Telemedicine using a desktop conference system (Phoenix) in Kyushu, Japan.

Objective: The Kyushu area of southwestern Japan has several mountains and 157 inhabited islands. We assessed the feasibility of implementing a desktop conference (DTC) system to improve medical care in this area. TELECOMMUNICATIONS TECHNOLOGY AND EQUIPMENT: The Phoenix DTC system (NTT Corporation, Tokyo, Japan) for personal computers includes a microphone, speaker, color CCD camera, and appropriate software. We used a digital camera for still pictures and image-analysis software for radiographs and CT and MRI films. The system was installed on a Pentium 133 MHz computer, which was connected by ISDN line at a 128 kbps data rate to a clinic on a small island where one physician cares for 1000 residents, two small nursing offices where each nurse tends 100 residents, two nursing homes, a hospital in a mountainous area, and the residence of a patient with atopic dermatitis. Connections were made once a week for a period of 6 months.

Results: The transmitted still pictures; e.g., senile nevus, atopic dermatitis, chickenpox, and a radiograph of a suspected fracture, were useful for diagnosis and clinical decision making. We received and responded to inquiries from residents of the participating nursing homes on nutrition, senile depression, nevus, decubitus ulcers, urinary tract infection, and protection against Legionella infection. We also used the system to deliver lectures on pediatrics to nurses; provided case discussions on diaphragmatic herniation and subtentorial tumor; and had on-line presentation of a patient with beta-thalassemia using presentation software.

Conclusion: The DTC system used in the present study seemed technically satisfactory and useful in improving medical care in remote sites of Japan.