STUDENT VIEW

Technology & the Healthcare Systems in
Uzbekistan & Japan: a New Platform to Make a
Sustainable Society with E-Healthcare by 2030
By Urmonbekov Mukhammad Diyor
This second article on my research project follows on from the one
published in the Japan SPOTLIGHT May-June 2020 issue (https://www.jef.or.jp/journal/pdf/231st_Student_View_02.pdf) and focuses on
the proposals I received from the GESL program research project inFinland, Estonia and Uzbekistan (Andijan city). Why I did research in
Uzbekistan was because I wanted to implement what I have learned
from experiments and seminars in Finland and Estonia.
As I have mentioned, the reason why I chose Uzbekistan is because
I got some comments from LINE, Takeda Pharmaceutical Co. Ltd andstaff from the Ministry of Education, Culture, Sports, Science andTechnology (MEXT) on my research when I participated in the Leading
Program 3rd Business Concept Competition in Tokyo in January 2018.
They suggested I conduct some experiments in my own country to see
whether people would accept and use a new system called the“e-healthcare smart card”. I worked with my lab members to record
health records in a chip, and doctors will work on R&D in Uzbekistan. Iwas planning to do some experiments in Japan but they said it waskind of risky, so I decided to focus my research in Uzbekistan where I
can understand the situation and the regulations of the Ministry ofHealth. Chart 1 shows how I compare the three nations to understandhow Japan can implement my proposed system based on these cases.

In Uzbekistan
One of the clinics I visited uses an Excel document to save patients’
CHART 1Experimental research results inUzbekistan, Finland & EstoniaComparison
Uzbekistan
OfflineNot Secure, Takes Time

Finland

Estonia

Online (Kela, Omakanta)

Online, Patient Portal (TEHIK, Digitlugu)

Secure, Fast

Secure, Fast

Source: Finland, Estonia and Uzbekistan research report by Keio University, Tallinn University
and Tampere University

https://www.jef.or.jp/journal/Author
Urmonbekov Mukhammad Diyor

health records. A doctor said it is better than a paper-based systemand faster and safer because it is connected to the Google Drive andthey will not lose the data if something happens to their PC. But it isstill a manual process in which they type the data by themselves. Twoother clinics use a local database for sharing internal data among
doctors and store it in their small databases which are not so secure if
a network crash occurs.

In Finland
Kela, the Social Insurance Institution (SII), is a Finnish government
agency in charge of settling benefits under national social securityprograms. Kela was founded in 1937 to handle retirement pay. In the1980s and 1990s, its role expanded to handle other fields like childbenefits, unemployment benefits, sickness benefits, health insurance
and student financial aid.
Kela is funded by compulsory payments into some of theadministered schemes and by taxation. Coverage under the schemes
is given to all permanent residents of Finland. Its proper nameKansaneläkelaitos (Folkpensionsanstalten in Swedish) literally means“People’s Pension Institute”, reflecting its original function as thenational provider of retirement benefits.
Under Kela is the Omakanta service – a platform on the Internet withvarious functions to manage a patient’s health profile and allowing
patients in Finland to access “prescription services”, “pharmaceuticaldatabase”, “patient data repository”, “patient data archives”, “clientdata archives for social welfare services”, and “medical certificates”,
and even allowing them to donate organs as well.

In Estonia
The Estonian nationwide Electronic Health Record system (EHR)
was launched in December 2008. Built on a comprehensive statedeveloped IT infrastructure, EHR is a central electronic database that
registers residents’ medical history from birth to death. In terms oftechnology, EHR utilizes the same state infrastructure solutions (IDcard, X-Road, etc.) that most Estonians already use to a great extent.
EHR has been successfully fused with other public IT services inEstonia and is therefore convenient for all types of users. Citizens andhealthcare professionals can use EHR to enter or view a patient’s
health-related data, make enquiries, book appointments, and so on. As
EHR forms part of the state information system, the content of thecentrally stored information was decided upon and fixed in statutory

Japan SPOTLIGHT • January / February 2021

51law.
The Estonian government initiated the development process of acomprehensive nationwide health information system in 2002. Indesigning such a multifaceted system, not only the technological but
also the legal, organizational and ethical aspects of the healthcare
service process needed to be taken into account.
Professor Peeter Ross of Tallinn Technical University helped me tounderstand Estonia’s digital healthcare system. He permitted me toaccess his personal health record and it is very impressive as he cansee about 10 years of data, and can manage his children’s page too.
The uniqueness of Estonia’s case is that people can manage theirpages from doctors and patients can give permission to doctors toaccess their health record data for a maximum of 10 minutes and aminimum of one minute.

In Process
A Japanese Ministry of Health, Labour and Welfare “Vision” entitled“Japan 2035: Leading the World through Health” says “Utilize the datanetwork to develop a policy evaluation process on prevention,
diagnosis, treatment, disease management, care services, and longterm care.” I think Japan has the capacity to implement this kind of
new platform for its healthcare system in the near future.
At the same time, the president of Uzbekistan announced in January
2020 a policy on E-government, Digital Economy Transparency, IT
Parks for young people and the Digital Uzbekistan 2030 program. But
there are still some obstacles the government and private sector need
to overcome, such as slow Internet speeds and power outages. The
education system is also still struggling to shift to modern technology
in rural areas. This should have been done in the early 2000s, but thispolicy has not been working because of corruption in some areas. I
think it is time to change the state policy and structure to make asustainable society by using high technologies and investing in its
young generation.

Effectiveness of Research
The Smart IC Card is a system of hardware, software, people, policy,
and processes that will work together to collect data from multiple
resources, thus providing information and decision-making support tomultiple healthcare providers irrespective of time and place. The
following are some key functions.
Health Information and Data – The system will be able to store andprovide access to a patient’s health information, such as history,
allergies, laboratory reports, diagnoses, current medications, and soon, to healthcare providers to make appropriate clinical decisions forbetter care. It will integrate data from various sources and make itavailable to the people involved in the care of a patient.
Replicate the Workflow – It will be able to work in sync with theoriginal workflow of the healthcare organization.
Efficient Interaction – The system will also save time for careproviders by keeping things concise.
Clinical Decision Support – It will also support provision ofreminders, prompts, and alerts. Such features help in improving
clinical and preventive practices and reducing the frequency of adverse
events.

52 Japan SPOTLIGHT • January / February 2021

CHART 2Future e-healthcare combined withcloud computing
Hospital B

Imaging Center
Shared Data
One Virtual
Repository

Hospital A

SharedWorkflow

One Virtual Community
One Virtual Desktop

CLOUD
Consultation

COMPUTING

Access to theRelevant
Information

Radiologist

Teleradiology

Hospital C

Seamless Remote
Reading & Reporting

Expertise

Collaboration
Around Patient

ExpertReferring Physician

Smart
Health Care System

Source: GESL research report submitted to MEXT

Patient Support – It will empower patients to access their healthinformation, enabling them to be involved in their own healthcare andmanage it via smartphone and PC.
Messaging and Data Processing Capability – It will also enable
exchange of data in known/standard formats for interoperability ofhealthcare applications. Additionally, it should enable processing ofincoming data in known/standard formats.
Chart 2 is a photo showing that a Smart Healthcare System can be
combined and work with Cloud Computing in the future for academic
purposes to prevent harmful diseases.

Access Rights
Since all e-health projects involve a significant amount of sensitive
personal data, ensuring the safety of this information is an extremely
important issue. Therefore, great effort has been put into designing themost appropriate and comprehensive security solutions to prevent any
adverse events. To correctly identify a specific health record user, it isnecessary to apply complex authentication methods. A good exampleof this is the ID card and its coding system, which enables local
citizens to provide electronic signatures and to identify a patient’s
health issues in the past. There are significant rules on accessing
patient data and how patients can protect themselves from doctors
and government officials when they do not want to share their datawith them for R&D or illness prevention purposes.
- All healthcare providers must send mutually agreed data to a
Ministry of Health database (as set out in legislation).
- All access rights and data use are regulated by law.
- Access is only granted to licensed medical professionals.
- A patient’s data can only be viewed by their attending physician – i.e.
the person currently associated with the patient’s treatment, who is ahealthcare employee registered with the Ministry of Health under theMinistry of Social Affairs.
- ID cards are used to authenticate and provide digital signatures.
- Citizens can access their own data through the Patient’s Portal,
where it is also possible to declare their intentions and preferencesregarding certain subjects. More specifically, patients have the rightto set access restrictions on single documents, cases of illness andall personal information in the database.

Action Plan by Stages
Chart 3 shows the project progress by timeline and stages for future
work. I have three further suggestions which could lead to applicableresearch with a secure and trustable platform.
1) In Japan, the “My Number” system gives people a unique
number, which they can use anonymously. Even if hackers manage toaccess a medical database and health records, the identity of thepatients will not be revealed because only the doctors know theiridentity, based on their ID number. The E-Healthcare Smart Card canbe combined with the My Number system to enhance security,especially for elderly people and employees who are concerned about
their privacy.
2) Some security companies in Japan like Secom Co. Ltd. andALSOK have contracts with financial institutions such as banks andinsurance companies, and are also responsible for cyber security as
well as physical security. They could develop a new internal platform
for the healthcare system in Japan. Almost all Japanese people knowof these security companies and would soon come to trust the newsystem.
3) In Uzbekistan, as in Japan, the healthcare system involves a lot ofpaperwork and often patients cannot find their health history records
after some years. Some are lost or destroyed in fires. The Uzbekistan
healthcare system needs a smart card which can keep all patient datafor life.
In my opinion, implementing new technologies such as patient
health diagnoses, recording IC cards and cloud computing systems in
the hospitals of Uzbekistan and Japan would be a significant
improvement in people’s lives. At the same time, by creating
applications for tablets, doctors will be able to check regularly on apatient’s history and condition.
Initially the Smart IC Card will be applicable only for internal use, atCHART 3

The project process & various steps

Stage 5
Stage 4
Stage 3
Stage 2
Stage 1

Project Plan &Field Trip.
Survey, interview anddiscussions with
doctors and patients

Design Smart
IC Card(Prototype Product)

Develop a systemarchitecture &improve functionality
and capability

Sources: GESL program pamphlet, author

Connect IC Cardsystem to Cloud
System withstrong security

Hospitals,
laboratories andmedical research
center will
have accessthis point domestic use, because many medical types of equipment
and conditions are not yet standardized around the world. I think many
hospitals need to adopt similar standards. Hospitals will need toregister for the system to obtain information about medical research
projects and diagnoses for many illnesses. An “Online Cure” systemcould contribute to international society by sharing many research
project results and diagnoses. Services on the system could be
provided in several major languages such as English, Chinese,Spanish, Russian and Japanese. By using the Internet and wirelessequipment, even if a patient is at home or somewhere else, a doctor
can check his or her health condition.
But the implementation of such new technologies in healthcare is aparticular struggle. If you were to ask, “How is the healthcare industry
keeping up with the pace of powerful tools being developed?” I would
reply, “Essentially, we are not.” With the Internet, we have entered a
new era of medicine in which every patient can have access to the fullmedical encyclopedia on his or her iPhone. As patients have become
more informed, we have moved away from the paternalistic
relationship doctors once had with their patients.

Uzbek-Japanese Collaboration
Uzbekistan and Japan have, to my knowledge, almost the sameadministrative system for healthcare which is based on paper andmanual tasks for elderly people. In Uzbekistan most people rely on
Japanese technology and security systems, and it is also a big market
for Japanese IT companies that work with systems management andhealthcare equipment. One of the main reasons for my research at
Keio University is to promote Japanese IT companies and enable
suitable and secure digital healthcare platforms in Uzbekistan. After I
have conducted some further experiments in Uzbekistan, I hope theJapanese Ministry of Health, Labour and Welfare and Japanese IT
companies will seek to create a market in Uzbekistan and a stablenetwork there with patients and security companies. It would be agood opportunity for them to act as a bridge between Central Asia andEast Asia.
In Uzbekistan, I have already talked with officials at the Ministry ofHealth and they said they are ready to work with Japanese companies
to implement such a Smart IC Card system. In the meantime, Japanand Uzbekistan need to promote IT in their hospitals for the interest ofelderly people in particular. In the case of Japan, the key issue is nothardware but people’s readiness to accept IT and a new platform thatwill be quite new for them. In the midst of the current pandemic, forexample, people still prefer going to the office and having a face-toface meeting. This is a question of Japanese culture. But in Uzbekistan,
the problem would be a lack of hardware and software for a new
system and secure digital platform. So Uzbekistan could be thebeneficiary of Japanese IT hardware, the quality of which is fine but
which is not used on a greater scale in Japan due to cultural factors.
In the future I hope I can serve as a bridge between Japan andUzbekistan with a view to improving Uzbekistan people’s healththrough the use of Japanese high tech to help prevent the occurrence
and spread of diseases and infections.
Urmonbekov Mukhammad Diyor is a graduate of the School of Media andGovernance and is studying for a Masters’ degree at Keio University in Japan.

Japan SPOTLIGHT • January / February 2021

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