Involvement of CEs
to the IoT in Healthcare
June 3 | 9:15-10:15
Hiroki Igeta, MSc, BEng, CCE 1) 2)
Aso Iizuka Hospital 1)
Japan Association for Clinical Engineers (JACE) 2)© AAMI 2018 www.aami.org

Agenda•Japanese Clinical Engineering System

•

EMR

•

Telemedicine

Japanese Clinical Engineering System

Clinical Engineers : Japan・ Clinical Engineer License System
Established in 1987
National License

・ Education
4 years education in universityor
3 years education at a polytechnic college

Clinical Engineers : Japan・ Clinical Engineer License System
Established in 1987
National License

・ Education
4 years education in universityor
3 years education at a polytechnic college

The Facts
Operating Equipment in the Clinical Environment••••••••••

40%

Respiratory therapy
Perfusion (HEART-LUNG machine)
Dialysis (Dialysis equipment)
Operative treatment (Surgical equipment)
Intensive care units
Cardiac catheterization
Catheter abrasion for arrhythmias
Hyperbaric oxygen therapy
Other treatment (defibrillators)
Pacemaker, ICD, CRT

Service Delivery Management

20%

Patient Safety

20%

Healthcare Technology Management (HTM)

20%

Our Clinical Fields(a case of Aso Iizuka Hospital)

HTM

Haemodialysis

Operation RoomOperation Assistance

Perfusion

Intensive Care

Cardiac Catheter(intervention)

Hyperbaric Oxygen Therapy

Endoscopy

Capsule Endoscopy(Interpretation)

Pacemaker Clinic

Staff Education

EMR(Electric Medical Record)

Penetration Rate of EMR
50.0%
45.0%

Ordering System

EMR

40.0%
35.0%

30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Data from :“Installed Condition Survey of Medical Information System”
Japanese Association of Healthcare Information Systems Industry

Penetration Rate of EMR
100%

Ordering System

EMR

90%
80%
70%
60%
50%
40%30%
20%
10%0%

Data from :“Installed Condition Survey of Medical Information System”
Japanese Association of Healthcare Information Systems Industry

EMR and Manpower
201-500(n=10)

501-800(n=7)

801(n=5)

No. of PC

690

831

2085

No. of SE

4.4

10.0

15.4

No. of PC/bed

1.8

1.5

2.1

No. of PC/SE

159.7

100.0

161.3

Vendor Staff stationed

0.0%

14.3%

60.0%

CEs usually do not take care of EMR and IT system

EMR and Network

EMR and ManpowerEMR• In-house Record
Patients cannot see their medical record
Other institutions can see their original medical record only
No common system for EMR (very limited)
Private-sector initiative• Cloud service in healthcare is not common for hospitals
No clear official guidelines from the government• Duplication of medical examinations and prescriptione.g.) Waste of leftover medicine cost could be 500 million USD a year

Telemedicine

Background of Promoting Telemedicine• Escalation of medical costs (about 400 billion USD a year)
Promoting an integrated community care system
Clarification of the roles of hospitals
Shifting to Home-care• Shortage of medical professions especially physicians• Aging society
Decreasing of mobility
Caring of the elderly by the elderly

Reimbursement on Telemedicine
Types of telemedicine
D to D(Doctor to Doctor)

Reimbursement

Consulting with specialists
using IT devices(e.g. Image transmission-reception)

On-line image diagnosis fee
On-line pathological diagnosis fee
for rapid diagnosis during surgery
for pathological image diagnosis

On-line Consultation
On-line consultation fee
On-line patient management fee
On-line home medical care fee

7 USD
10 USD
10 USD

D to P(Doctor to Patient)

Remote Monitoring

CIEDsremoteremotemonitoringmonitoringfee
feeCIEDs
Remotemonitoring
monitoringfee
feeRemoteforhomehomeoxygen
oxygenmanagement
managementon
15 USD
forhomehomerespirator
respiratormanagement
management 15 USD
onFrom : website of Japanese Ministry of Health, Labour and WelfareRemote monitoring of CIEDsRoles of CEs in CIEDs management

Implantation

Patient Education

CIEDs Clinic

Remote Monitoring

Reporting to physician

Roles of CEs in Remote Monitoring• Escalation of medical costs
Promoting an integrated community care system
Clarification of the roles of hospitals
Shifting to Home-care
Providing reports of conditions and/or remarkable events
obtained by the remote monitoring system to local physicians• Shortage of medical professions especially physicians
Reducing the time of consultation without reducing face to facetime by pre-analysing of data and/or arrhythmia ECGs

• Aging society
Decreasing of mobility
Caring elderly by the elderly
Reducing the number of hospital visits

Potential of Telemedicine• Prevention Medicine
Mobility and activity recording
DM management
Nutritional management
Sleep monitoring
Asthma attack prediction• Home Visit
Device monitoring and reporting system(e.g. ventilator, home oxygen therapy, vital sign monitor)
Automatic care report creation system
Route planning system
On-line consultation service for medical professions and/or patients
On-line interpretation service

Conclusion• Japanese CEs practicing in the clinical fields• EMR system isn’t open to the patients and other medical institutes• CEs are not involved in EMR and IT systems much

• Telemedicine is being strengthened through the reimbursement system• CIEDs management is one of the telemedicine fields where CEs can play the main role
• Rate of reimbursement for telemedicine is not high• Many types of IoT healthcare devices will be available in the clinical fields soon
• JACE needs to consider cultivating human resources for IT expert CEs.

Thank you for your attention

Sheep-Rin

Hiroki Igeta
Aso Iizuka Hospital

higetah2@aih-net.com