For more information contact: Dr. Keiko Nakamura, Tokyo Medical and Dental University, Dept. of Public Health and Environmental Science, Yushima 1-5-45, Bunkyo-ku, Tokyo 113, Japan. FAX: +81 3 3818 7176; email: nakamura.hlth@med.tmd.ac.jp

As in North America, Japan is faced with a rapidly aging society. Currently, about 3 million people need daily personal assistance, and about 15 million have chronic disabilities. Unlike North America, ISDN (switched digital phone lines transmitting at 128 kbps) services are almost ubiquitously available throughout Japan. Because of its ability to carry relatively high volumes of digital information, ISDN offers major advantages for interactive video traffic. This combination of (1) need and (2) telecommunications infrastructure capable of helping supply the need has produced a ripe situation for testing tele-home health care.

We have had the good fortune to have Dr. Keiko Nakamura, M.D./Ph.D. as our correspondent for this story. Dr. Nakamura specializes in public health medicine and rehabilitation medicine. Her current research interests focus on the application of advanced technology to urban health care. She and her colleagues at the Tokyo Medical and Dental University have put together an exciting tele-home health program. Furthermore, they have made evaluation a key part of the process, and have reported their early findings in a peer-reviewed journal -- cf. Takano T, Nakamura K, Akao C. Assessment of the value of videophones in home healthcare. Telecommunications Policy, 19,3:241-248, 1995.

In December, 1990 the Department of Public Health and Environmental Science began using videophones for home health care. Professor Takehito Takano, Chairman of the Department, initiated the project and has guided its development. The initial project used interactive systems based on the Fujitsu Callvision IS-100, transmitting 5-inch color pictures via a CODEC at 7 frames/second, with full 2-way audio. In the initial phase, transmission was at 64 kbps, with 96 x 60 lines of resolution. Still image captures achieved a resolution of 384 x 240. The research project involved twenty volunteers, each studied over a 3-month period, with a range of disabilities including cerebral vascular disease, muscular dystrophy, cerebral palsy, and arthritis. Each volunteer communicated daily from their home to a participating physician, nurse, or physical therapist using the telemedicine system. Services offered included medical consulations, physical therapy instructions, nutritional advice, help with accessing social services, and emotional support. A battery of assessment questionnaires, incorporating standard scales for measuring activities of daily living, clinical conditions, subjective well-being, etc. was administered before, during, and after the intervention period. Both clients and health care workers were surveyed. The pilot phase for this project was completed in March, 1993.

The results were impressive. For clients, there was a statistically significant improvement in nearly every parameter of communication independence and social cognition over the study period. For the health care workers, there was general satisfaction with the usefulness of the technology in assessing clients’ conditions, family relations, etc. Suggestions for improvements included: clearer and brighter pictures, easier operation for clients with disabilities, and better far-end (remote) control of the client’s unit by the health professional.

Since that pilot, Dr. Nakamura reports that the scope of the project has broadened to include another 40 clients. Occupational and speech therapists are now involved. Services are now provided not only to client homes, but also to local community care centers for the aged. The plan, after the current "phase 2 trial," is to integrate the video home-health services into the national healthcare system. Also, there is a plan to create a multipoint network linking the elderly with a hospital, clinic, support center, and even relatives. The videoconferencing equipment has been upgraded to the Fujitsu VS-700sc system, running at 128 kbps. This transmits at 15 fps, at 352 x 288 lines of resolution for moving images and 720 x 480 for still images. An integrated informatics system is being developed to incorporate an electronic patient record, graphical databases, and other supporting information. Physicians are now being reimbursed for their telemedicine evaluations. Cost-benefit studies are pending.

Dr. Nakamura feels strongly that it is the role of health professionals to extend the benefits of innovative technology to elderly and disabled people, to help them overcome their disadvantages. Moreover, it is the role of the government to create a supportive legislative, legal and financial environment for these technologies to assure access for the people who need them.