3. Overview of the Challenges Faced by Japanese Medical Device Companies

3.1 The demographic challenge in Japan: Population decline and a shrinking labor force

With respect to Figure 1, with an aging population, there is a possibility of reduced labor supply in the workforce, leading to a severe labor shortage in various industries. The healthcare sector may also face a shortage of medical professionals, particularly doctors and nurses. This shortage could potentially result in decreased quality and efficiency of healthcare delivery [1,2].

Decreased workforce could negatively impact economic growth. Reduced production and service capabilities could lead to a slowdown in the growth rate of the GrossDomestic Product (GDP). Additionally, the shrinking population might lead to acon traction in the domestic market and reduced consumer spending [3].

As shown in Table 1, the aging population could lead to an increase in social security expenses such as pensions and medical welfare. As the number of pension recipients grows along with the increase in healthcare and caregiving expenses, the sustainability of the social security system could be at risk [4,5].

The ability to adapt to technological advancements and changes in industries might decline. A decreased younger workforce could result in a lack of labor for adopting new technologies, potentially constraining innovation efforts. In the healthcare industry, this could lead to delays in the research and development of new treatments and medical technologies [6].

Figure1. Population and demographic structure in Japan [5]

Population decline could lead to changes in local communities. Especially in rural areas, an increasing proportion of elderly residents coupled with a decreasing younger population could impact the local economy and social infrastructure.Disparities in healthcare provision might also widen in rural regions, where shortages of medical facilities and specialists could affect residents' access to healthcare [7].

The growing elderly population might lead to an increase in the number of people requiring care. This could result in a higher demand for caregiving facilities and home care services, potentially affecting the supply structure of care giving services [8,9,10].

Mobile health applications utilizing smartphones and wearable devices are expanding.Mobile health apps for health management, medical information sharing, and communication with physicians are becoming competitive. Notable JapaneseCompanies are m3, Inc., PeptiDream Inc., Medley, Inc., and GangFood [13].

3.2 Labor force challenges in the medical device industry

Solutions utilizing digital technology for healthcare are gaining attention. Technologies such as health monitoring, telemedicine, and remote diagnosis support effective treatment and management, making it a competitive field. Notable Japanese companies in this field are SONY, Panasonic, Mitsubishi Electric, Hitachi, NEC, and DENSO WAVE [11].

Efforts to apply robotics technology in the medical field are underway. The development of surgical robots and automated medical devices aims to improve surgical precision and efficiency. Notable Japanese companies for robotics are Cyberdyne, MedRobotics, Riken Keiki, and OKI Electric Industry [12].

Medical imaging technology (MRI, CT, ultrasound, etc.) is essential for disease diagnosis and treatment planning. Advances in imaging technology, such as image analysis, high-resolution imaging, and new contrast agents, contribute to competitiveness. Notable Japanese companies are Canon Medical SystemsCorporation, Fuji film Holdings Corporation, Canon Medical Systems Corporation, and Shimadzu Corporation [13].

Biotechnology plays a crucial role in drug discovery and diagnostics. Applications of advanced biotechnology, such as biomarker discovery, gene therapy, and bio printing, have the potential to create a competitive advantage. NotableJapanese companies are Daiichi Sankyo, Chugai Pharmaceutical, Astellas Pharma, Olympus Corporation, and Takeda Pharmaceutical.

Artificial intelligence (AI) and machine learning are used for data analysis and diagnostic support. AI adoption facilitates efficient healthcare provision, including image analysis, disease prediction, and treatment optimization. NotableJapanese companies are Preferred Networks (PFN), Iyoda PharmaceuticalCorporation, Rakuten Medical, Hacarus, and IRIS OHYAMA Inc [13].

The medical device industry relies on technological advancements, and the pace of research and development could slow due to a declining workforce. This might result in decreased competitiveness and challenges in delivering innovative medical solutions [14].

Medical device manufacturing requires advanced technology and skilled workers. Reduced productivity due to a smaller workforce could lead to supply disruptions, potentially causing an inability to meet demand [15].

The medical device industry relies on professionals with specialized knowledge, such as engineers and researchers. Workforce reduction could make it difficult to secure appropriate talent, hindering progress on new projects and tasks.

An aging society may lead to significant changes in healthcare needs and market dynamics. Quick adaptation and appropriate product development are crucial to address new health issues and demands. A smaller workforce might hinder these adaptations [16].

If Japan's industries cannot maintain competitiveness due to workforce reduction, there is a risk of declining international market share and weaker competitiveness against foreign companies.

3.3 Current training, maintenance, and customer service challenges of medical device companies in Japan

During the expanding medical equipment market and increasing demand, there is a shortage of technicians and experts with the appropriate skills. The required workforce includes individuals with knowledge and experience in both medical and mechanical engineering, as well as digital technologies such as AI and IoT.Securing suitable personnel proves to be challenging and may lead to a compromised quality of training and maintenance [17].

The medical equipment industry witnesses’ rapid technological advancements, frequently introducing new products and features. Consequently, technicians and customer service representatives need to undergo training on these novel technologies and products, which can pose challenges. Particularly in Japan's medical diagnostic equipment sector, there exists a certain level of international competitiveness, yet the therapeutic equipment sector lags majorWestern companies in terms of market share and competitiveness [18].

Maintaining quality communication with customers and delivering effective customer support can be problematic. Failing to comprehend customer requests and issues adequately and provide efficient support may lead to decreased customer satisfaction and potential erosion of trust. To address this issue, stronger collaboration between medical institutions and medical equipment companies is essential, leveraging the wealth of collected customer data. In doing so, it is imperative to prioritize the protection of personal information [19].

3.4 Other challenges faced by Japanese medical device companies

The technology of medical equipment has become increasingly advanced, and the integration of digital technology is progressing. However, there is a notable shortage of personnel possessing suitable skills in this field. Especially, individuals who possess a fusion of medical knowledge and engineering expertise are in demand, and matching these skills has proven challenging [20].

The technology of medical equipment is rapidly evolving, leading to frequent introductions of new products and features. Swift implementation and training to keep up with these changes are required, but this can entail time and cost[21].

The medical equipment industry must adhere to strict regulatory and compliance requirements. The development and introduction of new technologies and products necessitate meticulous regulatory compliance and approval processes, demanding the allocation of time and resources [22].

With respect to Figure 3, within the medical device industry, the conventional competition with existing competitors continues as before. On the other hand, on the periphery, companies aiming for new market entry and alternatives based on new technologies are emerging, capitalizing on the opportunity presented by technological innovation, specifically "smart healthcare" (digital disruption). Furthermore, there is growing pressure from regulatory authorities for "strengthened regulations" (ensuring safety and security), along with increased transparency in relationships with medical institutions and healthcare professionals, in other words, the pressure for "ethics enhancement" (compliance) [23].

Competition with Western companies is intensifying, requiring Japanese medical equipment companies to maintain and enhance their international competitiveness. Efforts are necessary to sustain competitiveness in terms of quality, innovation, and cost efficiency. Effective customer support is indispensable for elevating customer satisfaction regarding medical equipment. Swift and appropriate provision of services such as problem-solving, training, and technical support is crucial. The evolution of digital technology has led to increased connectivity of medical equipment to networks. With this digitalization comes arise in cybersecurity threats, emphasizing the need for adequate security measures. To address these challenges, medical equipment companies are advancing initiatives in innovation, efficiency, workforce development, international expansion, improvement of customer satisfaction, and strengthening of cybersecurity [24].

3.5 Role of remote services for training, maintenance, and customer service in Japan

The progress of digital technology has made remote communication easier, enabling real-time communication even from distant locations. As a result, medical equipment companies can now provide remote support without the need to dispatch experts on-site for training or maintenance.

Remote services offer an efficient approach by reducing the expenses associated with experts' travel and accommodation. Additionally, medical equipment companies can optimize limited resources and allocate them effectively [25].

Swift response is crucial when issues or malfunctions arise with medical equipment.Through remote services, experts can diagnose problems from a distance and provide instructions, enabling quicker resolutions [26].

Remote services are also utilized for training medical equipment personnel and sharing specialized knowledge. Experts can conduct remote training sessions and provide necessary skills and knowledge to staff in remote locations [27].

GivenJapan's geographical expanse, providing training and maintenance for medical equipment in remote areas and islands can be challenging. Utilizing remote services allows for proper support to be extended to these regions [28].

Figure 3. The use of remote communication for training and consultant

Previously, medical diagnosis and treatment often focused on reactive responses after illnesses occurred. However, considering advancements in medical technology, increasing demand for improved quality of life, and the need to reduce societal healthcare costs and enhance overall productivity, a shift from treatment to prevention, exacerbation prevention, early diagnosis, and early treatment is anticipated. This shift is expected to emphasize medical interventions for maintaining health and prevention. Consequently, the demand for remote diagnosis is likely to further increase [29-30].

4. XR Technology and Its Applications in the Medical Device Industry

In recent years, XR technology, an umbrella term encompassing Virtual Reality(VR), Augmented Reality (AR), and Mixed Reality (MR), has been gaining traction for its wide range of applications across different industries. In the medical device industry, its potential is largely untapped but holds the promise of revolutionizing traditional processes.

Recently, a study conducted by the Yale University School of Medicine showed that VR-trained surgeons were 29% faster and made 6 times fewer errors. In another study, ImperialCollege of London reported that 83% of VR-trained surgical residents could successfully perform a new procedure. Whereas 0% of the traditionally trained residents could do the same. Also, in a study conducted by PWC, VR learners were40% more confident in applying what they were taught, and VR-based learners were3.75 times more emotionally connected to learning content. In addition, PWC study showed that VR-trained employees were up to four times more focused during training than their e-learning peers and 1.5 times more focused than their classroom colleagues. And according to the National Training Laboratory, VR experience has a retention rate of 75%, beating out more traditional-based methods such as lecture with 5%, reading with 10% and audio-visual learning with 20%.

A.Understanding XR technology XR technology creates immersive virtual environments (VR), overlays digital information on the physical world (AR), or blends the two in a seamless, interactive experience (MR). This transformative technology allows users to visualize, interact with, and manipulate digital elements in a realistic way, enhancing their understanding and knowledge retention.

B.Relevance to Product Training, Maintenance, and Customer Service In the context of the medical device industry, XR technology's relevance is threefold: product training, maintenance, and customer service.

Training:XR provides hands-on, immersive training experiences where trainees can interact with virtual models of medical devices. This not only facilitates better understanding but also allows trainees to make mistakes in a risk-free environment, leading to improved competence and confidence.

Maintenance:Through AR, service engineers can receive real-time guidance while performing maintenance tasks, significantly reducing downtime and improving service quality.

CustomerService: XR can provide remote assistance, enabling real-time collaboration between customer service representatives and customers, even across geographical boundaries. This can help in rapid troubleshooting, enhancing customer satisfaction and loyalty.

The following sections delve into the Veyond Connect™ platform's capabilities, demonstrating how it effectively harnesses the power of XR technology to address the challenges faced by the Japanese medical device industry.

5. Veyond Connect™: An Innovative Solution

Veyond Connect™ emerges as a game-changer in the field of surgical training and care by offering an advanced XR telepresence platform that blends the power of AR, VR, MR, AI, and haptics. This technology revolutionizes traditional surgical procedures and training by creating an immersive, real-time collaborative environment that is not restricted by geographical boundaries.

The value propositions of Veyond Connect™ lie in its ability to:

• Facilitate real-time collaboration and training, enabling proctors and operators to interact as if co-located.
• Leverage frontier technologies to create precise virtual emulations of real-world surgical scenarios, enriched with AI capabilities for enhanced interaction and personalization.
• Offer an unmatched telepresence using pioneering real-time 3D volumetric streaming technology, enhancing the reach and scalability of the platform.

Through these unique offerings, Veyond Connect™ stands at the forefront of revolutionizing surgical care, driving greater efficiency and democratizing access to surgical expertise on a global scale.

The Veyond Connect™ platform embodies the potential of XR technology, providing aversatile solution to the challenges faced by Japanese medical device companies.

Veyond Connect™ boasts a suite of impressive features that cater to the unique needs of the medical device industry.

1. Real-time Remote Collaboration: The platform enables real-time collaboration between various stakeholders, such as technicians, trainers, and customers, irrespective of geographical boundaries.
2. AR Overlays for Guidance: With augmented reality overlays, technicians can receive step-by-step guidance during complex maintenance tasks, reducing downtime, and minimizing errors.
3. Immersive VR Training: Through VR, the platform provides a realistic, risk-free environment for product training, resulting in better retention and understanding of the product's functionality.

Veyond Connect™ transforms the way companies provide training, perform maintenance, and deliver customer service.

1. Training: Immersive VR training enhances the learning experience, allowing trainees to interact with life-like models of medical devices. This results in increased competence, decreased training time, and enhanced productivity.
2. Maintenance: With AR-assisted maintenance, service engineers can perform tasks with higher accuracy and efficiency, leading to reduced device downtime and increased customer satisfaction.
3. Customer Service: The remote collaboration feature ensures that customer service representatives can assist customers more effectively, resolving issues quickly and reducing service costs.

The XR Surgical Training Center is a prime example of Veyond Connect's potential. With our technology, the center conducts regular sessions with partners in Latin America, exemplifying how we are making high-quality surgical training accessible beyond geographical constraints.

This tangible illustration serves to underscore the transformative potential of Veyond Connect™ in democratizing surgical training.

Fostering real-time collaboration between proctors and operators, Veyond Connect™ simulates a shared physical presence in the operating room. Harnessing the potential ofArtificial Intelligence (AI), dynamic digital twin technology, haptics, and XR, our platform creates an immersive, interactive, and incredibly realistic environment. This environment allows medical professionals globally to collaborate in real time as if they were physically present in the same operating room.  This ability to provide unparalleled telepresence during surgical procedures and training scenarios sets Veyond Connect™ apart from its competitors.

Figure4. Immersive XR Surgery Training Center in Latin America

As a frontier technology incorporating AR, VR, MR, and haptics, Veyond Connect™ transcends the conventional limits of VR applications. The hallmark of Veyond Connect™ lies not merely in being an XR node, but an influential force reshaping surgical procedures and training.

Veyond Connect's^TM pioneering real-time 3D volumetric streaming technology manifests unmatched telepresence, enabling an unlimited number of global professionals to share a virtual space for surgical collaboration and training. This capability to accommodate numerous participants from any location drastically enhances the reach and scalability of Veyond Connect™.

This two-pronged functionality distinctly positions Veyond Connect™ against competitors such as Proximie and Augmedics. Proximie, constrained by its 2D, non-immersive interface, and Augmedics, limited by specific imaging views and outdated hardware, fail to match Veyond Connect's^TM extensive XR offerings. Furthermore, unlike Osso VR, which focuses solely on training, Veyond Connect^TM facilitates real-time interaction during live surgeries and training scenarios, enhancing the degree of collaboration. Veyond Connect's^TM digital twin technology, a leap forward from the competition, yields an accurate virtual emulation of real-world surgical scenarios. In tandem with actual surgical tools, it enables strikingly precise interactions during live surgeries and training sessions. A masterstroke of integrating haptic feedback technology adds another dimension of realism, replicating the tactile sensations experienced during physical surgeries.

The standout features of Veyond Connect^TM are the ability to provide best-in-class or world-class surgical training without the need for physical travel. With Veyond Connect™, operators or trainees can seamlessly connect with proctors who maybe located far away, enabling them to receive the highest quality training and guidance remotely. This eliminates the limitations of traditional training methods and brings expertise directly to the operator's fingertips.

Figure 5. Veyond Connect^TM provides best-in-class or world-class surgical training without the need for physical travel.

Meticulously designed with a user-centric approach, Veyond Connect™ not only enhances user engagement and the overall learning experience through its intuitive design and interactive learning modules but also facilitates remote surgical collaboration and training, eliminating the need for physical travel. Veyond Connect™ democratizes access to surgical expertise, significantly enhancing the quality of surgical procedures and patient care in areas where surgical specialists may be scarce.

With the help of groundbreaking digital twin technology and the integration of haptic feedback, Veyond Connect™ creates accurate virtual replications of real-world surgical scenarios, facilitating precise interactions and seamless workflow integration. This takes it a step further by overlaying instructions directly onto the patient using annotation, ensuring a highly accurate and immersive experience.

Veyond Connect^TM utilizes AI to enhance the recognition, interpretation, and interaction with the digital twin. In addition to identifying and manipulating objects in the virtual space, it collaborates with the NaturalLanguage Processing (NLP) and Speech Recognition system to respond to voice-activated commands related to visual tasks such as zooming into specific are as, highlighting components, or retrieving specific data from the digital twin. Also, Veyond Connect^TM leveragesAI-powered services to provide real-time language translation for seamless international collaborations. In addition to translation, we incorporate voice recognition capabilities to interpret and execute verbal commands related to the digital twin's manipulation and information retrieval. The NLP system works in tandem with the computer vision system to ensure verbal commands translate into the appropriate visual actions on the digital twin. Veyond Connect^TMalso employs available AI-based cybersecurity solutions to ensure the security and integrity of user data. Furthermore, Veyond Connect^TM uses machine learning for predictive analysis and decision support. Finally, we manage and derive insights from the vast amount of data generated by the platform is done by the help of AI and using AI Veyond Connect^TM implements a reinforcement learning system for personalized and efficient training experiences.

Figure 6. Veyond Connect™ creates accurate virtual replications of surgical instruments using digital twin technology

6. Conclusion

Given the demographic challenges and increasing demand for sophisticated medical devices in Japan, adopting innovative solutions like Veyond Connect™ becomes crucial. By leveraging XR technology, companies can enhance product training, maintenance, and customer service, leading to improved productivity, reduced costs, and better customer satisfaction. As the case studies demonstrate, the potential for XR in the medical device industry is immense, and its high time companies embraced this transformative technology.

7. Recommendation

Based on the insights presented in this white paper, the following recommendations are made for medical device companies:

1. Invest in XR technology and incorporate platforms like Veyond Connect™ into their training,     maintenance, and customer service processes.
2. Continuously upskill their  workforce to be comfortable and efficient in using XR technology.
3. Monitor and measure the impact of XR technology implementation to continually refine and enhance its application.