Daisaku Yamazaki, Editorial Director, Nikkei Medical
(Translated from the webinar on October 27, 2021)
Telemedicine spreads globally, excluding Japan
Nikkei Medical
Japan is lagging behind in medical DX (digital transformation). The media has repeatedly reported the lack of online medical services not spread in Japan. In fact, according to Nikkei, online medical care was used less than once a month per 100,000 people across 35 prefectures during the fourth wave of COVID-19 in January-March 2021.
This includes the number of consultations over the phone, so the online medical care through a computer or such, as people generally imagine, must be even a smaller portion. While its use will free the time of access and eliminates the risk of infection, the media criticize that the low use rate should be blamed to doctors who are not motivated in installing them. However, if we look at countries where online medical care is widespread, we see a different picture.
For example, UK-based Push Doctor was established in 2013, roughly as the same timing as companies in Japan offering online medical services. Push Doctor can issue prescriptions for certain drugs and refer patients to specialists, but the most outstanding point is that the use of Push Doctor enables patients to see a doctor any time. In the UK, it is said that it usually takes 2 weeks from the time of an appointment to the time of a visit, but by using this system, that window time was shortened to 26 minutes. There are other leading companies providing telemedicine services in the UK.
One Medical, founded in 2007 in the US, is another company that provides telemedicine, but the key to their service is the combining of in-person and online. In the US, insurance premiums and medical costs are high, but by offering services online, people can see a doctor any time at a low cost. In urban areas, since they have actual clinics covered, people can see a doctor in-person according to their necessity. In short, both in the UK and the US, the remote medical services tackle the pain points of the current medical system.
Needs of telemedicine in Japan is not much heightened
What kind of pain points will be resolved by online medical care in Japan? In general, telemedicine does not allow testing and direct contact with the patient, so it cannot be said that the quality of care will improve. Also, in Japan, you can visit and be treated in a famous hospital at any time if you wish, or you can choose a medical institution with no waiting time. Telemedicine does not assure you an appointment with a famous doctor at any time, so the accessibility does not differ much. As for the cost, although transportation costs will be reduced, it should have not much difference. It will not work as the US insurance system, where you can get certain incentives.
The key is “who” will use that telemedicine. If you're in your 40s and have a repeat prescription for a lifestyle disease, you might use telemedicine because it's hard to take time off work. However, this should be based on two aspects: the risk of other diseases is low, and the prescription is repetitive for treating a chronic disease. In the case of children, there may be a need of consultation on whether to see a doctor or not, but in general treatment for adults, it is difficult to know without actually seeing the patient because most of them are in the acute stage, and the patient needs to receive the medicine immediately. On the other hand, the elderly uses medical institutions as if they were salons -- not being able to see a doctor in-person would be a demerit. Considering the situation, the needs for telemedicine in Japan are surprisingly limited. Historically, since the times when Nippon Telegraph and Telephone Corporation (NTT) was publicly held, demonstrative tests of telemedicine have been carried out in remote areas throughout Japan. Although, it has still not entered into a production level phase, indicating that, it should make more sense to think there are not many needs.
Will the My Number Insurance Card be widely used?
The root of the problem is much deeper. In Japan, medical DX is introduced as how it should improve the quality of medical care or how it will be more convenient. However, while I daily covering the stories, I feel the user's pain points are not always properly understood and not attracting the users.
There are also doubts about the widespread adoption of the online credential verification system; My Number insurance card (credited by the national identification number). How many patients really want to carry their medical information privately and how many want to enter their Personal Health Record (PHR) by themselves?
For users, they may see the insurance card changed to My Number card, but for medical institutions, the incentives for adoption would be low. Particularly for hospitals, since the number of card readers provided would be limited to a maximum of three machines, this will not be enough to handle the reception, and they will not see the benefits on additional investment.
According to an online survey conducted by the Health and Global Policy Institute, a think tank specialized in healthcare, 60% are satisfied with medical institutions. This may seem a little low, but if you narrow it down to only patients treated by doctors, the satisfaction level may become higher. In such environment, I think it would be difficult for medical institutions to promote DX for making their services better and attract more patients.
GE and others, driving DX forward in medical institutions
However, there is potential in DX for medical institutions. For example, HITO Hospital in Ehime Prefecture has introduced iPhones so that doctors can use voice input to enter and view electronic medical records, allowing them to check and work on data without returning to their desks at the office. Moreover, since they are able to communicate over social media, the speed of communication has also increased.
Today, coming rather slower than general companies, the wave of work style reform is about to hit medical institutions. Overtime work will be restricted to less than 100 hours monthly / 1,860 hours annually, by 2024. We will see DX for reviewing operations and structural reforms that go beyond simple ICT implementation, in the coming future.
In a project at Kurashiki Central Hospital in Okayama Prefecture, by GE Japan, various types of medical equipment are being migrated to an IoT system to analyze the path of medical staff and the operation rate of the equipment. Without the burden of workforce in the frontline, the system allows the analysis of loss -- within after one year since the start of the project, it showed that one-sixth of the installed diagnostic ultrasound equipment was hardly in use. In addition, the company was able to confirm the omission of medical fee claims based on the usage record of the equipment, resulting an increase in revenue.
Medical institutions have low profit margins and making investments is not easy, unless they are directly linked to income. If the improvements are expected to reduce costs and also improve quality, then there is more than enough reason to invest. I would like to see more and more medical institutions making this kind of progress around DX, and I think that, in order for medical institutions to survive in this midst of turbulence, pressure of work style reforms and medical cost reductions, they will have to move forward.
How will companies use digital data?
Last but not the least -- medical treatment is also going digital. In 2014, software was approved as a medical device, and last year, 2020, software was finally approved as a digital pill. This is an extremely hot area right now. Drug development is becoming more and more difficult and costly. On the other hand, software, as a medical device, are safe and development costs can be kept relatively low, they will surely expand inside the industry even more. Major pharmaceutical companies, one after another, have been partnering with related system development companies since 2018 to 2020.
If therapeutic apps and in-hospital DX become more widely installed, although the database cannot be integrated together, a variety of information held by medical institutions and patients will become digital data. In other words, what the government wants to do with online eligibility verification will become reality, in a natural course. Companies would need to constantly think about what data do what types of companies have in possession, and what they are going to use them for.
Widespread of the online credential verification system and the surrounding services is difficult, but I believe that the digitalization of pharmaceuticals and medical devices will make it possible to collect similar information. I think DX would advance around the operational workflow of medical institutions, and relevant data will be collected respectively. As a result, new businesses utilizing such data may surface.
