Telemedicine as a Tool in Japan Disaster Relief (Disaster Cardiovascular Prevention Network)

1. Telemedicine as a Tool in Japan Disaster Relief (Disaster Cardiovascular Prevention Network) Masatake Eto A&D Company Limited ITU Workshop February 5, 2013

2. Company profile DSP Weighing • 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 Medical/HHC Testing

3. Accurate, Reliable Measurement Technologies Five businesses Real-time, PC-basedMeasurement, Control, and Simulation Systems (Model Based Engineering) Medical and Healthcare Instruments Weighing and Analytical Instruments Electron Beam and Focused Ion Beam Systems Material Testing Instruments

4. Professional Medical Devices Consumer Healthcare Medical / Healthcare ICT Devices Pioneering “Bridging home and hospital”

5. Disaster Medical Support Activities after the Great Eastern Japan Earthquake March 11, 2011 14:46

6. Minami Sanrikucho Location for disaster medical support Population; 17,400 Dead/missing: 845 Lost households: 3,300 Evacuees: 3,581 (as of 7/11) 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.

7. 1,500 evacuees stayed at Bay Side Arena at one time. 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.

8. Cardiovascular diseases Stress-induced cardiomyopathy (takotsubo) Acute myocardial infarction Cerebrovascular accident (CVA) or stroke Sudden death (SD) Economy-class syndrome (ECS) Cardiac failure Right after Wounds Fractures Bleeding Drowning Cardiovascular diseases Stress-induced cardiomyopathy (takotsubo) Acute myocardial infarction Cerebrovascular accident (CVA) or stroke Sudden death (SD) Economy-class syndrome (ECS) Cardiac failure Infectious diseases Skin infections Infectious gastroenteritis Urinary-tract infections Pneumonia A week later Mental disorders Posttraumatic stress disorder (PTSD) Depression Several months later A few years later Medical needs change as time passes

9. Blood pressure elevation Blood clotting 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.

10. 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.

11. Dr. Kazuomi Kario, MD Professor & Chairman Division of Cardiovascular Medicine School of Medicine Jichi Medical University Driving force of D-CAP Team • Disaster Cardiovascular Prevention Network • 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.

12. D-CAP process Examination Register for D-CAP ID card Measure patient risk by Risk score card Monitor blood pressure Yes Yes BP over 180 mmHg Irregularity No Doctor’s visit Examination No No BP over 160 mmHg Individual advice and/or treatment Routine check-up Yes

13. D-CAP System for Evacuation Camp Jichi Medical School Evacuation camp Vital signs sent with Patient ID via 3G Data analysis, diagnostic support Inform and communicate with doctors at the site. Shizukawa Temporary Hospital Face-to-face meeting with patient Cloud / Data Center Internet 3G

14. D-CAP System Configuration Evacuation Camp Cloud / Data Center Internet Blood Pressure Monitor with BT Gateway PC Data Server System 3G Data Transmission Module Patient ID card and ID card reader Web application Data viewer

15. D-CAP System for Home Jichi Medical School Temporary housing Shizukawa Temporary Hospital Patient measures BP with BPM at home Patient vital sign data with patient ID uploaded to PC via BT Patient visits hospital with BPM Cloud / Data Center Internet 3G

16. Medical staff meeting Face-to-face meeting with evacuees Medical examination D-CAP systems D-CAP Team at work

17. Dr. Kario and Dr. Nishizawa in front of the temporary clinic Inside the temporary clinic D-CAP Team at work • Dr. Nishizawa, who is in charge of ShizukawaHospital, 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.

18. Seven companies working together • 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

19. 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.

20. 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.

21. 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.

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

23. Thank you for your attention. ITU Workshop February 5, 2013 Page 13 Confidential