Presentation abstract on the Disaster Cardiovascular Prevention Network, an interoperable remote cardiovascular monitoring program launched for evacuees following the Great Japan Earthquake of 2011.

1. The Disaster Cardiovascular Prevention Network:
Using interoperable technologies to mitigate CVD
risk after the Great East Japan Earthquake
Chuck Parker, Executive Director
Continua Health Alliance
Presented at Healthcare Informatics Society of Australia July 2013
Winner: Don Walker Award for Efficiency

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About These Slides
These slides provide details of the Disaster
Cardiovascular Prevention Network (DCAP)
program, a remote monitoring program designed to
mitigate cardiovascular risk in a group of evacuees
following the Great East Japan Earthquake of 2011.
DCAP was detailed in an award-winning abstract
submitted to the Healthcare Informatics of Australia
conference by Chuck Parker, Executive Director of
the Continua Health Alliance, and presented at HIC
in July 2013.

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Abstract Introduction
• Earthquake exposure and living in an evacuation camp
are factors associated with elevated cardiac risk, making
CVD management an important element of earthquake
recovery.
• After the Great East Japan Earthquake of 2011, hundreds
of evacuees were housed in a camp in Minami-
Sanrikucho, a town within the devastated Miyagi
Prefecture.
• The region lacked basic services such as electricity,
water and sewer for the first three months, limiting the
capability to provide treatment and access medical
records to assess pre-existing conditions.

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Technology Brief
• Dr. Kazuomi Kario, Chairman of Cardiovascular Medicine at Jichi
Medical University in Tochigi, Japan, recognized that a rapid solution
was needed to care for patients at high risk for a cardiovascular
incident. No off-the-shelf solution was available that met the
requirements.
• Dr. Kario worked with medical device manufacturer A&D, Inc. to
develop the Disaster Cardiovascular Prevention Network (D-CAP), in
order to remotely monitor the blood pressure of high-risk evacuees in
the Minami-Sanrikucho camp.
• The goal: to prevent cardiac events. An important technological aspect
of the program was pre-existing interoperability between all component
devices, which had been previously certified as interoperable by the
non-profit organization Continua Health Alliance according to
Continua’s publicly available Design Guidelines.
• The Technological components of D-CAP include: Automatic blood
pressure monitors (A&D, Inc.); Gateway firmware (Alive, Inc.); data
server (Ryoto Electro Corp.); clinical PC (Panasonic); patient ID cards
(Toppan Forms); web application development (Qute); and project
coordination (Intel).

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Implementation Processes
• DCAP consisted of examinations and assessments to stratify
high-risk patients, (systolic blood pressure above 180 mmHg).
• Screening of 1,500 evacuees identified 400 people with
elevated cardiac risk, who were enrolled in the D-CAP program
(26.6% of screened evacuees). Patients with persistent
symptoms were evaluated by physicians and prescribed oral
medications as needed.
• D-CAP registrants received electronic identification cards and
were encouraged to take their blood pressure at automated
stations within the camp. Data were sent wirelessly to data
server and relayed to Jichi Medical University. Clinicians
monitored the data and alerted on-site physicians by phone of
any significant developments.
• Subsequently, high-risk patients were moved from the
evacuation camp into temporary housing provided by the
government and given individual blood pressure monitors that
store a month of readings. Data could be downloaded at the
hospital and then uploaded to D-CAP’s data center.

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Conclusions
• D-CAP has been credited with saving lives. Nearly a year
and a half after the earthquake, every one of the 400 “high
risk” D-CAP evacuees was still alive and the program
remained in operation.
• Participating companies had certified their products for
interoperability using Continua’s publicly available Design
Guidelines. This facilitated a time from launch to
conception of just two weeks, or 12 man-weeks, at a cost
of USD 27,000. In interviews conducted with participating
companies, it was estimated that without pre-existing
interoperability, launching D-CAP would have taken twelve
weeks, or 72 man-weeks, at a cost of USD 166,000.
According to these estimates, deploying interoperable
technologies reduced launch time by 84%, or ten weeks,
and saved USD 139,000.

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Conclusions, cont’d.
• While it is impossible to measure the value of those first
ten weeks in terms of cardiovascular events averted or
lives saved, it is certainly easy to imagine the risk to the
400 D-CAP participants, had they received no specialized
screening, cardiac monitoring or care during that time.
Furthermore, the cost savings derived through pre-existing
interoperability would fund five additional programs
(without accounting for economies of scale), providing
monitoring for an additional 2,000 patients.
• D-CAP illustrates the clinical, time and cost advantages of
interoperability for program implementation following a
disaster, when time is of the essence, and shows how the
availability of certified, interoperable devices supports
connected health innovation.

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Continua Health Alliance
The Engine for a Plug and Play World
Please direct inquiries to:
Chuck Parker
Executive Director
Email: chuck.parker@continuaalliance.org
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