RECOMMENDATION 4 SUPPORT PROGRAMS TO EXPAND THE ROLE OF TELEHEALTH, VIRTUAL CARE, AND DIGITALTHERAPEUTICS IN PROVIDING HEALTHCARE TO VULNERABLE POPULATIONSAs the recent COVID-19 has made abundantly clear, digital health inJapan has fallen far behind the rest of the world.While Japan was an early adopter of electronic health records, theeffort was nullified by a delayed adoption of the practice and datasharing across the country. The same is true for the proliferation ofonline practices and digital prescriptions.On the other hand, the public's ICT literacy has risen, and accordingto a survey by Ministry of Internal Affairs and Communications,75.7% of people in their 60s, 53.6% of people in their 70s, and23.4% of people in their 80s and older use the Internet. All thesegroups have shown an increase in internet usage between 2010and 2016, but again, ICT literacy among senior citizens is notnecessarily high.Seniors are also at higher risk for new coronavirus infections, whilea higher proportion of them are receiving medical and nursing care.These are the people who must maintain social distance but are ina difficult position to do so.The development of 5G has laid the groundwork for thedevelopment of tele-surgery and other technologies that takeadvantage of "ultra-low latency."The widespread use of online medical care and digital prescriptionsneeds to be considered for those who are not necessarily ICTliterate, such as the elderly. However, this should be done in a waythat raises the literacy of the population (especially the elderly) inrelation to ICT. Even in countries with advanced ICT systems inhealthcare, such as Estonia, the ICT literacy of the elderly was nothigh from the beginning and required support from thegovernment (e.g. training) and family members.We should also urgently move forward with online health care forthose who need help the most for illnesses, disabilities andincurable diseases.The role of digital therapies is becoming increasingly important. Forexample, a therapeutic app for smoking cessation recently receivedan informal approval from the Ministry of Health, Labour andWelfare. These new types of “digital therapeutics” are rapidlyadvancing in the United States. With limited downsides to the useof these technologies, it is desirable for them to gain furthertraction and seek approval for additional uses in the future.Furthermore, it is necessary to spread Japan's advanced medicaltechnology, such as tele-surgery, to the world on a universal basis.CURRENT ISSUES RECOMMENDED DIRECTIONRECOMMENDATION 3THROUGH BROADER PRIVATE-PUBLIC PARTNERSHIP, PURSUE THE COLLECTION OF DATA THAT BENEFITS EVENTHE MOST VULNERABLE POPULATIONS, BUILDING THE INFRASTRUCTURE NECESSARY TO COLLECT DATA THATSUPPORTS A STRONGER EVIDENCE-BASE FOR THE USE OF MEDICINES AND MEDICAL TECHNOLOGIES In Japan, large-scale public healthcare data is being accumulatedacross multiple platforms including the national database (NDB),nursing care DB, DPCDB, MIDNET and other anonymous databases,in addition to nominal databases such as the National CancerRegistry DB, Incurable Disease DB, and Specific Pediatric ChronicDisease DB. However, apart from the linkage of the NDB andnursing care DB, there is not necessarily an active debate on thelinkage of the databases and their utilization in society.Utilization of these DBs is expected to bring great benefits not onlyto specific companies but also to society as a whole through thedevelopment and evaluation of drugs and medical devices.However, under the current concept and operation of the "publicinterest purposes" for third-party provision of data, access to thesedatabases is extremely limited, primarily only open to academicresearchers.In order to utilize these DBs, it is necessary to establish a system tocope with tasks such as DB management, prompt review ofinformation provision, user support, and confirmation of results onthe premise of securing anonymity, but the fact remains that,structurally speaking, we are not ready for expansion of the systemas resources are not sufficient in terms of both personnel andcosts.Although private-sector-based DBs already exist and are being usedin some parts of the country, there has not been sufficientdiscussion on the division of roles between the public and privatesectors, the system of cooperation, and cost sharing for future DButilizationPromote further enrichment of DBs, including the necessary linkageof DBs, in order to maximize the value of information extractedwhile paying maximum attention to ensuring anonymity.Rules and frameworks for the provision of third parties should beinstitutionalized at an early stage in order to promote the use of theinformation for public interest purposes by a wider range of actors,through discussions between the public and private sectors on the"public interest of use.”Prompt review of information provision, user support (applicationsupport, training on basic knowledge of the database and points tokeep in mind when analyzing it, etc.) is necessary. Discussionsshould be held on the division of roles between the public andprivate sectors, associated coordination efforts, and cost sharing inorder to secure the personnel and financial resources necessary todevelop a safe environment for use.In cases where it is difficult to collect sufficient cases of intractableor rare diseases in Japan alone, a system of collaboration withoverseas databases should be established, while considering theimportance of anonymity.While accumulating data on drugs and medical devices, efforts willalso be made to build an information base for more rigorousverification and appropriate evaluation of efficacy, identifyingtechnologies without significant medical need and limited clinicalbenefit, as well as those with high need. RECOMMENDED DIRECTIONCURRENT ISSUES
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