International Circulation: Would you like to give us a brief introduction of your topic about telemedicine in the management of heart failure?

Alfred Bove:  In the next decade or so we will be moving to an era where patients are expected to understand more about their healthcare.  I think that is one of the ways that we are going to improve healthcare， where patients can participate in their own care， understanding better the illnesses and risks that they have， and also what the appropriate guidelines for their care are.  Patients would know what the pertinent outcome data will be and what the pertinent guideline will be.  I think we are going to see better outcomes. 
How do we do that?  We have to educate the patients and give them the opportunity to communicate.  We have been in the habit of having a patient come to the office once or  every three months or twice per year， sometimes every month if we are really interested in trying to get control of the disease.  It is very inconvenient for an individual patient who may be working every day， taking time off in order to come in for an office visit with less than ideal waiting times.  If we can communicate with patients one way or another to avoid an office visit， it will be an advantage.  We also find now that treating heart failure， hypertension， asthma， or some other disorders that are chronic conditions requiring communication， treatment can be done well through communication without the patient being in the office. 
So the question is how do we communicate?  We could communicate by telephone.  The problem is that someone has to dial a phone number and wait for a patient to answer， with about 60% of the time not making contact on the first call.  It is a very inefficient way of communication.  Asynchronous communication， where you are doing things not at the same time， is much more efficient for communication.  Now with the Internet and the smart phone technology， patients can communicate with their practitioners asynchronously by having systems allowing for this type of communication.  A telemedicine system is a logical extension to meet communication needs in modern healthcare.  With the Internet and other technologies， effective communication can be achieve， whether by email or a secure message service， by smart telephones or interactive voice recognition systems.  We are going to move into that era.  Our telemedicine approach is an attempt to show that we can use this system and we can actually get benefit from it while at the same time reducing the cost of healthcare to maintain stable health.

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