日本遠隔診療の空間的特性：香川県の事例を中心として

抄録

Telemedicine is the use of telecommunications to support professional advice to low-level health facilities and share the patient’s medical records among medical institutions for stable regional health care. K-MIX (Kagawa Medical Internet eXchange) is one of the representative telemedicine methods in Japan and has been skillfully devised in Kagawa prefecture since 2003. To date, there has been minimal research regarding Japanese telemedicine (Takano, 1995; Mihara, 2004; Park, 2008) from geographical and research on geographical characteristics of telemedicine is still in its early stage. Therefore, the purpose of this discussion is to describe how telemedicine is carried on by telemedicine suppliers and demanders and how telemedicine mechanism influences geographical characteristics through a case of Kagawa prefecture. K-MIX is organized by telemedicine suppliers, telemedicine demanders, Kagawa prefecture government, Kagawa medical association and data center (refer to figure 1), and its characters and conducts are influenced by each objective’s role and complementary cooperation. For this discussion, my attention is directed to 1) K-MIX’s formation process and its networks 2) influence to users 3) ripple effects using GIS, survey and interview. By and large, general hospitals in Kagawa prefecture take a role for telemedicine suppliers and other subordinate medical facilities as telemedicine demanders refer high-dimensional diagnosis or medical treatment to telemedicine suppliers through K-MIX. In addition, Kagawa prefecture government and Kagawa medical association are functioning as mediators for stable telemedicine management, and especially data center performs the administration and control of patients’ data securely. Above all things, their relations are closely connected with each other and some major innovators are leading the development of K-MIX for regional medical service. Fundamentally, telemedicine suppliers and demanders of K-MIX are distributed within Kagawa prefecture. On the whole, telemedicine suppliers are agglomerated in major cities in Kagawa prefecture, e.g., Takamatsu city, and telemedicine demanders are scattered widely through all regions as compared with telemedicine suppliers (refer to figure 2). Excepting for a case of Kagawa university hospital, each telemedicine network is based on each unit of city or town. Each network is influenced by existing diagnostic relations between suppliers and demanders, accessibility and utilization for patients and stable regional health care, and necessities of medical staffs. Some outlying medical institutions are related with telemedicine suppliers in Kagawa prefecture through K-MIX and new venture capitals associated with medical service come out in Kagawa prefecture nowadays. Even though telemedicine is operated on cyberspace, telemedicine in Japan is influenced by off-line circumstances and backgrounds for stable health care.