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Coronavirus

Screen-shunning doctors open up to telehealth in pandemic era

Face-to-face consults, paper records and cash payments still the norm in Japan

The coronavirus outbreak highlights the benefits of telemedicine in Japan. 

TOKYO -- With two small children aged 1 and 2, Chieko Kuribayashi, 33, has serious concerns about visiting a clinic, fearing that they may catch the spreading coronavirus.

Kuribayashi, a medical doctor who works in a university hospital in Ube, western Japan, is keenly aware of how exposed both patients and health care workers are to the risk of coronavirus infection as the hospital receives more patients with flu-like symptoms. With more news of hospital infections, the mother of two is agitating for change.

"It is ideal to perform physical examination on the patient, but some diagnostics can be made through an online conversation also," she said. "What can be done online should be done online."

For years, telemedicine has been opposed by clinics, led by the Japan Medical Association, a powerful lobby representing the interests of doctors and a key support base of Prime Minister Shinzo Abe's Liberal Democratic Party. The coronavirus outbreak is shifting the tide, however.

Abe is now expected to announce on Tuesday that restrictions on the medical sector will be lifted later this month, opening the way for patients to consult with doctors online and receive prescription without physical examinations. Such service will be covered by Japan's national health care insurance.

It is not clear how many hospitals or clinics will be able to take advantage of the easing of the restrictions, however. Most Japanese clinics still do not even accept payment by credit card, which is necessary for telemedicine.

Telemedicine has been available in the country since 2018, but only to patients of chronic disease and those receiving prescriptions for existing illnesses. New illnesses have to be examined by a doctor in person.

Clinic For in Tokyo has been providing telemedicine and is now preparing to expand the service to cover coronavirus. The doctor will make diagnoses after determining if patients have chest pains or breathing problems. If a patient's conditions appear mild, the doctor will prescribe medicines to ease symptoms and request another online consultation a couple of days later, for example.

If the doctor suspects coronavirus, the patient will be advised to take a polymerase chain reaction test at specified locations.

Most doctors acknowledged that telemedicine is not quite the same as a face-to-face consultation. "It is like trying to hit the ball with eyes closed," said Kazuma Kaneko, doctor, co-founder and CEO of Linc'well, the operator of Clinic For.

"But telemedicine can help minimize contact between people, which is the cause of the virus' spread," he stressed. Telemedicine will be especially helpful for patients who are struggling to find clinics willing to see potentially infected patients.

Japan's slow embrace contrasts with a rapid expansion of telemedicine in China, where the new industry faces no restrictions and is seen as a solution to the problem of a shortage of clinics across the country. WeDoctor, owned by internet conglomerate Tencent Holdings, connects patients with a roster of more than 300,000 doctors, who charge as little as $30 for a consultation and prescription. Services such as telemedicine and online drug delivery are also provided by Ping An Insurance and e-commerce company Alibaba.

Japan's hospitals are not centrally controlled.

Japan has been served relatively well by 110,000 hospitals and clinics, health care professionals said. Small clinic operators tend to view telemedicine as a threat to their business.

Telemedicine could indeed drive some patients away, Kaneko acknowledged. But he said that, like any business, clinics should also constantly try to improve their service. Clinics "have little incentive to change," he said.

The Japan Medical Association argues that it will be difficult for doctors to provide an accurate assessment of a patient's conditions without listening to the heart and the lungs and examining the neck and the throat for swollen lymph nodes.

Older practitioners also tend to be resistant to digital technology. The average age of doctors working at small clinics has been rising over the years to 60 now, according to data from the health ministry.

In Japan, 65% of patient health records are still kept as hard copy. For example, when a woman becomes pregnant, she will be issued a small record-keeping book. Every patient in Japan is supposed to bring along their prescription book when they visit a pharmacy for drugs.

Hospitals in Japan are also not centrally controlled or linked on any technological platform. In a recent news conference, officials at the health ministry were asked about the number of available intensive care units for coronavirus, and were unable to give an answer because they did not have an overview of the sector on hand.

"Japanese hospitals need to make much more investment in IT," said Ryosuke Tsuchiya, senior fellow at the Tokyo Foundation for Policy Research and former head of the National Cancer Center Hospital. He claimed that most Japanese hospitals, even large ones, have few IT professionals on staff.

In response, the Abe government is expected to announce on Tuesday that it is developing a system that will allow the government to see how hospital resources are being used, including beds, ICUs, ventilators, doctors and nurses. Hospitals with 20 beds or more, totaling some 8,000 nationwide, will be required to provide updates on their status every day.

They will also be required to report on the stockpiles of protective gear such as masks, gloves, gowns and sanitizers every week. The data will be shared with local governments, allowing them to mobilize resources more efficiently. The system is set to go online next month.

Such moves will require a change in mindset of medical professionals.

"The idea of remote work doesn't even occur to many medical professionals, because their job tends to be on-site and involve physical interactions with patients," said Kaneko of Linc'well. "Many of them don't bring their smartphone into their workplace. They aren't even familiar with social media."

Yet, the ability to adopt digital technology could help Japan's medical services in the long term, beyond the immediate threat posed by coronavirus.

For example, the burden on hospitals posed by a growing aging population could be lessened by employing telemedicine, Kaneko said.

"Those who are now in the 60s know how to use the smartphone. We need to be ready to serve them online when they grow old into the 70s," Kaneko said.

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