This document discusses leveraging telemedicine and collaboration between medical professionals to improve community health resilience and disaster response. It proposes: 1) Establishing a network of doctors, hospitals, and subject matter experts that can provide telemedicine, share knowledge, and support each other's capacity. 2) Using this network to provide primary and preventative healthcare services, respond to disasters, and transfer patients when needed while maintaining the trust of local doctors. 3) Facilitating collaboration between urban and remote/island doctors to balance workloads and build capacity in remote areas through knowledge sharing.

1. Community based Post office
telehealth Clinic: Leveraging the
public sector for preventative health
& disaster relief
Telehealth Failures
&Secrets to SUCCESS
Silicon Valley
Sept.20-22, 2017 Newark CA
Yuki N. Karakawa
Board Director of IVeHospital
Community Health resilience with Telemedicine Networked Doctors, and
provisioning to Public, Environmental Health and Disaster Medicine
1

2. Constitution for Human Life/GHQ24
❖ Article XXIV. In all spheres of life, laws shall be designed for the
promotion and extension of social welfare, and of freedom, justice
and democracy. Free, universal and compulsory education shall be
established. The exploitation of children shall be prohibited. The
public health shall be promoted. Social security shall be provided.
Standards for working conditions, wages and hours shall be fixed.
2

3. Collaborative Community Resilience
❖ (1) achieving a living environment in which a healthy and cultural life
can be attained
❖ (2)building a disaster-resilient healthcare infrastructure, and
❖ (3)creating a social environment in which disability can live
independently in security, and the solutions thereof shall be dealt
scientifically.
3

4. Collaborative Telemedicine key framework
❖ All Med. Professional
Community shall support
Single Healthcare need/Patient
and Lead by Prime Doctor.
❖ Multi Level Service
collaboration
❖ Patient trust Doctors
4
Univ&Hospital
Trauma Center
SME
Telemedicine
Diagnose
Prescription
Emergency
Medicine
Triage
Safe and
Extension
Hospital
SME
Telemedicine
SME
Medicare
Patient transport without experties
70% is not necessary to transfer patient
Transportation risk for Patient move
not Effective Medical Service
Save CO2, LEED support
Transfer
Emergency Acceptance of Patient
DecisionSupport
Trust of Doctors
Disaster
Medicine Center
SME
Medicare
Education
CapacityBuilding
Knowledge
Sharing and
Capability Build
Security
Medical service
with you
Health
Protection
Walking HospitalHealth Check, Payment, Drug, ICT
Education
Citizen Resilience
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build

5. Face - Face with Profession& License
5
Diagnose
Prescription
Trust of Doctors
Prime Doctor
People want to see sky in difficulty
Prime Doctor is the DOOR to open
Patient

6. Patient Life risk increases while transfer
Trauma Center
Diagnose
Prescription
SME
Medicare
Patient transport without experties
Transfer
Trust of Doctors
Prime Doctor
70% is not necessary to transfer patient
Transportation life risk for Patient
against Effective Medical Service
loose CO2
When Doctor is not a specialist,
Doctor will transfer Patient to
other Hospital.
Loose Prime Doctor’s
TRUST for Patient
6
Patient

7. Prime Doctor needs another Door to open
7
Diagnose
Prescription
Emergency
Medicine
Triage
Safe and
Extension
Hospital
SME
Telemedicine
DecisionSupport
Trust of Doctors
Education
CapacityBuilding
Knowledge
Sharing and
Capability Build
Prime Doctor
Supporting
Subject Matter Expert
Doctors
Search available
and capable Doctors
and link to Prime Doctor
Centre of Excellence
Telemedicine
Dispatch
Patient

8. What is the state of Emergency
❖ The situation to give
up response
capability/mission
overwhelming
situation happened
❖ Search capable and
available service to
transfer role
❖ Nature is always great
and over come as
nature
❖ # Ambulance is not
emergency. It is under
control.
8
Too much
Legal
illegal
In-Capability Exeeded Capability
Emergency Definition
Planned (Operational)
OnScene Post-DisasterPre-Disaster
Emergency(Exeeded Capability)
Emergency declaration item is
missed in Japan constitution
Life Saving(Operational)
Operational
Disaster response
Planned (Operational)
Life Saving (Operational)
Support
RequestTime Gap
Deny of
assistance
Assist
Proposal
Business Contingency Plan
Time Gap
Order, Budget Transfer
We can force to run with Prime Minister
order
Emergency
decision Declaration
DisorderedSituation
Supporting Team
Fire Alarm

9. Life Secured Patient Transfer
9
Trauma Center
Diagnose
Prescription
SME
Telemedicine
SME
Medicare
Emergency Acceptance of Patient
DecisionSupport
Trust of Doctors
Education
CapacityBuilding
SME knows
best Available
Acceptable
Medical Centres
Doctors
and Can Select
PrePositioned Transfer
Monitored by SME while transfer
Prime Doctor
Patient

10. Hi-profile Collaborative Surgery
10
SME
Telemedicine
SME
Telemedicine
SME
Telemedicine
. . .
Projection Mapping on body
8K Camera feed
Diagnose
Prescription
Prime Doctor
Patient
SME
Telemedicine
SME
Telemedicine
SME
Telemedicine
. . .
8K Ultra High-Definition PinP Display
Digital Signage Solutions
HD live image
HD live image HD live image SNS screen
Data broadcast screen
2K Command
Navigable multi Frame

11. Backbone of Doctors Network
11
Univ&Hospital
Trauma Center
SME
Telemedicine
Diagnose
Prescription
Emergency
Medicine
Triage
Safe and
Extension
Hospital
SME
Telemedicine
SME
Medicare
Emergency Acceptance of Patient
DecisionSupport
Disaster
Medicine Center
SME
Medicare
Education
CapacityBuilding
Knowledge
Sharing and
Capability Build
Education
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Prime Doctor
Patient
First Response
Disaster Relief
Trauma Relief
Education & Training
Collaborative
Community
Resilience
by Professional
Community

12. Collaborative Telemedicine workflow
12
Diagnose
Prescription
Prime Doctor
Patient
SME
Telemedicine
SME Doctor
6 Trauma Doctors
30 Nurse and Administrator
SME Doctors Database
Information Archives and Sharing
Triage

13. ex.Tokyo DMAT for Tokyo Olympic
7
二次保健医療圏別東京ＤＭＡＴ指定病院配置図 （平成２２年８月２０日現在）
4
区中央部保健医療圏
北多摩北部保健医療圏西多摩保健医療圏 北多摩西部保健医療圏
№
12
区西南部保健医療圏
№
20
区西部保健医療圏
№
22 1419
北多摩南部保健医療圏
1
区南部保健医療圏
№
6
白鬚橋病院
区東北部保健医療圏区西北部保健医療圏
区東部保健医療圏
都立墨東病院
医療機関名№
13
№
7
№
89 2
医療機関名
医療機関名
昭和大学病院
東邦大学医療センター大森病院
医療機関名
21
№
東京医科大学八王子医療センター
医療機関名 医療機関名
南多摩保健医療圏
№
11
医療機関名
国立病院機構災害医療センター青梅市立総合病院
東京医科大学病院
東京女子医科大学病院
医療機関名
公立昭和病院16 帝京大学医学部附属病院
医療機関名
日本大学医学部附属板橋病院
№
3
18
№
10 東京女子医科大学東医療センター
医療機関名
都立広尾病院
国立病院機構東京医療センター
医療機関名
日本医科大学附属病院
東京医科歯科大学医学部附属病院
医療機関名
都立多摩総合医療センター
杏林大学医学部付属病院
武蔵野赤十字病院
№
5
15
17 東海大学八王子病院
日本医科大学多摩永山病院
千代田区
中央区
港区
文京区
台東区
品川区
大田区
目黒区
世田谷区
渋谷区
新宿区
中野区
杉並区
豊島区
北区板橋区
練馬区
荒川区
足立区
葛飾区
墨田区
江東区
江戸川区
青梅市
福生市
あきる野市
羽村市
瑞穂町
日の出町
檜原村
奥多摩町
八王子市
町田市
日野市
多摩市 稲城市
立川市
昭島市
国分寺市
国立市
東大和市
武蔵村山市
小金井市
狛江市
武蔵野市
三鷹市
府中市
調布市
小平市
東村山市
清瀬市
西東京市
東久留米市
1
２
３
７
７
６
５
４
10
13
８
９
11
12
７
１５
１７
１６
１４
18
19 ２０
２１
２２
Layout view of a Tokyo DMAT - designated hospitals
6
Dispatch system
Equipment
（１）Medical equipment
（２）Uniform
（３）DMAT car
Dispatch center
Fire department
Hospital
“ Wall of 72 hours “
No. of Rescued
No. of Survivor
Survival rate
Changes in the survival rate in five days
Activities of other DMAT in East Japan Great Earthquake
DMAT (all JAPAN) :340 team
1,500peaple
Active period :12 days
Activities :Hospital support
patient transportation
evacuation support
13

14. Multi Level mission support & Relay
14
Univ&Hospital
Trauma Center
SME
Telemedicine
Diagnose
Prescription
Emergency
Medicine
Triage
Safe and
Extension
Hospital
SME
Telemedicine
SME
Medicare
DecisionSupport
Trust of Doctors
Disaster
Medicine Center
SME
Medicare
Education
CapacityBuilding
Knowledge
Sharing and
Capability Build
SecurityHealth
Protection
Education
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Nurse
Health
AssistantDecision Support
EducationCapacity Building
Decision Support
Education
Capacity Building
Emergency Acceptance of Patient
Prime
Doctor
Patient
❖ Total risk management
and risk transfer for
Patient
❖ Effectiveness to
Practical
❖ Time Matter
❖ Collaboration by
Professional
Community Postman now
do Health
Assistance
in remote area

15. Technologies make Real, Dare to Care, Med. Info Archives
Mission Assurance for Medical Services
15
Bio Metric
Passcode
Medical and Confidential information shall be hashed and recorded
The recorded file is belong to Medical Doctor who writes notes. And
Patient life log is belong to Patient or personals who is the source.
The final Notes is secured, stored and managed. Upon request or
needs, The Notes can be transferred to suitable people.
Approach/Action
Medical and Confidential information shall be hashed, diverted and
secured Record is not a Crypto file. It is secured and protected inside
hashed database but it is not anonymised Inside database. It looks
anonymised in business process for assurance. Each contents/record
will be retrieved with owner only know information to hit position of
information then target information will be partially retrieved by owner
or beneficiary.For Statistical analysis, we make order with
mathematical function/routine to database and Database will give
back answer only and never bring Privacy information out of
Database. Once uncertain activity found, we shutdown one DB and all
data processing will be stop. And when it is confirmed integrity and
safe, we restart DB as normal mode. In worst case when world or
jurisdiction were broken integrity and we need and can destroy and
erase all data, we destroy more than two element down, System
execute termination for information.
Destroyable Medical Information, Privacy

16. Real and Virtual Clinic for services
16
Citizen Services
City Hall/Gov
BR
vL-Line
Disease Surveyllance
Principal Clinic
eMR, Secrete Computation
Secrete Sharing SchemeDB 難病
EMIS
Life
Resilience
Dispatch
Center
Life Protection
Disaster Relief
Web
Safe and
Extension
Hospital
Family
Care
v-PACS
File Server
Smart Phone
Radiation
Blood血液検査
Eye目
Decon
Station 除染
Prescription
Med Data
処方
診
察
HL7
Health
Record
Sensor
Net
環境
データ
Env. Data
Life
Security
Early
Warning
Lab.Sport&
Health Science
BIG
Data
医
Disease surveillance
Pharmacy
BR
vL-Line
eMR
Digital
Prescription
SME Clinic
ENIF
BR
vL-Line
Recept
Accounting
Future Clinic Primary Care
2020 FEP
Backup/ArchvesBR
vL-Line
BR
vL-Line
SME Clinic
BR
vL-Line
Person Health
Primary Care
Dear to Care
Finance
Transaction
❖ Copy Machine -
Existing service
infrastructure
❖ Staging Information
archive system with
resiliency
❖ For local Medical
Professional

17. Collaborative high-Availability and Load Balancing
❖ Practical cross regional collaboration
❖ Capacity building for CCR: Collaborative
Community Resilience
❖ Multi Level Service collaboration
❖ Patient trust Doctors
❖ Urban Doctor support special treatment to
Remote
❖ Remote Doctor support workload in Urban
❖ Special Doctor can get Credit for SME
❖ Remote Doctor has high-salary but low work
load and need to respond to all incidents
❖ Japan(3852 Islands, Main:5,Major Remote:
51+ Special:254(387,000 Population))
17
Time
Over capacity
Over capacity
8 13 16 19
Urban/Metroporitan Area
Remote Island/Mountain AreaPublic Health
and Primary Care
Service
-Capacity+
Service
-Capacity+
work load
work load
21
SpecialCare

18. Preventive Medicine, Primary Care
18
Security
Medical service
with you
Health
Protection
Walking Hospital
Citizen Resilience
Preventive Medicine
Univ&Hospital
Trauma Center
SME
Telemedicine
Emergency
Medicine
Triage
Safe and
Extension
Hospital
SME
Telemedicine
SME
Medicare
Emergency Acceptance of Patient
Disaster
Medicine Center
SME
Medicare
Knowledge
Sharing and
Capability Build
Education
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Knowledge
Sharing and
Capability Build
Health Check, Payment, Drug, ICT
Post
Logistics
Pharmacy/Delivery
Contact Station/remote Clinic
Banking
Insurance
Health Infra. Inv.
Postman can do the work
Post Office service transition
with expertise component
Capacity building
Hobby Health/Sports of Life
Medical Professional Community

19. Last Resort for Community Resilience
19
Universal Health Coverage
OCD
NDRRMC
Public Service Spot
eHospital
Front
eHospital
backbone
V-Office
DICT
Public Service
SOC
Gov Staff
eLearning
Prosess
Assurance
Postal Service
Bank Service
Ins. Service
eHospital Srv
HA/DR&DM Srv
Medicine Srv
Public Service Spot
Public Service Spot
Public Service Spot
3000 Barangy Location
JIE&MPE CiMiC
Link
ECG, RR, BT
BP
O2 saturation
Ultrasonic echo
Collect
vital signs
Send data
with cloud
Cloud
server
Share data
with
hospital
Connect cloud
with smart phone
Pro-active response
Bluetooth
Healthcare IoT
A Cloud-based Mobile System for Improving
Vital Signs Monitoring During Hospital Transfer
IoT platform is necessary for constructing pre-hospital emergency medical care
Monitoring patient’s status
MIL eHospital
Prv-eHospital
SME eHospital
SME eHospital
SME eHospital
LEED
Compliance
IVeH - IBOT
Framework
Health Crisis and Risk Information Supporting Internet System (H-CRISIS)
based information platform among organizations
Public Health
Center
Public Health
Institute
NIID
NIPH
NIHS
Health risk information platform
MHLW
Prefectural
Health Division
Manuals
Research products
Training scenarios
Government notices
Health risk archives
H-CRISIS
Provide guidelines for
preparedness
Infectious
agents
Chemical
agents
Community
Surveillance
Detection
Response
Public health
preparedness
- Citizen WiFi
- Citizen Fiber
Resilience
Capability Bld
Disaster
Response
Disaster
Medicine
Surveillance System in JapanSurveillance System in Japan
Sentinel-Reporting diseases
Sentinel clinics / hosp. Clinical isolates
and specimens
Health centers
Case Report Summary Report (wk/mo)
Quarantine stations
National IDSC
(NIID)
Laboratories
(NIID)MHLW
Reports
Specimens
Computer network
Patient (data entry by HCs)
Infectious agent (data entry by PHIs)
Information
dissemination
Notifiable diseases
All clinics / hosp.
Pref. Health
Depts.
Pref. IDSCs Pref. PHIs
Infectious Disease
Surveillance Center
Headquarters
Integrate information
from disaster-hit areas
Shelter surveillance
Information from
fax, mobile phones,
& tablets
Evacuee surveillance
Registration of
evacuees from tablets
Health Crisis & Risk Information Support Internet System(H-CRISIS)
Information
A cloud-based health support system
Secured
Profiling
Archives
Digital
TV
Digital
TV
5 Million Homes
ORMOC
Concept
Demo ASEAN
LEED
EMIS
Telemedicine & Alert
Telemedicine & Alert
ABroad Fiber
facebook

20. Complexity to the Bright Futures
Smart Phone
Radiation
Blood血液検査
Eye目
Decon
Station 除染
Prescription
Med Data
処方
診
察
GWU
Children Hospital
Telemedicine Center
RTAT
JP
Recomendation
HL7
Health
Record
Person Health
Primary Care
Dear to Care
Sensor
Net
環境
データ
Env. Data
Life
Security
Early
Warning
Resilience
Dispatch
Center
Env.
Health
Protection
Ass.
Health Crisis Div .
Public
Health Net
Pharmacy
relief Net
健康保護/保健所
日本健康
危機学会
Civil Services
検診、往診、遠隔健康支援
Disaster Relief
and Life Saving
Basic Training (Instructor-led or Online eLearning):
Emergency Management Principles
The Incident Command System
National Incident Management System compliance
Chem/Bio/Rad Agent identification
Crisis Communications
Decontamination Procedures
Simulation/Drill Exercise Design
Additional Training:
Critical infrastructure protection
Physical security assessment and preparedness
Industry-specific sessions (WMD, Chemical, Utility/Pipeline,
Airport, Port/Maritime, Nuclear, Public Health preparedness)
Custom Training Design & Development
Learning Management System
EV Training Services
災害時
市民健康支援
議員連盟(仮称）
Environmental Health Protection
Council in Parliament
Hospital Ship
and Asian
Health
Assistance
Lab.Sport&
Health Science
TOMODACHI
2013/04/03 4:55子育て応援団
1/3 ページhttp://www.kosodateouendan.jp/pc/
1検索
婦人科系の悩み
妊娠と感染症
不妊症の検査
子づくりチェッカー/排卵日チェ
ッカー
妊娠に気づいたら
妊娠・出産の悩み
出産準備
出産ツール/育児用品ツール/ベビ
の血液型は?/戌の日カレンダー
病気・事故・予防
子育てのキホン
クッキングレシピ
お祝い返しチェック
大手小町へ
子育て応援団Twitterへ
大手小町から子育てに関するクチコミ情報を
ご紹介!
◆三歳児への対応に悩んでいます。
◆息子よ、あなたが他人だったらプ...
◆毒親になっていく
【インフルエンザ】今シーズンのQ&A
【感染性胃腸炎】ノロウイルスの対応・予防
【RSウイルス感染症】注意したい症状
【マイコプラズマ肺炎】ご注意を!
【風疹Ｑ＆Ａ】妊娠初期の感染で胎児に影響する可能性も!
感染症ニュース
インフルエンザ脳症にご注意！ 3/27
風疹 妊婦が周りにいる方へ 3/8
大手小町:子どもニュース
小児がん啓発ウオーキング
小学生の金銭感覚は「堅実」
子ども服 襟首ひも禁止…消費者も危険性認識を
幼稚園・保育園特集
気になるお金のこと 4/3
ファミリー特集:2013年4月号
4月の注目する感染症は4つ! 4/1up
幼稚園・保育園特集
保育園と幼稚園の基礎知識 4/1
感染症ニュース
インフルエンザ脳症にご注意！ 3/27up
感染症ニュース
風疹 妊婦が周りにいる方へ 3/8up
勝手に子育て応援団団長 藤村直己の子育てハッピーダイアリー
ばんそうこう 3/22
スタッフママのつぶやき
原因不明の高熱１週間 4/2
幼稚園・保育園特集
気になるお金のこと 4/3
ファミリー特集:2013年4月号
4月の注目する感染症は4つ! 4/1
先月の話題ワード
夜泣き･ﾉﾛｳｲﾙｽ･ﾏｲｺﾌﾟﾗｽﾞﾏ肺炎･RSｳｲﾙｽ･ｲﾝﾌﾙｴﾝｻﾞ...
気になる症状をチェック
夜熱が出たら？
【感染性胃腸炎経験談】
kosodateouendan 【４月期・注目してほ
しい感染症】 ◆注目度NO1…A群溶血性レ
ンサ球菌咽頭炎(溶連菌感染症) ◆注目度
NO2…マイコプラズマ肺炎 ◆注目度NO3…
感染性胃腸炎 ◆注目度NO4…風疹（ふうし
ん）
12 hours ago · reply · retweet · favorite
kosodateouendan 子育て応援団連携局拡
大！・・・４月１日より、札幌テレビ、テレ
ビ信州、福井放送３局が連携局に加わりまし
２４
Yokota Relief
Medical Center
Tokyo L1 Trauma
Center - Kyorin
DMAT
NCCHD
US Civil Defense
Council
CDC-P
disease
Surveillance
system
Life Protection
Disaster Relief
Web
31
Telemedicine
Netcentric
Tele Health
and DMAT
Global Health
Auto, Air, Fleet Safe
Driver, Pilot, Navigator Health
and Disaster relief
市民健康支援
ネットワーク
災害医療病院連携
ネットワーク
医師看護師研修
ネットワーク
Hospital Federation Net
Med.Service Edu Net
Health Support Net
US
Recomendation
研修訓練
BIG
Data
Hospital VOD
Silver VOD
Hotel VOD
M
E
D
i
Home VOD
Mobile VOD
Public
Service Net
Family
Care
青年在宅医療
Pediatric
Obstetrics&Gynaecology
Child Telemed
小児科／産婦人科
Medical&Nursing
Vietnam
MyanmarKosovo
Alvenia
West
Africa
Thailand
Check
Prescript, TelMed
Dr. Second Opinion
Taiwan
B
M
T
NIPH
NIH
NIHS
予防
学会
Digital Archives
20
診療
キット
診療
キット
市民
CMS CMS
税金(Debit)
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