COVER STORY：FOREWORD
Jun Murai, Ph.D.
Professor, Faculty of Environment and Information Studies and Dean, Graduate School of Media and Governance, Keio University
Ph.D. in Engineering. He completed a doctoral course at the Division of Engineering, Keio University in 1984. He worked as an assistant at the Computer Center of the University of Tokyo and TITech Computer Center of the Tokyo Institute of Technology before taking up his current position.
In 1984, he established the Japan University Network (JUNET) that would latter go on to form the basis of the Internet in Japan. He also launched the Widely Integrated & Distributed Environment (WIDE) project in 1988 to conduct research into the Internet. He is a member of the IT Strategic Headquarters and of the Cyber Security Policy Council of the National Center of Incident Readiness and Strategy for Cybersecurity, and Chairman of the IoT Acceleration Consortium. He has also served in many leadership and other capacities on government committees and is active in international academic societies.
The Shonan Keiiku Hospital was opened in November 2017 on a site adjacent to Keio University’s Shonan Fujisawa Campus (SFC). Actually, this “adjacent site” is located in amongst the junior and senior high school, Faculty of Environment and Information Studies, Faculty of Policy Management, graduate school, and Faculty of Nursing and Medical Care. Working with Fujisawa City in which it is located and engaging in joint research with SFC are among the hospital’s stated purposes. I have held discussions with Dr. Sumio Matsumoto, the inaugural head of the hospital, and been involved over the last two years in preparatory work that forms part of joint research aimed at facilitating in-home and telemedicine, which are seen as posing challenges for Japan. Japan faces serious issues relating to the cost of healthcare and its aging population and low birthrate. It is also beyond doubt that in-home medical care is one of the keys to dealing with these. Nevertheless, with these issues growing in severity, radical improvements are needed along with innovations based on digital technology. To achieve this, we need to establish a collaborative environment on the Internet in which people taking responsibility for their own health management as well as families, communities, and regions, and also services like medical and nursing care, are tied in with hospitals and other specialist facilities. I believe a degree of consensus already exists among the public about what form such systems should take.
In summary, this assumes that broadband Internet is available and involves the establishment and recording of communications between individuals and their trusted family members and other helpers, care workers, nurses, and doctors. This would also be combined with the creation of an environment in which specialists with pharmaceutical and medical expertise can utilize and share digital data in order to serve those individuals’ health needs. If this is what is wanted, then the infrastructure of core technologies and service applications needed to achieve it is already in place. In the home, this comprises health monitoring devices that operate on the Internet of Things (IoT), social networks that record people’s activities and interactions with the community around them, electronic drug diaries and other techniques for keeping digital records of pill taking, the digitization and management of imaging and other electronic medical records, electronic payment systems for healthcare billing, drug distribution systems, and smart transportation systems that people can use to commute to hospitals. Despite all of the elements for an ideal society being in place, this society has yet to be realized. Making this breakthrough will represent a crucial point in Society 5.0.
Between December last year and the end of March, I worked in partnership with Shonan Keiiku Hospital on the design and development of prototypes together with a small-scale trial. Building on a system that is integrated with the electronic medical records used by medical practitioners, we added functions for communicating with patients at home and put it to as much practical use as time allowed, including conducting consultations remotely, operating cameras in patients’ homes, the collection and sharing of in-home health monitoring devices, and the verification of patient identity. Undertaken in accordance with protocols for trial ethics approved by the Japan Agency for Medical Research and Development (AMED), the testing involved 30 patients and their doctors, with assessments and surveys being conducted on both groups. Although the tests were limited in scope, the feedback was positive. We were able to collect valuable advice from the doctors, and considerable interest was expressed by patients who were able to envisage how a combination of hospital visits and in-home care might work in practice.
Nevertheless, numerous obstacles remain before such practices can be rolled out to the public at large. To begin with, the healthcare sector has only just started dealing with the question of how to bill for consultations conducted remotely. This is not unreasonable as, to date, discussion of telemedicine has not taken into account the existence of a digital society. Modern in-home health monitoring systems are IoT devices, but even in patient homes that are fitted out as smart houses, which form the principle focus of work in our field, the data formats and communication protocols used by these systems have yet to be standardized and remain vendor-specific. With the elderly in mind, we have started out using home television sets as the medium for remote consultations with doctors, but smart televisions do not have the same open development environments as smartphones. Moreover, while air conditioners and other electrical home appliances hold data that can be used to detect and monitor patient movements and other information about them, there is no framework for providing access to this data. Nor have practices been established for obtaining consent in relation to patients’ personal privacy, even for healthcare purposes. Likewise, no regulatory mechanisms have been established for dealing remotely with prescribed medicines in functional terms in relation to pharmacology. Japan does not even have a mechanism for handling the micropayments and other sophisticated electronic transactions that ensure correct payment to the various stakeholders involved.
Nevertheless, having made it this far, we can identify the issues that need to be resolved and take action to do so. By developing the ability to analyze valid data on people’s health-related living practices prior to their falling ill, and to share this information securely, we will be able to provide a rapid boost toward a healthy society together with fundamental improvements in the health insurance systems that underpin it.
As of 2017, 51.7% of the world’s population were using the Internet. The figure for Japan has already reached 83.5%. You no longer need to be an information technology (IT) specialist to design what a way of life might look like in which the Internet is an established fact and digital society is able to contribute to all aspects of our lives. The future will see a start made on bringing together people with all sorts of different roles to build a human-focused digital society in which future digital technologies are able to function correctly.
