1. Use Case: Robot-Assisted Surgery (RAS) System on the Cloud 2. Worldwide IT Industry 2023 Predictions 3. Japan IT Spending Forecast by Region: 2021-2026 4. Japan Public Cloud Spending Forecast: 2021-2026 5. Japan Private Cloud Spending Forecast: 2021-2026 6. Japan Information Security Market Forecast: 2020-2026 7. Green Transformation (GX) in Healthcare 8. Conclusion/Q&A

1. Landscape of Cloud-Driven
Digital Health Platform Market
in Japan 2023
October 10th, 2023
Eiji Sasahara, Ph.D., MBA
Partner - Healthcare Cloud Initiative, NPO
Representative, Cloud Security Alliance Japan Chapter
(A Member of European Connected Health Alliance)1

2. AGENDA
• 1. Use Case: Robot-Assisted Surgery (RAS) System
on the Cloud
• 2. Worldwide IT Industry 2023 Predictions by IDC
• 3. Japan IT Spending Forecast by Region: 2021-2026
• 4. Japan Public Cloud Spending Forecast: 2021-2026
• 5. Japan Private Cloud Spending Forecast: 2021-2026
• 6. Japan Information Security Market Forecast: 2020-2026
• 7. Green Transformation (GX) in Healthcare
• 8. Conclusion/Q&A
2

3. 1. Use Case:
Robot-Assisted Surgery (RAS) System on the Cloud
System Architecture for Robot-Assisted Surgery (RAS):
-Operating Environment
*Cameras, Sensors
-Network Component
-Robotic System
*Robotic Arm
-Surgeon Console
-Cloud Service
-Vendor
-EHR
Source:Cloud Security Alliance(CSA),
“Telesurgery Tabletop Guide Book”, January 30,
2023)
(https://cloudsecurityalliance.org/artifacts/te
lesurgery-tabletop-guide-book/)
3

4. “hinotori” Surgical Robot System “hinotori”
by Medicaroid(https://www.youtube.com/watch?v=UW9SLwMFL8I)
Approved as Medical Device (on-premise) by MHLW in August 2020
Source: Medicaroid, “Towards Service Platform Integrated with hinotori Surgical Robot System”,
February 18, 2021 (https://aws.amazon.com/jp/blogs/news/healthcare-cloud-seminar/)
Interference
Reduction
Fatigue
Reduction
High-definition
3D Imaging
Communications between
Surgeon and Surgical
Assistant
Remote
Trouble
Shooting
Working
Space for
Surgical
Assistant
4

5. Medicaroid Intelligent Network System on AWS
Transform Data Gathered from hinotori to Valuable
Contents for Secondary Use
*Critical Issue: Who Owns and Manages Data?
Source: Medicaroid, “Towards Service Platform Integrated with hinotori Surgical Robot System”,
February 18, 2021 (https://aws.amazon.com/jp/blogs/news/healthcare-cloud-seminar/)
[Supports Center]
Contact Point
Before/After
Surgery Setup
Surgery Monitoring
Realtime Supports
Training
Other Surgical Devices
Surgical Room Camera
(Video Data)
Endoscope Camera
(Video Data)
[Surgical Room] [Lab Test Information]
Simulator
Integrated
Surgical Data
Devices for Maintenance Operation
Log DB
Surgical Room
Imaging DB
Surgery
Imaging DB
Interface
Hinotori-related
data
API
5

6. Cybersecurity Rules for Medical Devices, including RAS System
IMDRF, “Principles and Practices for
Medical Device Cybersecurity”,
(March 2020)
(https://www.imdrf.org/sites/default/files/docs/i
mdrf/final/technical/imdrf-tech-200318-pp-mdc-
n60.pdf)
6
EU MDCG, “Guidance on Cybersecurity
for Medical Devices Rev.1”
(July 2020)
(https://health.ec.europa.eu/system/files/2022-
01/md_cybersecurity_en.pdf)
MHLW, “Guidance on Assuring
Cybersecurity for Medical Devices in
Medical Institutions” (March 2023)
(https://www.mhlw.go.jp/content/11120000/001094
637.pdf)

7. 2. Worldwide IT Industry 2023 Predictions by IDC
https://www.idc.com/getdoc.jsp?containerId=US49563122
Prediction 1: By 2027, over 50% of IT budgets in most G500 enterprises will be
allotted to connectivity, security, compute, and data assets used to deliver their own
as-a-service processes and smart products.
Prediction 2: In 2025, 60% of infrastructure, security, data, and network offerings will
require cloud-based control platforms that enable extensive automation and promise
major reductions in ongoing operating costs.
Prediction 3: Through 2024, shortcomings in critical skills creation and training efforts
by IT industry leaders will prevent 65% of businesses from achieving full value from
cloud, data, and automation investments.
Prediction 4: Sovereign assertions in sustainability, resiliency, and asset residency
through 2025 will force G2000 CIOs to shift staff, budgets, and operating processes for
more than 35% of IT and data assets.
Prediction 5: In 2023, 70% of enterprises' adoption of as-a-service
infrastructure/software will be curbed more by an inability to assess promises of faster
innovation and operational gains than by cost concerns.
7

8. Prediction 6: By the end of 2024, 60% of platinum-level aaS offerings in
security, business operations, and DaaS will include bundled access to
specialized SME teams to help reduce impact of skills shortages.
Prediction 7: In 2025, 20 high-visibility digital product launches reliant on
intelligent automation and aaS (as a Service) delivery will face major delays
due to global or regional silicon and code supply chain issues.
Prediction 8: Through 2026, 55% of enterprises attempting to use tech-by-
wire offerings will still struggle with a proliferation of siloed control systems
that raise connectivity costs and limit sharing of data.
Prediction 9: In 2026, 45% of G2000 enterprises will continue to face material
risks due to frontline workers' and business leaders' unwillingness to trust
actions initiated by vetted autonomous tech systems.
Prediction 10: By 2027, the ability to deploy and use machine vision as an
inherent capability in any new product/process will be a primary characteristic
of the five fastest-growing enterprises in most industries. 8

9. 3. Japan IT Spending Forecast by Region: 2021-2026
JPY 20,213,700M (EUR 127,935M) in 2022 (YoY Growth +4.6%)
JPY 21,371,600M (EUR 135,263M) in 2023 (YoY Growth +5.7%)
Source: IDC Japan, “Japan IT Spending Forecast by Region: 2021-2026”, January 26, 2023
(JPY Million)
Other areas
Urban areas including
-Tokyo metropolitan areas
-Kansai (Osaka, Kobe, & Kyoto)
-Nagoya
(EUR 1 = JPY 158.0 as of September 30, 2023)
9

10. Key Factors Affecting Total IT Spending
on the Japan Market in 2023
 Adoption of Cloud Computing and Subscription
Models among Enterprise Systems
 Recovery from COVID-19 Pandemic Emergency
among Retail & Food, Hospitality/Tourism, and
Transports
 Large Enterprise: Continuous DX-related Spending
 SMEs: Implementation of the Revised Enforcement
Rule of the Electronic Books Preservation Act (in
January 2024) and the Qualified Invoice-based
Method (the Invoice System) (in October 2024)10

11. (e.g.) Japan Business Fedelation, “HealthcareⅣ in the Era
of Society 5.0” (February 14, 2023)
[Recommendation for the Japanese Government]
Source: Cabinet Public Affairs Office, “Roadmap of Medical DX Promotion”, June 2, 2023
(https://www.cas.go.jp/jp/seisaku/iryou_dx_suishin/pdf/suisin_zentaizo.pdf)
Development of Platform for
Health Data Utilization
Development of the Japanese
Version of European Health
Data Space (EHDS)
Lifetime Health Data
Achieving People’s Well-Being at National Level Benefits from Health Data Utilization
・Promotion of Health Management by the People Themselves
・Improvement in Quality of Care
・Promotion of R&D on Pharmaceutical & Medical Devices
・Policy Making for Improvement in Public Health
・Improvement in Operational Effectiveness and Shortened Working Time for Health Workers
・Optimization of Healthcare Costs
Citizens
(Health Management & Medical Care)
Society
(R&D & Policy Making)
Sharing
11

12. 4. Japan Public Cloud Spending Forecast: 2021-2026
JPY 2,159,400M (EUR 13,667M) in 2022 (YoY Growth +29.8%)
JPY 4,279,500M (EUR 27,085M) in 2026
Source: IDC Japan, “Japan Public Cloud Spending Forecast: 2021-2026”, September 15, 2022
(JPY Billion) (YoY Growth %)
(EUR 1 = JPY 158.0 as of September 30, 2023)
12

13. Key Factors Affecting Public Cloud Spending
on the Japan Market in 2023
 Expand of Cloud Migration among Enterprise
Systems (Shift from IaaS/PaaS to SaaS)
 “Improvement” in Cost Optimization, Availability
Enhancement, and Productivity with Scalable
Cloud (from Small Start)
 “Transformation” to Data-driven Business Models
with Advanced Cloud-native Tech (e.g. Serverless)
 Challenge: UI/UX & Application Security by Design
13

14. (e.g.) Government Cloud Certification Program:ISMAP
Source: ISMAP Portal , “ISMAP Overview”, as of September 30, 2023
(https://www.ismap.go.jp/csm?id=kb_article_view&sysparm_article=KB0010301)
Reference:
-ISO 27000 series
-ISO 27017
-NIST SP800-53 rev.4
-NISC Common
Standards, etc.
Requirement
for National
Medical
Institutions
14

15. Basic Framework for ISMAP
①Basic Regulations
②ISMAP Cloud Services
Registration Rules
③ISMAP-LIU Cloud Services
Registration Rules
(for SaaS, November 2022)
④Guideline for Evaluating the
Impact of Operations and
Information
⑤Control Criteria of ISMAP
⑥Information Security
Assessment Guidelines
Source: ISMAP Portal, “ISMAP Overview”, as of September 30, 2023
(https://www.ismap.go.jp/csm?id=kb_article_view&sysparm_article=KB0010301)
15

16. ISMAP Cloud Service List
Reference for Procurement by the Central
Government Agencies
e.g.) Microsoft
Office 365
Source: ISMAP Portal , “ISMAP Cloud Service List”, as of September 30, 2023
(https://www.ismap.go.jp/csm?id=cloud_service_list)
16

17. 5. Japan Private Cloud Spending Forecast: 2021-2026
JPY 1,216,300M (EUR 7,698M) in 2021 (YoY Growth +32.3%)
JPY 3,077,100M (EUR 19,475M) in 2026
Source: IDC Japan, “Japan Private Cloud Spending Forecast: 2021-2026”, November 9, 2022
(JPY Billion) (YoY Growth %)
(EUR 1 = JPY 158.0 as of September 30, 2023)
17

18. Key Factors Affecting Private Cloud Spending
on the Japan Market in 2023
 Restart of Enterprise Private Cloud Projects after
COVID-19 Pandemic Emergency
 Shift from Silo-style Systems to Multi-
Cloud/Hybrid Cloud Deployment
 “Improvement” in existing IT Systems (e.g. SAP)
 “Transformation” to Data-driven Business Models
 Challenge: Shortage of Cloud Architect In-house
18

19. (e.g.)Cabinet Office: Headquarters for Medical Digital
Transformation (DX) Promotion (October 2022～)
Roadmap of Medical DX Promotion
FY2023 FY2024 FY2025 FY2026～
Integration of National ID Cards with Health Insurance Certificate
Health Information Sharing between Hospitals and Pharmacies
e-Prescription
EHR
e-Receipt
Standardization of EHR Data
Expansion of Health Information Sharing with Nursing Homes and Local Governments
Modernization of Health Information Systems via Modulation of Common Building Blocks
Source: Cabinet Public
Affairs Office,
“Roadmap of Medical
DX Promotion”, June 2,
2023
(https://www.cas.go.j
p/jp/seisaku/iryou_dx
_suishin/pdf/suisin_ze
ntaizo.pdf)
Development
of
National
Health
Information
Platform
19

20. (e.g.) Pilot Project on e-Prescription for
Medical DX with Private Cloud
Source: Ministry of Health, Labor, and Welfare (MHLW) “Summery of Pilot Projects and Medical DX Promotion”, October 30,
2022 (https://www.mhlw.go.jp/content/11120000/001001487.pdf)
①KYC/Authentication ④Information Retrieval ⑤KYC/Authentication
My Number
Card
Health Insurance
Card
Health Insurance
Card
My Number
Card
Patients
Patients
National ID Portal
e-Prescription Records
Physician/Dentist
Hospital/Clinic Public Health Insurance
Payment Funds
Pharmacy
Pharmacist
Online Certification System
③Registry of
Prescription
Details
e-Prescription
Management Service
Registry of
Dispensing
Details
②Review of Prescription/ Dispensing
Information & Duplicate Medication Check
⑧Getting Prescription Details
⑦Review of Prescription/ Dispensing
Information & Duplicate Medication Check
Patients
20

21. 6. Japan Information Security Market Forecast:
2020-2026
JPY 436,015M (EUR 2,759M) in 2021 (YoY Growth +16.0%)
JPY 531,745M (EUR 3,365M) in 2026
Source: IDC Japan, “Japan Information Security Market Forecast: 2020-2026”, May 26, 2022
(JPY Million)
Security Appliance
Security Software
(EUR 1 = JPY 158.0 as of September 30, 2023)
21

22. Key Factors Affecting Information Security
on the Japan Market in 2023
 Expanding the “Work at Home” Environment after
COVID-19 Pandemic Emergency
 Increase of Cyber Incidents Anywhere (e.g.
Ransomware, ID Theft, Personal Data Breach…)
 Shift from the On-premise Environment to the
Hybrid Environments Requires Software/Service-
driven Security Solutions (e.g. CASB)
 Challenge: Talent Shortage (e.g. DevSecOps) and
Organizational Structure (e.g. CSIRT Vs. PSIRT)
22

23. Healthcare Cybersecurity Rules in Japan
 MHLW: (for Healthcare & Nursing Care Providers)
"Guidelines for the Security Management of
Medical Information Systems Version 6.0”
(May 2023)“
(https://www.mhlw.go.jp/stf/shingi/0000516275_00006.html)
 MITI: (for Third-Party Health-related IT Vendors)
“Guidelines for the Security Management of
Medical Information Systems & Services Venders
Version 1.1”(July 2023)
(https://www.meti.go.jp/policy/mono_info_service/healthcare/01gl_20230707.pdf)
23

24. Check List for Guidelines for the Security Management of
Medical Information Systems Version 6.0 (June, 2023)
Source: Ministry of Health, Labor, and Welfare (MHLW) “Check List for Guidelines for the Security Management of Medical
Information Systems Version 6.0”, June 2023 (https://www.mhlw.go.jp/content/10808000/001139055.pdf)
For Healthcare Providers For Third-Party Vendors
*Added in FY2024 *Added in FY2024
24
*FY2023～
*FY2023～

25. 7. Green Transformation (GX) in Healthcare
Keisuke Nansai et al. “Carbon Footprint of Japanese
Health Care Services from 2011 to 2015”,
January 2020 (https://doi.org/10.1016/j.resconrec.2019.104525)
 In Japan, the carbon footprint of health care accounted for 4.6%
of total national emissions in 2011.
 By 2015, the annual carbon footprint had increased to 72.0
MtCO2e owing to the growth of medical expenditures.
 The carbon footprint per patient with or without hospitalization
was 12 and 2.1 tCO2e/y, respectively.
 Avoiding generation of unused medicines can potentially reduce
emissions by 1.24 MtCO2e/y.
 To safeguard planetary health, more options for health promotion
and carbon emission mitigation need to be provided.
25

26. Carbon Footprint of Health Care Service
Segments in Japan (2011)
Source: Keisuke Nansai et al. “Carbon Footprint of Japanese Health Care Services from 2011 to 2015”, January 2020
(https://doi.org/10.1016/j.resconrec.2019.104525)
26

27. Carbon Footprint of Health Care Service
Segments in Japan (2011)
Source: Keisuke Nansai et al. “Carbon Footprint of Japanese Health Care Services from 2011 to 2015”, January 2020
(https://doi.org/10.1016/j.resconrec.2019.104525)
27

28. Carbon Footprint of Japanese Medical Services
by Injury/Disease and Age Class (2011)
Source: Keisuke Nansai et al. “Carbon Footprint of Japanese Health Care Services from 2011 to 2015”, January 2020
(https://doi.org/10.1016/j.resconrec.2019.104525)
28

29. Cloud Computing Needs Carbon-Free Energies
Anywhere
Source: Renantis, “Renantis signs power purchase agreement with Amazon for wind farms in Finland”,
May 31, 2023 (https://renantis.com/media-centre/renantis-signs-power-purchase-agreement-with-
amazon-for-wind-farms-in-finland/)
29

30. 8. Conclusion／Q&A
30
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