1. Shimizu S, Kudo K, Antoku Y, Nakashima N Telemedicine Development Center of Asia, Kyushu University Hospital, Fukuoka, Japan www.temdec.med.kyushu-u.ac.jp/eng/index.php June 18, 2015, TNC, Porto Telemedicine project in Asia-Pacific: Changing needs and current problems

2. Today’s menu Background Activities Changes Kyushu Univ., Fukuoka

3. Key-hole operation: Open Endoscopic Many doctors want to learn the new surgeries. Big medical needs

4. Int’l Teleconf/Live demo Expensive! Satellite ISDN/Narrow Poor image! ? 1990s

5. Specific characteristics/conditions in telemedicine  High resolution  Moving images  Varieties at each hospital ＊ Common videoconference 1. Sit in front of monitor 2. Slides at most 3. Uniform equipment

6. Our project started in 2002 Korea- Japan: Big Broadband Network (2G). Korea- Japan: Big Broadband Network (2G). Japan Korea Network revolution

7. Mbps Compressed, degraded Original quality Big broadband Internet Clear & Smooth Movie transmission Cheap & Simple

8. Key technologies DVTS (Digital video transport system) Academic network (Research and education network) 2000s Only method to satisfy doctors.

9. Today’s menu Background Activities Changes Kyushu Univ., Fukuoka

10. KR China Gastric cancer Indonesia Thailand India Vietnam Malaysia JP Taiwan Singapore Philippines Recovery Less cost Back to work Endosc Early Admission Recurrence Death Ope Advanced Diagnosis and treatment Early detection is very important!

11. China-Japan Early Gastric Cancer Teleconference Tokyo/JP Fukuoka/JP Shanghai/CN 2011.11.15 Beijing/CN For diagnosis Video

12. Endoscopic Demonstration in Asia & Europe Bangkok, TH Kyoto, JP Hamburg, GR Kuala Lumpur, MY Taipei, TW Xian, CN Fukuoka, JP Seoul, KR 2007.8 For treatment: Endoscopic resection Video

13. Laparoscopic gastrectomy: Asia to Europe Tokyo/JP Fukuoka/JP Shanghai/CN 2009.10 Trondheim/NO Video

14. Bird Flu Teleconference: Infection 2007.1.24 Indonesia VietnamPhilippines Australia USA China ThailandJapan Dengue Ebola MERS

15. 2004.7 Sapporo 2004.1 Beijing 2004.12 2005.1 Tokyo Bangkok Shanghai Singapore Kuala Lumper NUS 2004.7 2004.1 Brisbane Manila Philippine U BandungITB 2005.11 2005.6 Iwate 2005.7 2005.11 Taichung New Dehli ERNET 2004.10 HaLong 2006.6 2006.7 Taipei Mumbai Tata MH 2003.2 Jilin Jakarta, UI Hanoi MelbourneSydney Auckland 2007.3 Canberra ANU Hawaii Ho Chi Min Cho Rai Hosp 2007.1 Before 2005 After 2008 2006 - 2007 2007.1 Adelaide Flinder’s Hosp 2005.11 2007.3 California 2007.1 Stanford, UC Irvine Hong Kong Chile Fukuoka Yokohama Cairnes Egypt Cairo U 2007.8 ＜ Asia Medical Project ＞ 55 countries 389 institutions 537 programsSeoul Europe South Africa

16. Today’s menu Background Activities Changes Kyushu Univ., Fukuoka

17. Choice of new technologies DVTS Vidyo Image quality Equipment Network Global IP Mobile Bottom line u-SD PC Big (30) Yes No Network c-HD Server, PC Small (2) No Easy Sending image HD-H323 c-HD VC system Small (2) Yes MCU *One-way streaming is another handy option. 2010s

18. Changes in Systems DVTS Vidyo H323

19. Changes in: REN vs Commercial Non- REN Newly connected institution /year REN

20. “Network threshold is decreasing ” H H H H NOW H H H H H H H H H H H H H H H H H 10 years ago H H H H H H REN DVTS Commercial Network HD-H323 Vidyo

21. Live surgery Japan to North America 2012.12.7 Tokyo => New York (2012), Canada (2014) with HD-H323 Bariatric surgery

22. Global endoscopic conference with Vidyo 2012.8.28 IN LK TW KR GE IN KR SG HK Video

23. Teleconference with Latin America: Vidyo Osaka, JP INNCZ, MX MX BR Alemana, CL Cali, CO La Paz, BO KUH, JP 2015.3.12.

24. Success and Failures in Telehealth, 4 th Annual Meeting of he Australian Telehealth Society Conclusions 1.There is no doubt that REN can provide better quality and that the network is much more stable. 2.However, the connectivity to hospitals is less with RENs, and more telemedicine has recently been done with commercial NWs with tech. development. 3.We may have to reconsider the role of RENs for telemedicine with the changing environment. EngineersMedical Staff