Abstract
We thank Pollari et al. 1 for their comments on our recent article. 2 We also greatly appreciate their attempt to conduct a pioneering experiment in cross-border telemedicine between major cities. Telecardiology has developed in various fields, including tele-echocardiography, tele-electrocardiography, and telemonitoring of vital information in patients with acute coronary syndrome and heart failure. 3,4 Emergent consultation using teleangiography is one of the features of the Kumamoto telemedicine network. At any time, physicians can consult experts in high-volume centers about emergent cases such as left main coronary artery disease associated with acute coronary syndrome. In contrast, our network has not yet been fully utilized for elective surgery. There are several factors that may be involved here.
First, cardiologists play a leading role in our network utilization. In Japan, percutaneous catheter intervention can be performed in each medical service area. Teleconsultation is usually performed when the treatment capacity available in a facility is exceeded. This is one of the reasons why the system utilization is different among facilities. Second, the Ministry of Health, Labor and Welfare requires that treatment be given face-to-face in Japan. Telemedicine is limited to patients with chronic disease who live in remote areas. In our network, doctors receive no fee under the public health insurance system. Policy promotion is necessary for the expansion of telemedicine in Japan. Finally, the difficulty of risk stratification of elderly people is an important problem. In recent years, an increasing number of elderly individuals are undergoing cardiac surgery. Although EuroSCORE is a proven predictor of operative mortality, 5 both physical frailties and cognitive impairments of patients are not fully reflected in this score. Pollari et al. use videoconferencing for evaluation of the general status of patients. Videoconferencing is expected to be used as a substitute for a face-to-face meeting. Unfortunately, the use of videoconferencing is limited in Japan for the reasons already listed.
Telemedicine for surgical cardiology is a developing area. There is not sufficient evidence to disseminate the system widely. We are hopeful that Pollari et al. will achieve success in this area.