Digital Transformation in Cardiology ― Mobile Health ―
Article ID: CJ-24-0654
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Article ID: CJ-24-0654
The World Health Organization recognizes digital health as a key driver for sustainable health systems. Digital health is broad concept that refers to the use of digital technologies to improve health and healthcare. Mobile health is part of digital health and refers to the use of mobile devices such as smartphones, tablets, and wearable gadgets to deliver health-related services. By proactively utilizing personal health records from mHealth, in conjunction with electronic health records, advanced medical practices can be achieved. This integration facilitates app-based patient education and encouragement, lifestyle modification, and efficient sharing of medical information between hospitals. Beyond emergency care, information sharing enables patients to visit multiple healthcare facilities without redundant tests or unnecessary referrals, reducing the burden on both patients and healthcare providers.
Japan’s medical care system has relied on the long working hours of physicians, but with a super-aging society and a decreasing number of healthcare providers, this reliance is unsustainable. To ensure the quality and safety of medical care, a healthy work environment for doctors is crucial.
Reforms in regional healthcare delivery, task shifting and sharing are necessary, given Japan’s lower number of doctors compared with other Organization for Economic Co-operation and Development countries (https://stats.oecd.org/index.aspx?queryid=30171).
The Ministry of Health, Labor, and Welfare’s “Medical Digitalization by 2030” proposal outlines a comprehensive plan to standardize and externalize healthcare data, aiming to enhance efficiency, reduce administrative burdens, and improve care coordination. (https://www.mhlw.go.jp/stf/newpage_28128.html). This proposal includes cloud sharing of electronic medical record data with 3 documents (health check results, referral letters, and discharge summaries) and 6 key pieces of information (disease names and onset, allergies, drug contraindications, drug prescription, infectious history, medical examination). Access to these data will enable medical institutions, nursing facilities, and local governments to build and link medical information infrastructure, enabling efficient medical operations and optimized infrastructure. Digitizing and standardizing the medical fee system will reduce the burden on medical institutions and system vendors and make it possible to quickly and efficiently update information in response to medical fee revisions. This review discusses the rapid digital evolution in cardiovascular (CV) medicine in particular.
The United Nations Sustainable Development Goals (SDGs) include 17 goals to be achieved by 2030 (https://sdgs.un.org/goals). Health has a central place in SDG3, “Good health and well-being”. Through technology, a greater number of people can access the services and data that may have previously been inaccessible or unaffordable. Digital technologies are essential components for health systems and universal health coverage. The World Health Organization has identified digital health as a key driver for sustainable health systems (https://www.who.int/publications/i/item/9789240020924). Digital health can integrate data across services; provide electronic decision support, resources, and interventions; improve patient–provider communication; and develop digital devices for monitoring and positive behavior change.
For patients who live in remote areas without medical facilities, or for people whose busy work schedules make it difficult to visit the doctor, telemedicine can be the solution. This shift has begun since the COVID-19 outbreak. As of March 31, 2023, only 16% of clinics or hospitals in Japan offer remote visits, up from 9.7% in 2020. However, this number includes remote visits via telephone, not necessarily online visits (https://www.mhlw.go.jp/content/001237012.pdf).
Singapore, a leader in digital health in Asia, has implemented Smart Nation health initiatives such as assistive technology, robotics in healthcare, HealthHub and TeleHealth. HealthHub is a one-stop portal for accessing medical records, laboratory results, prescriptions, doctor’s appointments, referrals, and payment. TeleHealth offers efficient online consultations.
Oschner Digital Medicine in the USA is among the most advanced, allowing patients with conditions such as hypertension and diabetes to monitor their health from home. Data are connected to an electronic health record (EHR), enabling real-time care team collaborations. The Centers for Medicare & Medicaid Services (CMS) promotes healthcare interoperability by adopting the FHIR (Fast Healthcare Interoperability Resources) standard and requiring regulated payers to implement patient access application programming interfaces (APIs) to access their health information via smartphones. The Medicare/Medicaid Promoting Interoperability program encourages the use of HL7-FHIR and APIs while ensuring compliance with the “Privacy Rule” and “Security Rule” under the HITECH Act to protect electronic health information.
In contrast, Japan faces significant challenges in achieving digital health integration, particularly in connecting personal health devices. One major obstacle is the concern over the Personal Information Protection Act, which imposes strict regulations that hinder the seamless sharing and utilization of health data. Additionally, the low rate of smartphone adoption among the elderly limits their access to digital health tools, further slowing progress. The slow adoption of the Individual Number Card (My Number) has also delayed efforts to integrate and standardize personal health information. Japan’s insurance system does not cover digital health using personal health records (PHRs). Moreover, there has been limited progress in enabling hospitals to share medical records via the cloud, which impedes coordination and interoperability across institutions. These factors underscore the gap between Japan’s ambitious goals for digital transformation and the practical challenges of implementation.
Monitoring and controlling risk factors for CV disease (CVD) is crucial for health promotion and prevention. Mobile health (mHealth), the use of mobile devices and wearables to support healthcare delivery and patient care, plays a key role. The American Heart Association’s “Life’s Essential 8” includes 8 components of CV health: healthy diet, participation in physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure (BP).1,2 mHealth is an ideal tool for monitoring these factors, helping track physical activity, body weight, BP, smoking habits, and dietary intake. By doing so, mHealth can effectively support lifestyle modifications and help individuals achieve the goals of the Essential 8. Consumer devices using bioimpedance technology, including smart scales, smart watches, and smart rings, may interfere with patients with cardiac implantable electronic device.3
Heart rhythm recording system has 2 types: ECG-based systems and non-ECG-based systems, including photoplethysmography (PPG) (Figure 1). The choice of the device depends on the patient’s preference and the frequency and duration of the symptom. Even with the ECG-based recording, physician confirmation is mandatory for correct diagnosis.4
Heart rhythm recording systems. There are mainly 2 types: ECG-based systems and non-ECG-based systems, including photoplethysmography (PPG).
Handheld ECG Most handheld devices (e.g., the Omron HCG-801, Alivecor Kardia Mobile, MyDiagnostick, Snap ECG E-H19) have 2 electrodes and record a single lead (lead I) ECG by holding the device with both hands. The Alivecor Kardia Mobile®6L, with its 3 electrodes, allows the recording of 6 limb leads when held with both hands and placed on the left leg.
ECG Patches As of August 2024, various ECG monitoring patches are available in Japan (e.g., AT-Patch, Rooti Rx, eMemo). These patches offer 7–14 days of continuous, waterproof, and wireless recording. However, they are reimbursed as 24-hour Holter monitoring in Japan.
Smartwatch ECG Several smartwatches can record a 30-s single-lead ECG using 2 electrodes: 1 on the back of the watch and the other on the crown or band. The ECG trace is stored in a mobile app, with the option to generate a PDF. Typically, lead I is recorded, but leads II and III can be obtained by placing the watch on the ankle or the leg and touching the crown with a right-hand finger for lead II, and a left-hand finger for lead III.5
BP MonitoringSeveral recent hypertension guidelines, scientific statements and position papers recommend self-measured BP monitoring.6,7 Many self-monitoring BP devices store and transmit the data to mobile phone apps using Bluetooth or Wi-Fi communication. The transmitted data can be shared with the patient’s care team for more effective BP management. The use of validated devices with appropriately sized cuffs is recommended for proper home BP monitoring.8 Omron’s BP monitor uses the smartphone to record the ECG while measuring BP, which allows periodic measurement of BP, heart rate and ECG.9
Body Weight RecordingSmart scales track weight over time, either by storing it in the scale or transmitting it to an app via Wi-Fi or Bluetooth, and some are called body composition scales or IoT scales because they provide information such as body fat, bone mass, muscle density, etc. Body composition monitors and body fat monitors measure body fat by passing a weak electrical current, so the manufacturer’s recommendation was not use them in patients with cardiac implantable electrical devices. However, recent evaluations have shown no interference.7,10
Recently, the result of a weight loss program using an AI-powered digital platform for lifestyle intervention platform were published. SureMediks, a digital intervention platform was tested for weight loss over 24 weeks. It consists of (1) mApp to access the platform and communicate with the system for motivation, guidance, accountability, support, gamification and progress tracking, (2) a digital scale connected to a cloud server for an automatic report of the body weight, (3) a cloud server, and (4) an AI-expert system to provide tailored guidance to the participants. In this trial, all participants lost body weight with average 14%, suggesting digital technologies and AI might provide a successful way to lose weight.11
Body TemperatureDuring the COVID19 pandemic, researchers used wearable sensors for early detection of infected patients. Monitoring of the body temperature and heart rate as the most common vital signs is used for early detection and early response to stop the spread of communicable diseases such as COVID 19, Ebola, and influenza-like illness.12 In that study, HEARThermo, a watch-like wearable device was used to continuously monitor the body surface temperature and heart rate every 10 s. The system allowed the triggering of reminders sent by chatbots for further in-person measurement by ear thermometers.
There are many different kinds of temperature sensors, but only a few in wearable devices.13 For example, the iFever monitor can operate for 648 h, providing real-time temperature, giving a high temperature alarm, and cloud backup.
The development of remote monitoring has led to the early diagnosis and improved disease management of atrial fibrillation (AF), rapid and appropriate emergency medical treatment of myocardial infarction (MI), and improved efficiency in the management of chronic diseases such as heart failure (HF) and pulmonary arterial hypertension. mHealth will provide access to a larger population.
AdherenceThe WHO report on medication adherence for chronic diseases found an average of 50% adherence in developed countries and worse in developing countries. A stronger commitment to a multidisciplinary approach is needed to make progress. A systematic review of 420 free apps showed that the majority (220) used “reminder”, followed by reminder and behavior change (133) to increase adherence.14 Of the reminder strategies, push notifications were most used, followed by alerts and short message service (SMS).
AF Detection and ManagementEarly detection of AF Detection of asymptomatic paroxysmal AF is challenging with repeated conventional 12-lead ECG and Holter monitoring, and mHealth will be a good option. As mentioned previously, there are numerous devices that can detect AF by pulse irregularity with good sensitivity and specificity, and some allow ECG recording. Despite FDA approval to guide clinical care, they are “not intended to replace traditional methods of diagnosis or treatment” of AF.
The Apple Heart Study recruited more than 400,000 participants over 8 months and used the Apple Watch’s PPG sensor to detect and notify participants of irregular heart rhythms.15 For urgent symptoms, participants were directed to urgent care or a hospital’s emergency department. For non-urgent symptoms, they were mailed an ECG patch for further evaluation. Among those who used the ECG patch, 34% were diagnosed with AF. The Apple Watch’s irregular pulse detection had an 84% positive predictive value when compared with concurrent ECG patch recordings. However, limitations included reliance on self-reported data and nearly half of the participants did not contact the study physician after receiving a notification. Other wearable devices, such as Huawei,16 Fitbit,17 and EPSON watches18 have also demonstrated efficacy. According to the EHRA Practical Guideline, although PPG systems are accurate, ECG-based devices are preferred for diagnosis.19
In addition, the detection of AF using mHealth in embolic stroke of undetermined source (ESUS) has been studied. One study investigated the usefulness of a smartwatch–smartphone dyad for AF detection (Pulsewatch system) in detecting AF in stroke survivors.20 The Pulsewatch system demonstrated an AF detection accuracy of 92.9% (95% confidence interval (CI): 85.3–97.4%), with participants wearing the watch for an average of 21.2±8.3 days out of 30 days. That study demonstrated that a smartwatch system is a viable option for long-term arrhythmia detection in older adults at risk for AF.
Management and Evaluation In a prospective study comparing a smartwatch with a PPG-based algorithm to a continuous ECG patch for estimating AF burden, the PPG showed high performance.21 The interval-level sensitivity of the PPG was 96.3% (95% CI: 96.2–96.4%) and the specificity was 99.5% (95% CI: 99.5–99.6%). These data indicate that PPG is highly accurate and stable for AF monitoring, demonstrating its potential for diagnosing and managing AF.
As of June 2024, the AF History App has been approved in Japan, which allows long-term AF burden assessment using an Apple Watch worn for 12 h, 5 days/week.
Hypertension Management BP-lowering treatment reduces the risk of death and CVD when baseline systolic BP is >140 mmHg. At less than 140 mmHg, the treatment effect is neutral, though patients with coronary artery disease may still benefit.22 A digital intervention study in primary care found that self-monitoring of BP led to better systolic BP control after 1 year compared with usual care, with low incremental cost.23,24 However, another study showed that self-monitoring alone was ineffective; however, combining it with co-interventions such as medication titration, education, or lifestyle counseling led to significant BP reduction that lasted at least 12 months.25
HF ManagementHome-based interventions can effectively reduce and shorten hospitalizations for HF. The HOMES-HF study was the first multicenter, open-label, randomized controlled trial to elucidate the effectiveness of home telemonitoring of physiological data for Japanese patients with HF.26 There was no statistically significant difference in the primary endpoint (all-cause death or rehospitalization due to worsening HF). The HF Matters program (Heartfailurematters.org), launched by the European Society of Cardiology (ESC), is a platform designed to engage patients at home through its educational website, available in 10 languages.27 It offers symptom diaries, appointment reminders, medication charts, and educational videos. Daily weight monitoring is crucial for HF patients to track volume status, though adherence is often a challenge. mHealth technologies support this by providing reminders and electronic recording of weight using Bluetooth-capable scales.28 Patients using “Heart Sign,” an mHealth application for self-management of HF, maintained high adherence to input and significantly improved their KCCQ (Kansas City Cardiomyopathy Questionnaire) scores, which are used to assess the quality of life in HF patient.29 Some apps also alert physicians and HF clinics when predefined weight limits are exceeded. mHealth telemonitoring, symptom diaries, and mobile phone alerts have shown improvements in daily weight monitoring, quality of life, B-type natriuretic peptide levels, and left ventricular ejection fraction (LVEF).30,31
MImHealth enhances triage by enabling the prehospital transmission of 12-lead ECGs. The STAT-MI system, using Bluetooth-enabled defibrillators (LIFEPAK 12, Medtronic) and phones, resulted in significantly shorter door-to-balloon times (63 vs. 119 min, P<0.00004), lower peak troponin I (39.5 vs 87.6 ng/mL, P=0.005) and creatine phosphokinase-MB (126.1 vs. 290.3 ng/mL, P=0.001), higher LVEF (50 vs 35%, P=0.004), and shorter hospital stay (3 vs. 5.5 days, P<0.001). The transmission of 12-lead ECGs from the field led to early evaluation, triage, and treatment of patients with acute MI.32
Interactive mHealth apps for post-MI patients have improved medication adherence and reduced CV risk factors.33,34 In the TEXT ME study, a semi-personalized messaging system led to lower low-density lipoprotein cholesterol levels (79 vs. 84 mg/dL, P=0.04), systolic BP (128.2 vs. 135.8 mmHg, P<0.001), body mass index (29 vs. 30.3 P<0.001), and smoking rates (26 vs. 42.9%, P<0.001), and increased physical activity (932 vs. 587 MET min/week, P<0.001).33 The SUPPORT trial showed that a comprehensive mHealth app improved medication adherence and patient satisfaction (87.3 vs. 78.1, P=0.001) compared with a simplified tool.34
A meta-analysis of 155 studies showed that mHealth programs using wireless communication devices (e.g., mobile phones, smartphones, electronic tablets, and laptops) and/or software technology (apps, video and teleconferencing, email, telemonitoring, social media, and SMS communication), excluding telephone-only interventions, reduced all-cause hospitalizations (relative risk (RR): 0.68; 95% CI: 0.50–0.91), cardiac-related hospitalizations (RR: 0.55; 95% CI: 0.44–0.68), and emergency department visits (RR: 0.37; 95% CI: 0.26–0.54) compared with care without mHealth, but did not affect mortality or major adverse events rates.35
Pulmonary HypertensionPulmonary hypertension is a progressive disease in which functional capacity affects clinical outcome. A smartphone-based app for the self-administered 6-min walk test (6MWT app) strongly correlated with a staff-administered 6MWT (r=0.88, correlation of coefficient 0.87–0.86).36 A 12-week text message intervention increased physical activity in patients with pulmonary arterial hypertension, showing a significant improvement in steps (1,409 vs. −149 steps; P=0.02).37
DiabetesFindings on the effectiveness of mHealth technologies in reducing HbA1C levels or preventing type 2 diabetes in patients with prediabetes are mixed. However, mHealth interventions show promise in reducing body weight.38 In a study with 221 participants, remote support from clinical pharmacists via video, phone, and text message improved HbA1c levels compared with routine care from primary care physicians.39
Apple Watch has features that support users’ health in several areas, including heart health, walking, activity, and medication. Walking metrics on Apple Watch include not only cardiorespiratory fitness (maximum oxygen uptake) and 6-minute walk distance, but also other indicators of measuring walking quality (e.g., walking speed, stride length, double stance phase, and walking asymmetry). These metrics provide valuable information for predicting long-term wellness.
Behind the scenes, the Apple Watch monitors for significantly high or low pulse rates. If a user’s pulse rate exceeds 120 beats/min or drops below 40 beats/min during a 10-min rest period, the user receives a notification. Using an optical heart rate sensor, Apple Watch detects pulse waves on the wrist and measures changes in resting pulse rate intervals. If the algorithm repeatedly detects irregular pulse beats consistent with AF, the user receives a notification, and the date, time, and heart rate are recorded in the Health app.
The ECG app records a single-lead ECG, similar to lead I, using the electrical heart rate sensor built into the digital crown and back crystal. After recording the ECG, results are displayed for sinus rhythm, AF, high heart rate, and indeterminate or poor recording quality. In cases where the user has an implanted cardioverter defibrillator, a pacemaker, or a weak electrical signal due to right axis deviation, the result may be indeterminate. Recorded waveforms, results, dates, times, and symptoms can be exported as a PDF from the Health app for sharing with healthcare professionals.
Using the Cycle Tracking app on Apple Watch, female users can record details of their menstrual cycle and predict the start date of their next period. With wearing an Apple Watch Series 8 or 9 while sleeping, the app can improve menstrual cycle predictions and estimate ovulation using wrist skin temperature.
Users receive reminders for medication adherence and can review long-term medication usage. They can also track their sleep patterns, including time spent in REM, core, and deep sleep, as well as any awakenings.
From the Apple Watch Series 4 onwards, fall detection alerts allow users to quickly call emergency services. If the alert is not needed, it can be dismissed. If there is no response within 1 min, the watch automatically initiates an emergency call notifying the user’s emergency contacts.
Smart watches, such as the Apple Watch, offers a range of digital health features for daily health management, including heart rate monitoring, activity tracking, sleep analysis, heart rate variability, blood oxygen levels, BP measurement, and exercise recording (Figure 2). Some smartwatches also feature ECG recording, but as of August 2024, only Omron’s BP watch has FDA clearance. These devices can significantly aid disease prevention and lifestyle management by monitoring physical activity, dietary habits, and improving medication adherence. However, their effect on lowering BP, HbA1c and improving lifestyle habits such as smoking and alcohol consumption remains limited.40
Smart watch features. Most smart watches have basic features such as heart rate (HR) monitoring, activity tracker, sleep level and duration, heart rate variability, blood oxygen concentration, exercise recording, and additional features. AF, atrial fibrillation.
Daily Step Count and All-Cause and CV Mortality Rates
A meta-analysis of data from 226,889 people worldwide found that ≥4,000 steps per day reduced the risk of premature death from all causes.41 A 1000-step increase was associated with a 15% lower risk of all-cause death, while a 500-step increase was associated with a 7% lower risk of CV death. The health benefits of walking were seen across sex and age groups, but the greatest benefits were seen in people under the age of 60.
Health Planning Based on PHRDoctors should educate patients on the value of using PHRs to actively monitor their health, adopt preventive measures, and make informed lifestyle choices. Encouraging patients to regularly document key health metrics, such as BP, weight, physical activity, smoking status, and dietary habits, can empower them to take greater control of their well-being. Patients should also be informed that sharing their PHR data with their healthcare providers enables more accurate and efficient evaluations.
Furthermore, doctors should partner with patients to leverage PHR in setting specific health goals aimed at early disease detection, prevention of lifestyle-related conditions, effective chronic disease management, and overall health promotion. This collaborative approach can lead to the development of personalized health management plans that address individual needs and priorities.
SmokingCigarette smoking is the second leading cause of early death and disability in Japan, and the leading cause in the USA.42 It is linked with CV morbidity and mortality. A randomized trial with 2,415 smokers found that an acceptance and commitment therapy (ACT)-based smartphone app (iCanQuit) was 1.49-fold more effective in achieving smoking cessation at 12 months than a US clinical practice guidelines-based smartphone app (QuitGuide).43 Both apps offer education and craving management techniques.
Carrasco-Hernandez et al. evaluated the long-term efficacy of a mobile app providing AI-generated, tailored support messages. The app group had 2.75-fold higher abstinence rates in the per-protocol analysis (adjusted odds ratio (OR) 3.45, P=0.01) and 2.15-fold higher in the intention-to-treat analysis (adjusted OR 3.13, P=0.02).44
In Japan, CureApp SC is the first therapeutic application approved as a medical device approved since 2020. It supports patients with a standard outpatient smoking cessation program through personalized guidance, a carbon monoxide (CO) checker for at-home CO measurement, and a web-based PC app for physicians to monitor patient progress between clinic visits.45
RehabilitationCardiac rehabilitation (CR) is a Class I recommendation in the AHA/ACC guidelines for CVD, yet it remains worldwide due to accessibility and adherence issues. Digital technology offers promising solutions through 3 formats: (1) synchronous virtual rehabilitation (real-time remote exercise with clinician support), (2) remote in-person rehabilitation (patients exercise independently and clinicians review the data later), and (3) synchronous in-person rehabilitation (enhanced with digital tools while patients and clinicians are co-located).46 An AHA Science Advisory Committee supports the development of digital CR.47 A systematic review of the 34 studies shows digital CR leads to better adherence and comparable short-term outcomes, such as improved functional capacity, physical activity, self-efficacy, adherence, weight management, dietary habits, and quality of life.48 However, the effectiveness of virtual CR compared with traditional methods varies. The potential for increased adherence and long-term engagement makes digital CAR a promising alternative for broader adoption. The state of available technology and future directions are detailed in a review.46
mHealth has proven highly effective in secondary prevention of coronary artery disease by improving medication adherence, lowering BP, and reducing the recurrence of angina, transient ischemic attack, and stroke, with a trend towards decreased mortality rates.49 For HF, SMS interventions enhance self-care behaviors and improve readmission-free survival,50 while telemedicine reduces short-term CV-related hospitalizations and deaths.51 Ongoing research continues to explore the effects of mHealth apps in secondary prevention of heart disease, with more detailed outcomes expected in the future.
A collaboration with Brigham and Women’s Hospital and the American Heart Association to study the effect of exercise on heart health, by monitoring heart rate and signs of physical function, hospitalizations, and falls to improve CV outcomes.52
Apple Women’s Health StudyA large-scale, long-term study focused on menstrual cycles and gynecological conditions to provide insights into screening and risk assessment for conditions such as polycystic ovarian syndrome, infertility, osteoporosis, pregnancy, menopause, and more.53
Apple Hearing StudyLed by the University of Michigan, this study investigates headphone use, environmental sound exposure, and their effects on hearing and CV health, contributing data to the WHO’s Make Listening Safe initiative.54
The use of PHR information from smart devices, such as smartphones and smartwatches, has become increasingly active in healthcare due to advances in device technology. The effectiveness of smartphone apps for managing PHR data is becoming apparent, but the integration of PHR with EHRs is also essential, as is the proactive use of PHRs in routine medical care. In addition, cloud-based interconnectivity of medical information across different hospitals is necessary for modern healthcare.
As summarized in Figure 3, the first step is to encourage patients to proactively adopt a PHR using apps and other tools. Effective use of apps, such as those for heart disease, exercise, smoking cessation, and nutrition management, is critical to maintaining health in the digital era. App-based patient education can encourage and sustain interest in health. The data are also valuable to healthcare providers, helping to improve the quality of care and discover new insights.
Medical care in a new era. Integration and interaction between personal and electronic health records are anticipated. The patient’s smartphone serves as a hub connecting PHR and EHR data through cloud services, which allows real-time updates and access by both the patient and healthcare providers. AI, artificial intelligence.
When patients actively use their PHR, a wealth of information is recorded on smartwatches and smartphones. To leverage this data in healthcare, it is essential to access PHR information from EHRs via cloud platforms. Integrating the patient’s PHR into routine outpatient care makes advanced medical practices possible. Patients can conveniently view prescription details, outpatient appointments, test results, and treatment information – all consolidated on their smartphones.
Another critical aspect of the digital transformation of healthcare is the sharing of medical information between hospitals. Even if EHRs differ between hospitals, key medical information can now be shared via the cloud. Details such as prescriptions, test results, treatments, referrals and discharge summaries are accessible, making it easier to retrieve information and begin treatment quickly, even in emergency situations.
In Japan, the implementation of a Health Information Exchange (HIE) for sharing EHRs between hospitals is not yet widely adopted compared to the United States. Research from the USA has shown that participation in a HIE is associated with significant benefits, including a reduction in 30-day readmission rates following acute MI. The findings underscore the potential of a HIE to improve care coordination, enhance patient outcomes, and reduce healthcare costs by enabling timely access to critical patient information across healthcare facilities. Expanding HIE adoption in Japan could provide similar advantages, fostering more efficient and high-quality healthcare delivery.55 Beyond emergency care, information sharing enables patients to visit multiple healthcare facilities without redundant tests or unnecessary referrals, reducing the burden on both patients and healthcare providers.
When addressing data security and privacy, it is crucial to adhere to the specific security guidelines established in each country. In Japan, compliance with the Guidelines for the Security Management of Medical Information Systems, Version 6.0 is mandatory, outlining stringent cybersecurity measures and protocols for protecting personal information. In the USA, the Health Insurance Portability and Accountability Act (HIPAA) governs the secure handling of medical information, emphasizing privacy and data security. Similarly, in the European Union (EU), the General Data Protection Regulation (GDPR) sets comprehensive requirements for the protection, collection, storage, and processing of personal data. Healthcare institutions and medical device manufacturers operating in the EU must align with GDPR to ensure patient data is managed securely and ethically.
This review highlights the transformative effect of digitalization in healthcare. Wearable devices, such as the Apple Watch, are playing an increasingly pivotal role in monitoring PHRs and empowering patients to actively manage their health. The integration of EHRs with PHRs further enables healthcare providers to deliver more precise and efficient care, leading to improved patient outcomes. Additionally, the effective implementation of a HIE facilitates the seamless sharing of information between hospitals, ensuring timely and appropriate treatment. Together, these advancements are poised to usher in a new era of patient-centered care, driving innovation.
During the preparation of this manuscript, the authors used DeepL for the final editing stage.
K.S. has received honorarium for lecturing from Medtronic Japan, Abbott Japan. H.Y. has no conflict of interests.
