Advancement in Pediatric Medicine through Online Consultations

Masahiro Kami, M.D., Ph.D.

Executive Director, Medical Governance Research Institute, Tokyo, Japan

63% of Online Consultation Users are Pediatric Patients

How is the medical field changing due to the coronavirus pandemic? My focus is on the proliferation of online consultations, especially within pediatrics, which seems to be a well-suited domain.

In January 2023, physicians at Stanford University in the United States reported in the Journal of Family Medicine that 43% of their consultations for 12 to 18-year-olds were conducted online. This trend was also prominent at Navitas Clinic in Tokyo, where I work. In our Kawasaki branch, 63% of those who used online consultations in 2020 were pediatric patients.

The proliferation of online consultations has accelerated advancements in pediatric medicine. A symbolic manifestation of this came on March 16th, when physicians at the University of Colorado in the United States presented a clinical study in the New England Journal of Medicine (NEJM). They reported that by using a 'closed-loop control system,' they had improved blood sugar management in children with Type 1 diabetes. The study, which was conducted between April 2021 and January 2022 during the height of the pandemic, targeted children between 2 and 6 years of age. 81% of patients received training for handling the 'closed-loop control system' online.

Such achievements were made possible because the pandemic enabled the establishment of an online consultation infrastructure. Since last September, this was the fourth time that NEJM has published papers related to the 'closed-loop control system' for Type 1 diabetes. It is clear that the editorial team is focusing on process innovation in medical provision due to the proliferation of online consultations.

Medical Consultations and Interviews Accumulated as Digital Data

The impact of online consultations does not end here. Records of medical interviews and examinations are stored as digital data - a veritable treasure trove. Recently, NEJM announced its collaboration with Microsoft to launch an online platform called 'NEJM AI'. In April 2021, Microsoft acquired Nuance Communications, which develops software for voice recognition using AI.

On March 21st this year, the company announced a new version utilizing GPT-4, the latest edition of Chat-GPT. Interactions between patients and physicians are automatically stored and analyzed using AI. The results will be published as academic papers on NEJM AI. We, too, must ride this wave.

Station-Clinics Fulfilling the Shortage of Pediatricians

However, pediatric medicine cannot be entirely conducted through online consultations. In the case of Navitas Clinic, most pediatric patients using online consultations also utilize face-to-face consultations.

A significant issue in our country is the shortage of pediatric clinics, particularly in urban areas. If you use 'Hospital-Navi' to search for practicing pediatric clinics in Minato Ward, in the richest area in the center of Tokyo, there are only three exclusive pediatric clinics. The high overhead costs in city centers might be making it difficult for exclusive pediatric clinics to operate.

So, what should be done? I believe convenience station clinics, like Navitas Clinic, can provide a useful model. The advantage of these clinics lies in their accessibility, conveniently located along daily commuting routes for both patients and physicians.

In the case of the Kawasaki branch, the daily average number of patients was 374 in 2019, before the pandemic. Out of these, 114 were pediatric cases. Dr. Kenzo Takahashi, a pediatrician, noted, "Some patients use the train and come from nearby stations. Among them are those who, after finishing work, bring their children who have been in daycare." Approximately 10% of the patients come from places more than 10 kilometers away using the railway.

Patients travel from far distances because the clinic is "open until 9 PM" (a comment from a guardian). Navitas Clinic can stay open late due to its convenience, which makes it easier to secure part-time physicians. Dr. Takahashi also works as a professor at the Graduate School of Teikyo University, and he lives in Matsudo. It takes about 50 minutes from Kawasaki Station to Matsudo Station.

A Medical Model of Setting Up Clinics at Stations

Navitas Clinic began as part of the "Station Renaissance" initiative by East Japan Railway company (JR East), opening at Tachikawa Station in Tokyo in June 2008. The driving force behind this was Ms. Yumiko Kamada, then President of Ecute Co.

Ms. Kamada repeatedly expressed, "We want to make the station user-friendly. To do that, we want to set up a clinic that serves children and women." Without going into detail, Navitas Clinic has received various forms of support from the people of JR East Japan.

I wonder if it would be beneficial to spread this model. Both railway companies and medical institutions are public service organizations. Wouldn't it be worthwhile for them to collaborate for the sake of children? It is bound to contribute to supporting child-rearing in our country.