Telehealth solutions to enable global collaboration in rheumatic heart disease screening

Abstract

Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

“…The project has collaborated with the development of cloud storage and reading systems dedicated to cardiovascular imaging and used a collaborative reading routine between Brazil and the United States, an innovation for large-scale RHD programs. 21 The incorporation of the RHD project was also an improvement for the Telehealth Network of Minas Gerais. The network was established in 2005 to connect hospitals from 5 public universities in the state.…”

“…Cloud computing environments, with online reading for DICOM files and Dropbox with proprietary offline software for Vscan files, were used for remote telemedicine interpretation in Brazil and the United States. 21 Readers were blinded to the screening scenario.…”

Task Sharing in the Diagnosis, Prevention, and Management of Rheumatic Heart Disease: A Systematic Review

“…The majority of studies looked at training nonphysician health care workers to conduct echocardiographic screening for RHD. The main reason for exclusion was that none of the studies were based on RHD treatment or prevention programs in health care settings, and they did not specifically assess how task sharing could improve clinical outcomes for ARF/RHD [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Table 3).…”

“…Engelman et al, 2015 [38] The paper is on an 8-week training program: 1 week of classroom-based workshop training on RHD followed by 7 weeks of supervised practical training. Lopes et al, 2018 [39] The paper is on an Online RHD educational course and 8-to 12-week hands-on training supervised by a cardiologist. Engelman et al, 2016 [40] The paper is on 1-week classroom-based workshops, followed by 7 weeks of practical training on echo screening.…”

Integration of echocardiographic screening by non-physicians with remote reading in primary care

“…A cloud computing environment (SigTel, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil) for online storage and reporting was developed, and proprietary offline software for VScan files were used for telemedicine interpretation (subjective evaluation and objective measurements) in Brazil and the USA 11. Screen-positive cases were reviewed by two experts (Brazil: MN and USA: CS and AT) and discrepancies were consensually solved.…”