Prepared forGrand Design by Japan－The 2011 Quake and Tsunami Project－ at Keio Business School

1. Impacts of the East Japan
Earthquake and Tsunami
towards Grand Design
for ICT in Healthcare
Prepared for
Grand Design by Japan
－The 2011 Quake and Tsunami Project－
at Keio Business School
February 19, 2012
Eiji Sasahara, Ph.D., MBA
(C) 2012 Healthcare Cloud Initiative

2. AGENDA
1.Introduction
2.Cases of Ishinomaki City, Miyagi
3.Discussion
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(C) 2012 Healthcare Cloud Initiative

3. 1.Introduction
• “Impacts of the East Japan Earthquake and
Tsunami towards Governance, Risk and
Compliance in Healthcare IT”
Synthesis Journal 2011
IT Standards Committee (ITSC)
Inforcomm Development Authority of Singapore (IDA)
November 2011.
http://www.itsc.org.sg/pdf/2011/Section4_Article1_021111.pdf
•Focuses on Cases of Healthcare Providers in
Ishinomaki City, Miyagi
•Case-oriented Recommendation for Healthcare ICT
Grand Design in Emerging Economies in Asia/Pacific
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(C) 2012 Healthcare Cloud Initiative

4. 2.Cases of Ishinomaki City, Miyagi
• 2.1 Landscape of Ishinomaki City(1)
• Coastal city near the peninsula in the northeastern
part of Miyagi Prefecture
• Shrinking and ageing population affecting healthcare
needs
-Total Population: 152,775 (As of Jan.2012)
Total Ratio of
Year population Age 0-14 Age 15-64 Age 65- Age 65-
2005 170,630 23,131 106,904 40,595 23.8%
2006 169,147 22,564 105,217 41,366 24.5%
2007 167,474 22,002 103,203 42,269 25.2%
2008 165,894 21,538 101,401 42,955 25.9%
2009 164,433 21,025 99,756 43,652 26.5%
2010 163,216 20,459 98,902 43,855 26.9% 4
(C) 2012 Healthcare Cloud Initiative Source: City of Ishinomaki

5. 2.Cases of Ishinomaki City, Miyagi
• 2.1 Landscape of Ishinomaki City(2)
• Damages of the East Japan Earthquake and
Tsunami in Ishinomaki
• Death: 2,978. Missing: 669 (As of Oct.2011)
• Damaged housing: 53,742 (About 70% of total)
• Evacuating people: Max. 50,000
• Evacuating shelters: Max. 250
• 3 of 10 hospitals and 90 of 106 clinics damaged in
Ishinmaki City.
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6. 2.Cases of Ishinomaki City, Miyagi
• 2.2 Location of Healthcare Institutions
Ishinomaki Red
Cross Hospital
You Home Clinic
Ishinomaki
New Location for
Ishinomaki Municipal
Hospital (FY2015)
Ishinomaki
Municipal
Hospital
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Source of Map: Ishinomaki City Basic Plan for Urban Infrastructure Recovery (Draft)
(C) 2012 Healthcare Cloud Initiative

7. 2.Cases of Ishinomaki City, Miyagi
• 2.3 Case of Ishinomaki Red Cross Hospital(1)
• #Bed = 402, #Total staff = 952 (#Physician = 113,
#Nurse =514, #Other medical expert = 134, #Clerk =
191) (Numbers as of Jan. 2012)
• Built in riverside area (Minato) of Ishinomaki in 1933
• Relocated in newly developed highland area (Hebita)
since 2006. (6km from the sea)
• Voluntarily developed "Ishinomaki Regional Network
Council of Disaster Medicine Professionals" jointly
with other healthcare institutions, regional medical
associations, disaster prevention authorities and local
governments. Business Continuity Planning (BCP)
and Disaster Recovery Planning (DRP)
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(C) 2012 Healthcare Cloud Initiative

8. 2.Cases of Ishinomaki City, Miyagi
• 2.3 Case of Ishinomaki Red Cross Hospital(2)
• Did not receive severe impacts from the tsunami
directly. However, due to electricity blackout, had to
continue operations with emergency electricity
generators. (LANs were available)
• Informed the local governments of its status via
wireless disaster prevention communication network.
• Before disaster: 60 patients/day, 1,800 patients/month.
After disaster: 99 on 3/11, 779 on 3/12, 1,251 on 3/13.
• IT operations as usual required even under an ad hoc
system and hostile user environment with limited
electricity and other resources.
*Emergency = Peak time in capacity planning 8
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9. 2.Cases of Ishinomaki City, Miyagi
• 2.4 Case of Ishinomaki Municipal Hospital(1)
• #Bed = 206, #Total staff = 221 (#Physician = 24,
#Nurse =150, #Other medical expert = 28, #Clerk =
19) (Numbers before the earthquake/tsunami)
• Located in central downtown area near the sea since
1996 (0.3 km from the sea)
• Severely damaged by the tsunami (maximum height
of 5 m). Server room in the 1st floor and emergency
electricity generators in the basement destroyed.
• Both intra-hospital and external communications
networks were not available due to electricity
blackout, and the hospital could not inform
emergency authorities about the status of its facilities. 9
(C) 2012 Healthcare Cloud Initiative

10. 2.Cases of Ishinomaki City, Miyagi
• 2.4 Case of Ishinomaki Municipal Hospital(2)
• In February 2011, Ishinomaki Municipal Hospital
started to share data of electronic medical records
(EMR) with Yamagata City Hospital SAISEIKAN for
backup purposes. (SIer:Software Service, Inc.)
• EMR data recovery works were
conducted in Yamagata side.
On April 7, Ishinomaki Municipal
Hospital was able to open
temporary clinic facilities in a
safer area and to resume daily
operations for outpatients.
*Benefits of Remote Backup/Cloud Services
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11. 2.Cases of Ishinomaki City, Miyagi
• 2.5 Case of You Home Clinic Ishinomaki(1)
• Community-based home care delivery initiative to
aging residents in damaged areas of Ishinomaki
(Established after the disaster)
• Initiative members include You Home Clinic, Kameda
General Hospital, Hokkaido Center for Family
Medicine, Nippon Foundation and Fujitsu.
• Developing cloud-based home medical care systems,
care team collaboration tools, telemedicine, etc.
• Planning to add life support services to prevent aging
residents from isolation.
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(C) 2012 Healthcare Cloud Initiative

12. 2.Cases of Ishinomaki City, Miyagi
• 2.5 Case of You Home Clinic Ishinomaki(2)
• Total concepts (image) of community-based home
care delivery initiative in Ishinomaki
Source: “Social Business Case Book” by METI (Jan.13, 2012)
Aging Residents Family Home Evacuation Households,
in Damaged Areas Temporary Housing, etc.
(Ishinimaki City)
You Home Clinic
(Tokyo)
You Home Support Groups (e.g. NPOs)
Kameda General Home-Visit Home-Visit
Clinic Social Workers
Hospital Pharmacies Stations
Ishinomaki Mental Healthcare Team, etc.
(Chiba)
Medical
Hokkaido Centre
Consultation
for Family
Supports
Medicine
(Hokkaido) Home Medical/Nursing Care
Information Exchange Systems 12
(C) 2012 Healthcare Cloud Initiative

13. 2.Cases of Ishinomaki City, Miyagi
• 2.6 Miyagi Prefecture Regional Healthcare
Recovery/Revitalization Plans (FY2011-2015)
宮城県、医療再生に 億円」
*Source: 「宮城県、医療再生に931億円」 by Kahoku Shimpo (Feb.8,2012)
億円
(http://www.kahoku.co.jp/news/2012/02/20120208t11017.htm)
• Total Budget = JPY 93,100M
• Enhancement in Emergency/Disaster Medicine at Ishinomaki
Red Cross Hospital (JPY 10,700M)
• Reconstruction of Ishinomaki Municipal Hospital(Completed by
FY2015) (JPY 9,900M)
• Development of Regional Health/Welfare Information Exchange
Network Systems (JPY 4,100M)
• Supports for General/Dental Clinics, Pharmacies, etc.
(JPY 2,900M)
• Supports for Home Health Care (JPY 400M) , etc.
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14. 2.Cases of Ishinomaki City, Miyagi
• 2.7 Ishinomaki City Basic Plan for Disaster
Revitalization (FY2011-2020)(1)
石巻市震災復興基本計画」
*Source: 「石巻市震災復興基本計画」 (Released in Dec. 2011, Japanese only)
(http://www.city.ishinomaki.lg.jp/reconst/re_const.jsp)
• Revitalization of regional healthcare delivery systems
• Mainly supported by government funding
• Hospitals as core infrastructure for “Smart City”
• Suburbs area: To develop highway interchange near
Ishinomaki Red Cross Hospital
• Downtown area: To reconstruct Ishinomaki Municipal
Hospital in front of JR East Ishinomaki Station
(Supported by Ishinomaki Chamber of Commerce)
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(C) 2012 Healthcare Cloud Initiative

15. 2.Cases of Ishinomaki City, Miyagi
• 2.7 Ishinomaki City Basic Plan for Disaster
Revitalization (FY2011-2020)(2)
• Health promotion for disaster-damaged citizens
• Supports for
• Mental healthcare
• Immunization/health check
• Disease management
• Prevention of lifestyle-related chronic diseases
• Prevention of hypokinetic disease/disuse syndrome
• Improvement in nutrition/food lifestyle
• Oral care
• Health promotion activities by health instructors
• Relief/revitalization of health promotion facilities
• The key is funding: “Public-Private Partnerships” or “Social”
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16. 3.Discussion
• 3.1 Learning From Perspectives of Human
人
Resources (人)
• Talent management for collaborative care team
• Ishinomaki Red Cross Hospital case:
-ICT Management and Facility Management
• Ishinomaki Municipal Hospital case:
-Ishinomaki ICT team and Yamagata ICT team
• You Home Clinic Ishinomaki case:
-Home-visit clinic/pharmacy/home nursing care
via regional health/welfare information exchange
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17. 3.Discussion
• 3.2 Learning From Perspectives of
物
Supplies/Product Resources (物)
• Healthcare delivery as the center of social
infrastructure/smart city value chains
• Requirement for Just-In-Time (JIT) healthcare
delivery in emergency
• Business Continuity/Disaster Recovery by Design
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18. 3.Discussion
• 3.3 Learning From Perspectives of Financial
金
Resources (金)
• ICT = Enabler of “Social” funding methods
e.g. PPP, Donor-assisted program, Crowd funding,etc.
Welfare
Wellness
Services
Home Home Nursing
Care Care Services
Pharmacy
General
Outpatient
Clinic
Care Non-profit
Hospital
Inpatient Public
Care Hospital
Public “Social” Private 18
(C) 2012 Healthcare Cloud Initiative
Funding Funding Funding

19. 3.Discussion
• 3.4 Learning From Perspectives of
情報)
情報
Information Resources (情報 (1)
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5
Basic HIS Advanced HIS Advanced Digital Hospital
Digital Virtual
HIS/CIS Enterprise
↑ Clinical Decision Support Systems
H Mobile Health
EMR (Electronic
Benefits & Risks
Medical Records））
PACS (Picture Archiving and
Communication Systems） ）
CIS (Clinical
Information Systems)
HIS (Hospital
L ）
Information Systems）
↓ 19 19
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20. 3.Discussion
• 3.4 Learning From Perspectives of
情報)
情報
Information Resources (情報 (2)
• Healthcare as the enabler of “Big Data” innovation
• Governance, Risk and Compliance (GRC) over “Big
Data” will be a topic of debate
• What is “Big Data”?
(e.g.)
"Technologies as a new generation of technologies
and architectures designed to extract value
economically from very large volumes of a wide
variety of data by enabling high-velocity capture,
discovery, and/or analysis."
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21. 3.Discussion
• 3.4 Learning From Perspectives of
情報)
情報
Information Resources (情報 (3)
• Characteristics of “Big Data”
Terabytes Data Volume Petabytes+
Size Is Not the Only Thing That Matters
Structured Data Variety Unstructured
Combination of Data Sources and Formats Is What Matters
Batch Data Velocity Streaming
Speed at Which Information Arrives and Is Analyzed and Delivered
¥ Value ¥¥¥¥¥¥
Capita, Operational, and Business Benefits All Matter 21
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22. 3.Discussion
• 3.4 Learning From Perspectives of
情報)
情報
Information Resources (情報 (4)
• Reference for “Big Data”
• "Big data: The next frontier for innovation, competition, and
productivity" by McKinsey Global Institute (May 2011)
(http://www.mckinsey.com/Insights/MGI/Research/Technology_and_Innovation/Big_data_The_
next_frontier_for_innovation)
• "Big Data, Big Impact: New Possibilities for International
Development" by World Economic Forum (January, 2012)
(http://www.weforum.org/reports/big-data-big-impact-new-possibilities-international-
development)
• "Health Care Is Next Frontier for Big Data" by The Wall
Street Journal (January 19, 2012)
(http://online.wsj.com/article/SB10001424052970204468004577169073508073892.html)
• “Privacy in the Age of Big Data: A Time for Big Decisions” by
Stanford Law Review (February 2, 2012)
(http://www.stanfordlawreview.org/online/privacy-paradox/big-data)
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23. 3.Discussion
• 3.5 Keywords for Recommendation on
Healthcare ICT Grand Design in Emerging
Economies
• Real time
• Preventive
• Actionable
• Transparency
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24. Question?
Eiji Sasahara, Ph.D., MBA
vyt04351@nifty.com
http://jp.linkedin.com/in/esasahara
http://www.facebook.com/esasahara
http://twitter.com/esasahara
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