Telemedicine In Japan

In the November 1996 issue of Telemedicine Today I wrote, "Japan is at the edge of a major push into telemedicine." Since that time, however, progress has slowed considerably. While the number of active programs jumped from 49 in 1995, to 98 in 1996 and to 148 in 1997, only 7 new programs have been identified this year, indicating that the expected boom has failed to materialized. Reasons are not hard to find.

Telemedicine in Russia

There are some interesting similarities between Russian and U.S. telemedicine. Both have grown up with and been shaped by the space program, and both are to a great extent driven by serious problems with access to medical expertise in rural areas. The technology developed for transmitting medical information from space stations and spaceships to earth was used extensively after the Armenian earthquake of 1988, and after the Ufa gas pipeline explosion in 1989, in which many people were injured. Currently the Russian Center for Space Biomedicine (which is in fact a telemedicine center), Moscow State University, and the Institute of Medical Biological Investigation are collaborating with NASA through an agreement by the Gore-Chernomyrdin Commission. Among other things, this collaboration includes creation of several Silicon Graphics workstations for medically related video sessions between hospital in Russia and the U.S.

Telemedicine in Pohnpei

Pohnpei ("PO-ne-pay") is a 129 square-mile (441 km2) island with about 34,000 people, one of the four constituent states of the Federated States of Micronesia that include Chuuk (formerly Truk), Yap, and Kosrae. It lies more or less midway between Hawaii, three time zones to the East, and Manila, three time zones to the West. Its extreme isolation has important medical and economic implications. Fully 25% of all health care dollars are spent on off-island medical referral costs for the less than 1% of patients who have to be transferred thousands of miles to Guam, Oahu, or Manila. To make matters worse, the medical education infrastructure has languished until recently, a casualty of regional politics and colonial policies (Spain, Germany, Japan, and since WWII the U.S.) directed toward the occupiers’ economic and political interests rather than local self-sufficiency. This has led to an "aid economy," with a tripling of food imports between 1977 and 1990 and an absolute fall in subsistence food production. Even medical care has been largely an import item: in 1985, 75% of all physicians in the Federated States of Micronesia were non-native.

TELEMEDICINE IN JAPAN

Japan is at the edge of a major push into telemedicine. While interesting research and implementation have been going on for many years (see Telemedicine Today vol. 3, no. 3 - Tele-Home Healthcare in Japan), several federal policy factors have hindered wider adoption until very recently. However, the headline in the Japan Times of September 23, 1996 heralds the coming change: "Ministry To Approve Remote Health Care." The Medical Services Law "bans the treatment or the prescription of medication without face-to-face diagnosis," the report states, "but the Ministry (Koseisho, the Ministry of Health and Welfare) interpretation of the law holds that face-to-face diagnosis is not necessary."

Telemedicine in Hong Kong

While Hong Kong has one of the most advanced telecommunications systems in the Asia Pacific region, development of telemedicine applications did not begin there in earnest until 1996. The initial momentum to develop telemedicine was created by a visionary group at the Faculty of Medicine, Chinese University of Hong Kong (CUHK). In April 1996, a task force for the development of telemedicine was formed, in collaboration with the Faculty of Engineering and other experts in IT and health administration. Its mission was to develop local, regional (especially with China), and international networks to evaluate efficacy of telemedical procedures in clinical care and medical education. Those applications determined to be of value would be systematically introduced into community practice.