デジタル医療Digital Healthcare

デジタル医療 (Digital Healthcare)

デジタル医療とは、ICTやAIやロボットなどを使って医療の平等化や医療の質の向上を目指して1つでも多くの命を救うというコンセプトです。

当直の若い先生が先輩医師の判断を仰ぎたい時、電話で相談しづらいのを解決しようと思って作ったのが「Join」というアプリです。Joinは、スマートフォンを使って医療情報や医療画像が見えるようにした医師専用のSNSアプリです。医師同士のコミュニケーションに役立てられるよう開発をしましたが、将来的にはオンライン診療での活用も視野に入れています。

先日、このJoinを使った遠隔医療の有効性について論文をまとめました。私は2年前に倒れてしまい、今も手が動かせない状態で文字入力もできませんが、なんとかリハビリスタッフに声を文字にしてもらうことで論文をまとめることができました。ここではその内容を少しご紹介します。また、他にもJoinやスマホ医療に関する論文がいくつかありますので、ここで4本ほどご紹介します。

2021年4月
高尾 洋之

Digital healthcare. by definition, is the concept of incorporating ICT (information and communication technologies) such as smart devices and its apps, Artificial Intelligence (AI),Internet of Things (IoT), robotics, and other elements, aiming to standardize and improve the quality and efficiency of healthcare system, resulting in saving as many lives as possible.

Join is an app created for young doctors to overcome the challenge and difficulty of reaching out to the senior physician over the phone and seek for his/her advice and opinion when needed on duty. Join is a social media network app for doctors that makes possible to see and share specifically relevant medical information and medical images using a smartphone. Even though the primary objective of Join is to facilitate the communication between doctors, new horizons of using it for online diagnosis has been recently explored.

Recently, I have finally completed a paper about the effectiveness of remote healthcare using Join, after being bed-ridden for the past 2 years.
I still cannot move my hands, rendering me unable to type, but I was able to find a way to complete this paper, thanks to the staff members involved with my rehabilitation who was writing down my dictation.
I would like to share a portion of its content here, along with couple of other papers about Join and smartphone healthcare.

April 2021
Hiroyuki Takao, M.D.

論文

タイトル A Smartphone Application as a Telemedicine Tool for Stroke Care Management
雑誌 NMC Neurologia medico-chirurgica
年度 2021 No.4
https://www.jstage.jst.go.jp/article/nmc/advpub/0/advpub_oa.2020-0302/_article/-char/en

今年COVID19が流行って専門医が直接患者さんをみれる機会が減ってしまいまいした。
脳卒中や循環器疾患、大きな外傷などは、診断・治療までの速さが救命率に大きく関わります。素早い診断・治療が出来ないと、医療崩壊にもつながります。僕らが作ったJoinというアプリは、専門医が直接患者さんを診られない場合でも、医師同士をつなぐことによって素早い診断や適切な処置の指示ができ、手術までの時間を短縮できます。この論文では、Joinを使って脳卒中の患者に対して素早い診断と素早い治療ができることをまとめました。Join導入前と導入後の時間を比較し、明らかに短くなったことを説明しています。「スマートフォンを使って情報を共有できれば時間短縮につながるのが当たり前だ」という人もいると思いますが、科学的な根拠を論文にまとめてみました。

タイトル Mobile Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App
雑誌 Neurointervention
年度 2017
https://pubmed.ncbi.nlm.nih.gov/28955508/

Joinは救急疾患に役立つと考え、救急車で導入したいと思っていました。東京消防庁に実験的に導入してもらうように頼みましたが、実績がないことや搬送時間に影響が出てしまう懸念を理由に断られてしまいました。そこで私たちは、日本で実証するのを諦めてアメリカでやることにしました。Demetrius K Lopes先生とDanilo M Nogueira先生のグループは、Joinを救急の現場で実際に使って論文にまとめています。この論文では脳卒中だけで試験運用していますが、スマートフォンアプリで位置情報を示すことが有用だと論文上に示されました(Joinではスマートフォンの位置情報をアプリ上で見れるようにしています)。

タイトル Reliability of smartphone for diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Scores in acute ischemic stroke patients: diagnostic test accuracy study.
雑誌 J Med Internet Res
年度 2020
https://pubmed.ncbi.nlm.nih.gov/32515744/

スマートフォンで画像を見ると病院で見るディスプレイの解像度と違うのでうまく診断できないという人がいます。そこで東京慈恵会医科大学の神経内科学講座の坂井健一郎先生は、スマートフォンの画像による診断と病院にあるディスプレイでの診断を比較し、スマートフォンでも遜色ない診断ができることを論文で示されました。

タイトル Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy
雑誌 Nurological Sciences
年度 2020
https://pubmed.ncbi.nlm.nih.gov/33638012/

発症から早急に治療を行うことが、脳梗塞の重症化を防ぐための最善の方法です。脳梗塞の患者が病院に搬送されると、救急部、脳卒中専門医、放射線部、脳血管内治療医、手術室、麻酔科、集中治療室など、さまざまな部署が連携して治療に当たります。しかし、関係するスタッフが多い分、コミュニケーションエラーが発生して治療開始までが遅れる可能性が課題となります。Joinは、SNSのように1対複数で同時にコミュニケーションが取れる利点があります。この論文では、Joinのこうした利点を生かすことで部署間のコミュニケーションが迅速になり、急性期脳梗塞の治療開始時間が短縮されることを示しています。

タイトル Thrombectomy for Stroke in the Public Health Care System of Brazil
雑誌 NEJM
年度 2020
https://pubmed.ncbi.nlm.nih.gov/32521133/

NEJMという臨床では一番有名な論文雑誌があります。ブラジルのSheila O Martins先生は、その雑誌でJoinを使った脳卒中システムに関する論文を発表しました。スマートフォンを使ったアプリで医療情報や医療画像を共有するが、脳卒中医療の改善に効果的であることを科学的に立証する論文です。デジタルの導入によって医療が良くなることが、科学的に示されました。

タイトル Primary Salvage Survey of the Interference of Radiowaves Emitted by Smartphones on Medical Equipment
雑誌 Health Phys
年度 2016
https://pubmed.ncbi.nlm.nih.gov/27575351/

病院では、スマートフォン(携帯電話)の利用が禁止されているところが多いです。携帯電話の電波が医療機器に影響を与えるからだと言われていますが、私たちは、携帯電話やPHSの電波がどれくらい医療機器に影響を与えるのかを調べて論文にしました。携帯電話は電波が悪いと電池の減りが早くなりますが、簡単に言うとそれは電波を探すために電力を使っているからです。電力を使っているとどうしても電磁波が出てそれが医療機器に悪影響を及ぼします。PHSは低電力だから大丈夫だと言いますが、電波が良ければ携帯電話のほうが低電力になります。だから病院の電波環境を整えてあげれば携帯電話やスマートフォンを使うことができます。スマートフォンが使えればパソコンを持ち歩くのと一緒なのでいろいろなことができます。この論文によって、根拠を持って病院にもスマートフォンを導入できると思います。

今回ご紹介した論文のうち4本はインターネット上のメディカル論文データベース「PubMed」でも読むことができます。興味を持った方はぜひPubMed上でお読みください。

分析 高尾洋之 2021年4月

Paper

Title A Smartphone Application as a Telemedicine Tool for Stroke Care Management
Journal NMC Neurologia medico-chirurgica
Year 2021 No.4
https://www.jstage.jst.go.jp/article/nmc/advpub/0/advpub_oa.2020-0302/_article/-char/en

Physicians have been facing unprecedent challenges to see the patients directly since early 2020 due to the spread of COVID-19 infections.
The impact is even bigger in cases such as stroke, circulatory diseases, major injuries, and any other conditions which the speed of the diagnosis and treatment can play a significant role in the chances of survival. Current inability to provide a diagnosis and treatment rapidly could even lead to a collapse of the healthcare system.
The Join app was created to network specialists and healthcare professionals, making possible to provide a rapid diagnosis, provide instructions for appropriate treatment, and reduce the time until surgery, even if medical specialists cannot see the patients directly. In this paper, we present how a rapid diagnosis and a rapid treatment can be provided to stroke patients using Join. The study shows that times have been clearly shortened when comparing the times before and after the introduction of Join. Many may think “It is obvious that sharing information using smartphones will lead to shortened times,” but it is important to have it in the paper based on scientific evidence.

Title Real-time Tracking of Acute Stroke Patients and Instant, Secure Inter-team Communication - the Join App
Journal Neurointervention
Year 2017
https://pubmed.ncbi.nlm.nih.gov/28955508/

With the belief that Join would be useful in treating emergency diseases, we sought to use for EMS (Emergency Medical Services). We asked Tokyo Fire Department to introduce the app experimentally in the ambulances, but unfortunately, our request was declined out of concerns about the lack of prior cases and transport times potentially being impacted. Seeking for a trial site outside of Japan, we found a new home for the research in the United States. The group involving Dr. Demetrius K. Lopes and Dr. Danilo M. Nogueira actually used Join in the field for emergency healthcare and wrote a paper about their findings. The app is only used experimentally for strokes in this paper, but it indicates sharing location information through the smartphone app may be very effective for stroke treatment, especially in the drip-n-ship model (Join allows the location information of a smartphone to be seen on the app).

Title Reliability of smartphone for diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Scores in acute ischemic stroke patients: diagnostic test accuracy study.
Journal J Med Internet Res
Year 2020
https://pubmed.ncbi.nlm.nih.gov/32515744/

There has always been a controversial debate about medical imaging in the mobile phones, especially with the advance of the screen resolution in the most recent smartphones. Some people say that it is not easy to provide a diagnosis after looking at images on a smartphone, since the resolution is different from the displays in hospitals. Dr. Kenichiro Sakai from the Department of Neurology at the Jikei University School of Medicine in Tokyo compared diagnoses provided using smartphone images with diagnoses provided using displays in hospitals and presented through this paper that diagnoses that are not inferior can also be provided through the smartphone.

Title Communication-type smartphone application can contribute to reducing elapsed time to reperfusion therapy
Journal Neurological Sciences
Year 2020
https://pubmed.ncbi.nlm.nih.gov/33638012/

Providing treatment as soon as possible after onset is the best method to prevent a stroke from worsening. When a stroke patient is transported to a hospital, the emergency department, stroke specialists, the radiology department, vascular neurologists, operating rooms, anesthesiologists, intensive care units, and various departments cooperate to provide treatment. However, given the large number of staff members involved, the possibility of the start of treatment being delayed by communication errors is a problem. Join has the benefit of simultaneous one-to-many communication, just like social media does. This paper presents that utilizing this benefit of Join accelerates communication between departments, reducing the time it takes until treatment on an acute stroke can begin.

Title Thrombectomy for Stroke in the Public Health Care System of Brazil
Journal NEJM
Year 2020
https://pubmed.ncbi.nlm.nih.gov/32521133/

The NEJM is the best-known journal in the field of medical practice. Dr. Sheila O. Martins from Brazil published a paper about the efficiency of mechanical thrombectomy in public healthcare system for developing countries. Join app was used to connect all the participant stroke centers, with the capability to share medical information and medical images through a smartphone app, contributing to the efficiency and quality standardization of this study. Digital technology will be playing major role, as a backbone, to improve the entire healthcare system.

Title Primary Salvage Survey of the Interference of Radiowaves Emitted by Smartphones on Medical Equipment
Journal Health Phys
Year 2016
https://pubmed.ncbi.nlm.nih.gov/27575351/

Many hospitals prohibit the use of smartphones (cell phones). Since this is said to be because of the effect that the radiowaves that are emitted by cell phones have on medical equipment, we researched how much the radiowaves emitted by cell phones and PHS affect medical equipment and summarized our findings in this paper. The battery consumption of cell phones accelerates when reception is poor. To put it simply, this is because the cell phone is using power to find a signal. When power is being used, it is inevitable for electromagnetic waves, which have a negative impact on medical equipment, to be emitted. The PHS is said to be all right because it has low power, but cell phones have less power if reception is good. Therefore, cell phones and smartphones can be used if the hospital has a radio wave environment set up. Since having a smartphone is just like carrying around a computer, being able to use a smartphone enables a lot of things. We believe this paper serves as evidence that the use of smartphones can be allowed in hospitals.

We have noticed some hospitals forbidding the use of smartphones in certain location of the facility. This is not only for the respect to the noise free policy, but also due to the potential influence of smartphone radio waves in certain medical equipment. We decided to investigate it deeply.

For instance, we have all noticed how the smartphone battery draws faster when we are in the location with weaker signal. This is because the device is increasing its radio waves trying to catch a better or any available signal. Issuing more radiowaves may result in the interference to the equipment around, include the medical ones.

The use of smartphone in the hospital brings priceless benefits to the clinical workflow, allowing doctors to be anywhere and they will be able to access the data even without the computer in front of him/her. Therefore, as a solution, we recommend the hospital to have good or excellent signal anywhere, which will keep smartphone radiowaves in lower issuing mode (as it does not need to look for the signal).

4 of the papers presented here are fully accessible thru medical paper database PubMed. Please be free to access if, whoever got interested on some of them. Thank you!

April 2021
Hiroyuki Takao, M.D.