[Event Report] Considering the Prospects for Extending Healthy Life Expectancy Through Data Utilization — Lecture: "The Current State and Future of Comprehensive Healthcare Systems" (Held on January 27, 2022)
Event Date
Event Venue
June 30, 2022
The "Project for Extending Healthy Life Expectancy" is a component of KGRI's "2040 Independence and Self-Respect Project." As part of its interdisciplinary research activities, the lecture "The Current State and Future of Comprehensive Healthcare Systems" was held on January 27, 2022.
Japan has entered an unprecedented super-aging society. One of the key questions is how to extend people's healthy life expectancy. Healthcare services that provide one-stop support from disease prevention and treatment to post-treatment follow-up, utilizing biometric data and other information, are gaining attention as a potential solution. However, various challenges have been pointed out regarding such data utilization, and active discussion is needed.
This lecture featured Professor Toshio Miyata of the Center for Advanced Biomedical Sciences, Waseda University Faculty of Science and Technology, who has been working on data-driven healthcare from the perspectives of a physician, a former medical officer at the Ministry of Health, Labour and Welfare, and an entrepreneur, to explore the current state and potential of comprehensive healthcare systems. In addition to the lecture content, this report provides a digest of the multifaceted discussion from perspectives such as legal frameworks and system design.
<Lecture>
Professor, Center for Advanced Biomedical Sciences, Waseda University Faculty of Science and Technology
<Opening Remarks & Introduction>
Masato Yasui
Professor, Keio University School of Medicine; Director, KGRI
<Discussion>
Commentators:
Masako Toriya
Project Professor, KGRI
Tetsu Isobe
Professor, Keio University Law School; senior researcher, KGRI
Moderator:
Haruna Kawashima
Project Associate Professor, KGRI
Lecturer: Toshio Miyata
Professor, Center for Advanced Biomedical Sciences, Waseda University Faculty of Science and Technology, and Chairman of the Board, Medical Corporation DEN Mii Clinic. He also serves as an invited professor at Osaka University School of Medicine, an advisor to Kanagawa Prefecture, a planning and strategy advisor at the National Cancer Center, an executive committee member of the Japan Health Council, and an expert committee member of the Pharmaceuticals and Medical Devices Agency (PMDA). In 2003, he joined the First Department of Surgery at Osaka University, and in 2009, he joined the Ministry of Health, Labour and Welfare. In 2016, he opened Mii Clinic, where he promotes the establishment of a comprehensive community care system and home medical care utilizing ICT. He also founded Medical Compass and developed and released the self-care app "Kencompass." His publications include "The Pharmaceutical Company Crisis: Growth Strategies for Survival."
Lecture: The Current State and Future of Comprehensive Healthcare Systems
Masato Yasui: Today, we are pleased to have Professor Toshio Miyata from Waseda University with us on the theme of "The Current State and Future of Comprehensive Healthcare Systems." As we head toward 2040, Japan will be on the front lines of the world as a society with a declining birthrate and a super-aging population. Fulfilling the desire to live energetically and as oneself until the very end is not something that can be solved by medical sciences alone. We hope to consider healthcare in an aging society, with various fields working together to find solutions for extending healthy life expectancy.
Haruna Kawashima: Professor Miyata is a professor at the Center for Advanced Biomedical Sciences, Waseda University Faculty of Science and Technology, and also teaches at the graduate school. He has served as a medical officer at the Ministry of Health, Labour and Welfare and as an advisor to Kanagawa Prefecture, contributing to the development of healthcare from a policy and institutional perspective. As a physician, he established Mii Clinic and developed the self-healthcare app "Kencompass," leading the way in healthcare that utilizes digital and ICT technologies.
Furthermore, under the National Health Insurance system, which has been in place since 1961, the working generation bears the medical costs of the elderly. Social security costs, including long-term care, medical care, and pensions, are expected to increase rapidly, reaching nearly 24% of the total GDP by 2040. Currently, one elderly person is supported by two people in the working population, but by 2040, the ratio will drop to less than 1.5 working-age people per elderly person. How to overcome this challenge amidst a declining workforce and a shrinking market is a key issue for the future.
Toshio Miyata: I joined Waseda University last year, but as a student, I was in an artificial heart research lab at the Waseda University Faculty of Science and Technology. To put that research into practical use, I transferred to the Osaka University School of Medicine and later worked as a cardiovascular surgeon at Osaka University Hospital. The Organ Transplant Act was revised in 2010, but as the number of heart transplants in Japan did not significantly increase, I changed careers to become a medical officer at the Ministry of Health, Labour and Welfare to tackle the problem from an institutional perspective. After that, I established the medical corporation "Mii Clinic," which brings me to the present.
The clinic's name, "Mii (mih)," stands for "Medical Innovation & Health." In addition to general medical care, we also conduct online health consultations connecting villages on Amami Oshima island and are working on a project in collaboration with Keio University Hospital to share information, view medical records, and care for elderly patients with polypharmacy (multiple medication use) through home medical care. In home medical care, we are also advancing research to manage data such as blood pressure measured by patients and their families using ICT.
In considering today's theme of extending healthy life expectancy, "self-care" is a key point. According to data from the National Cancer Center, adhering to five healthy habits, such as improving diet and maintaining a healthy weight, can reduce the risk of cancer by about 40%. Therefore, in parallel with the development of genomic medicine and anticancer drugs, I believe it is also important to promote DX (digital transformation), visualize lifestyle habits such as sleep and work hours as a PHR (Personal Health Record), and link this to behavioral change. Japan is about to become the world's leading super-aging society with a declining birthrate. While other countries say, "We must not become like Japan," if Japan, as a front-runner, can industrialize health services for extending healthy life expectancy, it could lead to the creation of new economic strength.
In 2015, the Japan Health Council was established by the Ministry of Health, Labour and Welfare and the Ministry of Economy, Trade and Industry. For the three stakeholders—the business community, the medical community, and local governments—extending healthy life expectancy and optimizing medical costs are areas of common agreement. Within this framework, the Japan Health Council adopted the "Declaration 2020 for Creating Healthy Towns and Workplaces," consisting of eight declarations in 2020. One is to increase the number of municipalities working on preventing the progression of lifestyle-related diseases. For example, there are many people who do not visit a medical institution or continue treatment even if a disease is suspected during a health checkup. If municipalities can use their data to encourage people to seek medical attention and control diseases before they become severe, the probability of severe progression can be significantly reduced, which in turn helps to control medical costs and leads to the optimization of medical expenses and the extension of healthy life expectancy.
Initiatives to Extend Healthy Life Expectancy Using Online Data
In 2017, Mii Clinic also created a self-medication support app called "Kencompass." While medical associations promote visiting a family doctor when feeling unwell, the spread of internet searches often prevents people from finding correct information, which has become a major issue. In light of this situation, we created an app supervised by physicians and pharmacists. Japan was lagging behind other countries in this field, so we took the lead, carefully coordinating with government agencies and medical associations. The number of "Kencompass" users increased rapidly due to the COVID-19 pandemic, and by also using social media, we are increasing the channels for accessing correct information. In this way, the tide is gradually turning for DX in the wellness field in Japan.
Another of our initiatives is "online medical consultations." Regulations were relaxed in response to the COVID-19 pandemic, allowing it to be applied not only to follow-up visits but also to initial consultations. In practice, it is difficult to obtain data from blood tests, health checkups, and "Okusuri Techo" (medication notebooks). There are also other issues such as online consultation tools, health insurance card registration, payment processing, and what to do at night when pharmacies are closed, as well as various challenges like what happens if a patient's condition worsens after an online consultation. We are considering the need for our own legal framework in collaboration with legal scholars. In the future, by utilizing new sensing and monitoring technologies, or artificial intelligence, a new form of medical care that aligns with new lifestyles will likely be established in combination with in-person consultations.
What I want to highlight here is the "Mobile ICU/ER Project" being promoted by the Tokyo Metropolitan Government, Toyota Motor Corporation, and emergency physicians in Tokyo. Ambulances are equipped with ultrasound and blood gas analyzers, and data measured during transport is sent to the hospital, so that surgery can be performed immediately after the ambulance arrives.
Various initiatives are also underway in the industrial sector. The PHR app "With Wellness" provides explanations of health checkup results and tests from comprehensive medical examinations. Unicharm's menstrual cycle tracking app allows users to manage their physical condition by inputting their menstrual cycle and PMS (premenstrual syndrome) symptoms. It is hoped that the accumulated data, combined with municipal data, will lead to the creation of services for women, known as "Femtech." Furthermore, the data accumulated by "Lalasia Connect," which is installed on all smartphone models for the elderly, is expected to lead to the development of IoT, sensors, and monitoring in the future.
In addition, Value HR , which supports the management of corporate health insurance associations, is about to start programs such as support for lifestyle-related diseases by health insurance associations, online medical consultations, and collaboration with pharmacies, as well as remote support through "SyncHealth." SoftBank is also working on online medical consultation prescriptions, health promotion, and proposing optimal insurance plans. Its digital healthcare service "HELPO" also offers at-home PCR testing. The Tokyo Metropolitan Government is also focusing on the wellness field as part of its promotion of digital industries, and is collaborating with KDDI, Toshima, Itabashi, and Edogawa wards, and local medical associations to link to diverse services while utilizing the Act on the Next-Generation Medical Infrastructure.
This field of PHR is attracting a great deal of attention, with the expectation that as data from hospitals and insurers is linked with that of municipalities and companies, it will be possible to newly establish evidence for the effects of supplements, which have previously lacked medical evidence, as well as for diet, exercise, and yoga.
Discussion: The Digitization of Medicine and the Challenges of Social Design
Kawashima: Thank you, Professor Miyata. Now, I would like to move on to the designated comments.
Masako Toriya: From my perspective, there are three points of interest. From the user's point of view, an integrated, one-stop service is very convenient, but my first point is about what has been the bottleneck so far and what needs to change in the future.
Miyata: First, Japan has a vertically segmented structure of ministries and municipalities, which makes it easy for services specializing in individual areas to develop, but difficult for services that connect horizontally to spread. From my own experience as a bureaucrat, I feel that there may have been a strong unconscious bias. University hospitals also used to prioritize basic research over clinical research, and there was a trend of going abroad if you wanted to do clinical work. However, the tide has recently turned, with a growing recognition that "clinical research is also important." I believe it is necessary to break through these points with a global thinking mindset.
Toriya: While I am surprised that such preconceived notions are an obstacle, I also feel there is hope. My second question is about the form of digital healthcare platforms. There are two approaches: one that starts from the medical side and spreads to the non-medical side, and another that starts from non-medical professionals. You mentioned that both are in the process of developing. Will the platform be a for-profit or non-profit organization? Which form is most likely to become widespread in Japan?
Miyata: In the medical world, the question of for-profit versus non-profit is also a major theme. In Japan, most hospitals and medical corporations are non-profit. However, rather than regulatory reform, it is expected that there will be an increase in collaborations between for-profit companies and non-profit organizations within a legal system rooted in society, and coordinating their respective objectives will be a key challenge. Furthermore, the number of young doctors with a development mindset is increasing in the medical community, and collaborations with insurance companies and other industries will also expand beyond just for-profit and non-profit organizations. I also believe that leadership education for doctors will become more important for such open innovation to become more active.
Toriya: I fully agree that rather than a for-profit or non-profit dichotomy, it is important to design a system that incorporates various stakeholders and functions as a whole, and that human resource development is also crucial. My third point is that as the medical field enters daily life through services like "Kencompass" and online consultations, I believe the stakeholders who should bear responsibility will change. The weight of responsibility for manufacturers in the management of medical devices may increase, and the nature of governance may also change in the future. If there is time, I would like to discuss this point later.
Patient Self-Determination, Ensuring Safety... Toward a Cross-Disciplinary Discussion
Tetsu Isobe: I specialize in administrative law and medical law, and at KGRI, I am considering from a social science perspective what kind of transformations the rise of platforms and other technologies will bring to this field in the future. In the Japan Science and Technology Agency (JST) "Moonshot Research and Development Program," where I am involved as a project manager, we are also examining challenges related to collecting and utilizing large amounts of data on various diseases and physical conditions, such as body temperature, blood pressure, and sleep quality, as part of an initiative to realize a society where diseases can be predicted and prevented at a very early stage by 2050. Regarding PHR, I felt that we have entered an era where we need to think on a very long-term basis about how to utilize the vast amount of information that accumulates from the moment a person is born until they die.
In medical jurisprudence, great importance is placed on patient self-determination. Therefore, laws such as the Medical Practitioners' Act require that the wishes of the person receiving medical care be respected and that medical providers give appropriate explanations. On the other hand, in recent years, there has also been a trend to emphasize self-responsibility, with laws like the Basic Act on Cancer Control requiring patients and the public to take reasonably rational actions for disease prevention. Furthermore, in Japan, there has long been a history of placing great importance on the role and position of the family, not just the patient, in various situations. Against this backdrop, I have been thinking that a key issue will be what functions and roles patients themselves and their families can or should actually play as parties who, along with medical professionals, are responsible for health management, including online medical consultations.
While affirming the idea of managing one's own health information with an app to extend healthy life expectancy as much as possible, there is also the fundamental question of whether being healthy is a right or, rather, a duty. There are many issues I would like to consider while observing the situation on the ground, such as how to specifically resolve the anxieties and difficulties of various vulnerable groups, including those who find it difficult to use apps. Regarding online medical consultations, their consistency with the interpretation of the Medical Practitioners' Act is also in question, and legal arrangements will be necessary to enable collaboration between the diverse related professions and medical professionals. Ensuring the efficacy and safety of apps that are exempt from approval as medical devices is another challenge. I felt that there are many themes that require major discussions at the level of creating new laws, such as establishing a legal basis for companies and municipalities to collaborate on data for research and development, and reviewing the emergency medical care system in municipalities where information security is often an issue.
In any case, as the relationship between doctors and patients will change significantly in the future, I felt that efforts to stimulate public debate on how society can accept these changes are also necessary.
Miyata: Of course, there are risks associated with medical care spreading into daily life, and there are various concerns, such as whether healthcare apps might cause people to miss opportunities to visit a hospital. For these points, the opinions of legal scholars like Professor Isobe are necessary. Also, the expansion of responsibility outside the hospital is, after all, a threat to hospital administrators. This is true for the use of AI and online medical consultations as well. Along with increasing efficiency, we need to properly create a system where doctors are involved in a comprehensive manner. Within that, it is necessary to work out the division of responsibility, and I believe services will become widespread as these aspects are advanced simultaneously.
Additionally, a question from an online participant was, "Won't the advancement of PHR hinder the progress of EHR (Electronic Health Record)?" but I believe that as PHR progresses, for example, the effort of writing referral letters will decrease, so EHR will also advance at the same time. In fact, the "Ajisai Net," a network connecting medical institutions in Nagasaki Prefecture, is well used. However, there are both cautious and progressive factions within medical associations, and of course, there are regional differences, so when trying out a new service, I believe it is necessary to work with forward-thinking municipalities.
Isobe: Some people are resistant to new initiatives, while others are supportive, but everyone has their own anxieties and hesitations. I felt it is very important to connect research results that take into account the actual situation on the ground to policy-making through dialogue with medical professionals and others.
Toriya: It's not just the medical community; society as a whole needs to accept change and build a legal system and governance structure that suits it.
Miyata: Even around me, there are people who have returned to the field from bureaucracy and are trying to connect policy with practice. If such movements increase, changes will occur in many areas. There are various challenges, but I hope to cooperate from diverse perspectives such as diversity and inclusion, and promote dialogue with society to lead to new movements.
Kawashima: Today, Professor Miyata has presented us with many challenges, and it seems we need to examine them not only from a legal perspective but also by incorporating viewpoints from medicine and system design. At KGRI, we would like to continue to address these issues through cross-disciplinary dialogue. Thank you very much for today.
[Notes]
Held on January 27, 2022, at G-Lab, East Research Building, Mita Campus (in-person + online format)
*Affiliations and titles are as of the time of the event.