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| 2004.04.15 |
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First Standard Medical Data Transmission Network in Japan
"Mobile Telemedicine" to Lower Fatality Rates Proven Effective Aiming for Trial Operations in FY 2005
The Mobile Telemedicine Society for Emergency Cardiovascular Care (Mr. Hiroshi Nonogi, Representative; National Cardiovascular Center Emergency Care Department) has conducted a verification test and confirmed the effectiveness of mobile telemedicine which will reduce fatality rates by enabling a prompt and early diagnosis of patients and assignment to an appropriate medical center using a real-time transmission system of patient data from the ambulance to the hospital. This test was conducted with the cooperation of Suita city (Mr. Yoshio Sakaguchi, Mayor) and is the first successful operation using the standard medical care data transmission in an emergency patient transfer test conducted with an ambulance equipped with related systems.
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[ Background ]
In the rapidly aging society of 21st century of Japan, it is essential to take measures against cardiac infarction and cerebral stroke which inflict illness serious enough to require nursing care. Within Japanese hospitals, the creation of well-organized intensive care units and the spread of reperfusion therapy have contributed to a significant decrease in the in-hospital death rate in recent years. However, half of the deaths resulting from acute cardiac infarctions are still said to occur outside of hospitals and the fatality rate remains high at 26-40%. In order to solve these issues, it is essential that the patients receive diagnosis and treatment as soon as possible following the onset of a cardiac infarction and cerebral stroke.
In recent years, the development of smaller high-performance telecommunications equipment and low-cost/high-rate mobile communications systems has lead to the emergence of the field of mobile telemedicine. Japan has surpassed Europe and North America in the development and spread of commercial mobile communications technology which makes Japan an ideal country to perform system development activities using these technologies.
[ Efforts to Improve the Current Level of Emergency Care ]
The primary means of communication between ambulances and hospitals is voice transmission through Fire Department radio channels and mobile phones. The 12 conductive electrocardiography transmission system for cardiac infarction and irregular pulse diagnosis has been installed in a number of the high-standard ambulances. However, this system is not yet fully utilized due to the requirement for dedicated receivers to render it operable with other incompatible systems, the complexity of its operation and the lengthy transmission time. Many efforts have been made to improve the transmission of data between ambulances and hospitals but this has resulted in a proliferation of specialized systems which are mutually incompatible which has hampered efforts at further system development.
[ Outline of Demonstration Test ]
For the demonstration test, an ambulance provided by Suita city was equipped with a 12 conductive electrocardiograph for diagnosis of cardiac infarction or irregular pulse, a bed-side monitor to indicate electrocardiogram/blood pressure/blood oxygen saturation, a network camera to monitor the patient remotely from the hospital and a super small server to transmit the patient's data to the equipment. The data was transmitted to the National Cardiovascular Center through the super small server and the third generation mobile phone (W-CDMA) with easy operation. The data transmitted to the center on a real time basis was displayed on off-the-shelf personal computers. This system enables a real-time voice and data transmission of biomedical information and video images of patients to enhance communication between paramedics and doctors, which will enable "paramedics to receive instructions directly from the hospital". The system will also allow "paramedics to determine which hospital the patient should be directed to" and "to provide doctors with a preliminary diagnosis before the patient arrives at the hospital". As the data transmission involves the use of Internet Protocol and MFER (Medical Waveform Encoding Rule), which is anticipated to become the standard data transmission waveform for medical information a data transmission is versatile and is not dependent upon the type of equipment or data transmission systems used. The system also carries the potential and expandability to develop into a system which would allow for the secure transmission of data to doctors in multiple locations, which will improve the precision of diagnosis.
[ Past Approaches and Future Developments ]
The Mobile Telemedicine Society for Emergency Cardiovascular Care was founded July 2002 with the objective of developing a system for emergency cardiovascular care and started the research and development. In April 2003, a prototype was developed and successfully conducted its first data transmission. Demonstration tests using an ambulance began in December 2003 and the effectiveness of the system was confirmed through an inspection of the operability, serviceability and security of a simulated data transmission. Further tests will be conducted transmitting data from healthy test subjects, and by the end of this year, the system will be used experimentally on emergency care patients. Based on the results of these tests and after coordination with the related institutions, a trial operation, using ambulances equipped with the required systems, is planned to begin in FY 2005 with the objective of establishing a permanent service for emergency care patients. In addition, through demonstration tests and trial operations, the Society will promote the medical control services through the demonstration tests and trial operations of this system into the emergency care centers of each of the involved institutions, as well as the application of permanent direction systems for paramedics and system reviews that will improve the quality of medical care.
Details on the progress made by the Society up until now will be presented at the Annual Meeting and Exposition of American Telemedicine Association to be held in Tampa, Florida on May 3.
[Roles of the Society Members]
- National Cardiovascular Center (Suita City, Osaka; Mr. Soichiro Kitamura, President)
Coordinates the needs of emergency care centers (triage to determine the criticality of patient injuries, dispatch to assign hospitals suitable to the needs of the patient and pre-hospital care to support the actions taken by paramedics) and the technological seeds.
- NTT Comware Corporation (Minato Ward, Tokyo; Mr. Yuji Matsuo, President)
Provides Linux-based super small servers and develops the Mobile Telemedicine system as a whole.
- Nihon Koden Corporation (Shinjuku Ward, Tokyo; Mr. Kazuro Ogino, President)
Provides 12 conductive electrocardiographs and its interface specification data.
- Fukuda Denshi Co., Ltd. (Bunkyo Ward, Tokyo; Mr. Kotaro Fukuda, President)
Provides bed-side monitors to indicate health data including electrocardiography, pulse and blood pressure and its interface specification data.
- Matsushita Electric Industrial Co., Ltd. Healthcare Business Company (Tsuzuki Ward, Yokohama; Mr. Yoshinori Nishida, President)
Provides the small network cameras used for remote control.
- Independent Administrative Institution, National Institute of Advanced Industrial Science and Technology (Ikeda City, Osaka; Mr. Takaharu Yasukawa, Director)
Provides overall coordination of the Mobile Telemedicine Society.
* Suita City (support) Provides ambulances and the support of paramedics.
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