 Distributed by Suda Yasuji, 2011
  • 56. 11 Healthcare Big Data approach(5) 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) Distributed by Suda Yasuji, 2011
  • 57. 11 Healthcare Big Data approach(6) 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
  • 58. Expectations and policy trends about healthcare industry ■ Healthcare As Services ■
  • 59. 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~ Distributed by Suda Yasuji, 2011
  • 60. 12 Healthcare as services ( 2) 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 Distributed by Suda Yasuji, 2011
  • 61. 12 Healthcare as services ( 3) 【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 Distributed by Suda Yasuji, 2011
  • 62. 12 Healthcare as services ( 4) Discussions Patient Community Sites are Goal of Health 2.0? Health & Medical Info. Clinical Financial Supplement (experience ) Provide Learning Opportunity search community (Web) Enhancing Enhancing Information Accessibility UGM? Information SharingFacing Trade-Off between PHRmedical care with Mitigateinsurance & preventivecare without Insurance ・time & spatial barrier Regimen, medication ・expertise barrier adherence Trend reducing ・Request for Prevention Affection for service gross volume purchasing behavior quality ? of med. service ・ Cost Effectiveness ? What types of recommendations ? Health Risk Communication could motivate patient/user to without obsessive phrase & word take action ? ≪Ethnographic Approach≫ is valid ? Distributed by Suda Yasuji, 2011
  • 63. 12 Healthcare as services ( 5) Discussions Healthcare Could/Should be experience goods? ~X-tainment view~ ~UX view~ R.Caillois Les Jeux et les B.J.PineⅡ, J.H.Gilmore Experience Economy Hommes 4 basic patterns of play Agon(competition) Entertainment Education Alea(gambling) solo or Mimicry combined Esthetic Escapist Ilinx(dizziness) Anomaly Health Games, Game for Health Healthcare as Services Procrastination Reversals of preference (Robert Wood Johnson Foundation) Beyond Evidence Based Healthcare ~Scheme view~ which simply combined with C.Lovelock et al. Service Theatre model Narrative Based Healthcare Front stage(touch point) Back stage ・should charge user directly? revenue=unit price× frequency Support Service Customer Staff Staff Process mng. ・ cognitive and emotionally Co-creation /Customization effective response model ? Distributed by Suda Yasuji, 2011
  • 64. 12 Healthcare as services ( 6) Quest for cognitive and emotionally effective model focusing not only Clinical Health, but also Nonclinical Health Bad conditions Healthy conditions (mind-set user mind-sets are (mind-set A) different B) “the more , the better” “less than more” user’s “higher, much better” perception nervous to nervous to intervention’s quality intervention itself value co-creation value co-creation (user commitment) (user commitment) contain cost &addressing issue Trying to change shift cost Collecting earlier “the more, the better” Intervention evidence for by policy maker & into Health/Stopping to develop “Less than more” sick &diseases provider (less care, better outcome?) and ・・・ CRF With/without user perception shift Distributed by Suda Yasuji, 2011
  • 65. 12 Healthcare as services ( 7) Metaphor for Healthcare Services ≪cognitive and emotionally effective models≫ “not Cure but Care one” ≪consensus for implementation of concept≫ “One fits All” Will this whole service scheme bring user happy ever after ? Services Health & Medical Care Cloud Services Pre Life Style Related Diseases Population (age 40-69) Senior (age 70-89) Life Style Improving Program Monitoring Service Metal Health Care Home/Tele Medicine Prediction Program Home Care Service Adherence Support Assisted Living Service Local Coordination Local Coordination source:Japan Cloud Consortium, health・med cloud WG http://www.japan-cloud.org/ Deemed exercises may have similar health effect? (Non Health centric web service) http://colopl.co.jp Distributed by Suda Yasuji, 2011
  • 66. 12 Healthcare as services ( 8) There is always an answer Explicitly Implicitly be-spoken be-spoken aggregated digital data He/She can tell you concretely He/She cannot tell you concretely about own healthcare needs processing what healthcare needs he/she has. with one’s words. What healthcare wants He/She What When How Where By whom does have are faint. “the more input, the better output” ~fine-tuned~ Prescribed Recommendations Mass Peerization Personalizat Customizatio n YOU MAY ion Those just like JUST FOR YOU YOU Distributed by Suda Yasuji, 2011
  • 67. 12 Healthcare as services ( 9) How could we define value of healthcare? Discussions (lessons from Google health、Keas・・・) 【Now】 Value proposition is divided into each provider. 【Future】 Value chain integration may generate new customer value such as one Healthcare service. are Fragmented stop Value Chain An image of Customer Value Integration in Healthcare Home Health Servicer Supplements Divided Producers Appliances Optimized Value will Fitness Studios provide to every unique person Divided Divided Supplements everywhere, anytime. Producers Devices Home Health Appliances Personalized UserFitness Studios Health Exams Care Support User Health Exams Medical Care •Training Record Divided Divided Providers Aggregated •Supplements Use Personal •Vital Data Record Medical Care Pharmacies Data •Health Exams Record Providers Pharmacies •Medical History •Drug Use source:Cloud Computing and Competitiveness of Japan meeting 3rd material 2 slide15 value integration conglomeration User really want service new value creation providers collaboration models just like department store and shopping mall? Distributed by Suda Yasuji, 2011
  • 68. 12 Healthcare as services (10) Abandon Rational patients/health consumer model New population health strategies (UK, US) adept information nudging approaches combined with financial incentives. Japan citizen financial Incentive preventive to motivate services citizen use provider 2 provider 1 life care medical health support care financial incentive for alliance “individuals’ decisions “nudging people in the are influenced by how METI sticks to financial incentives heavily right direction rather than environments are designed banning or significantly and how choices are But Some Consideration in restricting their choices” presented” New National Health P30 2010/10 ※1 Promotion Strategy under P22 2011/6 ※2 developing ※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
  • 69. 12 Healthcare as services (11) The Last 1 mile National interventions are welcomed in terms of socio- economic points Health-related services tend to be freemium by governments How to cope with those freemium-made serives? What will happen beyond open innovation? Ecosystem : Connection to application X Distributed by Suda Yasuji, 2011 Payment : When, for whom, how
  • 70. Paradox Dominate theMarket in Healthcare sudays17@gmail.com