0In developed countries including Japan, the aging society problem is causing a chronic shortage of doctors. Meanwhile, developing countries also have a chronic shortage of doctors but for a different reason, namely the limited availability of medical services.
Tele-medicine and e-Health are being studied as one solution for these problems, and ITU-T SG16 and ITU-D SG2 study standardizations on e-Health technologies and deploy it widely in developing countries. In November 2012, the ITU and WHO launched a partnership called the m-Health initiative, which aims to use mobile phones to deliver e-Health services to combat non-infectious illnesses. Since April 2012, the ITU-T focus group on machine-to-machine (M2M) service layer called FG-M2M has been studying the standardization of e-Health as an M2M application.
With the aim of ensuring that e-Health standardization proceeds smoothly in the future, the ITU-D and ITU-T held a joint e-Health workshop to provide a place for dialogue and the exchange of information between each of their members. In this way, it was expected to clarify the special requirements of developing countries, and to specify the items for future standardization towards the implementation of e-Health using advanced technology.
This contribution covers brief results of the workshop, and proposes future activities for progressing towards the standardization work and deployment in developing countries on e-Health services.
Photo 1: Opening speech from Vice- Minister of Japan
2.10.2 Overview of the Workshop
Opening speeches were made by Mr Eiichi Tanaka, vice-Minister for Policy Coordination in Ministry of Internal Affairs and Communications, MIC, Japan (Photo 1), and by Mr Sameer Sharma of the ITU Asia-Pacific regional office on behalf of the ITU Secretary-General. These were followed by keynote speeches from Mr Tetsushi Sakamoto, the State Secretary for MIC, Japan, on the subject of Japan's e-Health policies, and Prof. Kiyoshi Kurokawa of the National Graduate Institute for Policy Studies, who gave a presentation under the title of "Global Agenda in Post Fukushima" in which he raised issues that should be addressed not just by Japan but by the whole world in the wake of the Great East Japan Earthquake. Mr Mark Landry of Pacific regional office of World Health Organization, WHO, gave a speech on behalf of WHO in which he described some examples of e-Health policies across Asia, and the current status of cooperation with WHO (Photo 2).
Photo 2: Workshop
2.10.3 Requirements for Low-resource Settings
On the theme of implementing e-Health with low-resources, representatives from India, Sudan, Uganda, Algeria, the United Arab Emirates, Bangladesh, Vietnam and Myanmar gave presentations on the current situation of e-Health in each country, the issues that need to be addressed, and requirements in each case. The requirements of developing countries are characterized by delayed development of infrastructure, not only for medical care but also for insurance, sanitation and health management, and a shortage of healthcare workers coupled to a poor educational environment. Instead of the advanced e-Health systems that are being considered in developed countries, these presentations introduced solutions such as Web-based sharing and education of medical information, using video conferencing to facilitate collaboration between medical workers including doctors, and using mobile phones for medical consultation (m-Health), whereby e-Health is expected to provide a broad range of benefits.
Photo 3: Demonstrations on m-Health
2.10.4 Items for Standardization
Representatives from Japan, South Korea, Singapore, and the United States introduced some advanced examples of e-Health initiatives, and discussed the challenges of implementing e-Health. NTT Data gave a presentation introducing cases of Personal Health Record, called PHR, management and monitoring as examples of m-Health services in Japan, and stressed the importance of security and privacy protection. The representative from Singapore introduced a Smart TV health management system based on ITU standards, and showed that interactive e-Health using TV sets and remote control devices may be suitable for an aging society since these devices can be easily used even by elderly people. Also, the US representative introduced the importance of considering e-Health for people with disabilities; NICT introduced the possibility of a body area network (BAN) that people can wear in order to connect to healthcare equipment; and Fujitsu introduced the possibility of a heart simulator that aims to improve healthcare technology. These presentations highlighted the need for standardization of the data structures and protocols required for the transmission of PHR and other data, of the application interfaces and transmission methods used between medical/healthcare devices and telecommunication networks, wireless devices and fixed devices, and of security, which is essential when exchanging PHR data.
2.10.5 e-Health in the Event of Disaster
Experiences from the Great East Japan Earthquake with regard to the use of e-Health in disaster situations were introduced. A&D made a presentation about a monitoring system for information such as blood pressure for health management of people affected by disasters, which was actually put to use after the Great East Japan Earthquake. Professor Isao Nakajima of Tokai University – the vice rapporteur of ITU-D Q14/2 and co-chairman of this workshop – described items that need to be studied in e-Health and radiation related disasters in relation to the nuclear power plant incident. These presentations demonstrated the usefulness of e-Health in the event of disaster, and made a case for the importance of preserving two-way communications.
2.10.6 Future Direction for ITU Work
Mr. Masahito Kawamori of NTT - the rapporteur of ITU-T Q28/16 and co-chairman of this workshop, drew up the following summary of the results of the workshop and the future direction of e-Health standardization at the ITU.
To promote the spread of e-Health, it is important to provide education in order to eliminate misconceptions about the circumstances of developing countries.
From the viewpoint of standardization, to establish cooperation between requirements, terminology definitions, data sets/applications, and related organizations.
In particular, to make a terminology database, since the technical terminology relating to e-Health covers many fields including medicine, healthcare and ICT.
For e-Health related regions, to study the application of this technology as related to the elderly, stranded people, and disabled people.
In the future, to supply information to the ITU website including the content of speeches given at this workshop, and to hold an enlightenment event in cooperation with WHO.
2.10.7 Other Related Events
Alongside the workshop, there were also demonstrations from NTT Laboratories related to m-Health (photo 3). A simple health management system was introduced where healthcare equipment including blood pressure gauges and SMS text messaging is used to implement m-Health with low initial investment. In this exhibition, it was found that there are many different opinions regarding this technology.
Over 130 persons from 20 countries attended this workshop (photo 4), since e-Health has been globally recognized as important by developing and developed countries alike. It is expected that this field will continue to grow in the future. For its efficient global development, international standards, with appropriate consideration of the regional characteristics and environmental conditions of each country, are essential.
This contribution proposes to continue dialogue between ITU-T and ITU-D members by using workshop since this kind of workshop is expected to contribute to the expansion of developing countries, which is the scope of ITU-D, as well as the further development of ICT standardization, which is the scope of ITU-T. Furthermore, this contribution also proposes to collaborate with WHO for deployment m-Health solutions to developing countries, along with an MoU signed by ITU and WHO.
To access presentations delivered at the workshop, please visit: http://www.itu.int/en/ITU-T/Workshops-and-Seminars/e-Health/201302/Pages/default.aspx