Remote telemedical interpretation of neonatal echocardiograms: impact on clinical management in a primary care setting

Randolph, Guy R.; Hagler, Donald J.; Khandheria, Bijoy K.; Lunn, E; Cook, Walter J.; Seward, James B.; O’Leary, Patrick

doi:10.1016/s0735-1097(99)00182-5

Cited by 54 publications

(45 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tele-echocardiography has the potential to prevent unnecessary transports, resulting in decreased morbidity and direct financial savings. 10,11 The neonatal intensive care units in this study relied on anterior-posterior chest radiographs to confirm umbilical venous catheter position. Although catheter position is not an indication for echocardiography, unsuspected placement in the left atrium can be seen and corrected during a teleconference.…”

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on the Practice of Pediatric Cardiology in Community Hospitals

et al. 2002

View full text Add to dashboard Cite

ABSTRACT. Background. Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists. Initial reports suggest that telecardiology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists.Objective. We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals. We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate, improves patient care, enhances sonographer proficiency, allows for more efficient physician time management, increases patient referrals, and does not result in increased utilization of echocardiography.Methods. Using desktop videoconferencing computers, pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center. Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines (384 kilobits per second). This resulted in a frame rate of 23 to 30 frames per second. Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms. Additional views were suggested as deemed necessary by the interpreting physician, and interpretations were made during the videoconference. The results of the echocardiogram and recommendations for patient care were communicated to the referring physician over the telemedicine system. Analyses of accuracy, patient treatment, echocardiogram quality, time to diagnosis, pediatric cardiologist practice time management, patient referral patterns, and echocardiography utilization were conducted prospectively.Results. A total of 500 studies in 364 patients were transmitted during a 30-month period. The most common indication for echocardiography was to rule out congenital heart disease (208 of 500 studies). Signs and symptoms that prompted this concern included cyanosis, murmur, tachypnea, genetic syndrome, arrhythmia, abnormal fetal echocardiogram, and maternal diabetes. Other indications included suspected patent ductus arteriosus (PDA; 182 of 500 studies), intracardiac clot or catheter position, persistent pulmonary hypertension, and hemodynamic instability. Cardiac diagnoses included complex cong...

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of Telemedicine on the Practice of Pediatric Cardiology in Community Hospitals

et al. 2002

View full text Add to dashboard Cite

show abstract

“…The diagnosis, clinical management, and triaging of a sick newborn with suspected congenital heart disease can be done quickly with tele-echocardiography. Randolph et al 26 reported that using tele-echocardiography resulted in a complete diagnosis for 132 (99%) of 133 patients and a clinically adequate diagnosis for the remaining patient (1%). In their study, patient transfer was recommended or avoided in 7 patients, an immediate change in local medical management occurred in an additional 25 (19%) of 133 neonatal patients, and congenital heart disease not requiring immediate treatment was noted in 47 (35%) infants.…”

Section: Clinical Scenarios: Fetal Echocardiography and Fetal Cardiacmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

View full text Add to dashboard Cite

A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

show abstract

“…The sample size computation was based on previous literature 6 which showed a 78% prevalence of cardiac abnormalities among patients subjected to standard 2-dimensional echocardiography. Sixty-six (66) adult echo studies were targeted for this study, which will provide 80% statistical power based on an anticipated effect size (Cohen's d) of 78% and confi dence level of 95%.…”

Section: Data Analysis and Statistical Methodsmentioning

confidence: 99%

Remote imaging via FaceTime for potential long-distance diagnosis of suspected cardiac structural and shunt anomalies on contrast echocardiography (The RIFLE Study)

Magno¹,

Santos²,

Tucay³

et al. 2014

Asean Heart J

View full text Add to dashboard Cite

BackgroundCertain cardiac anomalies can be missed by standard transthoracic echocardiography and are usually confirmed through contrast echocardiography, a specialized procedure that warrants supervision by a cardiologist with advanced echo training. However, the maldistribution or lack of echo specialists in certain countries, especially in archipelagic settings, deprives many patients of such procedures and probably contributes to delayed diagnosis and treatment. We wanted to find out whether onsite interpretations of contrast echocardiograms of patients with suspected cardiac anomalies are comparable to offsite readings made via the real-time videoconferencing technology of FaceTime.

show abstract

Remote telemedical interpretation of neonatal echocardiograms: impact on clinical management in a primary care setting

Abstract: Telemedical echocardiography provides accurate diagnostic data in neonates. Rapid telediagnosis facilitates appropriate care of sick neonates with possible congenital heart disease in the primary care setting. Unnecessary long-distance transfers can be avoided with this technology.

Cited by 54 publications

References 8 publications

Impact of Telemedicine on the Practice of Pediatric Cardiology in Community Hospitals

Impact of Telemedicine on the Practice of Pediatric Cardiology in Community Hospitals

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Remote imaging via FaceTime for potential long-distance diagnosis of suspected cardiac structural and shunt anomalies on contrast echocardiography (The RIFLE Study)

Contact Info

Product

Resources

About