In Japan, I spent 2 days in Tokyo and 1 day in Kyoto, lecturing, meeting, and listening to stakeholders. There is a great desire to share data for care coordination and clinical trials/clinical research. Telemedicine/telehealth is increasingly important in an aging Japanese society that has increasing healthcare needs but a limited number of caregivers and few opportunities to increase healthcare budgets. Here are a few of the current issues we discussed:
1. Some early data exchange pilots in Japan have used a healthcare specific XML form called Medical Markup Language (MML). Others have used IHE standards such as XDS.b . There is not universal adoption of a specific content standard among the majority of Japanese EHRs, many of which are custom created for each hospital. I recommended that Japan adopt CCDA as a summary content standard and FHIR as a query/response standard.
2. There is limited adoption of controlled vocabularies. SNOMED-CT, LOINC, and ICD-10 are used in pockets, but are not mandated by national or local regulations. There is some early work being done on OpenEHR and the use of schemas/archtetypes to represent data in a semantically interoperable way. I recommended the universal adoption of a single controlled vocabulary for each clinical area - SNOMED-CT for problems, LOINC for Labs and ICD-10 for diagnoses.
3. There is no standard means to send/route data across the country. Japanese privacy laws are not “internet friendly” and require the use of VPNs, leased lines, dedicated fiber etc. I suggested that https over REST is good enough.
4. There are not significant incentives to adopt healthcare information technology. Although I did not encourage a Meaningful Use program for Japan, I did highlight the notion in HITECH of creating carrots and sticks for achieving specific policy goals.
5. Prime Minister Abe wants more entrepreneurial Japanese, but that is challenging in a country where the failure of a startup is considered a reputational risk. Building a startup culture requires the creation of a "safe zone" where risk and rapid failure are tolerated.
In New Zealand, I met with government ministers, academia, industry, providers, and patients to describe my international experiences with healthcare IT innovation and how lessons learned might apply to New Zealand efforts. There is a remarkable alignment of government sponsorship, technology expertise, and an urgency to change in New Zealand. The desire to share data for quality measurement, care management, and enhancing social services extends to the highest levels of government. With 5 million people, a national healthcare identifier, well organized district health boards, uniform privacy laws, and a robust planning process, New Zealand truly is the perfect storm for healthcare IT innovation. Here’s my sense of their short term priorities
1. Complete their current multi-stakeholder engagement process to define priorities for the next 5 years
2. Determine the range of privacy preferences in New Zealand society then implement the technology and policies needed respect those preferences for multiple uses of data
3. Based on their high priority business cases, develop appropriate tools to push, pull and view data among stakeholders
4. Encourage an ecosystem of innovation so that startups can build products which plug into existing enterprise software
5. Focus on the needs of patients and families by ensuring they collaborate in producing and managing their healthcare data.
Just as I’ve done with the England, Scotland, Canada, Nordic countries, and China, I wrote briefing/position papers for leaders in Japan and New Zealand before I left.
I’ve said previously that my goal in life is to make a difference. If I can be a catalyst around the world to accelerate healthcare IT best practices, mitigate risk, and minimize repeated mistakes, I will have achieved my goals.