Rebuilding Japan by promoting people-centered data-based healthmanagement initiatives-From “supply side” to “demand side”-

AMDD Monthly Lecture Meeting

December 13, 2022
Yasuhisa Shiozaki, Former Minister of Health, Labour and WelfareLost 30 Years
Changes in the world’s top 50 companies by market
capitalization
2021

Potential growth rate over the past 30 years

1989
World's Top 50 Companies byMarket Capitalization

Potential growth rate

Rank

GlobalGreat East
BNP Paribas Financial
Japan
CrisisShockEarthquake(August 2007) (September(March 2011)2008) European Debt
Crisis(From 2010) ）

Japan
U.S.
UK
Germany

A3

Company NameNTT
The Industrial Bank of JapanThe Sumitomo Bank, Ltd.
The Fuji Bank, Limited
The Dai-Ichi Kangyo Bank, Ltd.
IBM
The Mitsubishi Bank, Ltd.
Exxon corporation
Tokyo Electric PowerRoyal Dutch Shell
TOYOTA MOTOR CORPORATIONGEThe Sanwa Bank, Limited
Nomura Securities Co., Ltd.
NIPPON STEEL CORPORATION

AT&T
Hitachi, Ltd.
Matsushita Denki Sangyo Kabushiki Kaisha

Philip Morris International Inc.
TOSHIBA CORPORATION
Kansai Electric PowerThe bubble
Asian
economy burst in Financial
Japan
Crisis(early 1990s)(July 1997)

Financial
System Crisis IT bubble
burst
in Japan(2000)(1997)

Calendaryear

The Long-Term Credit Bank of Japan, Limited

The Tokai Bank, Ltd.
The Mitsui Bank, Ltd.
Merck & Co.
NISSAN MOTOR CO.,LTD.
Mitsubishi Heavy Industries, Ltd.

Du Pont(Note) Estimated by OECD.
(Source) OECD, HAVER

Growth = f (capital, labor, technologicalinnovation)
Japan's two fatal failures after the bubble economy burst(1) Innovation policy (university reform, etc.
(2) Population policyGM
Mitsubishi Trust & Banking Corporation

BT
BellSouthBP
Ford Motor Company
Amoco Corp.
The Bank of Tokyo, Ltd.
CHUBU Electric Power
Sumitomo Trust and Banking Co., Ltd. Coca-Cola
Walmart Inc.
Mitsubishi Estate Company, Limited

Kawasaki Steel Corporation
Mobil
TOKYO GAS CO.,LTD.
Tokio Marine & Nichido Fire Insurance Co., Ltd.

NKKARKO Corp.
NEC Corporation
Daiwa Securities Co. Ltd.
Asahi Glass Co., Ltd.

Marketcapitalization(US$ 0.1 billion)

World's Top 50 Companies byMarket Capitalization
Country ofheadquarters

Japan
Japan
Japan
Japan
Japan
U.S.
Japan
U.S.
Japan
UK
Japan
U.S.
Japan
Japan
Japan
U.S.
Japan
Japan
UK
Japan
Japan
Japan
Japan
Japan
U.S.
Japan
Japan
U.S.
U.S.
Japan
UK
U.S.
U.S.
U.S.
U.S.
Japan
Japan
Japan
U.S.
U.S.
Japan
Japan
U.S.
Japan
Japan
Japan
U.S
Japan
Japan
Japan

Source: Table published on page 45 of Diamond Weekly (August 25, 2018
issue)THE BUSINESS WEEK, U.S. Business Week (July 17, 1989 issue)

Rank

Company Name

Marketcapitalization(US$ 0.1 billion)

Apple
Saudi Aramco
Microsoft
Amazon.com, Inc.
Alphabet
Facebook
Tencent Holdings
Tesla
Berkshire Hathaway
Alibaba Group Holding
TSMC
Visa
Samsung Electro-Mechanics

JPMorgan Chase
Johnson & Johnson
WalmartUnitedHealth Group
Kweichow Moutai
VMH Moët Hennessy ‐ Louis Vuitton

Mastercard
Home Depot
NVIDIABank of America
Nestlé
Walt Disney
P&G
PayPalRoche Holding
Industrial and Commercial Bank of China

ASML Holding
ComcastExxon Mobil
Verizon Communications

L'OréalAdobe
Coca-ColaIntel Corporation
AT&T
Oracle Corporation
Meituan Dianping
Netflix
Pfizer
Cisco Systems
TOYOTA MOTOR CORPORATION

Abbott Laboratories
Nike
ChevronChina Merchants Bank
AbbViePing An Insurance (Group) Company of China

Country ofheadquarters

U.S.
Saudi Arabia

U.S.
U.S.
U.S.
U.S.
China
U.S.
U.S.
China
U.S.
U.S.
U.S.
U.S.
U.S.
U.S.
U.S.
China
France
U.S.
U.S.
U.S.
U.S.
Switzerland
U.S.
U.S.
U.S.
U.S.
China
Netherlands
U.S.
U.S.
U.S.
France
U.S.
U.S.
U.S.
U.S.
U.S.
China
U.S.
U.S.
U.S.
Japan
U.S.
U.S.
U.S.
China
U.S.
China

Source: Prepared based on data from SPEEDA and Bloomberg (dataacquired on May 6, 2021)

1 Japanese company (31 companies in 1989) and 5 companies in the healthcare sector (1company in 1989) out of 50 companies ranked by market capitalization in the world in 20201

スライド 2
A3

サイマル:英語社名表記を優先し、記載しておりますため少々レイアウトが乱れてしまい申し訳ございません。必要に応じて適宜ご調整をお願いいたします。
作成者, 2022/12/26

The speed of change will accelerate in the
post-COVID-19 world.

■ In a world where people have gone through the
COVID-19 pandemic, the speed of change will
accelerate significantly.
■ Meanwhile, if our country's digital transformation andother changes remain extremely slow as they are
now, sooner or later, the backs of the front runners
will finally be out of our sight.

2

Conditions for our growth■ In order to enhance the vitality of the Japanese economy, it is essential tocreate an environment that attracts a diverse range of global humanresources and enables them to fully demonstrate their capabilities.
■

Collaboration between “excellent government” and “excellent private

sector.”■ Speedy “investment” in and “movement of human resources” to growthareas are necessary.
■ Both the public and private sectors need to make a major shift from“seniority-based wages and skill-based pay” to “job-based employment
and job-based pay.”➡ A major reform to a “civil service system with freedom of movement inand out of the workforce”
3THE World University Rankings 2022
(Asia Pacific)（World）
Rank

University Name
University of Oxford
Harvard University
California Institute of Technology
Stanford University
University of Cambridge
Massachusetts Institute of Technology

Princeton University
University of California, Berkeley
Yale University
University of Chicago
Columbia University
Imperial College London
Johns Hopkins University
The University of Pennsylvania
Swiss Federal Institute of Technology in Zurich

Peking University
Tsinghua University
University of Toronto
University College London
University of California, Los Angeles

Country

UK
U.S.
U.S.
U.S.
UK
U.S.
U.S.
U.S.
U.S.
U.S.
U.S.
UK
U.S.
U.S.

Rank

University Name, Asia, Australia

Peking University
Tsinghua University
National University of Singapore

University of Hong Kong
The University of Melbourne
The University of Tokyo
Nanyang Technological University
The Chinese University of Hong Kong

The Australian National University

The University of Queensland
Seoul National University
Monash University
The University of Sydney
Fudan University

Kyoto University

Switzerland

The University of New South Wales

China
China

Tam Kang University
Shanghai Jiao Tong University

CanadaUniversity of Science and Technology ofChina
The Hong Kong Polytechnic University

UK
U.S

KAIST

Published on
September 2, 2021

Country
China
China
Singapore
Hong Kong
Australia
Japan
Singapore
Hong Kong
Australia
Australia
South Korea
Australia
Australia
China
Japan
Australia
China
China
China
Hong Kong
South Korea

Source: “THE World University Rankings 2022” published by Times Higher Education (THE), a British higher education magazine.

4

U.S.

12th place
PortugalSlovenia
FranceFinlandU.S.
Germany
Estonia
Lithuania
South Korea
PolandChile
TurkeyHungaryJapan
Colombia
LatviaChina
MexicoSlovakia
Czech

SwedenNorwayNew ZealandAustria
GreeceSpain

IcelandNetherlands
CanadaBelgium

Italy
Australia
Denmark
Luxembourg
UK

As of April 8, 2021

IsraelSwitzerland
IrelandNumber of papers per 100,000 population

Hungary

Finland

New Zealand

Chile

NorwayNumber of papers related to the COVID-19
published by each country

Colombia

Portugal

Denmark

Australia

Greek

Ireland

PolandMexicoSwedenSouth Korea

Belgium

IsraelTurkeyJapan

Netherlands

Switzerland

Spain

Australia

Germany

CanadaFrance

UK

Italy

China

Number of papers

Why were there so few Japanese papers related to the COVID-19?

Number of papers related to the COVID-19 published by OECD and China and number ofthe said papers per 100,000 population
Number of papers related to the COVID-19 published by
OECD and China per 100,000 population
As of April 8, 2021

Reference: PubMed
Reference: PubMed

32nd place

What is important is information sharing between the public andprivate sectors.
5

As for countries other than Japan, the labor market is open
to the world.
Australia's "28 years of consecutive growth" and "Changes in population"
 Australia's total population surpassed 25 million in August 2018*1. Every three years, the population increases by 1 million people (In the last 10 years, it increased
by 350,000 people per year.) The population increase can be attributed to two main factors.: “natural increase” and “increase due to migration.” In recent years, more than half of the increase has
been due to migration. Australia’s total fertility rate is approximately 1.77 (2017-18) *2, which is below the fertility rate that can sustain the population (approximately
2.1*3).

Real GDP YoY

Percentages of demographic changes in each country
Japan(year-on-year, 5-year average, %)Germany(year-on-year, 5-year average, %)Population and Population Increase

Population(left axis)

Population(10,000 people)

Population increase (2017-18): approximately 390,000 people
Breakdown
・Increase due to migration (NOM): approximately 240,000 people
・Natural increase (births - deaths): approximately 150,000 people

Increase due tomigration (right axis)

Natural increase(right axis)

A7

Population increase(10,000 people)

Real GDP YoY(%)(year-on-year, 5-year average, %)U.S.

Natural increase/decrease
Social increase or decrease
Total population(Source: World Bank, Ministry of Internal Affairs and Communications, HAVER)

Comparison of number* and percentage of immigrants in each country*Number of immigrants: Number of foreign-born residents

Comparison of number of immigrants*.
(Top 10 countries + Japan and South Korea)

Comparison of countries' percentages of immigrants to thetotal population(Top 10 G20 countries + Japan and South Korea)

U.S.

Saudi Arabia

Saudi Arabia

Australia

Germany

CanadaRussiaU.S.

UK

Germany

UAE

UK

FranceFranceCanadaItaly

Australia

RussiaSpain

South Africa

Japan

Japan ranked 26th in theworld.
South Korea ranked 45th in
the world.

South Korea

UK(year-on-year, 5-year average, %)Australia(year-on-year, 5-year average, %)New Zealand(year-on-year, 5-year average, %)Natural increase/decrease
Social increase or decrease
Total population

South Korea ranked 13thamong G20 countries.
Japan ranked 14th among G20
countries.

Japan

South Korea(Millions of people)

Source: Prepared by the Embassy of Japan in Australia based on “International migrant stocks: The 2017 revision,” issued by the Department of Economic and Social Affairs, United Nations(Source: World Bank, HAVER

6

スライド 7
A7

サイマル:左上のグラフ注釈は不鮮明なため作業対象外としております。
作成者, 2022/12/28

In order to achieve the growth rates of real GDP of 2%, it is essential to
improve productivity and increase the number of workers.
Japan
UK

U.S

Actualresults
1990-2021

Actualresults
1990-2021

Simulation (2022-2040)
ActualScenario for
Scenario for
Scenario withresults continuation of encouraging
flat labor
1990-2021 declining trend women and thein number ofworkers
Growth rates of real GDP(annual average)

elderly to takean employment

productivity
growth(Target)Labor productivity
growth rate
Percentage of an increase in
the number of workers

Increase/decrease in
the number of workers(million people)
Differences from the"Scenario for continuation of
declining trend in number ofworkers" (Million people)<Notes>• Scenario for continuation of declining trend in number of workers: Based on the assumption that the labor force participation rates for each age
group and gender remain unchanged at the 2021 level.
• Scenario for encouraging women and the elderly to take an employment: Based on the following assumptions. (1) The labor force participation rateof women aged between 30 and 59 will increase to a level roughly similar to that of Sweden in 2010 by 2040.
• (2) The labor force participation rates of the elderly aged between 60 and 64 will increase to the same level as that of those aged between 55 and 59 by
2040, and that the labor force participation rate of those aged 65 or older will also increase commensurately. (3) The unemployment rate will improve byaround 1% by 2025.
• Scenario with flat labor productivity growth: It is assumed that the labor productivity will remain at the historical (1990-2021) average.

8(Sources): SNA (National Accounts of Japan), Cabinet Office; Labor Force Survey, Ministry of Internal Affairs and Communications; National Institute of Population and Social Security Research; OECD, etc.

72021: G7 Summit Communiqué at the G7 Cornwall Summit held in
Cornwall, the United Kingdom

We, the leaders of the Group of Seven, met in Cornwall on 11-13 June 2021 determined to beat COVID-19 andbuild back better. We remembered everyone who has been lost to the pandemic and paid tribute to those still
striving to overcome it. Inspired by their example of collaboration and determination, we gathered united by theprinciple that brought us together originally, that shared beliefs and shared responsibilities are the bedrock ofleadership and prosperity. Guided by this, our enduring ideals as free open societies and democracies, and by ourcommitment to multilateralism, we have agreed a shared G7 agenda for global action to:● End the pandemic and prepare for the future by driving an intensified international effort, starting immediately, to vaccinate theworld by getting as many safe vaccines to as many people as possible as fast as possible. Total G7 commitments since the start of thepandemic provide for a total of over two billion vaccine doses, with the commitments since we last met in February 2021, including
here in Carbis Bay, providing for one billion doses over the next year. At the same time, we will create the appropriate frameworks tostrengthen our collective defenses against threats to global health by: increasing and coordinating on global manufacturing capacity
on all continents; improving early warning systems; and support science in a mission to shorten the cycle for the development ofsafe and effective vaccines, treatments and tests from 300 to 100 days.
From the website of the Ministry of Foreign Affairs of Japan

8

CEPI “100 Days Mission”

9IMD World Digital Competitiveness Ranking 2022
Japan ranked 29th
2022

2021

Country/Region

2022

2021

Country/Region

1

4

Denmark

16

14

UK

2

1

U.S.

17

15

China

3

3

Sweden18

16Austria

45Singapore

19

18

Germany

5

6

Switzerland

20

25

Estonia6

7Netherlands

21

21

Iceland7

11

Finland

22

24

France812South Korea

23

26

Belgium

92Hong Kong

24

18

Ireland

10

13

Canada25

30

Lithuania

118

Taiwan

26

29

Qatar

12

9

Norway27

23

New Zealand

13

10

UAE

28

31

Spain

14

20

Australia

29

28

Japan

15

17

Israel30

22

Luxembourg

Source: IMD World Digital Competitiveness Ranking 2022

10

Digital Transformation in health, medical care and long-term care■

Digital transformation (DX) in health, healthcare, andlong-term care is a priority policy of the government,along with education and disaster prevention.

■

In order to realize health, healthcare, and long-termcare based on data and evidence, the entire databased health management initiatives, including thepromotion of the protection and utilization of
personal
information,
must
bepromotedsystematically and promptly.

11

Priority plans for the realization of a digital society
Digital Agency “Priority plans for the realization of a digital society” (Cabinet decision on June 7, 2022)

Our vision for a digital society• “A society where people can select services that meet their individual needs through the utilization of digital technology
and can realize multiple forms of happiness” (“Basic policy on reforms for the realization of a digital society” (December
25, 2020)) → This will lead to the promotion of "people-friendly digitization, where no one is left behind.”

In order to realize our "vision for the society we aspire to,” the following (1) to (6) are required.
(1) Growth strategy through digitalization

Related ministries and agencies
How a digital society should be(2) Digitization of quasi-public fields
such as healthcare, education,
disaster prevention, children, etc.
(3) Revitalization of regions throughdigitalization

Digital Society Planning Meeting

Local public bodies

Collaboration/
Cooperation

Local
municipalities

Digitalagency(4) A digital society where no one is left
behind(5) Development and securement ofdigital human resources(6) International strategies, including thepromotion of DFFT

National and Local Structural
Reforms

Privatecompanies, etc.
Companies

Digital Provisional Commission
for Administrative Reform

Digital infrastructuredevelopment, etc.
Conference on therealization of the vision
for a digital garden city
nation• Satisfaction and utilization rates of citizens and private companies were set as indicators to grasp the progress ofdigitization in the big picture, including the progress toward the realization of (1) through (6) above. The progress will be
periodically monitored and presented to citizens in order to steadily promote digitization.

12

Welfare’s data-based health management initiatives" (2017)“Data-based health management initiatives promotion plan and roadmap on the promotion of big data utilization
to ensure people's health” (July 4, 2017) issued by the Ministry of Health, Labour and Welfare (MHLW)
Data-based health management initiatives promotion plan and roadmap on the promotion of big datautilization to ensure people's healthThrough the thorough utilization of health and medical data,
we will realize “healthier lives” for all people.

Material 1

Japan is currently facing challenges associated with its declining birthrate and aging population. One important clue tosolving this problem is “data-based health management initiatives.”
Japan faces a super-aging society ahead of the rest of the world. The world is paying attention to how to extend the healthy life expectancy ofeach individual, from the elderly to children. Moreover, we will tackle the unprecedented issue of how to continue to ensure the sustainability ofthe social security system even in an aging society with a declining birthrate. One important clue to solving this issue is data-based healthmanagement initiatives.
How our lives willchangeMedical and long-term care professionals, researchers, insurers, companies, and governments, etc. work together tosupport citizens and patients and lead them to good health.

• Each person will be able to easily grasp changes in his/her own health data and take preventive actions on his/her own.
• Management will be able to achieve the improvement of productivity by increasing the vitality of employees with improved health through health management initiatives based ondata utilization.
• Children (and persons) with disabilities who need medical care can go out safety, without anxiety in case of emergency.
• Even if you encounter unexpected disasters or accidents, you can receive reliable medical care with peace of mind.
• Independence-supportive long-term care will be realized through scientifically based long-term care services to reduce anxiety of the individuals and their family members.
• Genomic (genetic) medicine will greatly advance personalized cancer care and bring us closer to overcoming cancer.
• Optimal cure and care will be achieved through analysis of factors contributing to dementia. We aim to advance research on innovative drug discovery and overcome the challenges
associated with dementia.

How to realize them.

We provide data and the fruits of advanced technology to citizens on the premise of reliable protection of personal
information. We develop and provide healthcare ICT services from the “perspective of citizens, patients, and users.”

Based on the premise of reliable protection of personal information, eliminate the stove-piped structure of health, medical care, and long-term care, andestablish a system for "development of an ICT environment that allows data to be organically linked," "construction of a healthcare data platform," and"introduction of cutting-edge technologies such as genome analysis and AI into healthcare.
At the same time, reform the health insurance claims review & reimbursement services institutions that handle vast amounts of data from a "business group" to a"brain group that thinks and acts on its own" to achieve nationwide unification of reviews and promotion of smoother utilization of big data, etc.
Introduce advanced security monitoring utilizing AI, and defensive technologies, in order to protect the information on citizens’ medical and long-term care.
Establish an environment where healthcare data can be utilized with peace of mind by publishing guidelines for ensuring security with regard to the utilization ofdata and the results of security assessments and audits of utilization conditions.
The Ministry of Health, Labour and Welfare’s “data-based health management initiatives promotion headquarters" will lead these initiatives to realize world-classhealthcare services.

13

Data-based health management initiatives roadmap“Data-based health management initiatives roadmap” prepared by the Ministry of Health,Labour and Welfare (June 4, 2021)
 Enable accessing one’s health and medical information via the portal site called “Mynaportal,” etc., and build a system with a convenient user interface (UI). In
addition, by developing the framework, information which can be accessed by the patients themselves (medical examination data, claims/prescription data,
electronic medical record data, long-term care data etc.) can be also accessed by medical institutions and long-term care institutions.
→This will enable people to access their health and medical data throughout their lives, as well as enable medical institutions and long-term care institutions
to provide optimal medical and long-term care services based on the needs of patients and users.
FY2020

FY2021

FY2022

FY2023

FY2024FY2025

Building a system that enables people to access their own health and medical
information

Medical checkup/
examination data
Medical checkups for infants
and pregnant women

Accessible via “Mynaportal” (from June 2020)
Accessible via “Mynaportal” (from October 2021)

Specific health checkups
Employer health checkups（Health checkups for
employees under 40）
Municipality examinations
Examinations for cancer, osteoporosis,
periodontal diseases, and hepatitis virus

School physical checkups(Elementary, junior high, and high schools,
and universities including private schools）

Vaccinations

Routine vaccinations
Class A: Diphtheria,
pertussis, etc. Class B:
Influenza in the elderly,
pneumococcus

Develop an environmental
arrangement to accelerate theutilization of safe and secure
private PHR services
Investigate suitable accessenvironments with superior
usability

Accessible via “Mynaportal”(from FY2023)

Legal and administrative preparations/system
improvements
Legal andadministrative
preparations/syste
m improvements

Systemimprovements

Standard
recording format
formulation

Pilot demonstration/system improvements

Accessible via “Mynaportal” (from early FY2023)

Start to provide information as soon assystem improvements completed

Accessible via “Mynaportal”(from FY2022)*Available at all schools
nationwide from FY2024

Routine vaccination history data from June 2017 accessible via “Mynaportal” (from June 2017)*Develop and operate COVID-19*COVID-19-related information will be madeavailable at as early a stage as possible.
vaccination recording system (VRS)
Start using API to link “Mynaportal” and private PHR operators (from early
FY2021)
Start operation of third-party certification
Develop
Develop additional guidelines for
Launch third party
system, etc. to provide appropriate private
guidelines
high quality service levels incertification incollaboration with industry
groups, etc.

Initiatives to improvethe convenience of“Mynaportal”

collaboration withindustry groups, etc.

PHR services (from FY2023)

Investigate suitable access environments withfavorable usability, such as a framework thatenables easy access to historical health data(including measures other than “Mynaportal”)

Actions based on the evaluation
results (sequentially fromFY2024)*Start enabling access sequentially as available, without
waiting until FY2024.

14

Data-based health management initiatives roadmap
FY2020

FY2021

FY2022

FY2023

FY2024FY2025

Building a system that enables people to access their own health and medical information

Claims/prescription data
Pharmaceutical data
(Past prescription/dispensing
information based on claims）
Electronic prescription data （Realtime prescription/dispensing
information）
Health data:
・Medical institution names, etc.
・Surgery and dialysis data, etc.
・Medical management data, etc.

Medical information for children
who require medical care

Accessible via “Mynaportal” (from October 2021)

System improvements
Organizesystemrequirements

System improvements

Organizesystemrequirements

System improvements

Accessible via “Mynaportal” (from summer 2022)

Accessible via “Mynaportal” (from summer 2022)

Evaluate and address system needs, including improvements needed
based on the operational status, such as use during emergency
transportation, while taking into account, e.g., the trend toward
standardization of electronic medical record information (sequential)

Starting full-scale operation of systemcalled “MEIS” (From July 2020)

Electronic medical records,
long-term care data, etc.
Test result/allergy data

Consider the priority of accessible
data based on technical andpractical issues, etc

Organize system requirements,
conduct system improvements,
etc.

Notified diagnosis data

Consider the method of enabling theconfirmation of notified diagnosis data
based on technical and practical issues, etc.

Consider a specific framework for providing
notified diagnosis data, organize system
requirements, conduct system
improvements etc.

Imaging data

Long-term care data

Other data

Consider the range of imaging data, such as key images,
and an exchange framework to achieve usefulness for
one's own health management based on technical andpractical issues, etc.
Develop feedback
function for
database called"CHASE"

Accessible via “Mynaportal”,
etc. (from FY2024)
Accessible via “Mynaportal”,
etc. (from FY2024)

Organize system
requirements, conduct
system improvements, etc.

Feedback of analysis results of CHASE, etc. in unitsof users, etc. (From FY 2021)

Accessible via “Mynaportal”,
etc. (from FY2024)
Further feedback based on datafrom start of operation of next
system, etc. (from FY2024)

Verify the effect of independence support using "CHASE," etc.

Consider, based on technical and practical issues, etc., therange of information essential for users and long-term caresites, and a framework that enables access to nationwide longterm care data

Organize system
requirements,
conduct system
improvements, etc.

Consider the priority of accessible data based ontechnical and practical issues, organize system
requirements, conduct system improvements, etc.

Accessible via “Mynaportal,” etc.
(sequentially from FY2024)

Accessible via “Mynaportal,” etc.
(sequentially from FY2025)

15

Data-based health management initiatives roadmap
FY2020

Framework that enables accessto patient data by medical
institutions, etc.

FY2021

FY2022

FY02023

FY2024FY2025

Promoting utilization of medical records in medical and long -term care

Build a framework that enables medical institutions and long-term care institutions to access the same data patients have access to with theconsent of patients (medical examination data, claims/prescription data, electronic medical record data, long-term care data, etc.)*Build a system in which data can be accessed by identity verification in case(sequentially from FY2020)of disaster and emergency
Electronic prescription data (real-time prescription/dispensing data); canRegarding other data (municipality examinations, vaccination
be accessed from summer 2022
histories, school physical checkups, etc.), reach a consensus
Specific medical examination data/pharmaceutical data (past prescription/dispensing dataon specific actions without putting an additional burden on
based on claims) can be accessed from October 2021
people and the implementation schedule by the end of
FY2021 in consultation with the IT Office (Digital Agency).

Institutions which are already exchanging data (image data, inspection data, etc.) will start
sharing information regardless of the followingStandardize data to be included inelectronic medical records, etc. toenable data sharing between
medical institutions

Consider and determine data
items and technical standards
to share (exchange) between
data medical institutions

Develop framework
supporting technicalstandards which enable
exchanging data withdifferent electronic
medical record systems
and PHR.

Build into
medicalinstitution
network
Consider data (image
data, etc.) which will beshared with PHR, etc.

With the IT Office (Digital Agency), consider
the ideal foundation (*) to make electronic
medical record data accessible nationwide
and reach a conclusion.

*Subject, cost, relation with the Online Confirmation System
for Health Insurance Qualification and common government
infrastructure, operation starting period, the ideal legal
system related to protection and utilization of medical data

Standardize long-term care data to enable
data sharing between long-term careinstitutions, and between longterm careinstitutions and medical institutions

Promote evidence-based longterm care that supports
independence and preventsfunctional decline, etc.

Survey regarding thesharing andstandardization of
long-term care data

Develop feedback
function for databasecalled "CHASE"

Start concatenation
analysis of
NDB/long-term careDB

Share data sequentially, starting from supporting medical
institutions (sequentially from FY2022)
Organize system
requirements,
conduct system
improvements, etc.

Start the operation of the system(sequentially from FY2024)

Organize issues based on items described on the left,
and conduct development

With the IT Office (Digital Agency), consider the ideal
foundation to make long-term care data available
nationwide, including data stored in long-term carerecord support systems, and reach a conclusion.

Resolve issues based on items
described on the left, and conduct
development

Promote evidence-based long-term care based on analysis and feedback from long-termcare institutions and users (from FY2021)
Verify the effect of independence support using "CHASE,"
etc.
Integrate the operation of"CHASE" and “VISIT,” start
concatenation analysis
with long-term care DB

Organize additional data
items for a new datacollection system
Develop thenext system

Realize advanced evidence-based
long-term care based on data by
operating next system (fromFY2024)*From 2021, the following unified name will be used from the viewpoint of understanding and achieving the permeation of evidence-based
long-term care when operating "CHASE" and “VISIT” integrally. (LIFE: Long-term care Information system For Evidence

16

Data-based health management initiatives roadmap
FY2020
Promoting utilization of
Promoting of
medical records in medical
genomic medicine
and long-term care

Build effective collaboration
structure between public healthcenters and regional medicine

Other

FY2021

FY2022

FY2023

FY2024FY2025

Consideration including legal amendments if necessary
Build a framework to shareessential medical information
between relevant parties(health centers, medical
institutions, etc.) to ensure theprovision of home visits andonline medical care to thoserecovering from COVID-19 athome (from FY2021).

Consider and build a similar
framework for infectious
diseases other than COVID19

Execute effective collaboration between
health centers and medical institutions
assuming an emergency for all infectious
diseases (from FY2024)

In addition, with regard to, for example, the further enhancement of the emergency medical system andthe efficient confirmation of decision of intent to donate organs, sequentially consider how to support theefforts of local governments and technical/practical issues, etc. to contribute to the provision of optimal
medical and long-term care services through the sharing and utilization of information among the people
involved.

Improve organizational structures in order to steadily promote the “Action Plan for Whole Genome Analysis,” and return the
results of whole genome analysis, etc. to patients, as well as to promote utilization for research and drug discovery, anddeliver new personalized medicine, etc. to patients (from 2020).

“Action Plan for Whole
Genome Analysis”

Utilize the results of whole genome analysis, etc. for medical treatment to new patients andpatients whose samples are stored in biobanks or analysis centers, for whom the results ofwhole genome analysis, etc. can be returned (from FY2021).

Increase the number of medical institutions that utilize theresults of whole-genome analysis, etc. for medical treatment
for relevant patients (from FY2022).
Operations related to Data-based Health Management will be expanded accordingly by Health Insurance Claims Review &Reimbursement Services and the National Health Insurance Organizations. Firstly, operations will be launched for a systemthat allows the My Number Card to be used as a health insurance card (Online Confirmation System for Health Insurance
Qualification operations) (sequential expansion).
Launch new system for review & reimbursement for
90% of reviews completed by computer checking
Health Insurance Claims Review & Reimbursement(within 2 years after the start of the new system)
Services (from Sept. 2021)

Developing the foundation

Initiative on health insurance
claims review &reimbursement services(Health Insurance Claims Review& Reimbursement Services andNational Health Insurance
Organizations)Publish computer checking rules in a file format that can be easily incorporated into
systems of medical institutions, etc. (from FY2022)
Unify computer checking rules of both institutions nationwide.
Go through the examinations of review standards for national
unification for each institution (the period required to complete theunification will be confirmed by Oct. 2022).
System upgrade to enable implementation of cloud computing andjoint use by Health Insurance Claims Review & Reimbursement
Services and National Health Insurance Organizations

Launch renewed comprehensive National
Health Insurance system (from Apr.
2024)

Joint development to realize shared use of both institutions in claims review & reimbursement area (cooperate with Digital Agency).
*Immediately conduct verifications including cost effectiveness and draw conclusions with regard to the shared use of thereimbursement area, etc., apart from review area.
*Consider the possibility of utilizing Gov-Cloud (tentative name) as the infrastructure of the review & reimbursement system.

With regard to Health Insurance Claims Review & Reimbursement Services,
verify the quality of home-based reviews, etc. in FY2021-22 and consolidate thereview office functions by the end of FY2022, then expand sequentially.
Consolidate the review office functions into 14 locations nationwide (from Oct. 2022).
Consider prompt abolition of the 4 branch offices which will be established in next 10
years, based on further progress of digitization and work style reform.

Related to the leveling of review & reimbursement operations, continuously consider the respond to the urgent cashneeds of medical institutions, etc. in the event of a pandemic or natural disaster, considering the COVID-19 situation.

(Note 1) While ensuring consistency with system optimization in the national government, incorporated administrative agencies, local public organizations, and quasipublic fields, take steps in advance accordingly to support services that can be brought in ahead of schedule.
(Note 2) Optimize the schedule as needed according to the progress of each project.

17

Data-based health management initiatives roadmap
Important Matters
Fiscal year of
implementation
Standardize data to be included inelectronic medical records, etc. toenable data sharing between
medical institutions

With the IT Office (Digital Agency), consider theideal foundation (*) to make electronic medical
record data accessible nationwide and reach aconclusion.
*Subject, cost, relation with the Online
Confirmation System for Health Insurance
Qualification and common government
infrastructure, operation starting period, the ideal
legal system related to protection and utilizationof medical data

FY2021/FY2022

Standardize long-term care data toenable data sharing between longterm care institutions, andbetween long-term careinstitutions and medical
institutions

With the IT Office (Digital Agency), consider theideal foundation to make long-term care data
available nationwide, including data stored inlong-term care record support systems, and reacha conclusion.

FY2022/FY2023

Build effective collaboration
structure between public healthcenters and regional medicine

Build a framework to share essential medical
information between relevant parties(health centers, medical institutions, etc.) toensure the provision of home visits andonline medical care to those recovering fromCOVID-19 at home.

From FY2021
Establish collaboration
between health centersand medical institutions
in all infectious diseases
by the end of FY2025

18

Mr. Akira Morita (Next Generation Fundamental Policy Research Institute) presentationmaterial at the “Study Group for the Promotion of Genomic Medicine” (hosted by
Yasuhisa Shiozaki), entitled “Legal System for the Utilization of Medical Information-What the European Health Data Space (EHDS) concept suggests-” (June 8, 2022)

Proposal on a system for the utilization of medical data
In order to eliminate the current restrictions and promote the utilization of medical data, the following
legal systems should be enacted.
1.

Special laws that promote the utilization of information and incorporate sufficient protection mechanismsthat do not contradict the purpose of the Act on the Protection of Personal Information should be enacted.

2.

The regulations on the acquisition of information should be replaced by the regulations on the utilization of(access to) information.

3.

A distinction should be made between primary use (use for treatment) and secondary use (public health,
medical research, development of pharmaceuticals, etc., and health care services), and with regard tosecondary use, the regulations should be imposed for each function according to the purpose of use, user,
and form of information processing (pseudonymized processed information, anonymously processed
information, statistical information, etc.).

4.

In acquiring information for primary use, in principle, the generated data should be automatically stored in a
database, and access should be broadly permitted to healthcare professionals in charge of patient care.

5.

In the case of secondary use, the main objective should be creating value through utilization. The cases inwhich the data can be used without specific confirmation of the person's intention should be set as broadly
as possible. In this case, the scope of permitted use should be expanded to include pseudonymized
processed information, which is processed medical data.

19

Direction of Medical DX by the Liberal Democratic Party of Japan (LDP) and theMinistry of Health, Labour and Welfare (MHLW)First “Medical DX Vision 2030” (Liberal Democratic Party of Japan: May 17, 2022)
Materials issued by the Ministry of Health, Labour and Welfare Promotion Team (August 8, 2022)
Direction of Medical DX
Background In Japan, where the birthrate is declining and the population is aging ahead of the rest of the world, it is very importantto promote the digitalization of the medical field and to actively promote the utilization of health and medical information(including long-term care) in order to improve the health of citizens and provide seamless, high quality medical care.
 In addition, as issues that have been recognized in response to the recent COVID-19 pandemic, it is imperative toestablish a system that can promptly respond to the next infectious disease crisis by promoting "visualization" ofmedical care, through speeding up and expanding the scope of data collection from normal times, improving
operational efficiency and data sharing by digitization of medical care, and other efforts.

Direction
 Efforts will be made to extend healthy life expectancy by enabling citizens to easily access their own health and medical information(including long-term care) and utilizing it to maintain and promote their own health and to promote improvement of the quality of
medical care and optimization of treatment through efficient and effective provision of medical care.
 In addition, while utilizing the existing systems that were developed during the recent COVID-19 pandemic, a mechanism will beestablished as the overall system related to medical information to enable prompt and reliable acquisition of necessary informationin the next infectious disease crisis.
 Furthermore, it is expected that the acceleration of the development of new drugs and treatments through the appropriate use of
medical information will lead to the promotion of industries in related fields, and that the improvement of work efficiency, etc.
through the digitization of medical care will lead to more effective use of human resources, including SE personnel.

Skeleton
1. "National medical information platform"
2. Standardization of electronic medical record information, consideration of standardized electronic medical records
3. "Medical fee revision DX

20

First "Medical DX Vision 2030" Material issued by the Ministry of Health, Labour and Welfare Promotion
Team (August 8, 2022)

Standardization of electronic medical record information and exchange methods,
consideration of standardized electronic medical records
Standardization of electronic medical record information and exchange methods(Basic Concept)
 In order to promote smooth data exchange and sharing among medical institutions, HL7 FHIR will be
used as a standard for exchange of information, standard data items to be exchanged and electronic
specifications will be defined, and these specifications will be standardized as a national standard.
(Specific Efforts)
 In March 2022, the Ministry of Health, Labour and Welfare (MHLW) adopted three documents and six
pieces of information* as MHLW standards. In the future, we will expand the scope of standardization
while taking into consideration its usefulness in the medical field. In FY2022, we will work on
standardization of dialysis information and some notifications of infectious disease outbreaks as part ofa project funded by Grants-in-Aid for Scientific Research.
(*) 3 documents: patient referral document, discharge summary, medical checkup result report
6 information: name of injury or disease, allergy information, infectious disease information, drug contraindication
information, test information (useful tests in emergency, tests related to lifestyle-related diseases), prescription
information

Consideration of standardized electronic medical records
 At the same time, we are considering the development of a cloud-based electronic medical records(standard electronic medical records) for small medical institutions that conforms to this standard. In
FY2022, we plan to implement the FY2023 research and study project, while conducting interviews
with related parties.

Abandoned standardization of the entire electronic medical record？
21Current status of introduction of electronic medical records (general hospitals <Note>) and
MHLW's proposal for standardization“The Static Surveys of Medical Institutions” conducted by the Ministry of Health, Labour and Welfare, FY 2020

HL7 FHIR as replacement standard <MHLW’s proposal>

Number of beds (Share of beds . %)Penetration rate of electronic
medical records (%)

400 beds
200- 300 beds
200 or more beds

Policy of standardizing only for “199 beds or less” + “clinics” <MHLW's proposal>
199 bed or less
Total

<Note> Excluding psychiatric hospitals.

It is difficult to realize data-based health management initiatives through thestandardization limited to “199 beds or less” plus “clinics.”
22

Status of the development of peoplecentered medical DX in Europe■ Estonia: “eHealth Service”■ Finland: “Kanta”■ Denmark: “Sundhed.dk”■ UK: “NHS Digital”■ EU : “European Health Data Space(EHDS）”(Policy for establishment announced in May 2022)

23

Estonia: “eHealth Services”

24

Finland: “Kanta”

25

Denmark: “Sundhed.dk”

26

UK: “NHS Digital”
Utilization of data forverification of research
results and policies
Infrastructure

Selective
medicine

First aid and emergency
medical care

Paperless in the medical field

Public trust towards
and security of NHS
information systems

Integration of health andsocial welfare
Developments
and activities inother fields

Involvement of citizens in theirhealth:Self-management andprevention

Digitalization ofdispensing

Digitization of general practitioners(GPs)

Liberal Democratic Party’s Special Committee on Data Health Promotion (April 2018), processed from EY presentationmaterial, “Health Data Reform (Digitization)” in the UK.

27

EU: European Health Data Space(EHDS)
3. Key points of EHDS
Unification of market concerning data in Europe

Digital Single Market (DSM) Strategy

A Europe fit for the digital age
Digital Strategy
EHDS Bill

Data
Governance
Act Bill（2021）NIS Directive(General Data
Protection
Regulation/2016)

Data Act Bill Establish discipline for“critical infrastructure
operators“ and “digital
service providers.”

 Establish general rules fordata protection.
 Provide mutual recognition
with Japanese Act on theProtection of Personal
Information

 Promote the utilizationof data (e.g., IoT data)
related to the use or theenvironment.

 Ensure trust in data
linkage services.
 Discipline also the reuseof data held by the public
sector.

 First proposal for a common data
space in Europe.
 Address health-specific issues
regarding accessing to and sharingof electronic health data.
 Align uneven implementation andinterpretation of the GDPR bymember countries, increase legal
certainty, and remove barriers tosecondary use of electronic healthdata.
 Prescribe also the utilization ofelectronic health data for
emergencies in the health andmedical field, as reaffirmed by the
COVID-19 pandemic.
 Contribute to a truly single market
for digital health products andservices by harmonizing rules
within Europe and increase theefficiency of the healthcare system.

Mr. Akira Morita (Next Generation Fundamental Policy Research Institute) presentation material entitled “Legal System
for the Utilization of Medical Information-What the European Health Data Space (EHDS) concept suggests-” (June 8, 2022)

28

Importance of information sharing between the public and private sectors
Establishment of an organization to implement the project (Genome
Medical Center Japan (tentative name))
An organization to implement the project should be newly established andwhole-genome analysis etc. should be steadily promoted, with reference tothe concept of project promotion in Genomics England. Genomics Englandtakes the form of a state-funded company and widely invites participationfrom academia and industry. This enables flexible management decisions
based on the latest knowledge. Based on this, we should make Japan'sorganization to implement the project a transparent and open organizationin which academia and the business community participate widely in terms ofideas, human resources, investment, and financing etc., rather than aclosed organization consisting only of national research institutes andnational research and development corporations, and we should make it theone that can also function as a business model integrating the public andprivate sectors. In order to promote the establishment and operation ofsuch an organization to implement the project, the public and private
sectors need to work together, and measures that include the utilization ofprivate funds in addition to sufficient public budgets should be considered.
June 1, 2021: Liberal Democratic Party of Japan “Recommendations by the Special Mission Committee on Data
Health Promotion” Data:https://www.jimin.jp/news/policy/201657.html

29

Global collaboration in crisis management on the issue of antimicrobial resistanceEstablished in November 2020

Overview
Background
After the UN High-Level Meeting on AMR held in September
2016, the UN Secretary-General convened the “UN InterAgency Coordinating Committee on AMR.”
It was created in response to the Committee's
recommendation in its April 2019 report to the UN SecretaryGeneral to establish a One Health Global Leaders Group on
AMR.
The World Health Organization (WHO), the Food andAgriculture Organization (FAO), and the Office International
des Epizooties (OIE) serve as the secretariat.
Roles
The roles of this group are as follows.
• To maintain political momentum and citizens' support for
AMR within the international community.
• To support and raise awareness of the activities of WHO,
FAO, and OIE.
• To manage the progress of the response from theinternational community on AMR, etc.
Members
It is co-chaired by Prime Minister Sheikh Hasina of
Bangladesh and Prime Minister Mottley of Barbados andcomposed of current and former heads of state, ministers, andsenior government officials. Yasuhisa Shiozaki, a member ofthe House of Representatives, was elected from Japan.
Future Activities
The meeting is scheduled to be held four times a year.

Co-Chairs (2 persons)◎ Sheikh Hasina, Prime Minister, PEOPLE'S REPUBLIC OF BANGLADESH◎ Mia Amor Mottley, Prime Minister, Minister of Finance, Economic Affairs and Investment,
BARBADOS
Committee members (18 persons)● Dr Hamad Abdullaziz Al-Batshan
Deputy Minister for Animal Resources, Ministry of Environment, Water, and Agriculture, SAUDIARABIA● Dr. Hasan Mohamed Abbas Al-Temimi
Minister of Health and Environment, IRAQ
● Prof António Correia de Campos
Professor Emeritus of Health Economics, National School of Public Health, New University of
Lisbon, PORTUGAL● Prof C.O. Onyebuchi Chukwu
Former Minister of Health, Professor of Orthopaedic Surgery, Alex Ekwueme Federal University
Ndufu Alike, NIGERIA● Dr Guilherme Antônio da Costa Júnior
Chairperson of the Codex Alimentarius Commission, BRAZIL●Prof Dame Sally Davies
Former Chief Medical Officer, UK Special Envoy on Antimicrobial Resistance, UNITED KINGDOM●Prof Sir Jeremy James Farrar
Director, Wellcome Trust, UNITED KINGDOM●Dr Julie Gerberding
Chief Patient Officer and Executive Vice President, Merck & Co., Inc., UNITED STATES OF
AMERICA●Ms Grace Fu
Minister for Sustainability and the Environment, SINGAPORE●Ms Lena Hallengren
Minister of Health and Social Affairs, SWEDEN●Sussan Ley
Minister for Agriculture, Water and the Environment, Australia●Aminata Mbengue Ndiaye
Former Minister of Livestock and Animal Production, Former Minister of Fishery and Maritime
Economy, Senegal●Ms Sunita Narain
Director-General, Centre for Science and Environment, INDIA●Anna Yuryevna Popova
Head of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare,
Russia●Mr Yasuhisa Shiozaki
Former Minister of Health, Labour and Welfare, Member of the House of Representatives, JAPAN●Ms Dechen Wangmo
Minister of Health, BHUTAN●Dr Jeffrey Scott Weese
Professor at the University of Guelph, Director of the Centre for Public Health and Zoonoses,
CANADA●Prof Lothar H. Wieler
President of the Robert Koch Institute, GERMANY

30