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Session 4: Panel Discussion “Technology Contributing to the Future of Medicine and Health”
Panelists：
・Kaoru Asano, President, Medicaroid Corporation
・Kiyoyuki Chinzei, Deputy Director, Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology
・Yoshihiro Muragaki, Professor, Center for Advanced Medical Engineering R&D, Kobe University
・Tomohiro Tada, CEO, AI Medical Service, Inc.
・Sho Okiyama, Founder & CEO, Aillis, Inc.
・Yoshinori Abe, Co-Founder, Ubie, Inc.
Floor Speaker :
・Yasuhiko Hashimoto, President and CEO, Kawasaki Heavy Industries Ltd.
・Raizou Yamaguchi, Professor, Graduate School of Medicine Faculty of Medical Sciences, Kobe University
・Koichi Suda, Professor, School of Medicine, Department of Gastroenterological Surgery, Fujita Health University
・Masahiro Jinzaki, Professor, School of Medicine, Department of Radiology, Deputy Director, Keio University Hospital
・Moderator: Jun Murai
(Murai) I would like to ask you, Mr. Okiyama, about the difficulties you faced when applying to the PMDA (Pharmaceutical and Medical Devices Agency) and how you felt about the vast number of paper documents required for the application.
(Okiyama) About 2,000 pages were required for the approval application documents, and 17 copies of them had to be brought in for inspections within the ministry.
(Murai) Is this normal?
(Chinzei) With this number of pages, it is inconvenient even if it is handed over digitally, and there might be inconveniences in attaching sticky notes or written memos.
(Murai) Mr. Kono, Minister of State for Digital Agency, might want to say something about it if he were here.
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(Murai) I want to ask Mr. Asano. What is the biggest issue facing medical DX?
(Asano) The most important thing is getting along with doctors, listening to their opinions, and implementing them. ‘Medicaroid’ made five prototypes in as many years. Hundreds of improvements have been made. We can only do something beneficial for practical application if we understand the actual needs. Besides, we must consider the coexistence of doctors and robots to increase public awareness and automation. From the initial stage of development, it is the biggest challenge for us to get doctors to be more serious and make sure of their actual needs.
(Murai) Many robots are made in Japan, such as Tetsujin 28-go(Gigantor), Astro Boy, and Doraemon. Did you have a dream of such a robot?
(Hashimoto) Of course, I have a dream. I grew up in a family of doctors and a disabled older brother. As a student, I met a man who couldn’t even turn his body, and his parents didn’t sleep for more than two hours to care for him. Developing a robot to be used by doctors is hard for an engineer, but human life is extremely valuable, and that’s why it’s worth doing it. This fusion of technology and medicine with Japanese engineers and doctors working together to achieve such a dream is a true treasure.
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(Murai) I want to ask Mr. Muragaki about mobility. I think mobile operating rooms have a wide range of versatility, but what issues exist?
(Muragaki) There are some problematic issues in Japan. It is easy to understand the benefits of using mobile operating rooms during disasters. Still, when it comes to regular use, we need to spread out their use gradually, starting, for example, with medical examinations at local roadside stations. Even if digitalization makes it possible to live in rural areas without problems, medical care remains a worry. It will also have to be involved in regional revitalization.
(Chinzei) A few years ago, the Ministry of Health, Labor and Welfare made a big fuss when it estimated that hundreds of public hospitals could not continue to operate. Soon, a hospital that was in some given place may no longer exist. Instead of “going to the hospital,” we might have to consider “the hospital coming to us” from here on.
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(Murai) It appears that training is essential for the appropriate expansion of robotic surgery, and an educational system called the proctor system is necessary. The problem is that of scale and sustainability. I have seen various medical research projects, most of which stop when the subsidy ends. I have a sense of institutional issues.
(Suda) The proctor system itself is similar to volunteer work. In addition, new regulatory statements affecting this system come out every year from relevant academic societies. There is no choice but to find doctors who can understand and teach them. But there is almost no budget for this. Even though each stakeholder will be a beneficiary, I think that it will not work unless we create a new proctor system that the beneficiary pays for.
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(Murai) Various robotics, from surgical robots to in-hospital guidance robots, came up as a topic today. What challenges did you face when introducing robots in the hospital?
(Jinzaki) We have a lot of requests from various companies to introduce their robots. We choose those with lower maintenance costs and with a view to sustainability even if the research funds end. In this way, other hospitals could also bring in robots.
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(Murai) It is vital to have a perspective of the horizontal deployment of robotic devices to other hospitals. Can we roll out successful trials at this university to other hospitals? What do we need for that?
(Suda) Perhaps I can represent young doctors in saying that they would tend to use the same medical devices on which they had learned a given procedure for the first time. For example, a robotic surgeon who grew up with ‘hinotori’ will want to keep using it. In contrast, those who grew up with ‘da Vinci’ will inevitably compare it with the former. While attending university, young students can have opportunities to improve medical equipment with various manufacturers in an industry-government-academia collaboration. It is essential to develop such an environment horizontally.
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(Murai) There is the possibility of a kind of ‘vendor lock-in’ in what you have just said. I specialize in networks, and although various companies made network equipment, CISCO began to monopolize it. People found it easier to use CISCO equipment. Then, Chinese companies which made products similar to CISCO’s came out. However, at some point, CISCO began to commit to international standards. The entire market was raised when interoperability emerged, and the network industry developed. Is there such a trend in medical care? For example, is there any part in SCOT and ‘hinotori’ that can be standardized?
(Chinzei) In DICOM standardization the minimum common parts are determined; apart from that, each company is allowed to have its own proprietary features. However, valuable details are to be imitated so that they could be incorporated into the standard later. So, just because it’s the medical area doesn’t mean there’s no trend toward standardization.
(Muragaki) There are various standards for medical data, but in the end, there are particular dialects called ‘vendor lock-in’ in electronic medical records. Prime Minister Kishida says that the government will take action in this area. There is a way to make it easier, such as using semantic data modeling that recreates useful data by tagging only in time and space.
(Chinzei) The medical area is highly conservative when it comes to breaking the workflow. The protocol reflects the workflow unlike the data format. Even if the government manages to take the lead in unifying electronic medical records, there will inevitably be a big outcry. From the point of view of interoperability, not only the data format but also protocol uniformity inevitably comes up.
(Muragaki) SCOT deals with data structures and protocols. We are discussing how to standardize many biological and related data in surgical fields.
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(Murai) I have a question for Mr. Tada. You mentioned that high-quality endoscope image data has accumulated in Japan and can contribute to the world. Is there a standard or analysis methodology in this field?
(Tada) There is no standard like DICOM for endoscopes. I used to collect still images, but since 2018, I’ve switched to high-definition video data collection. Since doctors examine real-time video, I’ve been searching for a data collection method that suits it.
(Murai) Mr. Tada is a pioneer in endoscopic data analysis. Do you have any thoughts on the standardization of such video data? How data is accumulated, tagged, and archived must be extremely important.
(Tada) In the current situation of endoscopic data analysis, before standardization, we need tools such as for recording and annotation, as well as servers, etc. We are developing tools on our own and are mid-way through this challenge.
(Murai) As expected of an entrepreneur, you are doing challenging things. I wanted to hear that story, so I invited people from venture companies.
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(Murai) What do you think about standardization at ‘Medicaroid?’
(Asano) As the first step, we want to make MINS an open platform and provide it to many companies so that they can create applications. After that, we will move on to interoperability and global standards, but we are not yet at that stage though I would like to take the lead in the future.
(Suda) I think that we must aim for global standardization to sell products overseas. Still, there are many excellent companies in the field of minimally invasive surgery in Japan. We can standardize their products in Japan before taking them overseas. As experienced on several occasions, foreign-affiliated R&D departments only seem to absorb a point made one-way without further communication or discussion.
(Murai) Mr. Hashimoto said earlier that Japanese manufacturers had captured the global market share for industrial robots. Is this related to standardization?
(Hashimoto) Although there is ORiN, things in a rapidly changing industry would progress quickly regardless of standardization. As a result, resources for standardization might be unproductive. The Japanese need to improve how to develop something which involves public opinion. We could naturally grasp the genuine demand for standardization by recognizing development as a social issue. Therefore, firstly, we are working on visualizing and sharing data with doctors.
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(Murai) AI will come into play when data has been distributed. Increasing the amount of good data is of great value to AI. So, what do you think about today’s discussion, Mr. Okiyama?
(Okiyama) Standardizing, sharing, and distributing data will give overwhelming benefits to doctors. However, doctors with a sense of issues and needs should be educated more deeply at medical school. Conventional medical school education cannot sufficiently deal with today’s topics, and doctors must rely on the outside world for advanced information.
(Murai) Has it become common to teach data science and AI to medical students?
(Muragaki) Yes, it has been spreading little by little. In the case of Keio University, there is an education program with an AI consortium that provides education beyond the faculty. In medical school, those who wish can study data science courses. The challenge is to train people who can connect medical information and AI.
(Yamaguchi) Quick response is required because it is competitive in this field. You must team up with a company beyond the university if you want to do something practical. I think the vendor lock-in will break as technology develops radically. In the last three years, there were COVID-19 and Ukraine, and the demand for telemedicine increased rapidly. I feel that this field is also progressing differently than before.
(Murai) Vendor competition was fierce in the computer-related field. Still, the university’s neutral approach of creating a foothold in various companies by engaging them in the same way worked very well. (In Japanese, we say: 呉越同舟, i.e., friend and foe in the same boat to beat the common enemy.) The public and private sectors have to play their respective roles, while universities can only play a limited role.
Closing Remarks
Kiyoshi Kurokawa, Honorary Director, National Graduate Institute for Policy Studies, President, Japan Health Policy Institute
I heard an exciting story today. However, the world is already digitally and globally connected. I want everyone to have a passion for sharing those wonderful ideas with the world and consider how to use them beyond national borders.
The first thing I would like you to keep in mind is whether Japan, which has only been open to the world for about 150 years, has achieved democracy. So far, government-led economic growth has been successful by chance.
If you have a problem, I want you to think for yourself and take action on a global scale instead of going to the cabinet office. For example, Yukichi Fukuzawa thought deeply about what Japan should do in the future, then went and collected necessary information overseas on his own, translated it, and famously carried out enlightenment activities.
Finally, I would like to take this opportunity to share my thoughts on dementia, an urgent medical issue in Japan. Although there are no universal diagnostic criteria or treatments yet, the population affected by dementia continues to grow. This problem should be solved digitally, so I would like everyone here to consider a solution for dementia.
(written by Hitomi Sano , photo by Shun Arima)