In the revision of medical service fees in 2018, the section on online healthcare services was included for the first time. Remote healthcare services or telemedicine, which are provided by a doctor to a patient by means of information and communications technology, have been positioned differently under different systems. According to a notification issued in 1997 by the Director of the Health Policy Bureau of the Ministry of Health, Labour and Welfare (MHLW), an initial medical consultation should be conducted face to face, as a rule. The notification provides nine examples of patients eligible for telemedicine services, including residents on remote islands and in remote areas, and home-based diabetic patients. The following two documents issued in 2015-the Basic Policy on Economic and Fiscal Management and Reform 2015, commonly known as the Basic Policy 2015, and an office communication issued in August by the MHLW-did not limit eligible patients to those defined in the 1997 notification. The 2015 office communication clarified that the examples listed in the 1997 notification were merely examples. As a result, telemedicine has since drawn increasing attention. Over the years, there have been different interpretations of Article 20 of the Medical Practitioners' Act, which prohibits providing a medical diagnosis or treatment without a face-to-face examination by a medical practitioner. In 1997, a notification was issued stipulating that if a reasonable substitute for a face-to-face consultation is available, telemedicine does not directly deviate from Article 20 of the Medical Practitioners' Act. Following this notification, telemedicine gradually started to be applied widely. According to a notification issued in 2016 by the Director of the Medical Professions Division of the Health Policy Bureau, MHLW, which was provided in response to an inquiry from the Tokyo Metropolitan Government, telemedicine through which useful information cannot be obtained or that which does not include an in-person examination deviates from the Medical Practitioners' Act. In 2017, it was clarified that treatment discontinuation based on the patient's personal reasons does not directly deviate from Article 20 or other relevant articles of the Medical Practitioners' Act. In 2018, the Guideline Development Committee for the "Guidelines on Healthcare Services using Information Technology" and the Regulatory Reform Implementation Plan clearly specified telemedicine, leading to the aforementioned 2018 revision of medical service fees.
 Online healthcare services have yet to be applied widely, partly due to the requirements stipulated in the guidelines and other regulations under the medical service fee system. However, there is no doubt that the national government is promoting the implementation of online healthcare services. We must now discuss how to more appropriately implement online healthcare services.
 In this paper, I will discuss the shift from telemedicine to online healthcare services, and the discussion conducted by the Guideline Development Committee. In addition, I will report on online healthcare services provided in psychiatric hospital settings.
 Author's abstract