ASOURCE Times

Remote face-to-face medical care is possible from the first visit

Telemedicine in Japan, which started about 50 years ago, was limited to diagnostic imaging services centered on image interpretation until recent years due to legal development / interpretation problems and communication speed restrictions. With the widespread use of information and communication equipment, the technical issues in telemedicine communication have been almost eliminated. Regarding the issue of legal development and interpretation, the Ministry of Health, Labor and Welfare clearly exemplifies the target of telemedicine in 2015, and in 2018, in order to strengthen and promote the "family doctor function", only re-examination online or telephone medical treatment Certain rules have been established, such as allowing insurance medical treatment by (online medical treatment), and movements have begun toward the appropriate implementation and dissemination of telemedicine.

Furthermore, in April of this year, the Ministry of Health, Labor and Welfare decided to allow online medical treatment at the first visit as a measure to prevent the spread of new coronavirus infection, although it is a timely and special measure. With the relaxation of conditions in telemedicine and the resolution of technical issues, the interest of medical institutions and the general public is rapidly increasing.

In addition, it is expected that telemedicine will be further developed with the advent of 5G, which started commercial service in March, and various demonstration experiments using 5G have been conducted at medical institutions all over the country for several years. There is.

Listen to auscultation sounds in real time at a remote location

With 5G, ultra-high speed and large capacity will be realized so that a 2-hour movie can be downloaded in 3 seconds. Until now, joint medical care has been carried out by connecting a clinic in a remote area and a university hospital in an urban area via a network line, but with 5G, images of the affected area taken from the clinic with a 4K high-definition camera can be transferred to the university hospital. High-speed transmission becomes possible.

According to the doctors who participated in the demonstration experiment, the image quality was surprisingly clear and the quality of the diagnosis was improved. In addition, since the conversation is not delayed, there is a sense of realism as if talking in front of you, and it seems that you do not feel stress in remote medical treatment. With the advent of the 5G era, telemedicine will become one of the important and effective forms of medical care, and it is expected to contribute to the elimination of regional medical disparities.

Even with the current online medical care, in Tobishima, where doctors are absent, and in Yamagata Prefecture, where there are mountainous areas, the prefecture has been improving the environment, and it boasts the highest online medical care penetration rate of 30% or more in Japan. (From the list of medical institutions that support online medical care by the Ministry of Health, Labor and Welfare) However, there are still some local governments with low penetration rates, such as areas with many elderly people. In addition to the difficulty of dealing with the elderly, there are various reasons such as low medical fees compared to face-to-face medical care, system introduction costs, and concerns about security.
In the future, the key to the spread of telemedicine will be for the government to actively support and improve the environment for the problems of telemedicine that each medical institution has.

Another unique attempt at telemedicine is the use of remote digital stethoscopes. First, the patient wears an examination gown with a numbered points for auscultation. Then, the patient himself puts a stethoscope on the number of the examination clothes instructed by the doctor in a remote place through the screen. Then, the patient's heart sounds and lung sounds are transmitted in real time to a doctor at a remote location, which is one of the diagnostic materials. In the field of home medical care, attempts have already begun to combine digital stethoscopes and telemedicine to lead to early detection of respiratory diseases that are common in the elderly, and transmission with higher sound quality using 5G is planned in the future.

To telemedicine that can perform not only diagnosis but also treatment by 5G

In addition to high-speed communication, 5G has features such as "multiple simultaneous connections" that allow about 100 devices and sensors to be connected to the Internet at the same time, and "ultra-low latency" that can minimize the time lag in communication networks. Demonstration experiments of remote surgery support that make the best use of these 5G features are underway in the field of neurosurgery.

In the field of neurosurgery, in recent years, a "smart treatment room" has been developed to improve the accuracy and safety of surgery. It connects multiple medical devices in the operating room via a network, integrates various data such as MRI images taken on the spot, patient's biological information, and the progress of surgery, and displays them on one monitor. , A mechanism in which a skilled doctor in a remote location confirms it and gives advice to the surgeon in the operating room. With conventional communication technology, the monitor room and operating room could only be connected within the same facility, but by utilizing 5G, it has become possible to provide surgical support remotely.

In this way, telemedicine will steadily expand not only in the field of diagnosis but also in the field of treatment. However, the Japan Medical Association has stated that "diagnosis and prescription only by interviews and inspections without information is dangerous", and we are extremely cautious about online medical treatment from the first visit. In telemedicine, including online medical care, instead of deciding the superiority or inferiority in comparison with face-to-face medical care, how to combine and apply it with developing technology as a new medical care form alongside inpatient, outpatient, and home care. Case studies and lively discussions are needed.

Figure 5 Expectations for G medical applications

Source: Medical Technology Association of Japan Efforts of the Japanese medical device industry toward the 5G era
https://www.mtjapan.or.jp/jp/mtj/cn/pdf/hospeq2019/jp_01.pdf