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Abstract
Over a century of innovations in technology and medical care have led to the current day capabilities in telemedicine. In this chapter, we discuss the evolution of telemedicine over the last century and highlight various applications in neonatal care. We hope this chapter demonstrates the exponential adoption of telemedicine, particularly in neonatology, and the breadth and depth of the technology being used.
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Lu J, Lin J, Yin L, Shi R, Li H, Ge Y, Luo J. Using remote consultation to enhance diagnostic accuracy of bedside transthoracic echocardiography during COVID-19 pandemic. Echocardiography 2021; 38:1245-1253. [PMID: 34056743 PMCID: PMC8239538 DOI: 10.1111/echo.15124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study was to evaluate the clinical significance of remote consultation over bedside transthoracic echocardiography (RC‐B‐TTE) for patients with coronavirus disease 2019 (COVID‐19). Methods Five frontline echocardiographers performed and interpreted B‐TTE for 30 patients with COVID‐19 in the isolation wards, and the on‐site B‐TTE reports (OSR) were generated. Then remote consultation over the 30 B‐TTE studies was conducted by two experienced echocardiographic consultants while blinded to the OSR, and the corresponding remote consultation reports (RCR) were generated. Subsequently, the five frontline echocardiographers were convened together to discuss the difference between the OSR and RCR, and to confirm the correct interpretation and the misdiagnosis using a “majority‐vote” consensus as the diagnostic “gold standard”. Afterwards the reasons for the misdiagnosis were given by the frontline echocardiographers themselves. The inter‐rater agreement between the OSR and the “gold standard” was assessed using Kappa coefficient and percent agreement. Results Complete correctness of the 30 copies of the RCR were determined by the 5 frontline echocardiographers. The reliability of the OSR in the findings of cardiac chamber dilation, left ventricular hypertrophy and pulmonary hypertension were weak (Kappa <0.6). The reliability of the OSR in the recognition of major cardiac abnormalities was very weak (Kappa =0.304, percent agreement =63.3%). Misdiagnosis of major abnormalities was found in 11 copies of OSR (11/30, 36.7%). Conclusions The protocol of RC‐B‐TTE has shown noticeable superiority in ameliorating diagnostic accuracy of echocardiography, which should be generalized to clinical practice during the COVID‐19 or similar pandemic.
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Affiliation(s)
- Jing Lu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Lin
- Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Lixue Yin
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Chengdu, China
| | - Rui Shi
- Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Huanxing Li
- Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Yang Ge
- Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Jing Luo
- Department of Ultrasonography, Public Health Clinical Center of Chengdu, Chengdu, China
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Makkar A, Milsten J, McCoy M, Szyld EG, Lapadula MC, Ganguly A, DeShea LA, Ponniah U. Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System. Telemed J E Health 2021; 27:1136-1142. [PMID: 33449839 DOI: 10.1089/tmj.2020.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system. Methods: Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables. Results: Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs. Conclusions: Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
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Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Milsten
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edgardo G Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria C Lapadula
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhrajit Ganguly
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lise A DeShea
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Umakumaran Ponniah
- Division of Cardiology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Abstract
OBJECTIVES The aims of this study were to identify locations of births in Arizona with critical CHD, as well as to assess the current use of pulse-oximetry screening and capacities of birth centres to manage a positive screen. Study design Infants (n=487) with a potentially critical CHD were identified from the Arizona Department of Health Services from 2012 and 2013; charts were retrospectively reviewed. Diagnosis was confirmed using echocardiographies. ArcGIS was used to generate maps to visualise the location of treating facility and mother's residence. Birth centres were surveyed to assess screening practices and capacities to manage critical CHD in 2015. RESULTS Of the 272 patients identified with critical CHD, 52% had been diagnosed prenatally. Patients travelled an average distance of 55.1 miles to their treating facility. Mortality was not related to prenatal diagnosis (p=0.30), living at a high elevation (p=0.82), or to distance travelled to the treating facility (p=0.68). Of 50 birth centres, 33 responded to the survey and all centres practiced critical CHD screening. A total of 25 centres could perform paediatric echocardiographies; 64% of these centres could digitally transmit echocardiograms. In all, 24 birth centres maintained access to prostaglandins. CONCLUSIONS Pulse-oximetry screening in newborns is currently implemented in the majority of Arizona hospitals. Although most centres could perform initial management steps following a positive screen, access to paediatric cardiology services was limited. Patients with critical CHD sometimes travelled a great distance to treating facilities. Digital transmission of echocardiograms or tele-echocardiography would reduce the distance travelled for the management of a positive screen, decrease the financial burden of transportation, and expedite care for critically ill neonates.
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Behera SK, Smith SN, Tacy TA. Impact of Accreditation on Quality in Echocardiograms: A Quantitative Approach. J Am Soc Echocardiogr 2017; 30:913-922. [DOI: 10.1016/j.echo.2017.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Indexed: 11/29/2022]
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Colombo JN, Seckeler MD, Barber BJ, Krupinski EA, Weinstein RS, Sisk D, Lax D. Application and Utility of iPads in Pediatric Tele-echocardiography. Telemed J E Health 2015; 22:429-33. [PMID: 26414237 DOI: 10.1089/tmj.2015.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telemedicine is used with increasing frequency to improve patient care in remote areas. The interpretation of medical imaging on iPad(®) (Apple, Cupertino, CA) tablets has been reported to be accurate. There are no studies on the use of iPads for interpretation of pediatric echocardiograms. We compared the quality of echo images, diagnostic accuracy, and review time using three different modalities: remote access on an iPad Air (iPad), remote access via a computer (Remote), and direct access on a computer linked through Ethernet to the server, the "gold standard" (Direct). MATERIALS AND METHODS Fifty consecutive archived pediatric echocardiograms were interpreted using the three modalities. Studies were analyzed blindly by three pediatric cardiologists; review time, diagnostic accuracy, and image quality were documented. Diagnostic accuracy was assessed by comparing the study diagnoses with the official diagnosis in the patient's chart. Discrepancies between diagnoses were graded as major (more than one grade difference) or minor (one grade difference in severity of lesion). RESULTS There were no significant differences in accuracy among the three modalities. There was one major discrepancy (size of patent ductus arteriosus); all others were minor, hemodynamically insignificant. Image quality ratings were better for iPad than Remote; Direct had the highest ratings. Review times (mean [standard deviation] minutes) were longest for iPad (5.89 [3.87]) and then Remote (4.72 [2.69]), with Direct having the shortest times (3.52 [1.42]) (p < 0.0001). CONCLUSIONS Pediatric echocardiograms can be interpreted using convenient, portable devices while preserving accuracy and quality with slightly longer review times (1-2 min). These findings are important in the current era of increasing need for mobile health.
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Affiliation(s)
- Jamie N Colombo
- 1 Department of Pediatrics, The University of Arizona , Tucson, Arizona
| | - Michael D Seckeler
- 1 Department of Pediatrics, The University of Arizona , Tucson, Arizona.,2 Section of Pediatric Cardiology, The University of Arizona , Tucson, Arizona
| | - Brent J Barber
- 1 Department of Pediatrics, The University of Arizona , Tucson, Arizona.,2 Section of Pediatric Cardiology, The University of Arizona , Tucson, Arizona
| | | | - Ronald S Weinstein
- 4 Arizona Telemedicine Program, The University of Arizona , Tucson, Arizona
| | - David Sisk
- 2 Section of Pediatric Cardiology, The University of Arizona , Tucson, Arizona
| | - Daniela Lax
- 1 Department of Pediatrics, The University of Arizona , Tucson, Arizona.,2 Section of Pediatric Cardiology, The University of Arizona , Tucson, Arizona
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Abstract
Telemedicine was recognized in the 1970s as a legitimate entity for applying the use of modern information and communications technologies to the delivery of health services. Telecardiology is one of the fastest growing fields in telemedicine. The advancement of technologies and Web-based applications has allowed better transmission of health care delivery. This article discusses current advancements, the scope of telemedicine in cardiology, and its application to the critically ill. The impact of telecardiology consultation continues to evolve and includes many promising applications with potential positive implications for admission rates, morbidity, and mortality.
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Affiliation(s)
- Jayashree Raikhelkar
- Department of Anesthesiology and Critical Care, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
| | - Jayant K Raikhelkar
- Department of Cardiovascular Medicine, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Weinstein RS, Lopez AM, Joseph BA, Erps KA, Holcomb M, Barker GP, Krupinski EA. Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. Am J Med 2014; 127:183-7. [PMID: 24384059 DOI: 10.1016/j.amjmed.2013.09.032] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 01/17/2023]
Abstract
There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.
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Affiliation(s)
- Ronald S Weinstein
- Department of Pathology, College of Medicine-Tucson, Tucson, Ariz; Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz.
| | - Ana Maria Lopez
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz; Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Ariz
| | - Bellal A Joseph
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; Department of Surgery, University of Arizona College of Medicine-Tucson, Tucson, Ariz
| | - Kristine A Erps
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz
| | - Michael Holcomb
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz
| | - Gail P Barker
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; College of Medicine-Phoenix, Phoenix, Ariz
| | - Elizabeth A Krupinski
- Arizona Telemedicine Program, College of Medicine-Tucson, Tucson, Ariz; Department of Medical Imaging, University of Arizona College of Medicine-Tucson, Tucson, Ariz
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