According to Professor Tsuji, Japan currently constitutes one of the most advanced economies in telemedicine with regard to the number of systems implemented by local governments as well as the type of manufactured devices related to telecare. Japan has 76 local governments and there are 8092 devices in use as of August 2000.
These devices are being applied in three different types of health care setting comprising telehomecare, telehealth and community health and welfare management. In the telehomecare system which by far is the most popular telemedicine application, hospitals and patients are interconnected via Internet or ISDN. The images and health data are sent through the home patiet terminal to intermediary terminals such as PCs, servers, and cameras, and then further transmitted to the hospital for advice and consultation.
Kamaishi City, Katsurao Village and Nanmolu Village form the three pilot sites that have been prepared for telehomecare in Japan, as Professor Tsuji explained. Necessary conditions for the implementation are that the system should be easy to operate for the elderly, that it is able to provide a variety of health information, and that it is easy to maintain. In Kamaishi City, 211 devices are now available for 348 users which have to pay a monthly charge of US$ 20, while in Katsurao Village, there is no monthly charge for the 330 devices which are used by 926 patients.
The remote monitoring devices are developed by major Japanese household electric appliance manufacturers. As such, Sanyo is selling Medicom and NEC the Sukoyaka Mate. For this type of multi-functional devices, the PC serves as a platform to transmit images and voice data. An important drawback is that these systems tend to be costly, as the speaker pointed out.
The largest share however is occupied by the Urara system, developed by the Nasa Corporation and which has been in use since 1990. Urara offers simple functions and is relatively inexpensive since Urara costs only US$ 2000. The peripheral device is equipped with memory features and an electronic sphygmomanometer plus an electrocardiograph, an electronic signboard and additional buttons for the answering of questions. Some 26.7 percent of telehomecare patients in Japan use Urara daily.
The usage of telehomecare devices is supported by user associations and medical institutions while there also exists a strong collaboration between medical, health, welfare, and homecare networks. As for the medical insurance companies in Japan, they already cover teleradiology and chronic disease at present. In scientific research, the focus is being put on the economic benefits and medical effects of telehealth and telehomecare.
Professor Tsuji ended his talk by saying that some legal issues still have to be solved to get private companies involved to participate in telemedicine. In any case the third generation of telehomecare users will be bound to use advanced systems of mobile communication and Internet Application Service Provider (ASP) models.