A Study on Regionalization of Telemedicine in Japan : A Case of the Kagawa Prefecture

일본 원격진료의 지역화 형성 및 특성에 관한 연구 : 카가와현(香川県)을 통한 지방의 원격진료 사례를 중심으로

  • Received : 2011.06.23
  • Accepted : 2011.08.17
  • Published : 2011.08.31

Abstract

This research investigates a geographical issue as to which factor discovered in the only Japanese telemedicine with regard to social and medical circumstances performs a role as a determinant in regionalization, especially, local areas in Japan. According to the results, strong human networks based on regionalism are mirrored in regionalization and are associated with not only the development and management of telemedicine operations, but also the choice of telemedicine users concretely. In other words, all processes from the suggestion stage of telemedicine to the practical usage or application stage of telemedicine are involved in the existing human networks within one prefecture (the third diagnostic area); further, personal stakes are transferred to public health care services (telemedicine) and their relationships have been formulated by the telemedicine council including local government, medical association, region-rooted companies, core health centers and universities, etc. Accordingly, the telemedicine council responses to the need of telemedicine users immediately and contributes to develop regional health care. Also, telemedicine users have been connected with each other closely before operating telemedicine; accordingly, the human relationships between doctors and patients or among doctors influence the choice of telemedicine serving sites and their behaviors comes down to regional-based diagnosis via the telemedicine system.

본 연구에서는 원격진료 기술로 병원간 통합을 꾀하고 있는 일본의 사례를 중심으로, 원격진료의 지역화 형성 및 특성에 대해 알아보았다. 연구를 통한 결과는 다음과 같다. 첫째, 일본에서는 원격진료의 효과적인 운용을 위해, 현청, 지역 내 대학, 의사회, 지역 산업을 기반으로 하는 기업 등을 주축으로 하는 "원격진료 의원회"를 구성하여, 이를 활발한 의사 교환의 장(場)으로 이용하고 있다. 따라서 지역의 다양한 의료 종사자와 환자의 직접적인 수요를 최대한 반영하고, 조속히 맞춤형 원격진료 서비스를 제공할 수 있는 환경을 형성하였다. 둘째, 이미 형성된 긴밀한 인간관계가 원격의료의 지역화에 크게 관여하고 있다. 지역의료의 발전을 위한 정책 결정자-의사 집단 간의 관계, 의사회의 정기적인 모임과 연장자 의사 집단의 지역의료에 대한 깊은 이해 및 지원 등을 기반으로 하는 의사-의사 간의 관계, 긴 시간 신뢰를 쌓은 의사-환자 간의 관계 등은 원격진료의 발안 단계에서부터 실제적인 이용과 응용의 단계까지 두루 걸쳐 일본에서만 보여지는 지역화의 특성을 결정짓는다. 결론적으로 오프라인에서 형성된 개인적 차원의 관계(게마인샤프트)가 온라인상의 공적 차원(게젤샤프트)의 서비스로 전환되는 현상이 일본 원격진료의 지역화에서 보여지는 고유한 양식이라고 할 수 있다. 이는 하나의 현을 중심으로 하는 사회, 경제, 문화적인 특성들이 원격진료에서도 고스란히 투영되어 나타나기 때문인 것으로 파악된다.

Keywords

References

  1. Abou-Shaaba, R. R. A., and Niazy, E. M., 1991, Telemedicine and telepharmaceutical services: a model to improve maldistribution of medical resources between regions and urban/rural sectors in the Kingdom of Saudi Arabia, GeoJournal, 25, 401-412. https://doi.org/10.1007/BF02439492
  2. American Telemedicine Association, 2010, About telemedicine, http://www.atmeda.org/news/library.htm (last accessed Augusts 31, 2010).
  3. Andrews, G.. and Kitchin, R., 2005, Geography and nursing: convergence in cyberspace?, Nursing Inquiry, 12, 316-324. https://doi.org/10.1111/j.1440-1800.2005.00291.x
  4. Bashshur, R. L., Reardon, T. G., and Shannon, G. W., 2000, Telemedicine: a new health care delivery system, Annual Review of Public Health, 21, 613-637. https://doi.org/10.1146/annurev.publhealth.21.1.613
  5. Braa, J. and Hedberg, C., 2002, The struggle for districtbased health information systems in South Africa, The Information Society, 18, 113-127. https://doi.org/10.1080/01972240290075048
  6. Capalbo, S. M. and Heggem, C. N., 1999, Innovation in the delivery of health care services to rural communities: telemedicine and limited-service hospital, Rural Development Perspectives, 14, 8-13.
  7. Church, J. and Barker, P., 1998, Regionalization of health services in Canada: a critical perspective, International Journal of Health Services, 28 (3), 467-486. https://doi.org/10.2190/UFPT-7XPW-794C-VJ52
  8. Cutchin, M., 2002, Virtual medical geographies: conceptualizing telemedicine and regionalization, Progress in Human Geography, 26, 19-39. https://doi.org/10.1191/0309132502ph352ra
  9. Demiris, G., Speedie, S. M., and Hicks, L. L., 2004, Assessment of patients' acceptance of and satisfaction with teledermatology., Journal of Medical Systems, 28, 575-579.
  10. DeVerteuil, G., 2000, Reconsidering the legacy of urban public facility location theory in human geography, Progress in Human Geography, 24, 47-69. https://doi.org/10.1191/030913200668094045
  11. Donabedian, A., 1984, Volume, quality, and the regionalization of health care services, Med Care, 22 (2), 95-97. https://doi.org/10.1097/00005650-198402000-00001
  12. Dyb, K. and Halford, S., 2009, Placing globalizing technologies: telemedicine and the making of difference, Sociology, 43, 232-249.
  13. Frey, K. A. and Bratton, R. L., 2002, Role of Telemedicine in the Health Care Delivery System, Journal of the American Board of Family Medicine, 15, 170-171.
  14. Gilbert, M. R., Masucci, M., Homko, C., and Bove, A. A., 2008, Theorizing the digital divide: information and communication technology use frameworks among poor women using a telemedicine system, Geoforum, 39, 912-925. https://doi.org/10.1016/j.geoforum.2007.08.001
  15. Gilmour, E., 1998, Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study, British Journal of Dermatology, 139, 81-87. https://doi.org/10.1046/j.1365-2133.1998.02318.x
  16. Glasgow, A., 2002, Locating telemedicine satellite hub sites in the Gulf of Mexico. ESRI Map Book Gallery,18. http://gis.esri.com/library/userconf/proc02/pap0171/p0171.htm (last accessed Augusts 31, 2010).
  17. Graham, S. and Marvin, S., 1996, Telecommunications and the city - electronic spaces, urban places, Routledge, New York.
  18. Grigsby, J., Brega, A. G., and Devore, P. A., 2005, The evaluation of telemedicine and health services research, Telemedicine and e-Health, 11, 317-328. https://doi.org/10.1089/tmj.2005.11.317
  19. Grimson, J., 2001, Delivering the electronic healthcare record for the 21st century, International Journal of Medical Informatics, 64, 111-127. https://doi.org/10.1016/S1386-5056(01)00205-2
  20. Hara, K., 2009, The present condition and models of the Japanese medicine, Japanese Journal of Telemedicine and Telecare, 5, 80 (in Japanese).
  21. Hasegawa, T. and Murase, S., 2007, Distribution of telemedicine in Japan, Telemedicine and e-Health, 13, 695-702. https://doi.org/10.1089/tmj.2007.0013
  22. Kahn, J. M., Asch, R. J., Iwashyna, T. J., Haynes, K., Rubenfeld, G. D., Angus, D. C., and Asch, D. A., 2009, Physician attitudes toward regionalization of adult critical care: a national survey, Critical Care Medicine, 37 (7), 2149-2154. https://doi.org/10.1097/CCM.0b013e3181a009d0
  23. Kitchin, R. M., 1998, Toward geographies of cyberspace, Progress in Human Geography, 22 (3), 385-406. https://doi.org/10.1191/030913298668331585
  24. Kim, K. Y., Shin, J. Y., Lee, K.H., and Cho, D.H, 2009, A location model and algorithm for visiting healthcare districting for the rural elderly, Journal of the Korean Geographical Society, 44(6), 813-831 (in Korean).
  25. Lewis. S. and Kouri. D., 2004, Regionalization: making sense of the Canadian experience, Healthc Pap, 5 (1), 12-31.
  26. Lucas, H., 2008, Information and communications technology for future health systems in developing countries, Social Science and Medicine, 66, 2122-2132. https://doi.org/10.1016/j.socscimed.2008.01.033
  27. Maenpaa, T., Suominen, T., Asikainen, P., Maass, M., and Rostila, I., 2009, The outcomes of regional healthcare information systems in health care: a review of the research literature, International Journal of Medical Informatics, 78, 757-771. https://doi.org/10.1016/j.ijmedinf.2009.07.001
  28. McLaughlin, M. L., Osborne, K. K. and Smith, C.B., 1995, Standards of conduct on Usenet, In Jones, S.G. (Ed.), Cybersociety: computer mediated communication and community, London, Sage.
  29. Mihara, M., 2004, Telemedicine and Accessibility: a case of Hukushima prefecture, Proceedings of The Association of Japanese Geographers, Tokyo (in Japanese).
  30. Mills, A., 1990, Decentralization concepts and issues: a review, In Mills, A., Vaughan, J.P., Smith, D. L., and Tabibzadeh, I. (Eds.), Health system decentralization: concepts, issues and country experience, Geneva, World Health Organization.
  31. Nguyen, Y. L., Kahn, J. M., and Angus, D. C., 2010, Reorganizing adult critical care delivery: the role of regionalization, telemedicine, and community outreach, American Journal of Respiratory and Critical Care Medicine, 181, 1164-1169. https://doi.org/10.1164/rccm.200909-1441CP
  32. Norris, A. C., 2002, Essentials of telemedicine and telecare, John Wiley and Sons, New York.
  33. Norris, T. E., Hart, G. L., and Larson, H., 2002, Lowbandwidth, low-cost telemedicine consultations in rural family practice, The Journal of the American Board of Family Medicine, 15, 123-127.
  34. Oudshoorn, N., 2009, Physical and digital proximity: emerging ways of health care in face-to-face and telemonitoring of heart-failure patients, Sociology of Health and Illness, 31, 390-405. https://doi.org/10.1111/j.1467-9566.2008.01141.x
  35. Park A, S. K., 2004, Telemedicine in Korea: spatial characteristics of the referral system between hospitals and clinics. Journal of Geography, 41, 81-100 (in Korean).
  36. Park B, S. K., 2010, Geographical characteristics of telemedicine in Korea and Japan, Geographical Review of Japan, 83 (1), 32-46. https://doi.org/10.4157/geogrevjapanb.83.32
  37. Park C, S. K., 2010, The centralization and decentralization of telemedecine networks in Korea: case studies of Choongbook and Kagawa, Netcom, 24, 79-108.
  38. Reid, J., 1996, A telemedicine primer: understanding the issues, Innovative Medical Communications, New York.
  39. Rheingold, H., 1994, The virtual community: surfing the Internet, Minerva, London.
  40. Shannon, G.. W., 1997, Telemedicine: restructuring rural medical care in space and time, In Bashshur, R. L., Sanders, J. H., and Shannon, G. W. (Ed.), Telemedicine: theory and practice, America Thomas Books, Illinois.
  41. Shannon, G. W., Nesbitt, T., Bakalar, R., Kratochwill, E., Kvedar, J., and Vargas, L., 2002, Organization models of telemedicine and regional telemedicine networks, Telemedicine and e-Health, 8, 61-70. https://doi.org/10.1089/15305620252933400
  42. Smith, D. M., 1977, Human geography: a welfare approach, Edward Arnold, London.
  43. Solomon, M. R., 2007, Regional health information organizations: a vehicle for transforming health care delivery?, Journal of Medical Systems, 31, 35-47.
  44. Takahashi, T., 2001, The present and future of telemedicine in Japan, International Journal of Medical Informatics, 61, 131-137. https://doi.org/10.1016/S1386-5056(01)00135-6
  45. Tanriverdi, H. and Iacono, C.S., 1999, Diffusion of telemedicine: a knowledge barrier perspective, Telemedicine Journal, 5, 223-244. https://doi.org/10.1089/107830299311989
  46. Tatara, K. and Okamoto, E., 2009, Japan-health system review,http://www.euro.who.int/Document/E92927.pdf (last accessed 31 October 2009).
  47. Tonnies, F., 1988, Community and Society (Gemeinschaft und Gesellschaft), Transaction Publishers, New Jersey.
  48. Wang, H., Xiong, W., Hupert, N., Sandrock, C., Siddiqui, J., and Bair, A., 2009, Concept of operations for a regional telemedicine hub to improve medical emergency response, Proceedings of the 2009 Winter Simulations Conference, Texas.
  49. Warf, B., 2000, Compromising positions - the body in cyberspace, In Wheeler, J.O., Aoyama, Y., and Warf, B. (Ed.), Telecommunications age - the fracturing of geographies, Routledge, New York.
  50. Whitten, P. and Love, B., 2005, Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautions enthusiasm, Journal of Postgraduate Medicine, 51, 294-300.
  51. WHO (World Health Organization). (n.d.). eHealth for health-care delivery - strategy 2004-2007, http://www.who.int/eht/en/eHealth_HCD.pdf (last accessed October 31, 2009).
  52. Yamada, T., 2001, History of way in Japan, Yoshikawakoubunkan, Tokyo (in Japanese).