Telemedicine as a Toolin Japan Disaster Relief

(Disaster Cardiovascular Prevention Network)

ITU Workshop February 5, 2013

Masatake EtoA&D Company Limited

WeighingDSP

Medical/HHCTesting

Founded in May 1977 with a vision of becoming a global measuring instrument company based on both Analog and Digital technologies.

Headquarters in Tokyo and Technical Center in Saitama with subsidiaries in 10 countries: USA, UK, Germany, Russia, China, Korea, Taiwan, India, Australia, Japan

Sales (FY2011): $400 Million(Consolidated) Corporate culture: Technology driven, market and globally oriented Striving for “Honmono” /…Clearly a Better Value

Company profile

Medical and Healthcare Instruments

Electron Beam and Focused Ion Beam Systems

Weighing and Analytical Instruments

Material Testing Instruments

Accurate, Accurate, ReliableReliable

Measurement Measurement TechnologiesTechnologies

Real-time, PC-based Measurement, Control, and Simulation Systems (Model Based Engineering)

Five businesses

Pioneering “Bridging home and hospital”

Consumer Healthcare

Medical / Healthcare ICT

Devices

Professional Medical Devices

Disaster Medical Support Activities after the Great Eastern

Japan EarthquakeMarch 11, 2011

14:46

Minami Sanrikucho is located in northeastern Miyagi Prefecture, north of the Oshika Peninsula. It is a resort town with numerous tourist attractions based on its natural beauty and the aquaculture industry is prevalent on the coastline.

It is in the middle of Minami Sanriku Kinkasan National Park and known for its beautiful ria coasts with wooded islands and mountainous inlets.

Minami Sanrikucho

Location for disaster medical support

Population; 17,400Dead/missing: 845Lost households: 3,300Evacuees: 3,581 (as of 7/11)

On-going hardships of the survivors

The magnitude of the disaster, which includes the total loss of communities on top of the loss of families and homes, can put a great number of survivors at risk leading to “Disaster-related death”.

In case of The Great Hanshin Earthquake of January 17, 1995 14% of the victims, 919 people, passed away after they survived the disaster out of the death toll was 6,402.

1,500 evacuees stayed at Bay Side Arena at one time.

Cardiovascular diseases

Stress-induced cardiomyopathy(takotsubo) Acute myocardial infarctionCerebrovascular accident (CVA) or strokeSudden death (SD)Economy-class syndrome (ECS)Cardiac failure 　　

WoundsFracturesBleedingDrowning

Medical needs change as time passes

Infectious diseasesSkin infectionsInfectious gastroenteritisUrinary-tract infectionsPneumonia

Mental disorders

Posttraumatic stress disorder (PTSD)

Depression

Rightafter

A weeklater

Several monthslater

A few years later

Cardiovascular diseases

Stress-induced cardiomyopathy(takotsubo) Acute myocardial infarctionCerebrovascular accident (CVA) or strokeSudden death (SD)Economy-class syndrome (ECS)Cardiac failure 　　

Cardiovascular risk after a disaster Blood pressure as a sign of risks Environmental changes after a disaster alter one’s lifestyle patterns

immensely leading to stress and this stress causes the body to store more salt or become salt-sensitive.

The intake of salt increases due to the types of food eaten at evacuation sites.

Physical activity tends to decrease due to the loss of daily work and household activities.

The body tends to get dehydrated due to a reduced intake of water because of the colder or less convenient environment.

One tends to go to toilet less frequently and reduces water intake.

Blood pressure elevation Blood clotting

Background of special medical activities

Medical support must shift from emergency medical treatments to daily disease management immediately after a disaster due to the stress and risks the evacuees face.

Medical staff and doctors at disaster sites are occupied with the unpredictable medical matters, thus they cannot provide adequate medical support to the evacuees.

We received a request from the disaster medical support team of Jichi Medical University asking if we could organize a special medical support team for evacuees immediately.

We then created a special medical support team with the several key members of Continua. Thanks to the eagerness of the members and key products of modular concept already developed under Continua protocols, we had this team up and running within a week.

He lived through the Great Hanshin earthquake and experienced the hardships the survivors and medical staff went through. “How can we save lives of the people who survived the disaster?” was his main theme for medical support activities.

The mission of the D-CAP Team is to monitor the blood pressure of the evacuees remotely and provide timely advice to the medical staff at the disaster sites.

　 Disaster Cardiovascular Prevention Network

Driving force of D-CAP Team

Dr. Kazuomi Kario, MDProfessor & ChairmanDivision of Cardiovascular MedicineSchool of MedicineJichi Medical University

D-CAP process

Doctor’s visit

Monitor blood pressure

No

Irregularity

Examination

Measure patient risk by Risk score card

Yes

BP over

180 mmHg

Yes

No

BP over

160 mmHg

No

Yes

Examination

Routine check-up

Register for D-CAP ID card

Individual advice and/or treatment

D-CAP System for Evacuation Camp

Internet

Cloud / Data Center

Shizukawa Temporary Hospital

Inform and communicate with doctors at the site.

Jichi Medical School

Data analysis, diagnostic support

Face-to-face meeting with patient

Evacuation camp 3G

Vital signs sent with Patient ID via 3G

D-CAP System Configuration

Evacuation Camp

Patient ID card and ID card reader

3G Data Transmission Module

GatewayBlood Pressure Monitor with BT

Internet

Cloud / Data Center

Data Server System

PC

Data viewerWeb application

Temporary housing

Patient measures BP with BPM at home

Internet

Cloud / Data Center

3G

Jichi Medical School

D-CAP System for Home

Patient vital sign data with patient ID uploaded to PC via BT

Shizukawa Temporary Hospital

Patient visits hospital with BPM

D-CAP Team at work

Face-to-face meeting with evacuees

Medical examination

Medical staff meeting

D-CAP systems

Dr. Nishizawa, who is in charge of Shizukawa Hospital, said: Very few of the evacuees have lost their lives thanks to the efforts of the medical staff and the support from all over the world. D-CAP system gives us real time coordination with Dr. Kario’s medical staff, who monitor patients 200 km away from the evacuee camp. It helps identify high risk evacuees in the early stages. Thus, we can respond to evacuees’ needs individually depending on their risks, which can be a pioneering effort for order-made medicine in a community. It can eliminate unnecessary health exams and doctors’ visits, which is a great plus as there are shortages of medical staff.

Dr. Kario and Dr. Nishizawa in front of the temporary clinic

Inside the temporary clinic

D-CAP Team at work

Alive: Gateway AP3201(Bluegiga), its firmware development Panasonic: PC Toppan Forms: NFC ID cards and NFC card reader Ryoyo Electro: Data center/server Qute: Web application development Intel: Project coordination A&D: Fully automatic blood pressure monitor TM-2656PBT-C

Automatic blood pressure monitor UA-767PBT-C

Seven companies working together

From left, Ohsako-san of Qute, Tagami-san of Intel, Hayashi-san of Toppan Forms, Ozaki-san, Nozoe-san, and Yasui-san of A&D, and Yamamoto-san of Ryoyo.

D-CAP Team at work

Colleagues from different companies worked in collaboration under the Continua Alliance on the set-up of the D-CAP systems. They completed and installed the systems and had them up running in a week after we received a request from Dr. Kario.

Summary

For disaster health management, team work of all concerned and the coordination between the medical supporters and medical staff at disaster sites is so mportancet for successful implementation.

Timely response to local needs is not only important to reduce the health risks of the evacuees but also plays a critical role in motivating the evacuees into active participation.

Now that technologies are available, unforeseen difficulties can be overcome if the team has leadership and shares a clear vision.

Reliable instruments and a solid system integration concept must be deployed.

Compatibility and interoperability of instruments are of primary importance.

Continua has proved to be a great help not only for creating an eco systems but also for nurturing partnerships.

Summary

Disaster-related death toll as of March 31, 2012

Minamisanriku-cho: 20 or 2.3% of the total death/missing Nation-wide: 1,632 or 7.9% of the total death/missing

D-CAP system, triggered by this tragedy, happens to be the one of the earliest realizations of the ehealth by ICT in a bottom up approach.

Not only can we support people to overcome the catastrophic disaster through D-CAP activities but also contribute to create cost-effective health care systems by ICT in a community.

With the people’s will and support, the beautiful nature and heart-warming scenery of Tohoku will return!

Confidential

Page 13

Thank you for your attention.

ITU Workshop February 5, 2013