The Journey of Global Expansion of the Perinatal Management System and Mobile
CTG Developed in Kagawa Prefecture
Kazuhiro Hara
Emeritus Professor at Kagawa University
Specially Appointed Professor of Seto Inland Sea Regional Research Center, Kagawa
University
President of e-Health Care Innovation in Kagawa (e-HCIK)
President of Japanese Telemedicine and Telecare Association

Introduction
The 10th International Conference on Maternal and Child Health (MCH)
Handbook (Chair: Prof. Yasuhide Nakamura, Professor of Osaka University, Graduate
School) was held at United Nation University in Shibuya-Ward, Tokyo and the research
center of Japan International Cooperation Agency (JICA) located in Shinjuku-Wardfrom November 23 to 25, 2016. (Reference 1)
As reported on the Monthly Report of Hyakujyushi Bank Economic ResearchInstitute issued in June 2014, Japanese maternal, fetal and neonatal mortality rates(perinatal mortality rate) mark the lowest in the world. As a factor of these lowest
rates, MCH Handbook developed in Japan over 70 years ago is drawing attention.
(Reference 2 and 3)
JICA has been supporting diffusion of MCH Handbook to reduce maternalmortality and perinatal mortality rate in the developing nations. The first International
Conference on MCH Handbook was held in 1998 under the name of “The 1st
International Symposium on MCH Handbook” at Tokyo University as a group researchsession of Ministry of Health, Labour and Welfare (MHLW). Five nations attended
this first conference. Following that, the conference was held almost every two years
mainly in ASEAN nations and African nations. In 2016, International Conference on
MCH Handbook was held in Japan, and that was the third time that Japan hosted theconference. More and more nations participated in the conference every time, andabout 400 people from 38 nations attended in 2016. We sensed high interest in MCH
Handbook in the developing nations. The followings were main topics reported in theconference to study the history of MCH Handbook to learn new things; History of MCH
Handbook, history of Japanese midwives’ activities and MCH Handbook, effectivenessof MCH Handbook at the time of disasters, needs for electric MCH Handbook and theimportance of standardization of the electric MCH Handbook, MCH Handbook for
low-weight neonates, a case in Mongolia for continuous support to mothers and children
with MCH Handbook, a case in Netherlands which is the only European nation where
MCH Handbook including electric version is diffused, MCH Handbook for Palestine
refugees, MCH Handbook for minorities, and methods to continue MCH Handbook
efforts. Many important topics were presented.
Among these topics, cases from Netherlands and India about electric version of
MCH Handbook drew attention. Also, our project of perinatal electric records andMobile CTG with JICA’s Partnership Project in Chiang Mai, Thailand was recognized.
Standardization and importance of collaboration were confirmed for the future use.
Those are achievements of Prof. Nakamura’s great efforts over the years.
http://www.hands.or.jp/activity/mch/hb/conf/10th.html(Figure1) National statistical data
issued by MHLW printed on Shikoku
Newspapers on May 2, 2016
Kagawa Prefecture marked the lowest
perinatal mortality rate (2.2 per 1000
neonates, same as the previous year)
both in Japan and the world for two
consecutive years

1. The journey of Kagawa Prefecture to realize the lowest perinatal mortality rate both
domestically and internationally for two consecutive years
According to the annual statistical report by MHLW, Kagawa Prefecture marked thelowest perinatal mortality rate (2.2 per 1000 neonates, same as the previous year) bothin Japan and the world for two years in row. (Figure 1) (Reference 4)
In the 1970s, Kagawa Prefecture’s perinatal mortality rate was always among
the worst five in Japan. (In 1971, Kagawa’s perinatal mortality rate was 11.5 and was
the worst in Japan.) Therefore, when Kagawa Medical School was founded in 1980,
Kagawa Prefecture requested Ministry of Education, Culture, Sports, Science andTechnology to open a department enforcing efforts on perinatal management instead ofa regular department of obstetrics and gynecology. Thus, establishment of Departmentof Perinatology and Gynecology, and Perinatal Medical Center for an actual clinicalpractice was approved. As a characteristics of Department of Perinatology andGynecology, obstetricians and pediatrics in charge of neonates, and pediatric surgeons㏌ charge of neonates continuously and seamlessly collaborate as a team. Currently inJapanese perinatal medicine, such a collaboration is nothing new. However, then, it
was an ordinary case for obstetricians not to contact with pediatrics and pediatricsurgeons in charge of neonates until abnormality was found with neonates after delivery.
When I first arrived in Kagawa Medical School in 1980, I put the most effort
into continuous use of the fetal monitoring system (fetal heart monitor) from thepregnancy period until the delivery so that we could constantly monitor the fetal healthcondition, conduct a successful delivery of healthy neonates, and hand them topediatricians in charge of neonates. Additionally, another point for which I madeefforts was to transfer high risk expected mothers to core hospitals during theirpregnancy prior to delivery (maternal transport) instead of emergent transfer of neonates
to core hospitals after their birth (neonate transport). We could use private vehicles,
taxis and so forth for maternal transport, and reduce the use of ambulances for neonate
transport accompanied by a pediatrician in charge of neonates. By doing so, we could
also reduce premature delivery cases, Cesarean sections, and loads of medical workers.
Along with those reductions, we accomplished significant drop of perinatal mortality
rate.
Taking Kagawa Prefecture’s perinatal management as a model, MHLW
intended to establish a perinatal care center for every 1 million people in each prefecture.
(Reference 5)
Currently, Kagawa Prefecture has two perinatal care centers; one is located in
Kagawa University Hospital, and another is Shikoku Medical Center for Children and
Adults. Since Kagawa Prefecture has a perinatal care center per every 500 thousandpeople, Kagawa is the most ideal region for expected mothers domestically andinternationally.
2. Perinatal mortality rate and maternal mortality rate in the developing nations are
significantly high compared with those in Japan

(Figure 2) Annual shift of perinatal
mortality rate per 1000 deliveries in theworld
In 1970, perinatal mortality rate was 21.7
in Japan, 27.8 in U.S and 26.7 inGermany, and their figures were very
close. However, 40 years later, in 2010,
perinatal mortality rate was 2.9 in Japan,
but it was 6.8 in U.S and 5.5 in Germany.
Japan demonstrated significantly goodresults.

Figure 2 indicates annual shift of perinatal mortality rate per every thousand
deliveries in the world. In 1970, perinatal mortality rate was 21.7 in Japan, 27.8 in U.S
and 26.7 in Germany. Japan’s rate was slightly lower, but these figures were very
close. However, 40 years later, in 2010, perinatal mortality rate was 2.9 in Japan, but it
was 6.8 in U.S and 5.5 in Germany. Compared to the Japan’s rate, each rate of U.S
and Germany was about double. We could see significantly reduction of Japan’s
perinatal mortality rate. As for maternal mortality rate, Japan also marked the lowest
compared with other advanced nations. Maternal mortality rare in developing nations
such as Congo and Laos was more than 100 times higher than that of Japan.
The above indicates importance of perinatal medical support from advanced
nations, especially from Japan. (Figure 3)
Japan has provided medical support to developing nations with Official
Development Assistance (ODA) and JICA budget. However, the support was for
hospital construction, medical equipment provision, or dispatch of physicians, publichealth nurses and nurses rather than for perinatal medicine. The most important
support for developing nations is to decrease maternal mortality and perinatal mortality.
Akihiko Tanaka, former president of JICA stated “Decrease of maternal mortality is aneffective indicator in supporting developing nations.”(Figure 3)
Japanese maternal mortality rate is thelowest among advanced nations.
Maternal mortality rates in developing
nations such as Congo and Laos are morethan 100 times of that of Japan.
(Figure 4)
Akihiko Tanaka, former president of JICA
stated “Decrease of maternal mortality isan effective indicator in supporting
developing nations. Reported on
Yomiuri Newspaper on May 9, 2016.

In Kagawa Prefecture, Kagawa University collaborates with Chiang Mai
University in Thailand to work for electric perinatal record project which Kagawa
Prefecture developed through JICA Partnership Program and achieved a good result.
3. Introduction of electric perinatal record and Mobile CTG to developing nations
Issues in perinatal medicine in developing nations are that they are significantly
short of obstetricians, gynecologists, and midwives let alone base and core hospitals toprovide advanced perinatal medicine, and also systemic and continuous maternalmanagement is hardly implemented.
Japan Society of Obstetrics and Gynecology has worked to develop and diffuse
home maternal management system with electric perinatal record and mobile devices
for the purpose of pregnancy management in the whole region to respond a rapiddecrease of the number of obstetricians and gynecologists in Japan for over 15 years.
The achievement of this effort implemented in four regions was highly evaluated as“standardization and verification project of regional medical information collaboration
system” of Ministry of Economy, Trade and Industry. (Reference 6, 7, 8)This effort in Iwate Prefecture, especially, developed as Cloud-type perinatal electricrecord network called “Ihatov” by the budget of MHLW. Furthermore, when the Great
East Japan Earthquake hit Iwate Prefecture, this network effectively functioned toreissue MCH Handbook to expected mothers in the destructed coastal region, to make areference of the expected mothers to inland hospitals, and also to transport them to theinland hospitals. Thus, the network drew attention of the central government, andsignificantly influenced to develop Cloud-type regional medicine network.
Mobile CTG was originally developed for expected mothers living in isolatedislands and remoted area without enough obstetricians and gynecologists. Thus, if
Mobile CTG is introduced in the developing nations, it is expected to demonstrate its
immense capability. Nevertheless, since this Mobile CTG had not shown achievement
in foreign countries in the past, the governmental budget for this project was difficult tobe approved. Additionally, since the Internet service, especially Mobile environment
in developing nations was not well-established, it was considered too early to introduce
Mobile CTG to those nations. However, recently, as a part of supports from advanced
nations to developing nations, the Internet service, especially Mobile environment
establishment has been advanced drastically. Mobile devices and smart phones use areavailable in major parts of developing nations. Once the Internet environment isestablished, the next point to draw attention is information delivered through theInternet. The most valuable among the information transmitted through the Internet isapplication for medical services.
4. Supports for overseas from Ministry of Internal Affairs and Communications (MIC)and JICA for ASEAN nations and South Africa
MIC implemented ICT foundation establishment and personnel development supports
for countries in Asia-Pacific regions through Asia-Pacific Telecommunity (APT). As apart of APT, the Mobile CTG project was adopted fortunately. The title of the project
was “The Thai –Japan collaborative pilot system for rural e-Health development in
Indochina region in honor of 84th anniversary of King Bhumibol Adulyadej Maharaja.”(2011, APT-J2/J3 Project). The first overseas verification experiment of the Mobile
CTG was conducted in Phitsanulok Province in Thailand.

Furthermore, nearly coincidently, the Mobile CTG was also adopted as “The Ubiquitous
Alliance Project” of MIC, and its verification experiment was conducted in Vientiane,
Laos.
In October 2013, when the 18th International Conference of Telemedicine was heldat Sunport Takamatsu, which was really fortunate to hold this conference at this time,
Japan’s advanced telemedicine technology drew attention from the world.
http://www.j-telemed-s.jp/isfteh18/index.php
Prime Minister Abe visited Vientiane, Laos in November 2013, and signed on
the agreement to provide Japanese medical technology for Laos’s telemedicine andelectric record development. (Figure 5) As a result of these events, Prime MinisterThongsing of Laos visited Kagawa Prefecture in December 2013. (Figure 6)(Figure 5)
Prime Minister Abe visited Laos in
November 2013. Picture taken from thewebsite of MHLW.
MHLW signed on the agreement toprovide Japanese medical technology for
Laos’s telemedicine and electric record
development when Prime Minister Abe
visited Laos.

(Figure 6)
Prime Minister Thongsing of Laos visited
Kagawa Prefecture in December 2013.
Prime Minister Thongsing visited Kagawa
Medical Association.
In the picture, Governor Hamada, the farleft in the front line, Dr. Morishita, Chairof Kagawa Medical Association, next toGovernor Hamada, and Prime MinisterThongsing, next to Dr. Morikawa.
Telemedicine was introduced throughteleconference system between Takamatsu
and Vientiane, Laos.

Through the above two projects, the central government of Japan deepened its
understanding about the perinatal electric record and Mobile CTG projects, andinternational development of the projects was suddenly advanced.
From 2011 to 2012, the central government of Japan launched “Comprehensive
Special Zone System” to promote Japan’s revitalization and reconstruction. Kagawa

Prefecture applied for this system with the project, “Kagawa Medical and Welfare
Comprehensive Special Zone, A Plan to build a safe town with Kagawa Medical
Information eXchange (K-MIX)”, and its application was approved with positive
evaluation. (Reference 11)
In addition, fortunately, it was later decided that the central government’s
supplementary budget would provide financial support to projects which would also bebeneficial to foreign nations. The budget was allocated to JICA Partnership Project.
Therefore, with the advice from Governor Hamada, Kagawa Prefecture applied for thisJICA project with “A Collaboration Project using ICT Telemedicine for Perinatal Careand Diabetes in Thailand”, and it was adopted fortunately.
To be approved by JICA, a trustable organization to support the project wasnecessary. Luckily, e-HCIK, non-profit organization which was founded for thecomprehensive special zone system under Kagawa Prefecture already started its
activities, then. Originally, applications for the comprehensive special zone system
and JICA project were also Kagawa Prefecture’s intension as well as ours. Therefore,
we feel very grateful to Kagawa Prefecture. Without coincidence of the above events,
I do not think that international development of our Mobile CTG would have been
advanced in a speedy manner.
1) The Thai –Japan collaborative pilot system for rural e-Health development in
Indochina region in honor of 84th anniversary of King Bhumibol Adulyadej
Maharaja
The above project was the first and memorable international project of our perinatal
electric record and Mobile CTG. (APT-J2/J3 Project 2012-2014) This project was
supported by Kagawa Prefecture, Kagawa University, Kagawa Medical Association,e-HCIK, non-profit organization, and C/O BHN Association from Japanese side andalso Naresuan University from Thai side, and implemented in Phitsanulok Province inThailand.
As for its actual operation, Chattrakan hospital located 130 km away from
Buddha Chinaraj Hospital, Bang Klang clinic located 60 km away, and Bang Klang
Clinic, a core hospital in the region were connected through optical fiber cables totransmit maternal information and fetal HR data to obstetricians and gynecologists. It
was confirmed that this project was very effective for maternal management in theregions without obstetricians and gynecologists. (Figure 7)

(Figure 7)
MIC “The Thai –Japan collaborative pilot
system for rural e-Health development in
Indochina region in honor of 84th
anniversary of King Bhumibol Adulyadej
Maharaja” (APT-J2/J3 Project)
Chattrakan hospital, Bang Klang clinic,
and Buddha Chinaraj Hospital wereconnected to transmit maternal
information and fetus HR data to
obstetricians and gynecologists. This
project was confirmed very effective formaternal management in the regions
without obstetricians and gynecologists.

(The exclusive server for our perinatal project located at STNet was used for this projectin Thailand instead of directly connecting these three medical institutions.)
2) MIC’s project A project to support perinatal medicine in Laos, “The Ubiquitous
Alliance Project”
We also implemented a project to support perinatal medicine in Laos at about thesame time as the above Thai project (APT-J2/J3 project) in 2013. As for actual
operation, Outhoumphone hospital, Savannakhet without obstetricians andgynecologists, Nambak Hospital, Luang Prabang, and Mittaphab Hospital, a core
hospital in Vientiane were connected. The result of this project in Laos was also very
successful. (Figure 8) (For this project, a server for tele-counseling established inVientiane by Lao Ministry of Health was used.)(Figure 8)
MIC’s project to support perinatal
medicine in Laos, “The Ubiquitous
Alliance Project”
Outhoumphone hospital,in Savannakhet
Province without obstetricians andgynecologists, Nambak hospital, in
Luang Prabang County, and Mittaphab
hospital, Vientiane were connected.
The result of this project in Laos was
also very successful.

3) A Collaboration Project using ICT Telemedicine for Perinatal Care and Diabetes inThailand by JICA Partnership Project (Regional Economic Activation Special
Framework)
As mentioned previously, “A Collaboration Project using ICT Telemedicine for
Perinatal Care and Diabetes in Thailand” was approved as JICA Partnership Projectfrom 2013 to 2016 as successful results of APT-J2/J3 Project and “The Ubiquitous
Alliance Project” of Ministry of Internal Affairs and Communications, and also a launchof Regional Economic Activation Special Framework, which was an internationalversion of comprehensive special zone project.
Since Kagawa University and Chiang Mai University have been sister
universities before the start of this project, it was very easy to proceed this project.

(Figure 9)
The Kick-off meeting held at Chiang Mai
University, Department of Medicine.
We felt Thai people’s significant interest
and passion toward this project from the
beginning.

Figure 9 showed the Kick-off meeting held at Department of Medicine in
Chiang Mai University. We felt Thai people’s great interest and passion toward thisproject from the start.
In this project, we worked for DM management for expected mothers andresearch in hepatitis B in addition to perinatal ICT telemedicine supports. As for theperinatal ICT telemedicine supports, centering Chiang Mai University Hospital,
department of obstetrics and gynecology, the following three medical facilities wereconnected; Mae Chaem Hospital where there were no obstetricians and gynecologist
deployed, located 150 km away from Chiang Mai, Hod Hospital located 100 km away,and Doi Tao Hospital located 140 km away from Chiang Mai. (Figure 10)

(Figure 10)
The outline of Japanese technicalcooperation under the JICA partnershipprogram (Perinatal System)
Chiang Mai University, Mae Chaem
Hospital without obstetricians andgynecologist, located 150 km away from
Chiang Mai, Hod Hospital located 100 km
away, and Doi Tao Hospital located 140
km away from Chiang Mai wereconnected through mobile network.

Also, it was epochal that we could establish a datacenter at Chiang Mai
University with JICA budget. Thus, we used the Thai datacenter instead of the data
center located in Kagawa Prefecture. (Figure 11) This Thai datacenter will make asignificant contribution to reduce operation cost to develop projects in ASEAN nationsin the future.

(Figure 11)
The perinatal data-server located in
Chiang Mai University HospitalThis datacenter will make a significant
contribution to reduce operation cost to
develop projects in ASEAN nations in the
future.

Figure 12 shows people actually using our system in hospitals in the regions.
The system was very welcomed by not only expected mothers but also medical
professionals. The fetal cardiogram can also be monitored from Japan when necessary.
The upper indicates fetal cardiogram, the middle shows fetal movements, and thebottom is for uterine contraction. Since active fetal movement and fetal HR rise alongwith fetal movement were observed, it could be diagnosed that the fetus was healthy.
(Figure13) Over 1500 of fetal HR totally was transmitted by Mobile CTG. The datawas constantly stable, and we could confirm that the Mobile CTG was beneficial for
expected mothers in the regions without obstetricians and gynecologists.

(Figure 12)
The pictures showing this system actually
being used. It was welcomed by not
only expected mothers but medical
professionals.

(Figure 13)
The fetal cardiogram can also bemonitored from Japan when necessary.
The upper indicates fetal cardiogram, themiddle shows fetal movements, and thebottom is for uterine contraction. Since
active fetal movement and fetal HR risealong with fetal movement were observed,
it could be diagnosed that the fetus washealthy.

4) Collaboration with Luang Prabang Provincial Hospital in Laos by Takamatsu
Central Rotary Club
Takamatsu Central Rotary Club donated Mobile CTG to Luang Prabang
Provincial Hospital in Laos to support developing nations for JICA Partnership
Project. The Internet environment is in Luang Prabang Province was not
sufficiently established yet, but collaboration was relatively easy with direct support
from Chiang Mai University. Fetal HR waves were very steadily transmitted from
Luang Prabang Provincial Hospital to the server located at Chiang Mai University.
5) Digital Health Management System for Mothers and Children in Indonesia(APT-J2/J3 Project)Compared with other ASEAN nations, Indonesia has significantly large
numbers of islands, and thus, early introduction of telemedicine is expected.
Fortunately, our project was adopted as MIC’s APT-J2/J3 Project from 2014 to2015, and we could work for digital health management system for mothers andchildren in Bandung. With collaboration of Kagawa University, Department ofMedicine, C/O BHN Association, Bajrang University, Department of Medicine, West
Bandung Health Center, Indonesian Telecom and so forth, we worked for an alert
system for mothers and midwives with application of MCH, teleconference system for
midwives, obstetricians, and also to apply mobile health system for midwives andmedical professionals. The results of our works were very highly evaluated. (Figure
14)(Figure 14)
Digital Health Management System for
Mothers and Children in Indonesia(APT-J2/J3 Project)

When the Internet environment is established in the islands in the future,
Indonesia is expected to be an ideal model for telemedicine.
6) Under the JICA project “Feasibility Survey with the Private Sector for Utilizing
Japanese Technologies in ODA Projects”
Feasibility Study for Maternal and Neonatal Telemedicine in the Republic of South
AfricaPreviously, we reported our projects in ASEAN nations. Maternal andperinatal mortality rates in African nations are further higher than those of ASEAN
nations.
Accidental encounter at the international conference triggered our project with
South Africa. When I presented our work at Mobile CTG at European Telemedicine
Conference, Med@tel, which was held in April annually in Luxemburg in 2013, Dr.
Bogosi Mogale, EU Minister at Belgium for the Republic of South Africa requested me
to introduce excellent Japanese perinatal management system, especially Mobile CTG
to South Africa. Public Health is Dr. Mogale’s expertise, and he has a very highinterest in health of mothers and children. He is influential to the government of SouthAfrica, and is willing to cooperate to develop Mobile CTG not only in South Africa but
also all over the African continent. Since Japanese government is enforcing support toAfrican nations currently, I thought that his proposal was excellent. (Reference 12)(Figure 15)(Figure 15)
Picture with Dr. Bogosi Mogale, EU Ministerin Belgium for the Republic of South Africa
at Mobile CTG at European Telemedicine
Conference, Med@tel

Therefore, we made application to JICA SME overseas development support project
research. Fortunately, our project of “Feasibility Survey with the Private Sector for
Utilizing Japanese Technologies in ODA Projects” was adopted.
We conducted on-site survey at Gauteng State suffering from urban issues and Limpopo
State with poverty issue. We visited JICA office, JETRO office, UNICEF, and Central
Ministry of Health in South Africa to select medical facilities, and to find issues tointroduce our system. We also visited Sunnywin Hengs Energy Pty Ltd which has
worked for JICA project before to introduce medical equipment, and exchange opinions
for business possibility in the future. We implemented maternal management at
Mamelodi Hospital in Gauteng State and two related clinics, Pietersburg Academic
Hospital in Limpopo State, Seshego District Hospital and two clinics using perinatal
electric record and Mobile CTG.
In perinatal primary medical facilities in South Africa, their urgent assignments
are early diagnosis of high risk expected mothers and division of patients based on theirrisks so that they can be allocated to suitable medical facilities which can provide
necessary services. Therefore, maternal management enforcement is required, andintroduction of Mobile CTG is confirmed very effective for their needs.
We would like to make achievements of our projects as well as some businessaspects, and continue to develop our project all over Africa in the future.

5. Development of Super Small-size Mobile CTG (Petit CTG)
As previously reported, our perinatal electric record and Mobile CTG were highly
evaluated in the verification projects in ASEAN nations and South Africa. However,
we also received further improvement requests as follows. The perinatal electricrecord should be multi-lingual, reduce test items for simplification to be also used as
MCH Handbook. Regarding Mobile CTG, we also heard requests of downsizing andcordless version.
Receiving such requests, Melody International Co. Ltd, which is a joint venture
established through cooperation with Kagawa University, developed a completely newsuper small-sized Mobile CTG (Petit CTG). Development of Petit CTG was adopted
by Ministry of Internal Affairs and Communications ICT Innovation Creation Challenge
Program, and is highly expected from various sectors.
Conventional fetal HR monitoring equipment including Mobile CTG connects
an ultrasound transducer and a uterine contraction transducer to main body with codes.
However, in Petit CTG, its electric circuit itself is mounted within the ultrasoundtransducer. Fetal HR measured by the ultrasound transducer and uterine contraction
measured by the uterine contraction transducer. Both data were transmitted wirelessly
through Bluetooth to the tablet available in the market.

(Figure 16)
Development of Super Small-size Mobile
CTG (Petit CTG)
The electric circuit for fetal HR
measurement is mounted within theultrasound vibrator in Petit CTG. Fetal
HR data is transmitted wirelessly throughBluetooth to the tablet. From the tablet,
the data is accessed to Internet (by Wi-Fi
or 3G, LTE depending on the location).

From the tablet, the data is transmitted to the conventional Mobile CTG data center via

Internet (Wi-Fi or 3G, LTE depending on the location).

(Figure 16)

Currently, the servers for Mobile CTG are located at STNet in Kagawa
Prefecture and Chiang Mai University. We are hoping to establish more datacenters in
the world for mutual connection in the future.
We often hear the term of IoT, Internet of Things lately. We hope to realize a
network for perinatal management for fetuses in the world and IoF, Internet of Fetusesin the future.
Conclusion
I have presented a chronological summary of how MCH developed in Japandiffused globally, and the perinatal electric record, electric MCH, and Mobile CTG
developed in Kagawa Prefecture were approved by Ministry of Internal Affairs andCommunications and JICA to be introduced in the world. This paper reports somecases in ASEAN nations and South Africa, but we have received inquiries fromMicronesia, Myanmar, Mongolia, Russia, and South American nations. Advanced
nation’s institutes such as Center for Strategic and International Studies (CSIS) andInternational Telecommunication Union (ITU) also show interest in our project.
Especially, Mr. Yoshio Utsumi, a former general secretary of ITU is from Takamatsu
City, and I feel a turn of fate. (Reference 13)
We would like to ask for your support to realize a network for perinatalmanagement for fetuses in the world.
Acknowledgement
I would like to extend my deep appreciation to the following people who have fully
supported international development of our project.
Mr. Hachihei Kurematsu, Chairman of C/O BHN Association
Dr. Masaaki Tokuda, Vice President of Kagawa University, who is in charge ofinternational strategy and special assignment
Mr. Jitsuo Matsuoka, Director General of e-Health Care Innovation in Kagawa(e-HCIK)(This research was supported by Ministry of Internal Affairs and Communications,
Ministry of Economy, Trade and Industry, Ministry of Health, Labour and Welfare,Japan International Cooperation Agency, Japan Society of Obstetrics and Gynecology,
and Japanese Telemedicine and Telecare Association.)References:
1) Yasuhide Nakamura, Boshi Techou: Kako, Genzai, Mirai, Shonika Rinshou, 65 (8):1745-1755, August 2012
Mother and Child Health Handbook: The past, present and future, Clinical pediatrics
65 (8): 1745-1755, August 2012
2) Kazuhiro Hara, Hideto Yokoi, Hiroki Okada, et al. Kagawa Enkaku Iryou Network
kara Nihonban EHR no Jitsugen e Gekkan Shin Iryou, 2008:35 (2) 48-53, 2008
To realize Japanese version EHR from Telemedicine Network in Kagawa
3) Kazuhiro Hara, IT ga Musubu Chiiki Iryou Renkei no Jitsuryoku, Chiiki Iryou Netto
waku ga Iryou no Kyuuseishu to Naru Deshou Gekkan Shin Iryou, 36 (2) 36-39,
2009
The power of the regional medical collaboration connected by IT. The regional
medical network will save Japan’ medicine.
4) Kazuhiro Hara, Chiiki Iryou Saisei Kikin ni yoru Kagawa Iryou Netto waaku(K-MIX) no Kinou Kyouka, Hyakujuushi Keizai Kenkyusho Chousa Geppou, No.
331, 9, 12-20 2014
The functional reinforcement of Kagawa Medical Information eXchange (K-MIX)
by the regional foundation for reconstruction, 114 economic research survey
monthly report
5) Kazuhiro Hara, Shuusanki Denshi Karute Nettowaak to Boshi Techo no Denshika,
Hyakujuushi Keizai Kenkyusho Chousa Geppou, No.328, 6 2-10, 2014
Perinatal electric record network and electric mother-child health handbook, 114
economic research survey monthly report
6) Kazuhiro Hara, Nihon Sanfujinka Ikai ni yoru Boshi Techo no Hyoujunka to
Gurobaru Tenkai – Shuusanki Iryou Jouhou Shisutemu kara Denshi Boshi Kenkou
Techou e Bosei Eisei 57, 1, 47-54, 2015
Standardization and Global Development of Mother-Child Health Handbook by
Japan Society of Obstetrics and Gynecology, - From Perinatal Medical Information
System to Electric Mother-Child Health Handbook- Hygiene of Mother and Child
7) Kazuhiro Hara, Tounyoubyou Chiiki Renkei Kurithikaru Pasu ni yoru Chiiki Zentai
deno Tounyoubyou Kanri, Hyakujuushi Keizai Kenkyusho Chousa Geppou, No. 365,
12, 11-19, 2015
Management of Diabetes by the whole region through the critical path of theregional collaboration, 114 economic research survey monthly report8) Kazuhiro Hara, Kagawa Enkaku Iryou Nettowaaku (K-MIX) no Kaihatsu to Kongono Tenkai- Denshi Shohousen Nettowaak, Denshi Okusuri Techou, Soshite
Dokodemo MY Byouin Kousou no JItugen e, Hyakujuushi Keizai Kenkyusho Chousa
Geppou, No. 322, 12, 2-8, 2013
Development of telemedicine network (K-MIX) and the future development –Electric prescription network, Electric medicine handbook, and realization of “every
hospital could be my hospital,” 114 economic research survey monthly report
9) Kazuhiro Hara, Kokudo Koutsu Shou ni yoru Kenkou Iryou Bunya ni okeru
Kouikiteki Chiiki kan Sougo Shien Suishin Projekuto, Hyakujuushi Keizai
Kenkyusho Chousa Geppou, No. 339, 6, 2-9, 2015
The project to promote wide-range regional mutual support by the Ministry of Land,
Infrastructure, Transportation and Tourism, 114 economic research survey monthly
report10) Kazuhiro Hara, Houkai suru Shuusanki Iryou wo Sukuu IT, Jouhou Shori, Vol. 15, 8,1039-1048, 2010
IT to save destruction of perinatal medicine, Information Processing11) Kazuhiro Hara, Kagawa Iryou Fukushi Sougou Tokku ga Mezasu Enkaku Iryou –Chiiki Iryou Renkei kara Guroobaru Tenkai Made, Nextcom KDDI Souken Vol.15:
04-11, 2014
Telemedicine as an aim of Kagawa Prefecture’s medical and welfare comprehensive
special zone – From regional medical collaboration to global development
Nextcom, KDDI Research12) Kazuhiro Hara, Network System of Electronic Patient Medical Record forTelemedicine and Telecare in Kagawa Prefecture and International Future
Deployment, Med-e-Tel vol.7. 2014, 483-488, 201413) The Hara-factor, Some lessons from innovations in governance in Japan , Jorrit deJong and Arre Zuurmond1, Transforming Asian Governance, Rethinking
assumptions, challenging practices, edited by M Ramesh and Scott Fritzen,
Routledge London, 2008