Telemedicine project in Asia-Pacific Changing needs and current

Telemedicine project in Asia-Pacific: Changing needs and current problems Shimizu S, Kudo K, Antoku Y, Nakashima N Telemedicine Development Center of Asia, Kyushu University Hospital, Fukuoka, Japan www. temdec. med. kyushu-u. ac. jp/eng/index. php June 18, 2015, TNC, Porto

Today’s menu n n n Background Activities Changes Kyushu Univ. , Fukuoka

Key-hole operation: Big medical needs Open Endoscopic Many doctors want to learn the new surgeries.

Int’l Teleconf/Live demo 1990 s ? ISDN/Narrow Satellite Poor image! Expensive!

Specific characteristics/conditions in telemedicine Ø High resolution Ø Moving images Ø Varieties at each hospital Technically challenging ＊Common videoconference 1. Sit in front of monitor 2. Slides at most 3. Uniform equipment

Our project started in 2002 Korea- Japan: Big Broadband Network (2 G). Network revolution Japan

Big broadband Internet Original quality Mbps Compressed, degraded Clear & Smooth Movie transmission Cheap & Simple

Key technologies 2000 s n DVTS (Digital video transport system) n Academic network (Research and education network) Only method to satisfy doctors.

Today’s menu n n n Background Activities Changes Kyushu Univ. , Fukuoka

Gastric cancer China Diagnosis and treatment Advanced Endosc Admission Recurrence Death KR Early Ope JP Recovery Less cost Back to work Taiwan India Thailand Vietnam Malaysia Singapore Philippines Indonesia Early detection is very important!

China-Japan Early Gastric Cancer Teleconference For diagnosis Fukuoka/JP Tokyo/JP Video Shanghai/CN Beijing/CN 2011. 15

Endoscopic Demonstration in Asia & Europe Kyoto, JP For treatment: Endoscopic resection 2007. 8 Xian, CN Fukuoka, JP Video Hamburg, GR Seoul, KR Kuala Lumpur, MY Bangkok, TH Taipei, TW

Laparoscopic gastrectomy: Asia to Europe 2009. 10 Fukuoka/JP Tokyo/JP Video Shanghai/CN Trondheim/NO

Bird Flu Teleconference: Infection 2007. 1. 24 Indonesia China Australia USA Philippines Vietnam Thailand Japan • Dengue • Ebola • MERS

＜Asia Medical Project＞ 55 countries 389 institutions 537 programs 2004. 10 Europe Jilin Sapporo 2004. 7 2003. 2 Iwate 2005. 7 Seoul Tokyo 2004. 1 Yokohama 2005. 11 Fukuoka 2007. 8 Beijing Shanghai 2005. 6 Egypt Hong 2006. 7 Cairo U New Dehli Kong ERNET Hanoi 2007. 1 Mumbai Ha. Long Bangkok Tata MH 2006. 6 2005. 1 2007. 1 California Taipei Stanford, UC Irvine 2007. 1 2004. 12 Taichung 2005. 11 Flinder’s Hosp 2006 - 2007 After 2008 Singapore 2005. 11 NUS 2004. 1 Manila Kuala Lumper Ho Chi Min Philippine U Adelaide Cho Rai Hosp South Africa 2007. 3 2007. 1 Before 2005 Hawaii Cairnes 2004. 7 2005. 11 Bandung Canberra ITB 2006. 7 Jakarta, UI Auckland ANU 2007. 3 Brisbane Melbourne Chile Sydney

Today’s menu n n n Background Activities Changes Kyushu Univ. , Fukuoka

Choice of new technologies DVTS Image quality Equipment Network Global IP Mobile Bottom line u-SD PC Big (30) Yes No Network HD-H 323 c-HD VC system Small (2) Yes MCU *One-way streaming is another handy option. 2010 s Vidyo c-HD Server, PC Small (2) No Easy Sending image

Changes in Systems Vidyo H 323 DVTS

Changes in: REN vs Commercial Non. REN Newly connected institution /year

“Network threshold is decreasing ” Commercial Network H H H • REN • DVTS H H 10 years ago H H H HD-H 323 H H Vidyo H H H NOW H H

Live surgery Japan to North America with HD-H 323 Bariatric surgery 2012. 7 Tokyo => New York (2012), Canada (2014)

Global endoscopic conference with Vidyo 2012. 8. 28 Video IN IN SG KR GE TW LK HK KR

Teleconference with Latin America: Vidyo La Paz, BO Osaka, JP 2015. 3. 12. Cali, CO KUH, JP BR INNCZ, MX Alemana, CL MX

Conclusions 1. There is no doubt that REN can provide better quality and that the network is much more stable. 2. However, the connectivity to hospitals is less with RENs, and more telemedicine has recently been done with commercial NWs with tech. development. 3. We may have to reconsider the role of RENs for telemedicine with the changing environment. Engineers Medical Staff Success and Failures in Telehealth, 4 th Annual Meeting of he Australian Telehealth Society