title: Telemedicine to Improve Access to Specialist Care in Fetal Heart Rate Monitoring: Analysis of 17 Years of TOCOMAT Network Clinical Activity.
abstract: The objective of this article is to provide an overview of the clinical experience of our telemedicine network (TOCOMAT) for fetal well-being assessment through computerized Cardiotocography (cCTG), analyzing cultural, socioeconomic, and environmental conditions of pregnant women and its economic sustainability over time.
  
  
  
  We used the central data store, including all cCTG records collected in Campania region (Italy) during 17 years of activity. The Operations Center acquires the traces recorded in the Remote Units and simultaneously performs a complex fetal heart rate analysis. An Internet or phone conference calling is available to discuss the information transmitted. Finally, the report is send back to the Remote Units.
  
  
  
  The number of cCTG traces performed was constantly increasing, despite the progressive reduction in the number of peripheral units involved. Pregnant women in Remote Unit group were younger and overweight and showed a higher incidence of diabetes and fetal defects than Operations Center ones. Moreover, a high rate of African migrant women and low socioeconomic and cultural standards were found in Remote Unit group. The cost analysis showed an economic advantage both in the reduction of inappropriate admissions and in the improvement of admission indicators (hospital stay days) for pregnant women.
  
  
  
  The global economic recession has had a significant impact on the Italian regional healthcare system and socioeconomic deprivation.
  
  
  
  Telemedicine could avoid unnecessary referral to Level III centers (Hospital) in Campania region, where the average population density is very high, allowing equal access to ultra-specialist assessment irrespective of the geographical location of the pregnant woman with medium to high risk, as well as rationalizing the costs for maternal and fetal care.
authors.affiliation: 1 Departments of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University , Naples, Italy .
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tagliaferri
authors.affiliation: 1 Departments of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University , Naples, Italy .
authors.forename: Francesca Giovanna
authors.initials: FG
authors.lastname: Esposito
authors.affiliation: 2 Simas - InterDept. Centre for Innovation Systems & Health Management, University of Salerno , Italy .
authors.forename: Adelaide
authors.initials: A
authors.lastname: Ippolito
authors.affiliation: 1 Departments of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University , Naples, Italy .
authors.forename: Flavia
authors.initials: F
authors.lastname: Mereghini
authors.affiliation: 3 Department of Electrical, Computer and Biomedical Engineering, University of Pavia , Pavia, Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Magenes
authors.affiliation: 1 Departments of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University , Naples, Italy .
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martinelli
authors.affiliation: 1 Departments of Obstetrical-Gynaecological and Urological Science and Reproductive Medicine, Federico II University , Naples, Italy .
authors.forename: Marta
authors.initials: M
authors.lastname: Campanile
authors.affiliation: 4 Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB) , Politecnico di Milano, Milano, Italy .
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Signorini
mesh_terms: D000328:Adult; D015148:Cardiotocography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006340:Heart Rate, Fetal / Q000502:physiology*; D006801:Humans; D007558:Italy; D018670:Monitoring, Ambulatory / Q000379:methods* / Q000706:statistics & numerical data*; D011247:Pregnancy; D017216:Telemedicine / Q000379:methods* / Q000706:statistics & numerical data*
keywords: distance; e-health; medical records; telemedicine