Initial Experience of the Synchronized, Real-Time, Interactive, Remote Transthoracic Echocardiogram Consultation System in Rural China: Longitudinal Observational Study

Abstract

Background China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability.

Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study

“…Active prevention and monitoring of the public’s psychological behavior is an integral part of a reasonable response to public health emergencies. Telemedicine is a health service discipline that combines modern communication, electronic technology, computer networks, and medicine [ 11 ]. Telemedicine can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients [ 12 , 13 ].…”

Treatment of Left Ventricular Circulation Disorder: Application of Echocardiography Information Data Monitoring

“…In recent years, some scholars have proposed models of aortic arch and ascending aorta coarctation, but the models need the support of endotracheal intubation and artificial ventilation conditions [ 13 ]. However, ligation of the aortic arch can increase the pressure of the right brain and its limbs, increase the collateral circulation through the head and arm, and then reduce the afterload, making the modeling a failure [ 14 ].…”

Development Status and Prospect of Remote Diagnosis and Treatment of Echocardiography Worldwide

“…Labeling Toll Support senmding voice, text, and local files scholar Christopher A Rouse and other doctors reported the remote diagnosis of echocardiography performed in the asynchronous mode across the Pacific Ocean, which also confirmed the avoidance of long-term and potentially dangerous transshipment of patients across the Pacific Ocean, and greatly reduced the cost [8]. Cloud servicebased triple synchronous dual real-time interactive remote echocardiography consultation between the People's Hospital of Henan Province and the grass-roots hospitals in China in 2019 not only solved difficult cases at the grassroots hospitals, reduced unnecessary transfers of patients, but also provided real-time guidance to the operation methods of primary-level ultrasound doctors, improved the medical technology level of primary-level hospital doctors, and won unanimous praise from primary-level hospital doctors [5]. During the outbreak of "Corona Virus Disease-19 (COVID-19)" in 2020, ultrasound doctors at Hainan Hospital of PLA General Hospital used remote ultrasound robots to perform real-time cardiopulmonary function examinations for COVID-19 patients in the cabin hospital.…”

“…In summary, the advantages of remote echocardiography are summarized as follows: (1) Remote echocardiography consultation provides high-quality medical services to basic-level hospitals with insufficient medical resources to optimize the allocation of medical resources, helps diagnose clinically difficult cases, reduces the referral rate of patients at primary-level hospitals, and reduces unnecessary expenses for patients [25]. (2) Remote echocardiography diagnosis has established a good technology upgrading platform for basic-level ultrasound doctors, promoted information sharing among hospitals, and helped improve the service capabilities of basic-level ultrasound workers [5].…”

“…Compared with remote imaging or remote pathology, which requires a large number of static images, remote echocardiography features dynamic and real-time performance of ultrasound images for the diagnosis, treatment and prognosis of cardiovascular disease [4]. Due to the limitations of dynamic image encoding and decoding, the immature multi-channel information synchronization technology, and slow network transmission speeds, however, the development of remote echocardiography is lagging behind [5]. This article aims to review the development status and application prospects of remote diagnosis and treatment of echocardiography at home and abroad.…”