title: Clinical Impact of Telemedicine Network System at Rural Hospitals Without On-Site Cardiac Surgery Backup.
abstract: In Japan, catheterization laboratories are available in each medical service area. However, cardiovascular centers capable of surgical procedures are concentrated in urban areas. Critically ill patients with complex coronary lesions must be transferred to receive advanced medical care. Interhospital conferencing is necessary for an optimal patient transfer. We investigated the benefit and utility of a Digital Imaging and Communications in Medicine (DICOM) telemedicine network at a rural hospital without on-site cardiac surgery backup in Japan.
  
  
  
  The Kumamoto telemedicine network consists of 2 high-volume centers and 12 rural low-volume hospitals without on-site cardiac surgery. Between January 2010 and December 2014, 293 teleconferences were conducted. At the Aso Medical Center, a low-volume hospital, teleconferences were carried out in 48 cases (30 coronary artery disease, 6 peripheral artery disease, 3 aortic aneurysm, 3 deep vein thrombosis, 2 inflammatory aortitis, 1 annuloaortic ectasia, 1 cardiac tamponade, 1 myocarditis, and 1 heart failure). After the conferences were initiated, 10 cases (20.8%) were transferred to the high-volume center. We investigated the prevalence of patient transfer before and after network system deployment. Telemedicine-based collaborative care significantly decreased the frequency of patient transfers from the Aso area.
  
  
  
  The Kumamoto telemedicine network enabled open communication between distant hospitals. This collaboration has the potential to improve cardiac care in rural areas.
authors.affiliation: 1 Department of Cardiovascular Medicine, Aso Medical Center , Aso, Japan .|2 Department of Cerebrovascular and Acute Coronary Syndrome, Graduate School of Medical Sciences, Kumamoto University , Kumamoto, Japan .
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nagayoshi
authors.affiliation: 3 Department of Cardiology, Kumamoto Central Hospital , Kumamoto, Japan .
authors.forename: Shuichi
authors.initials: S
authors.lastname: Oshima
authors.affiliation: 4 Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , Kumamoto, Japan .|5 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center , Suita, Japan .
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002318:Cardiovascular Diseases / Q000601:surgery*; D003299:Cooperative Behavior; D005260:Female; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000458:organization & administration*; D012189:Retrospective Studies
keywords: cardiology/cardiovascular disease; emergency medicine/teletrauma; telecardiology; telemedicine