OBJECTIVES: There is no systematic review on economic evaluations of telemedicine in Japan, despite over 1000 trials implemented. Our systematic review aims to examine whether Japan's telemedicine is cost-saving or cost-effective, examine the methodological rigorousness of the economic evaluations, and discuss future studies needed to improve telemedicine's financial sustainability. METHODS: We searched five databases, including two Japanese databases, to find peer-reviewed articles published between January 1, 2000 and December 31, 2014 in English and Japanese that performed economic evaluations of Japan's telemedicine programs. The methodological rigorousness of the economic analyses was assessed with a well-established checklist. We calculated the benefit-to-cost ratio (BCR) when a reviewed study reported related data but did not report the BCR. All cost values were adjusted to 2014 US dollars. RESULTS: Among the 17 articles identified, six studies reported on settings connecting physicians for specialist consultations, and eleven studies on settings connecting healthcare providers and patients at home. There are three cost-benefit analyses and three cost-minimization analyses. The remaining studies measured the benefit of telemedicine only, using medical expenditure saved or users' willingness-to-pay. There was substantial diversity in the methodological rigorousness. Studies on teledermatology and teleradiology indicated a favorable level of economic efficiency. Studies on telehomecare gave mixed results. One cost-benefit analysis on telehomecare indicated a low economic efficiency, partly due to public subsidy rules, e.g., a too short budget period. CONCLUSIONS: Overall, telemedicine programs in Japan were indicated to have a favorable level of economic efficiency. However, the scarcity of the economic literature indicates the need for further rigorous economic evaluation studies.
Asian Continental Ancestry Group ; Budgets ; Checklist ; Cost-Benefit Analysis* ; Costs and Cost Analysis ; Health Expenditures ; Health Personnel ; Humans ; Japan* ; Referral and Consultation ; Specialization ; Telemedicine* ; Teleradiology

PURPOSE: In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor. METHODS: Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale. RESULTS: The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628+/-0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879+/- 0.054) in LCD, 0.828-1.000 (Mean=0.898+/-0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750+/-0.117) in LCD and 0.560-0.880 (Mean=0.708+/-0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room. CONCLUSION: In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Aged ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Liquid Crystals ; Mortality ; Remote Consultation ; Rib Fractures* ; Ribs* ; Sensitivity and Specificity ; Specialization ; Teleradiology

PURPOSE: This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. MATERIALS AND METHODS: Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. RESULTS: Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. CONCLUSION: A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.
Accounting ; Dentists ; Diagnosis, Differential ; General Practice, Dental ; Humans ; Teleradiology

BACKGROUND AND PURPOSE: Information technology and mobile devices may be beneficial and useful in many aspects of stroke management, including recognition of stroke, transport and triage of patients, emergent stroke evaluation at the hospital, and rehabilitation. In this review, we address the contributions of information technology and mobile health to stroke management. SUMMARY OF ISSUES: Rapid detection and triage are essential for effective thrombolytic treatment. Awareness of stroke warning signs and responses to stroke could be enhanced by using mobile applications. Furthermore, prehospital assessment and notification could be streamlined for use in telemedicine and teleradiology. A mobile telemedicine system for assessing the National Institutes of Health Stroke Scale scores has shown higher correlation and fast assessment comparing with face-to-face method. Because the benefits of thrombolytic treatment are time-dependent, treatment should be initiated as quickly as possible. In-hospital communication between multidisciplinary team members can be enhanced using information technology. A computerized in-hospital alert system using computerized physician-order entry was shown to be effective in reducing the time intervals from hospital arrival to medical evaluations and thrombolytic treatment. Mobile devices can also be used as supplementary tools for neurologic examination and clinical decision-making. In post-stroke rehabilitation, virtual reality and telerehabilitation are helpful. Mobile applications might be useful for public awareness, lifestyle modification, and education/training of healthcare professionals. CONCLUSIONS: Information technology and mobile health are useful tools for management of stroke patients from the acute period to rehabilitation. Further improvement of technology will change and enhance stroke prevention and treatment.
Delivery of Health Care ; Humans ; Life Style ; National Institutes of Health (U.S.) ; Neurologic Examination ; Stroke ; Telemedicine ; Teleradiology ; Triage

Telemedicine ; Teleradiology

This paper introduces the design and development of a teleimaging diagnosis system by using B/S mode. A detailed design on the telediagnosis process and telediagnosis management is presented, focusing on resolving medical image transmission, management and display in the internet, and is trying to integrate the teleimaging diagnosis system with PACS.
Diagnostic Imaging ; Information Storage and Retrieval ; Internet ; Software Design ; Teleradiology ; methods

Considering the real conditions in China, the strategy and scheme of DICOM-E-Mail's clinical applications in China are discussed in this paper.
China ; Computer Communication Networks ; Electronic Mail ; instrumentation ; standards ; Radiology Information Systems ; instrumentation ; standards ; Teleradiology ; instrumentation ; standards

OBJECTIVE: Our objective was to compare correctness of diagnosis from phonecamera MMS (Multimedia Messaging Service)-transmitted radiographic images to actual radiographs in confirming diagnosis of surgical conditions.

METHODS: After relaying history anAphysical examination findings through cellphones, 180 radiographs (30 each from General Surgery, Urology, Neurosurgery, Orthopedics, Thoracocardiovascular and Pediatric Surgery) were also captured and transmitted by residents. Images were interpreted at remote sites by surgical specialists who confirmed diagnosis and suggested prompt treatment. Upon arrival at hospital, surgical consultants compared diagnosis with actual radiographic films. Data were analyzed using Binomial Test at the 0.05 level of significance.

RESULTS: Clinical diagnoses were confirmed using 150 conventional radiograms, 28 CT scans and 2 angiograms. Phone-transmitted digital radiographs were compared with actual films viewed. Correctness of diagnosis was: 100 percent (30/30) from Neurosurgery; 93.3 percent (28/30) respectively from General Surgery, Urology, Orthopedics and Thoracocardiovascular Surgery; 90 percent (27/30) from Pediatric Surgery. Phone-transmitted radiographic image interpretations compared with actual radiographic readings showed statistically significant concordance of 96 percent (p = 0.01) for each surgical specialty.

CONCLUSION: Phonecamera MMS images of radiograms, CT scans and angiograms taken by surgical residents in the hospital and transmitted to cellphones of surgeons at remote sites had high correctness of diagnosis. When used to confirm diagnosis from clinical history and physical findings, prompt treatment decisions of different surgical specialty conditions may be made.

OBJECTIVE: Neuroimaging data are of paramount importance in making correct diagnosis. We herein evaluate the clinical usefulness of image transfer using cellular phones to facilitate neurological diagnosis and decision-making. METHODS: Selected images from CT, MRI scans, and plain films obtained from 50 neurosurgical patients were transferred by cellular phones. A cellular phone with a built-in 1,300,000-pixel digital camera was used to capture and send the images. A cellular phone with a 262,000 color thin-film transistor liquid crystal display was used to receive the images. Communication between both cellular phones was operated by the same wireless protocol and the same wireless internet service. We compared the concordance of diagnoses and treatment plans between a house staff who could review full-scale original films and a consultant who could only review transferred images. These finding were later analyzed by a third observer. RESULTS: The mean time of complete transfer was 2~3 minutes. The quality of all images received was good enough to make precise diagnosis and to select treatment options. Transferred images were helpful in making correct diagnosis and decision making in 49/50 (98%) cases. Discordant result was caused in one patient by improper selection of images by the house staff. CONCLUSION: The cellular phone system was useful for image transfer and delivery of patient's information, leading to earlier diagnosis and initiation of treatment. This usefulness was due to sufficient resolution of the built-in camera and the TFT-LCD, the user-friendly features of the devices, and their low cost.
Cellular Phone* ; Consultants ; Decision Making ; Diagnosis ; Humans ; Internet* ; Internship and Residency ; Liquid Crystals ; Magnetic Resonance Imaging ; Neuroimaging ; Telemedicine ; Teleradiology

DICOM-e-mail is a secure teleradiology protocol released by German Radiology Society and has already been applied clinically. To improve the robustness of the system, the protocol has been upgraded by adding some mechanisms such as system feedback. Moreover, a test method is also implemented by sending erroneous mails to application software that supports DICOM-e-mail. Through the tests for two different DICOM-e-mail teleradiology application, the validity of the new protocol is proved and at the same time some bugs are found. The implementation of the latest protocol and the general error tests can help to make the whole teleradiology system a better robustness. The implementation of DICOM-e-mail protocol in our country is also discussed in this paper.
Computer Communication Networks ; standards ; Computer Security ; standards ; Electronic Mail ; standards ; Humans ; Internet ; Radiology Information Systems ; standards ; Software ; Teleradiology