保健医療科学

2023

Vol.72 No.1 p.2－13

Topics: Recent topics in public health in Japan 2023

＜ Review ＞
The challenge to develop and implement artificial intelligence (AI)technologies in health and medical care in Japan
TAKEMURA Shinji
Department of Health Policy and Technology Assessment, National Institute of Public Health
Abstract
Since the statement by then Prime Minister Shinzo Abe in 2016, the development and application of artificial intelligence (AI) technologies in Japan has progressed rapidly. AI can be used and applied in several
domains, of which health and medical care are among the most important and most emphasized. In this article, the history of the challenges to develop AI technologies in Japan is outlined and past achievements andfuture prospects for the research, development, and implementation of AI are reviewed and discussed, witha particular focus on the fields of health and medical care.
AI is clearly identified as one of the core technologies needed to promote science, technology, and innovation and to grow the economy of Japan. AI was first mentioned in the fifth phase of the “Science, Technology and Innovation Basic Plan,” in which AI was regarded as an important part of realizing “Society 5.0.”
A specific vision for promoting the application of AI has then been presented in the “Integrated Innovation
Strategy,” an annual action program for realizing this basic plan. Additionally, in an annual strategy that
presents a comprehensive set of initiatives for economic growth, AI has been described as a key measurefor economic growth and productivity improvement in Japan.
In the “Artificial Intelligence Technology Strategy,” which was formulated in 2017 by the Strategic Council for AI Technology, a council composed of three ministries (the Ministry of Education, Culture, Sports,
Science and Technology, Ministry of Internal Affairs and Communications, and Ministry of Economy, Tradeand Industry) relevant to AI, the priority areas specified included productivity, health, medical care, welfare,mobility, and information security. Subsequently, the “Social Principles of Human-Centric AI,” which were
formulated in 2019, described ethics and other issues that should be considered in the utilization of AI. In
line with this strategy and these principles, the first “AI Strategy” was developed in 2019 by the Cabinet
Office, and a framework for promoting AI throughout the government, including all ministries, was established. In this strategy, key areas in which social implementation should be achieved were designated.
These areas included health, medical care, long-term care, agriculture, national resilience, transportation
infrastructure and logistics, regional revitalization (smart cities), and manufacturing.
Because health and medical care have been defined from the beginning as a priority area in which to promote the application of AI, the Ministry of Health, Labour and Welfare began its efforts on AI quite earlyand has taken on a leading role. The process chart for accelerating the development of AI in the field ofhealth and medical care was released in 2020, and priority areas were identified, including genomic medicine; support for diagnostic imaging; support for diagnosis and treatment; drug discovery and development;
long-term care and dementia; support for surgical procedures; prevention; infrastructure for the development of AI; and improvement in the efficiency of operations for reimbursing medical fees. Of these priority
areas, diagnostic imaging is the most advanced because it has the largest number of related research projCorresponding author: TAKEMURA Shinji
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: 048-458-6166
Fax: 048-469-3875
E-mail: takemura.s.aa@niph.go.jp

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J. Natl. Inst. Public Health, 72 (1) : 2023

The challenge to develop and implement artificial intelligence (AI) technologies in health and medical care in Japanects, resulting in the completion of a database through collaboration among six related academic societies.
With regard to other cases, the project to integrate data held by industry and academia on drug targets,efficacy, and toxicity and to build AI for drug discovery and the “AI Hospital System” project were conducted. The AI Hospital System aims at providing highly advanced medical services, improving the efficiency of
medical care, reducing burden on medical personnel, and increasing the productivity of medical care.
keywords: artificial intelligence (AI); ethical, legal, and social issues (ELSI); Society 5.0; social implementation; diagnostic imaging(accepted for publication, November 11, 2022)

I. Introduction

II. Role of AI in various policies of Japan

In recent years, artificial intelligence (AI) technologies,
which can perform portions of human intellectual activities,
have developed at an accelerating pace around the world.
These technologies are expected to transform our society,not only by substituting for routinized tasks but also by supporting and enhancing human activities and decision-making. Governments and companies invest tremendously inthe research and development (R&D) of AI technology as adriving force for realizing a sustainable society and as coretechnologies for industrial strengthening. Additionally, domains in which AI can be used and applied have expanded,and health and medical care are positioned as one of themost important and most focused-upon domains.
It is no exaggeration to say that the initiatives for AI in
Japan began with the following statement by then Prime
Minister Shinzo Abe on April 12, 2016, at the Fifth Meetingof the “Public-Private Dialogue toward Investment for the
Future,” which was established under the Japan Economic
Revitalization Headquarters.

1. AI in science, technology, and innovation policies
On the basis of the Basic Act on Science, Technology andInnovation [2], the “Science, Technology and Innovation
Basic Plan” has been formulated to achieve comprehensive
and systematic promotion of policies to advance scienceand technology from a long-term perspective. The first plan
was developed in 1995 and has since been revised every
five years. AI technology was first mentioned in the fifth
phase of the plan [3], which was formulated in 2016. In thisplan, the concept of “Society 5.0” was first proposed as a
future society for which Japan should aim. Society 5.0, defined as a human-centered society that balances economic
development and the resolution of social issues through asystem that integrates cyberspace (virtual space) and physical space (real space), denotes a new society following thehunting (Society 1.0), agricultural (Society 2.0), industrial(Society 3.0), and information (Society 4.0) societies [3].
Moreover, AI technology was regarded as an important partof realizing Society 5.0, and thus the promotion of the R&D
of AI; development of human resources capable of utilizing
AI; and resolution of ethical, legal, and social issues (ELSI),
such as the influence of the advancement of AI on society
and humans, were highlighted.
In addition to this basic plan, the “Comprehensive Strategy on Science, Technology and Innovation” has beendeveloped annually since 2013. This strategy describes
a long-term vision that includes an overview of science,technology, and innovation policy and a short-term action
program that summarizes the policies to be implemented
to realize this vision consistently with the basic plan [4]. AI
was first indicated in the 2015 version of the strategy [5].
In the 2016 version of the strategy, it was then specified
that with regard to AI, which is indispensable for realizing
Society 5.0, relevant efforts that were introduced in thebasic plan should be strengthened [6]. Other matters thatwere highlighted included establishing a system to promote
AI-related R&D in an integrated manner, addressing ELSI
related to AI, protecting intellectual property related to creation by AI, reviewing systems and rules for implementing“R&D goals and a roadmap for industrialization of AI will
be developed this year. To this end, the Strategic Council
for AI Technology will be established to gather the wisdomof industry, academia, and government and to eliminate
stove-piping” [1].
Since then, a whole-of-government approach to AI has
intensified, and R&D has accelerated the implementationof AI in various fields to contribute to the development ofscience and technology and the economy. Although these
efforts have not necessarily progressed as markedly as
those in the United States and other developed countries,
the steady and systematic development process in Japan
may be useful for other countries.
In this article, the history of the challenges to develop
AI technologies in Japan is outlined, and past achievements
and future prospects for R&D and implementation of AI are
reviewed and discussed, with a particular focus on the fieldsof health and medical care.

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TAKEMURA Shinji
AI, and fostering social acceptance of the use of AI [6]. In
the 2017 version of the strategy, it was reported that public
and private investments in the R&D of innovative cyberspace infrastructure technologies, such as AI and the Internet of Things (IoT), had increased [7].
In 2018, when the “Comprehensive Strategy on Science,
Technology and Innovation” was renamed to the “Integrated
Innovation Strategy,” AI was clearly identified as a key area
where efforts should be particularly strengthened, and agoal and deadline were set for the implementation of AI by2022 [8]. In the 2019 version of the strategy, it was specified
that AI efforts would be based on the newly developed “AI
Strategy” (explained later in this article), which was aimed
at spreading AI to all people, industries, communities, andgovernments [9]. In 2020, the development of a consultation assistance system for COVID-19 using AI avatars andR&D on medical devices based on the use of AI technology
were added as initiatives in the areas of health and medicalcare [10].
The 6th Science, Technology and Innovation Basic Plan
was launched in 2021. From the 6th period, AI has beenclearly positioned as a fundamental technology, and specificefforts related to AI, including R&D and human resource
development, have been emphasized [11]. In the Integrated Innovation Strategy 2021, which was formulated in thesame year, Behavioral Insights x Technology (BI-Tech), disaster prevention chatbots, and smart cities, among others,
were newly added as specific examples of the applicationof AI [12]. Additionally, in the latest Integrated Innovation
Strategy, it was indicated that efforts to address AI will bepromoted on the basis of the AI Strategy as revised in 2022
[13].
2. AI in policies for economic growth
AI is expected to play an important role not only in theadvancement of science, technology, and innovation but also
in the economic growth of Japan. The Japanese government
has developed an annual strategy that presents a comprehensive set of initiatives for economic growth since 2013[14], and in the 2015 revision of the Japan Revitalization
Strategy, reform of industrial and employment structures
through IoT, big data, and AI was described as a key measure for economic growth and productivity improvement inJapan [15]. Subsequently, in the Japan Revitalization Strategy 2016, the concretization of the R&D and implementationof AI were cited as one of the key measures for economic
growth [16].
It was clearly stated in the strategy for economic growthdeveloped in 2017, named the Future Investment Strategy
2017, that the realization of Society 5.0 is key to breaking
the long-term stagnation of economic growth in Japan [17].

4

To realize Society 5.0, policy resources in Japan are to beconcentrated in five areas: extending healthy life expectancy, realizing a mobility revolution, next-generation supply
chains, comfortable infrastructure and community development, and fintech; it was specifically stated that the use of
AI would be promoted in each of these areas [17]. According to the Future Investment Strategy 2018, the directionof economic growth in Japan will be focused not only on
the realization of Society 5.0 but also on the achievementof Sustainable Development Goals (SDGs), for which thefollowing were identified as future focus areas: mobility systems, healthcare systems, sustenance of economic activity,
public administration and infrastructure, and communities
and small and medium enterprises (SMEs) [18].
The “Super City” concept, proposed for realizing futuristic lifestyles ahead of the rest of the world using AI, bigdata, etc., was presented as a new initiative in the “Action
Plan of the Growth Strategy” [19] in 2019. In the 2020 edition of this action plan, it was then specified that various
regulations should be reexamined in light of the implementation of digital technologies, including AI, in the near future
and that demonstration projects should be implemented forthis purpose, focusing on three areas: mobility, fintech, andarchitecture [20]. In the 2021 edition of the action plan, it
was indicated that support must be provided for the implementation of AI and other important advanced technologies
from the viewpoint of economic security [21]. Thus far, inthe latest plan, called the “Grand Design and Action Plan
for a New Form of Capitalism,” it was specified that efforts
for the implementation of AI will be promoted [22].

III. Overview of strategies to promote AI inJapan
1. Artificial Intelligence Technology Strategy
The “Strategic Council for AI Technology” was established on April 18, 2016, by the joint jurisdiction of the Ministry of Education, Culture, Sports, Science and Technology(MEXT); Ministry of Internal Affairs and Communications(MIC); and Ministry of Economy, Trade and Industry(METI) for promoting the R&D and implementation of AI
technology. The council was initially intended to provide coordination among these three ministries, which have beenpromoting the R&D of AI technology at research institutes
under their jurisdictions. Later on, the Ministry of Health,Labour and Welfare (MHLW); Ministry of Agriculture, Forestry and Fisheries; and Ministry of Land, Infrastructure,
Transport and Tourism joined the council. In particular,
because health and medical care have attracted attention
as fields where AI technologies are being applied and implemented, the MHLW was encouraged to join the council

J. Natl. Inst. Public Health, 72 (1) : 2023

The challenge to develop and implement artificial intelligence (AI) technologies in health and medical care in Japan
and, fully aware of the importance of AI, decided to actively
participate.
The “Artificial Intelligence Technology Strategy” wasdevised on March 31, 2017. From this strategy, the “Industrialization Roadmap Projected by Fusion of AI and otherrelated Technologies (Industrialization Roadmap)” was formulated, and “productivity”; “health, medical care, and welfare”; “mobility”; and “information security” were specified
as priority areas that should be adopted for the time being
as part of the industrialization roadmap [23]. Additionally,an action plan was developed on the basis of the “Artificial
Intelligence Technology Strategy” on August 17, 2018, andspecific goals for R&D were established. The goals related
to health, medical care, and welfare were as follows [24]:/to collect training image data necessary for the development of AI in cooperation with medical societies and provide these data to companies and other entities that developAI/to standardize interfaces for interconnecting data related
to surgery to build a system that supports surgery using AI
technology/to develop techniques for analyzing the brain characteristics of healthy individuals and patients using big data on
brain function and network analysis of brain activity/to seek targets in drug discovery for idiopathic pulmonary fibrosis and other diseases by collecting informationfrom medical records, omics analysis, literature, etc., andutilizing AI/to improve the quality of care at medical institutions andlong-term care facilities by measuring the daily functionsof caregivers and patients using wearable sensors, etc., andanalyzing the data using AI/to develop, build, and implement an “AI Hospital System” using AI, IoT, and big data, which will provide highly
advanced medical services; improve the efficiency of medical care; reduce the burden on doctors, nurses, and othermedical personnel; and increase the productivity of medicalcare
2. Recommendations regarding the relationship between humans and AI
The “Advisory Board on Artificial Intelligence and Human Society” was established to discuss issues and directions that should be addressed in the future regarding therelationship between AI and human society to promotesound progress in the R&D and utilization of AI. Their firstmeeting was held on May 30, 2016, and their report wasissued on March 24, 2017. The key issues extracted in thisreport were ethical, legal, economic, social, and R&D issues[25].
In 2018, a review conference on the Social Principlesof Human-Centric AI was established under the Strategic
Council for AI Technology. The purpose of this conference
was to discuss the basic principles of ethics and other issues that should be considered in the R&D and utilizationof AI from a broad perspective by multiple stakeholders
from industry, academia, and the government. Their firstmeeting was held on May 8, 2018, and the “Social Principles of Human-Centric AI” [26] were formulated on March
29, 2019. Among these principles, it was indicated that thebasic philosophy for the utilization of AI was to respect thethree values of dignity, diversity and inclusion, and sustainability, followed by the following seven principles [26]:(1) human-centric principle;(2) principle of education/literacy;(3) principle of privacy protection;(4) principle of ensuring security;(5) principle of fair competition;(6) principle of fairness, accountability, and transparency;and(7) principle of innovation.
3. AI Strategy
The AI Strategy expert meeting was established as oneof the expert meetings for promoting and strengthening
innovation policy under the Integrated Innovation Strategy
Promotion Council; the first of these meetings was held
on September 5, 2018. Although the Artificial Intelligence
Technology Strategy has thus far been promoted jointly by
three ministries, i.e., MEXT, MIC, and METI, the Cabinet
Office has taken the lead in developing and promoting a new
strategy for AI, given that many other ministries have also
become involved in AI.
On June 11, 2019, the first AI Strategy (AI Strategy 2019[27]) was developed. The purpose of this strategy was tospecify the environment and measures conducive to theeffective future utilization of AI for contributing to the solution of global issues through the realization of Society 5.0
and to overcome the issues facing Japanese society. The
following strategic objectives were devised for this strategy[27].
/Strategic Objective 1: For Japan to develop a base of human resources which leads the world in being aligned with
the needs of the AI era and to become a country that attracts human resources from around the world. Additionally,
to build a mechanism to achieve this objective on a sustainable basis/Strategic Objective 2: For Japan to become a frontrunnerin the application of AI to real-world industry and to achievestrengthened industrial competitiveness/Strategic Objective 3: For a series of technology systems
to be established in Japan that will realize a “sustainable

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TAKEMURA Shinjisociety that incorporates diversity” and to implement amechanism to operate them
/Strategic Objective 4: For Japan to take a leadership rolein building international research, education, and social
infrastructure networks in the AI field and to accelerate
AI-related R&D, human resource development, achievement of SDGs, etc.
Specific initiatives, including for education reform, reconstruction of the R&D system, social implementation,
development of data-related infrastructure, AI era digital
government, support for SMEs and venture companies,
and ethics, were developed, and main and specific objectives were established for each initiative [27]. Additionally,
key areas in which to achieve social implementation wereidentified, including (1) health, medical care, and long-term
care; (2) agriculture; (3) national resilience (to disasters); (4)transportation infrastructure and logistics; and (5) regional
revitalization (smart cities) [27].
The main objectives of the field of health, medical care,and long-term care are to maintain an environment in whichpeople feel assured that they can receive the most advanced
and effective treatments and high-quality long-term careregardless of location and to reduce the burden on medical
and long-term care providers [27]. Specific objectives forhealth, medical care, and long-term care are as follows: (1)provision of a data infrastructure for the utilization of AI
in the health, medical care, and long-term care fields; (2)promotion of AI technology development in medical fields,
in which Japan is known to have strengths, and reduction of
the burden on healthcare workers through utilization of AI
in medical treatment; (3) promotion of the introduction of
AI/IoT technology to the field of prevention and long-termcare and reduction of the burden on care workers throughthe use of AI/IoT for long-term care; (4) formation of theleading medical AI market and medical AI hub in the world;and (5) education in training facilities and training centerson the use of AI for medical professionals and recurrent education for healthcare workers [27].
On June 11, 2021, AI Strategy 2019 was revised, and AI
Strategy 2021 [28] was developed in light of changes inthe environment, such as delays in digitization during the
COVID-19 pandemic and the establishment of the Digital
Agency in September 2021. Amendments from AI Strategy
2019 were to include Strategic Objective 0 (for Japan toestablish a system and technical infrastructure that can protect the lives of people and their property to the maximum
extent possible against pandemics and large-scale disasters
and to ensure proper and sustainable operation of the infrastructure) and to add “manufacturing” to the key areas forsocial implementation.
On April 22, 2022, AI Strategy 2022 [29], a major revision

6of the previous strategy, was formulated. In this revision,
although the purpose of the strategy and strategic objectives remained unchanged, the framework of the initiatives
was reconstructed. First, the establishment of AI for national resilience, AI for planetary resilience, and resilient
and responsible AI were decided upon as main objectives
corresponding to Strategic Objective 0. Second, the mainand specific objectives regarding social implementation
were changed significantly. Objectives previously stipulated
for each key area, such as health, medical care, and longterm care, were changed to objectives that are common
to all areas, including improvement in the reliability of AI,
enhancement of data to support the utilization of AI, efforts
regarding human resources, information sharing with regard to technology, rules for data handling, promotion of theutilization of AI in governments, and fusion with fields inwhich Japan is known to have strengths [29].
The major actions for health, medical care, and long-termcare described in AI Strategy 2022 were as follows [30]:/evaluation of the availability of public databases for thedevelopment of AI;/improvement of the environment in which patient data
are used in the R&D of medical devices that apply AI;/development of a tool that assesses the likelihood ofchild abuse using AI, to be made available at child guidance
centers across the country;/drug discovery target search using AI to analyze omics
and clinical information, in addition to whole-genome information;/implementation of high-quality clinical research, investigator-initiated clinical trials, etc., aimed at the developmentof innovative medical devices;/development of AI for microbiome analysis to accelerate
personalized diabetes prevention;/implementation of prevention and long-term care field
verification projects and support through building a networkof AI start-up businesses in the same field; and/information gathering and risk management using AI to
support decision-making in response to infectious diseases.

IV. Actions to apply AI to health and medicalcare
1. Overview of approaches to promote AI, led by MHLWThe MHLW began its efforts on AI quite early. The expert panel on the promotion of the use of information andcommunications technology (ICT) in the fields of healthand medical care was established, and their first meeting
was held on November 19, 2015. This panel recommended
the formulation of AI-based techniques for pathologicaldiagnosis and the development of AI-based technology for

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The challenge to develop and implement artificial intelligence (AI) technologies in health and medical care in Japan
standardizing information contained in electronic medical
records [31].
The expert panel on the promotion of the use of AI in thefields of health and medical care was then established forclarifying the effectiveness of the use of AI for patients andthe public and discussing necessary measures to promote
the development of AI and to ensure the quality and safetyof services that use AI. Their first meeting was held on January 12, 2017, and their report was published on June 27,
2017. In this report, priority areas for the development of
AI in the fields of health and medical care were identified:genomic medicine; support for diagnostic imaging; support
for diagnosis and treatment; drug discovery and development; long-term care and dementia; and support for surgicalprocedures [32].
Subsequently, the consortium for accelerating the development of AI in the fields of health and medical care wasestablished to further develop in the directions set forth in
this report. Their first meeting was held on July 23, 2018;
their documentation [33] summarizing discussions among
the consortium and outlining future directions was published on June 28, 2019; and their process chart [34] wasreleased on June 18, 2020.
The consortium discussed the roadblocks to develop
AI in terms of stages of development, which included an
institutional review board; informed consent; annotation/labeling; transfer, standardization, and anonymization of
data; computation and data storage in the cloud; validationin clinical settings; review and regulatory approval by the
Pharmaceuticals and Medical Devices Agency; and commercial development and update [33,34]. The consortium
also formulated a bird’s-eye view of the areas where AI canbe expected to be developed and utilized in the fields ofhealth and medical care, long-term care, and welfare [33,34].
It was then specified that the burden of data entry, standardization of electronic medical records, human resource
development, and quality assurance and evaluation of AI
need to be considered. Medical safety, infrastructure forthe development of AI, and improvement of the efficiency
of operations for reimbursing medical fees were also newly
identified as additional areas to be addressed in AI researchand implementation [33,34].
The specific initiatives outlined in the process chart developed by the consortium are listed in Table 1 [34].
2. Recent trends in R&D related to the application of
AI to health and medical care
R&D on AI in the fields of health and medical care isconducted mainly in research programs subsidized by the
MHLW and the Japan Agency for Medical Research andDevelopment (AMED) under the jurisdiction of the MHLW
and other ministries. The research program on medical

Table 1 List of specific initiatives outlined in the process chart [34](1) Genomic medicine/Implementation of whole-genome analysis on cancer and rare and intractable diseases(2) Support for diagnostic imaging/Construction of databases of images by relevant academic societies/Provision of training data of images to manufacturers of medical devices and development of programs to support diagnostic imaging using AI(3) Support for diagnosis and treatment/Construction of knowledge database on rare and intractable diseases and development of AI/Investigation of the usefulness of medical safety data analysis using AI/Implementation of support for diagnosis and treatment using AI for common diseases/Implementation of support for diagnosis and treatment using AI for rare diseases(4) Drug discovery and development/Construction of database for discovery of drug targets and development of AI/Construction of databases containing data on efficacy of drugs owned by companies and empirical knowledge related to structural optimizationand development of AI technology that can be used for compound optimization/Development of AI that can be applied to drug development and achievement of efficient drug development using AI(5) Long-term care and dementia/Identification of issues related to support for the design of care plans using AI/Development of systems to assist in coping with patients with dementia using AI/Research for development of systems to support interpersonal interaction and community development for elderly with dementia using AI/Establishment of a base to support the process of developing, introducing, utilizing, and improving robots to assist caregivers(6) Support for surgical procedures/Collection, integration, and deposition of data related to surgical procedures(7) Prevention/The basic concepts and issues regarding the direction of the personal health record should be organized, and a process chart should be formulated. Then, initiatives will be developed on the basis of the process chart.
(8) Infrastructure for development of AI/Review of criteria for security needed in cloud environment for developing AI/Identification and promotion of cloud environments that fulfill those criteria(9) Improvement of the efficiency of operations for the reimbursement of medical fees
/Development of a new system for review and payment of medical fee claims and development of AI for review/Operation of a new system and implementation of AI in review

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TAKEMURA Shinji
ICT and artificial intelligence was launched in 2016 at
the MHLW and AMED, respectively [35]. (In 2021, theresearch program of AMED was renamed to the research
project for medical–engineering collaboration and implementation of artificial intelligence.)
In the review for this study, research projects conductedin the research program on medical ICT and artificial intelligence and the research project for medical–engineeringcollaboration and implementation of artificial intelligencethat have been completed by 2021 were searched using the
MHLW Grants System (https://mhlw-grants.niph.go.jp/)
and the AMED funding for innovation database (AMEDfind) (https://amedfind.amed.go.jp/amed/index.html). As aresult, ninety-one projects (including fifty-one projects by
the MHLW and forty projects by AMED) were identified.
Thirty of the research projects (33%) were conducted fora period of one year, twenty-two projects (24%) for a period of two years, thirty-nine projects (43%) for a period of
three to four years. More than half of the research projects
required a short period of one to two years to produce research results. With regard to research funds allocated toeach research project, more than half of the projects by the
AMED had a research fund of more than 100 million yen
each, whereas more than half of the projects by the MHLW
had a research fund of less than 30 million yen each. Thisshows that AMED has conducted research projects withlarger budgets than those of the projects by the MHLW.
Table 2 presents the numbers and percentages of research projects with respect to their main research purposes. In total, thirty-five projects (38.5%) addressed thedevelopment and application of AI, and thirty-nine projects(42.9%) prepared the data and infrastructure necessary forpromoting the development and application of AI. Approximately half of the research projects by AMED were aimed
primarily at the development and application of AI, whereas
approximately 30% of the projects by the MHLW were
aimed mainly at AI. Other purposes included telemedicine,surveys to understand the current status of AI development
and implementation, and human resource development related to AI.
Table 3 shows the numbers and percentages of research
projects, among those whose main research purpose was
the development and application of AI, with respect to area.
More than half of the research projects in total, and morethan 80% of those by AMED, addressed the development
and application of AI for supporting diagnostic imaging.
Conversely, with regard to the specific initiatives identified
in the process chart [34], few studies have been conductedon drug discovery and development and support for surgicalprocedures, whereas research on the application of AI tolong-term care and dementia has not yet been conducted.
3. Achievements to date on the application of AI to
health and medical care
Prior to the application of AI to the fields of health andmedical care, a review of the laws and regulations that AI
might affect was initiated. First, in relation to the “Medical
Practitioners’ Act,” a notice was issued on December 19,
2018, stating that even when a physician uses an AI-based
program to assist in diagnosis or treatment, the physician isregarded as the main entity that performs the diagnosis andtreatment and is therefore responsible for the final decision

Table 2 Numbers and percentages of research projects by main research purpose
MHLW(51 projects)

AMED(40 projects)

Total(91 projects)

No

%

No

%

No

%

Development and application of AI

16

31.4

19

47.5

35

38.5

Preparation of data and infrastructure

23

45.1

16

40.0

39

42.9

Telemedicine

2

3.9

2

5.0

4

4.4

Surveys about AI

3

5.9

1

2.5

4

4.4

Human resource development

2

3.9

1

2.5

3

3.3

Others

5

9.8

1

2.5

6

6.6

Table 3 Numbers and percentages of research projects by area for development and application of AI

Support for diagnostic imaging

8MHLW(16 projects)

AMED(19 projects)

Total(35 projects)

No

%

No

%

No

%

2

12.5

16

84.2

18

51.4

Support for diagnosis and treatment

4

25.0

3

15.8

7

20.0

Support for prediction of prognosis

5

31.3

0

0.0

5

14.3

Drug discovery and development

3

18.8

0

0.0

3

8.6

Support for surgical procedures

1

6.3

0

0.0

1

2.9

Evaluation of adverse effects of drugs

1

6.3

0

0.0

1

2.9

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The challenge to develop and implement artificial intelligence (AI) technologies in health and medical care in Japan[36]. Subsequently, the “Act on Securing Quality, Efficacy and Safety of Products Including Pharmaceuticals andMedical Devices” was revised in December 2019, making
it possible to flexibly change the approval details based onchanges in the performance of the devices after marketingby evaluating the process of improvement of the AI-based
medical devices, whose performance can change with learning, when reviewing the approval of such devices [37]. Sucha system for the review and approval of medical devices,
called IDATEN, has been effective as of September 1, 2020.
With regard to the development of AI infrastructure,
databases for diagnostic imaging have been established incollaboration with the Japanese Society of Pathology, Japan
Gastroenterological Endoscopy Society, Japan RadiologicalSociety, Japanese Ophthalmological Society, Japanese Dermatological Association, and Japan Society of Ultrasonics in
Medicine [38]. Additionally, a program was launched to integrate data held by industry and academia on drug targets,efficacy, and toxicity and to build AI for drug discovery [38].
As of December 2021, 18 firms have participated in thisproject.
With regard to the implementation of AI, the “AI Hospital
System” has been established since the early stages of AI
initiatives in Japan [8,24]. Using the results of this program,a consultation assistance system that uses avatars and a database infrastructure that contributes to the development ofdrugs and vaccines were developed [38]. In April 2021, theHealthcare AI Platform Collaborative Innovation Partnership was developed to promote R&D, contributing to theutilization of AI technology in the healthcare field. Others,
such as a platform for smart care prevention, an application
for an online day care, a consultation system for long-termcare facilities that introduce the use of AI/IoT, and a training
program for medical professionals who can develop and utilize AI, have also been developed for the implementation ofAI [38].

V. Conclusions
Since the statement by then Prime Minister Abe in 2016,
the development and application of AI in Japan has progressed rapidly. First, AI was clearly identified as one of thecore technologies needed to promote science, technology,
and innovation and to grow the economy of Japan. Consequently, there was a need to develop a specific strategy
for accelerating the R&D and implementation of AI. The
Artificial Intelligence Technology Strategy, the first comprehensive strategy with regard to AI, was formulated primarily by three ministries (MEXT, MIC, and METI) that had
been spearheading efforts to apply AI technologies to theirrespective fields. An AI Strategy was then developed to co-ordinate efforts among almost all ministries involved in AI;
this strategy is now being promoted accordingly. Although
the development of a strategy involving all ministries wasconsidered from the beginning, the differences among theministries in their efforts toward AI may have prevented
the establishment of such a policy. Therefore, it is inferredthat through the involvement of the leading ministries in
the first phase to set the direction of the strategy, whileconsidering how the other ministries could be involved according to that direction in the next phase, it eventually became possible to develop an AI Strategy that would enable
all ministries to work together.
The MHLW recognized the potential of AI even before
the statement of Prime Minister Abe and, therefore, was involved in the formulation of the Artificial Intelligence Technology Strategy from the early stages. Additionally, because
the fields of health and medical care have been defined fromthe beginning as priority areas for the application of AI, the
MHLW has taken on a leading role and has been promoting
its own initiatives in accordance with the strategy on AI. In
particular, the process chart formulated by the consortium
for accelerating the development of AI in the fields of healthand medical care shows the goals and priority areas that canrealistically contribute to improving the health and welfareof the population based on an analysis of AI technologies
that are currently established and those that are expected
to be established in the future.
Discussions about ELSI related to AI were facilitated inparallel with, or even ahead of, the promotion of R&D and
implementation of AI. On the basis of these discussions,ministries could have established legislation to promote AI.
With regard to the laws and regulations under the jurisdiction of the MHLW, the physician is considered the main entity that performs diagnosis and treatment, as described in
the “Medical Practitioners’ Act,” even if the physician uses
an AI-based program. Furthermore, the “Act on Securing
Quality, Efficacy and Safety of Products Including Pharmaceuticals and Medical Devices” was revised to facilitate thereview and approval process for AI-based medical devices.
Although laws and regulations often fail to catch up withadvances in science and technology in general, it is noteworthy that laws and regulations related to AI are being developed concurrently or ahead of time to avoid discouraging
the R&D and implementation of AI.
The challenges to applying AI to health and medical careare being promoted on the basis of specific objectives set
forth in various strategies, such as the AI Strategy and theprocess chart. Although the strategies are consistent witheach other, different timelines for accomplishment havebeen set for each objective, and there are differences in the
progression of the various initiatives. Among the various

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9

TAKEMURA Shinji
initiatives, the most advanced was diagnostic imaging. In
research programs by the MHLW and AMED, the numberof research projects conducted in relation to diagnostic
imaging was the highest, resulting in the completion of adatabase through collaboration among related academic
societies and the progression of efforts toward the practicalapplication of AI. Significant results have been achieved
through this research focused on diagnostic imaging, whichis the most advanced technology in Japan. Although AI is
expected to have applications in all areas, it is impossible toprogress in all areas simultaneously. Therefore, to effectively and efficiently promote the application of AI to health andmedical care, it is necessary to promote it through “selection
and concentration,” as is the case with diagnostic imaging.
Through this approach, it is expected that areas that have
not yet been fully researched and developed, including drug
discovery and development, long-term care and dementia,
and support for surgical procedures, will also be developed.

Conflicts of Interest
The author declares no conflicts of interest regarding the
publication of this article.

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第 1 号．平成30年12月19日．
Iji kacho, Health Policy Bureau, Ministry of Health, Labourand Welfare. [Jinko chino (AI) o mochiita shindan, chiryo
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no kitei tono kankei ni tsuite. December 19, 2018.] https://www.pmda.go.jp/files/000227450.pdf (in Japanese)(accessed 2022-11-11)[37] 法令検索．医薬品，医療機器等の品質，有効性及び安全性の確保等に関する法律．昭和三十五年法律第百四十五号, 1960.
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「AI戦略2021」別紙 ～進捗詳細及び2021年度
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The challenge to develop and implement artificial intelligence (AI) technologies in health and medical care in Japan＜総説＞
日本の保健医療分野における人工知能（AI）の開発と実装の取り組み
武村真治
国立保健医療科学院政策技術評価研究部

抄録
本稿では，日本における人工知能（AI）の開発と応用に向けた取り組みを概観するとともに，特に保健医療分野に焦点を当てて，AIの研究開発や社会実装に関するこれまでの成果を振り返り，今後の展望を論述する．
AIは日本の科学技術・イノベーションの推進と経済成長に不可欠な中核的な技術の一つとして明確に位置づけられている．平成28年度からの第 5 期科学技術基本計画においてAI は「Society 5.0」を実現するための重要な基本要素であること，また成長戦略においてもAIは日本の経済成長と生産性の向上のための主要な手段であることが明示された．
平成29年，総務省，文部科学省，経済産業省が設置した人工知能技術戦略会議によって「人工知能技術戦略」が策定され，その中で，生産性，健康，医療・介護，空間の移動，情報セキュリティが重点分野として明示された．また平成31年に策定された「人間中心のAI 社会原則」においてAIを活用する上で考慮すべき倫理面等の問題が提示された．そして同年，これらの戦略や原則を踏まえて，内閣府によって最初の「AI戦略」が策定され，全省庁を含む政府全体でAIを推進する枠組みが構築された．この戦略の中で，AIの社会実装を達成すべき優先領域として，健康・医療・介護，農業，国土強靭化（インフラ，防災），交通インフラ・物流，地方創生（スマートシティ），ものづくりが設定された．
厚生労働省は，保健医療分野が当初からAIを活用すべき分野に位置づけられたため，早い段階から積極的にAIの推進に取り組んできた．令和 2 年に保健医療分野におけるAI 開発を加速するための工程表が策定され，「ゲノム医療」，「画像診断支援」，「診断・治療支援」，「医薬品開発」，「介護・認知症」，「手術支援」，「予防（PHR）」，「人工知能開発基盤」，「診療報酬支払業務の効率化」を重点領域として様々な取り組みが進められている．特に「画像診断支援」に関しては，関連する多くの研究課題が実施された結果，関係 6 学会の協働による画像データベースが構築されるなど，著しい進展がみられている．その他，産学の保有する創薬ターゲット，薬効，毒性に関するデータの集約と創薬のためのAIの構築，高度な医療サービスの提供，医療従事者の負担軽減，医療の生産性の向上を目指した「AIホスピタル」などの取り組みが行われている．
キーワード：人工知能（AI），倫理的・法的・社会的課題（ELSI），Society 5.0，社会実装，画像診断

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