1
|
Kalwani NM, Osmanlliu E, Parameswaran V, Qureshi L, Dash R, Heidenreich PA, Scheinker D, Rodriguez F. Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic. J Telemed Telecare 2024; 30:543-548. [PMID: 35108126 PMCID: PMC8814611 DOI: 10.1177/1357633x211073428] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
Early in the COVID-19 pandemic, cardiology clinics rapidly implemented telemedicine to maintain access to care. Little is known about subsequent trends in telemedicine use and visit volumes across cardiology subspecialties. We conducted a retrospective cohort study including all patients with ambulatory visits at a multispecialty cardiovascular center in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). Telemedicine use increased from 3.5% of visits (1200/33,976) during the pre-COVID period to 63.0% (21,251/33,706) during the COVID period. Visit volumes were below pre-COVID levels from March to May 2020 but exceeded pre-COVID levels after June 2020, including when local COVID-19 cases peaked. Telemedicine use was above 75% of visits in all cardiology subspecialties in April 2020 and stabilized at rates ranging from over 95% in electrophysiology to under 25% in heart transplant and vascular medicine. From June 2020 to February 2021, subspecialties delivering a greater percentage of visits through telemedicine experienced larger increases in new patient visits (r = 0.81, p = 0.029). Telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care though utilization varies across subspecialties. Higher rates of telemedicine adoption may increase access to care in cardiology clinics.
Collapse
Affiliation(s)
- Neil M Kalwani
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Esli Osmanlliu
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Canada
| | - Vijaya Parameswaran
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Lubna Qureshi
- Digital Health Care Integration, Stanford Health Care, Stanford, CA, USA
| | - Rajesh Dash
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Bijani M, Abedi S, Zare A, Tavacol Z, Abadi F, Alkamel A. Exploring the challenges to using telecardiology as perceived by pre-hospital emergency care personnel: a qualitative study. BMC Emerg Med 2023; 23:143. [PMID: 38049778 PMCID: PMC10696672 DOI: 10.1186/s12873-023-00913-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Today, using the medical technology of telecardiology, as part of advanced medical services, plays an essential role in providing care to cardiac patients in life-threatening conditions who need emergency care. However, pre-hospital emergency care personnel are faced with certain challenges in using telecardiology, with adverse effects on their performance. Therefore, the present study aimed to investigate the challenges to using telecardiology as viewed by pre-hospital emergency care personnel in Southern Iran. METHODS The present study is a qualitative work of research with a content analysis approach. Selected using purposeful sampling, 19 pre-hospital emergency care personnel were interviewed on a semi-structured, personal, in-depth basis. The qualitative data obtained were analyzed using the Graneheim and Lundman's conventional content analysis approach (2004). RESULTS Based on the qualitative data analysis, 3 themes and 8 subthemes were obtained. The three main themes included professional barriers (lack of clinical knowledge of telecardiology, lack of clinical skill in telecardiology, violation of patients' privacy, lack of clinical guidelines on telecardiology), medical equipment and telecommunication barriers (poor reception and ineffective means of communication, low charge on the battery of tele-electrocardiogram machines), and organizational management barriers (serious lack of cardiologists available for medical counseling and lack of continual personal development of the telecardiology personnel). CONCLUSION Senior managers in pre-hospital emergency care services are recommended to use the results of this study to identify the influential factors in using telecardiology and take the necessary measures to eliminate the existing barriers toward making optimal use of telemedicine, thereby improving the quality of care provided for cardiac patients.
Collapse
Affiliation(s)
- Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran.
| | - Saeed Abedi
- Department of Emergency Medical Services, Fasa University of Medical Sciences, Fasa, Iran
| | - Azam Zare
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Ziba Tavacol
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Fozieh Abadi
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdulhakim Alkamel
- Department of Cardiology, Fasa University of Medical Sciences, Fasa, Iran
| |
Collapse
|
3
|
Foti ML, Stelmaszewski ÉV, Micheli DC, Lafuente MV, Mouratian M, Di Santo MV, Villa A. [Pediatric telecardiology experience in the COVID-19 pandemic context]. Arch Cardiol Mex 2023; 93:108-114. [PMID: 37931895 DOI: 10.24875/acm.22000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/21/2023] [Indexed: 11/08/2023] Open
Abstract
Introduction The COVID-19 pandemic has caused a global impact on public health services. Using new strategies through telehealth for the management of patients with congenital heart disease was the challenge. Objective To describe the experience in telecardiology, and the strategies implemented during the pandemic. Method Retrospective, qualitative study that includes the period from April 2020 to April 2021. Inquiries were received through the service's official e-mail or telephone. They were classified according to the type of concern and complexity of heart disease using color coding. The responses were asynchronous (by e-mail) or synchronous (videoconferences). The videoconferences were made using a secure platform (Cisco-Webex). Results From April 2020 to April 2021, a total of 3372 queries were answered. The responses were distributed via e-mail (64.9%), phone calls (1.2%) and videoconferences (14.5%). The most frequent reasons for consultation were the request for missed appointments (68%), and remote clinical monitoring (20%). A total of 2296 families was contacted. Only 14.1% of the inquiries were cited in person. With color coding, a stratification was performed according to urgency. Conclusions Telehealth proved to be a useful tool for the clinical management of patients with congenital heart disease in their place of origin. It prevented a considerable number of transfers, identified patients at risk rapidly, comforted families, and strengthened ties with local hospitals that make up the health network.
Collapse
Affiliation(s)
- Mariel L Foti
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - Érica V Stelmaszewski
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - Diego C Micheli
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - M Victoria Lafuente
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - Mariela Mouratian
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - Marisa V Di Santo
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| | - Alejandra Villa
- Servicio de Cardiología Infantil, Hospital de Pediatría SAMIC Prof. Dr. Juan P. Garrahan, Ciudad de Buenos Aires, Argentina
| |
Collapse
|
4
|
Tsirintani M. Remote Monitoring of Patients with Implantable Devices-Telemonitoring and Chronic Diseases. Stud Health Technol Inform 2023; 305:460-463. [PMID: 37387065 DOI: 10.3233/shti230531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
The high health care costs and poor quality associated with heart failure have led to the development of remote patient monitoring (RPM or RM) systems and cost-effective disease management strategies. RM of cardiac implantable electronic devices (CIEDs) is the application of communication technology to patients carrying a pacemaker (PM), an implantable cardioverter defibrillator (ICD) for cardiac resynchronization therapy (CRT) or an implantable loop recorder (ILR). The aim of this study is to define and analyze the benefits of modern telecardiology to provide patients with remote clinical assistance especially for patients with implantable devices for early detection of the development of heart failure as well as the limitations inherent therein. Furthermore, the study examines the benefits of telemonitoring in chronic and cardiovascular diseases proposing holistic care. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-PRISMA methodology. The results highlight that telemonitoring has augmented beneficial effects on clinical outcomes of heart failure, including, a reduction in mortality, heart failure hospitalization, all cause hospitalization and also an improvement in Quality of Life.
Collapse
|
5
|
Maurizi N, Fumagalli C, Skalidis I, Muller O, Armentano N, Cecchi F, Marchionni N, Olivotto I. Layman electrocardiographic screening using smartphone-based multiple‑lead ECG device in school children. Int J Cardiol 2023; 373:142-144. [PMID: 36513281 DOI: 10.1016/j.ijcard.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pre-partecipation ECG screening of large populations has a significant socioeconomic impact. Technological progress now allows for high-tech-low-cost ECG screening using validated smartphone-based devices capable of guiding to the correct performance of a 12‑lead ECG by layman with no medical background. METHODS We enrolled 728 (364, 52% males) individuals, aged 12-13 years who underwent ECG screening with a smartphone 12‑lead ECG during school hours by layman volunteers. Correct electrodes placement was provided by a validated image-processing algorithm by the smartphone camera in the App. ECG interpretation was via a telecardiology platform and alterations classified following current standards. RESULTS A total of 741 ECGs were recorded, of which 13(2%) were technically not interpretable. Mean PR, QRS and QTc were: 145 ± 22, 85 ± 19 and 387 ± 57 msec. No QTc prolongation was observed. Mean QRS axis was 15°; 26 (4%) patients presented an iRBB. T-wave inversion from V1-V3 was present in 145 (21%) subjects. Twenty-one(3%) patients were referred to second level examination: deep Q-waves in inferior leads in 12(1.6%), ventricular ectopics in 5(0.7%), anterior T-waves inversions V1-V4 in 3(0.4%); extreme right axis deviation in 1(0.3%). Second line investigations did not provide any definitive diagnosis. Total project costs (material equipment and human cost) was 14.460€, 19.51€ per individual. The potential net saving with respect to current pre-participation screening cost was 19%. CONCLUSIONS Layman 12‑lead Smartphone-ECG population screening proved feasible and effective, with a rate of non-interpretable ECG of <5%. Potential cost-saving in ECG screening and recording was 19%, providing an appealing opportunity when large campaigns should be addressed also in developing countries.
Collapse
Affiliation(s)
- Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Cardiology, University Hospital of Lausanne, Switzerland.
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Ioannis Skalidis
- Department of Cardiology, University Hospital of Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Switzerland
| | | | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Manzi G, Papa S, Mariani MV, Scoccia G, Filomena D, Malerba C, Adamo FI, Caputo A, De Lazzari C, De Lazzari B, Cedrone N, Madonna R, Recchioni T, Serino G, Vizza CD, Badagliacca R. Telehealth: A winning weapon to face the COVID-19 outbreak for patients with pulmonary arterial hypertension. Vascul Pharmacol 2022; 145:107024. [PMID: 35716991 DOI: 10.1016/j.vph.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Background COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH). Main body The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities. Conclusion Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools.
Collapse
|
7
|
Mohammadzadeh N, Rezayi S, Tanhapour M, Saeedi S. Telecardiology interventions for patients with cardiovascular Disease: A systematic review on characteristics and effects. Int J Med Inform 2021; 158:104663. [PMID: 34922178 DOI: 10.1016/j.ijmedinf.2021.104663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects. METHODS A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included. RESULTS Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction. CONCLUSION Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction.
Collapse
Affiliation(s)
- Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorayya Rezayi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Tanhapour
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Saeedi
- Clinical Research Development Unit of Farshchian Heart Center, Hamadan University of Medical Sciences, Hamadan, Iran; Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Maines M, Tomasi G, Moggio P, Poian L, Peruzza F, Catanzariti D, Angheben C, Cont N, Valsecchi S, Del Greco M. Scheduled versus alert transmissions for remote follow-up of cardiac implantable electronic devices: Clinical relevance and resource consumption. Int J Cardiol 2021; 334:49-54. [PMID: 33930512 DOI: 10.1016/j.ijcard.2021.04.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management. METHODS At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it). RESULTS Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%. CONCLUSION Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center.
Collapse
Affiliation(s)
| | | | - Paolo Moggio
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | - Luisa Poian
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | | | | - Natascia Cont
- Santa Maria del Carmine Hospital, Rovereto, TN, Italy
| | | | | |
Collapse
|
9
|
De Bonis S, Salerno N, Bisignani A, Capristo A, Sosto G, Verta A, Borselli R, Capristo C, Bisignani G. COVID-19 and STEMI: The role of telecardiology in the management of STEMI diagnosis during COVID 19 pandemic. Int J Cardiol Heart Vasc 2021; 32:100720. [PMID: 33501370 PMCID: PMC7817440 DOI: 10.1016/j.ijcha.2021.100720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Telecardiology has the advantage of reducing patient's access time to the hemodynamics units. Data from literature show a reduction in ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic. However, there is a low number of studies on the impact of telecardiology during the pandemic. METHODS Our telecardiology system is composed of a Hub-and-Spoke network of hospitals and ambulances that ensures a rapid exchange of information allowing STEMI patients to be treated in the shortest time possible. We compared data from electrocardiograms (ECGs) transmissions and STEMI diagnosis collected between February and April 2020 with the data from the same period of 2019. RESULTS Despite a significant reduction of ECGs transmissions from the telecardiology network was observed, the number of diagnosed STEMI during 2020 was stable and did not show any significant difference compared to 2019. The total number of STEMI diagnosis in the months under examination during 2019 were 47 out of 7463 ECGs (0.63%), while in 2020 were 48 out of 5797 ECGs (0.83%). CONCLUSIONS The efficiency of our telecardiology system along with the low spread of the infection in our region contributed to maintaining the number of STEMI diagnosis and patient's care in line with the past even during the pandemic.
Collapse
Affiliation(s)
- Silvana De Bonis
- Department of Cardiology, Ospedale “Ferrari”, Castrovillari, CS, Italy
| | - Nadia Salerno
- Department of Cardiology, Ospedale “Ferrari”, Castrovillari, CS, Italy
| | - Antonio Bisignani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Gennaro Sosto
- Direzione Generale ASL Napoli 3 – Coordinatore Area Innovazione e Tecnologie Sanitarie di Federsanità, Italy
| | | | | | | | | |
Collapse
|
10
|
Maines M, Zorzi A, Benetollo PP, Guarrera GM, Moz M, Manica A, Demattè C, Del Greco M. Short-term outcome associated with remote evaluation ( telecardiology) of patients with cardiovascular diseases during the COVID-19 pandemic. Int J Cardiol Heart Vasc 2020; 30:100625. [PMID: 32905165 DOI: 10.1016/j.ijcha.2020.100625] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/22/2022]
Abstract
Introduction During the recent COVID-19 outbreak, Italian health authorities mandated to replace in-person outpatient evaluations with remote evaluations. Methods From March 16th 2020 to April 22th 2020, all outpatients scheduled for in-person cardiac evaluations were instead evaluated by phone. We aimed to report the short-term follow-up of 345 patients evaluated remotely and to compare it with a cohort of patients evaluated in-person during the same period in 2019. Results During a mean follow-up of 54 ± 11 days, a significantly higher proportion of patients evaluated in-person in 2019 visited the emergency department or died for any cause (39/391, 10% versus 13/345 3.7%, p = 0.001) and visited the emergency department for cardiovascular causes (19/391, 4.9% versus 7/345, 2.0%, p = 0.04) compared to 2020. No cardiovascular death was recorded in the two periods. To an evaluation with a satisfaction questionnaire 49% of patients would like to continue using remote controls in addition to traditional ones. Conclusion These findings may have important implications for the management of patients during the current COVID-19 pandemic because they suggest that remote cardiovascular evaluations may replace in-hospital visits for a limited period.
Collapse
|
11
|
Maia MR, Castela E, Pires A, Lapão LV. How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on - an exploratory study. BMC Health Serv Res 2019; 19:681. [PMID: 31547824 PMCID: PMC6757431 DOI: 10.1186/s12913-019-4511-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. Methods This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making. Results With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. Conclusion The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.
Collapse
Affiliation(s)
- Mélanie Raimundo Maia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal.
| | - Eduardo Castela
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - António Pires
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal
| |
Collapse
|
12
|
Abstract
Heart murmur evaluation is the most common cause of referral to cardiology, and auscultation of heart sounds with a stethoscope remains a key component of the initial cardiovascular exam. Adoption of telecardiology has been limited by challenges in teleauscultation. We set out to compare in-person auscultatory findings with heart sounds recorded by the Core stethoscope (Eko, Berkeley, CA) in patients with normal heart sounds, innocent heart murmurs, and a variety of pathologic findings. Our study demonstrates that Eko recordings had a high percent of agreement with in-person auscultation findings and echocardiogram findings, with moderate inter-rater reliability. It was useful in identifying patients with pathologic murmurs who would benefit from further assessment. It was able to discern major types of pathological murmurs. Certain qualitative differences in the recorded sounds as compared to in-person auscultation were identified by the reading cardiologists. They were able to acclimate to these subtle differences. The system was felt to be easy to use, and most cardiologists in the study would consider using it in clinical settings. The Eko Core system may be a useful screening tool for murmur evaluation.
Collapse
Affiliation(s)
- Shashank Behere
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, 19899, USA
| | - Jeanne Marie Baffa
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, 19899, USA
| | | | - Nicholas Slamon
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, 19899, USA.
| |
Collapse
|
13
|
Frederix I, Vanderlinden L, Verboven AS, Welten M, Wouters D, De Keulenaer G, Ector B, Elegeert I, Troisfontaines P, Weytjens C, Mullens W, Dendale P. Long-term impact of a six-month telemedical care programme on mortality, heart failure readmissions and healthcare costs in patients with chronic heart failure. J Telemed Telecare 2018; 25:286-293. [PMID: 29742959 DOI: 10.1177/1357633x18774632] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The TElemonitoring in the MAnagement of Heart Failure (TEMA-HF) 1 long-term follow-up study assessed whether an initial six-month telemonitoring (TM) programme compared with usual care (UC) would result in reduced all-cause mortality, heart failure admissions and healthcare costs in chronic heart failure (CHF) patients at long-term follow-up. METHODS Of the 160 patients included in the multi-centre, randomised controlled telemonitoring trial (TEMA-HF 1, time point t0); 142 CHF patients (65% male; age: 76 ± 10 years; EF: 36 ± 15%) were alive and entered the follow-up study (time point: t1) with a final evaluation at 79 months (time point: t2). Both TM and UC group patients received standard heart failure care during the follow-up study (time points: t1 - t2). The primary endpoint was all-cause mortality. Secondary outcomes included days lost due to heart failure readmissions and readmission/patient follow-up related healthcare costs. RESULTS Compared with usual care, the initial six-month TM programme had no significant effect on all-cause mortality (hazard ratio: 0.83; 95% confidence interval, 0.57 to 1.20; p = 0.32). The number of days lost due to heart failure readmissions was significantly lower in the TM group ( p = 0.04). Healthcare costs did not differ significantly between the TM (€ 9140 ± 10580) and UC group (€ 12495 ± 22433) ( p = 0.87). DISCUSSION An initial six-month telemonitoring programme was not associated with reduced all-cause mortality in CHF patients at long-term follow-up but resulted in a reduction in the number of days lost due to heart failure readmissions. This study is registered in the ClinicalTrials.gov registry (NCT03171038) (URL: https://clinicaltrials.gov/ct2/show/NCT03171038 ).
Collapse
Affiliation(s)
- Ines Frederix
- 1 Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,2 Department of Cardiology, Jessa Hospital, Belgium.,3 Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | | | | | - Maria Welten
- 3 Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Donna Wouters
- 5 Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | | | - Bavo Ector
- 7 Department of Cardiology, Imelda Hospital, Belgium
| | - Ivan Elegeert
- 8 Department of Cardiology, Groeninge Hospital, Belgium
| | | | | | | | - Paul Dendale
- 1 Faculty of Medicine and Life Sciences, Hasselt University, Belgium.,2 Department of Cardiology, Jessa Hospital, Belgium
| |
Collapse
|
14
|
Caldarola P, Gulizia MM, Gabrielli D, Sicuro M, De Gennaro L, Giammaria M, Grieco NB, Grosseto D, Mantovan R, Mazzanti M, Menotti A, Brunetti ND, Severi S, Russo G, Gensini GF. ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks. Eur Heart J Suppl 2017; 19:D229-D243. [PMID: 28751844 PMCID: PMC5520753 DOI: 10.1093/eurheartj/sux028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects.
Collapse
Affiliation(s)
- Pasquale Caldarola
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibal-Nesima Hospital, Ospedale Nesima-Garibaldi, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | | | - Marco Sicuro
- Cardiology and Cardiac Intensive Care, Regionale Umberto Parini Hospital, Aosta, Italy
| | - Luisa De Gennaro
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | | | | | | | - Roberto Mantovan
- Cardiology Unit, Ospedale Santa Maria dei Battuti, Conegliano (Treviso), Italy
| | - Marco Mazzanti
- Cardiology Hemodynamics-CCU Department, University "Ospedali Riuniti" Hospital, Ancona, Italy
| | | | | | - Silva Severi
- Cardiology Unit, Misericordia Hospital, Grosseto, Italy
| | - Giancarmine Russo
- Italian Society for Telemedicine and eHealth (Digital SIT), Rome, Italy
| | | |
Collapse
|
15
|
Lopes EL, Beaton AZ, Nascimento BR, Tompsett A, Dos Santos JP, Perlman L, Diamantino AC, Oliveira KK, Oliveira CM, Nunes MDCP, Bonisson L, Ribeiro AL, Sable C. Telehealth solutions to enable global collaboration in rheumatic heart disease screening. J Telemed Telecare 2016; 24:101-109. [PMID: 27815494 DOI: 10.1177/1357633x16677902] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
Collapse
Affiliation(s)
- Eduardo Lv Lopes
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Cassio M Oliveira
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | - Leonardo Bonisson
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | | | | |
Collapse
|
16
|
Marcolino MS, Palhares DMF, Benjamin EJ, Ribeiro AL. Atrial fibrillation: prevalence in a large database of primary care patients in Brazil. Europace 2015; 17:1787-90. [PMID: 26056188 PMCID: PMC4700731 DOI: 10.1093/europace/euv185] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/01/2015] [Indexed: 02/07/2023] Open
Abstract
AIMS Although an increasing prevalence of atrial fibrillation (AF) has been reported worldwide, there are few studies from low- and middle-income countries. Our objective is to assess the prevalence of AF and the associated medical conditions in Brazilian primary care patients. METHODS AND RESULTS This is an observational retrospective study. Patients ≥5 years of age from primary care centres of 658 municipalities in Minas Gerais, Brazil, who performed digital electrocardiograms (ECGs) by a public telehealth service in 2011 were assessed. Clinical data were self-reported, and ECGs were interpreted by a team of trained cardiologists using standardized criteria. To assess the relation between clinical characteristics and AF, odds ratios were estimated by logistic regression. A total of 262 685 primary care patients were included, mean (SD) age of 50.3 (19.3) years, 59.6% female. Hypertension was reported in 32.0%, family history of coronary heart disease in 15.0%, diabetes in 5.4%, hyperlipidaemia in 2.8%, Chagas disease in 2.9%, and 7.1% reported current smoking. The prevalence of AF was 1.8% overall: 2.4% in men (ranging from 0.001% from 5-19 years old to 14.6% in nonagenarians) and 1.3% in women (ranging from 0.001% from 5-19 years old to 8.7% in nonagenarians) (P < 0.001). The prevalence of AF increased with advancing age. The comorbidities associated with AF were Chagas disease, previous myocardial infarction, hypertension, and chronic obstructive pulmonary disease. Vitamin K antagonist use was reported by 1.5% of patients. CONCLUSION The prevalence and age distribution of AF were similar to studies in high-income countries. The proportion of patients who reported the use of anticoagulants was alarmingly low. Our findings point out the necessity to formulate effective treatment strategies for AF in Brazilian primary care settings.
Collapse
Affiliation(s)
- Milena S Marcolino
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190 Room 246, CEP 30130-100 Belo Horizonte, Brazil Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Daniel M F Palhares
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190 Room 246, CEP 30130-100 Belo Horizonte, Brazil Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Antonio L Ribeiro
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190 Room 246, CEP 30130-100 Belo Horizonte, Brazil Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
17
|
Abstract
This paper presents the design and implementation of a system for digital telecardiology on mobile devices called Remote Cardio Consultation (RCC). Using RCC may improve first intervention procedures in case of heart attack. In fact, it allows physicians to remotely consult ECG signals from a mobile device or smartphone by using a so-called app. The remote consultation is implemented by a server application collecting physician availability to answer upon client support requests. The app can be used by first intervention clinicians and allows reducing delays and decision errors in emergency interventions. Thus, best decision, certified and supported by cardiologists, can be obtained in case of heart attacks and first interventions even by base medical doctors able to produce and send an ECG. RCC tests have been performed, and the prototype is freely available as a service for testing.
Collapse
Affiliation(s)
- Pietro Cinaglia
- Department of Clinical and Surgical Science, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Tradigo
- Department of Computer Science, Modeling, Electronics and Systems Engineering, DIMES University of Calabria, Cosenza, Italy
| | - Pietro H Guzzi
- Department of Clinical and Surgical Science, University Magna Græcia of Catanzaro, Catanzaro, Italy.
| | - Pierangelo Veltri
- Department of Clinical and Surgical Science, University Magna Græcia of Catanzaro, Catanzaro, Italy
| |
Collapse
|
18
|
Scheuermeyer FX, Grunau BE, Findlay T, Grafstein E, Christenson J, Lang E, Rowe B, Ho K. Speed and accuracy of text-messaging emergency department electrocardiograms from a small community hospital to a provincial referral center. J Telemed Telecare 2015; 22:105-13. [PMID: 26026182 DOI: 10.1177/1357633x15587626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 04/16/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Currently, transmission of electrocardiograms (EKGs) from a small emergency department (ED) to specialists at referral hospitals can be a time-consuming and laborious process. We investigate whether text messaging by use of short message service (SMS) of EKGs from a small hospital to consultants at a large hospital is rapid and accurate. METHODS This study involved a one-month prospective evaluation of consecutive EKGs recorded in a small community ED. Investigators obtained de-identified photographs of each EKG via a mobile phone camera. Each EKG picture, along with a brief patient clinical history, was sent via SMS to on-call emergency physicians located at a large referral care site. All images were evaluated solely on a mobile phone. The primary outcome was the proportion of SMS that were received within two minutes of being sent. As a secondary outcome, the intra-rater evaluation of the initial EKG and the SMS EKG image were compared on 13 standardized features. The tertiary outcome was cost of text messaging. RESULTS A total of 298 patients (14.6%) had 409 EKGs performed and a total of 926 SMS were sent. 921 SMS (99.5%, 95% confidence interval (CI) 98.7-99.8%) arrived within two minutes with a median transmission time of nine seconds (interquartile range (IQR) 3-32 s). Between the gold standard original EKG, and the interpretation of the texted image, six out of 409 (1.5%, 95% CI 0.6-3.3%) had any differences recorded, across all 13 categories. Overall, the study cost 4.1 cents per texted image. CONCLUSIONS Systematic text messaging of ED EKGs from a small community hospital to a referral center is a rapid, accurate, portable, and inexpensive method of data transfer. This may be a safe and effective strategy to communicate vital patient information.
Collapse
Affiliation(s)
| | - Brian E Grunau
- Department of Emergency Medicine, St Paul's Hospital, Canada
| | - Timothy Findlay
- Department of Emergency Medicine, Mount St Joseph's Hospital, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, St Paul's Hospital, Canada
| | - Jim Christenson
- Department of Emergency Medicine, St Paul's Hospital, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Canada
| | - Brian Rowe
- Department of Emergency Medicine, University of Alberta, Canada
| | - Kendall Ho
- Department of Emergency Medicine, Vancouver General Hospital, Canada
| |
Collapse
|
19
|
Brunetti ND, Scalvini S, Acquistapace F, Parati G, Volterrani M, Fedele F, Molinari G. Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics. Int J Cardiol 2015; 184:452-8. [PMID: 25755064 DOI: 10.1016/j.ijcard.2015.02.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 11/20/2022]
Abstract
Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease.
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Laurent G, Amara W, Mansourati J, Bizeau O, Couderc P, Delarche N, Garrigue S, Guyomar Y, Hermida JS, Moïni C, Popescu E. Role of patient education in the perception and acceptance of home monitoring after recent implantation of cardioverter defibrillators: the EDUCAT study. Arch Cardiovasc Dis 2014; 107:508-18. [PMID: 25218008 DOI: 10.1016/j.acvd.2014.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 06/04/2014] [Accepted: 06/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Much attention is being paid to the education of and provision of medical information to patients, to optimize their understanding and acceptance of their disease. AIMS To ascertain the impact of educating recent recipients of an implantable cardioverter defibrillator (ICD) on their perception and acceptance of a home monitoring (HM) system. METHODS Questionnaire 1, completed one month after ICD implantation, was designed to assess: the quality of patient preparation for HM; patient comprehension of HM; and patient anxiety experienced during its installation. The comprehension questions were assigned a score of -2 for an incorrect answer, +1 for a correct answer and 0 for neither (total score ranging from -40 to +20). Questionnaire 2, completed six months after ICD implantation, assessed patient acceptance of and anxiety about HM. RESULTS The registry included 571 patients (mean age 63.9±12.8 years; 83% men; 76% of ICDs implanted for primary prevention) followed by HM for 6.2±1.2 months. Questionnaire 1 was completed by 430 (75.3%) patients and questionnaire 2 by 398 (69.7%) patients. Younger patients had a better comprehension of HM than older patients. High-quality training conditions improved the comprehension score, and a positive association was observed between anxiety and acceptance levels and the comprehension score. The 80±20% mean data transmission rate (days of transmission/days of follow-up ratio) was unrelated to the comprehension scores. CONCLUSION A clear understanding was associated with a higher acceptance of HM, although it was unrelated to the data transmission rate.
Collapse
Affiliation(s)
- Gabriel Laurent
- Service de rythmologie et d'insuffisance cardiaque, centre hospitalier universitaire Le Bocage, 2, boulevard de Lattre-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - Walid Amara
- Centre hospitalier intercommunal de Montfermeil, Montfermeil, France
| | | | - Olivier Bizeau
- Centre hospitalier régional Orléans-La-Source, Orléans, France
| | | | | | | | - Yves Guyomar
- Centre hospitalier Saint-Philibert, Lomme, France
| | | | | | | | | |
Collapse
|
22
|
Lacerda TC, von Wangenheim CG, von Wangenheim A, Giuliano I. Does the use of structured reporting improve usability? A comparative evaluation of the usability of two approaches for findings reporting in a large-scale telecardiology context. J Biomed Inform 2014; 52:222-30. [PMID: 25017250 DOI: 10.1016/j.jbi.2014.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/03/2014] [Accepted: 07/06/2014] [Indexed: 11/29/2022]
Abstract
One of the main reasons that leads to a low adoption rate of telemedicine systems is poor usability. An aspect that influences usability during the reporting of findings is the input mode, e.g., if a free-text (FT) or a structured report (SR) interface is employed. The objective of our study is to compare the usability of FT and ST telemedicine systems, specifically in terms of user satisfaction, efficiency and general usability. We comparatively evaluate the usability of these two input modes in a telecardiology system for issuing electrocardiography reports in the context of a statewide telemedicine system in Brazil with more than 350.000 performed tele-electrocardiography examinations. We adopted a multiple method research strategy, applying three different kinds of usability evaluations: user satisfaction was evaluated through interviews with seven medical professionals using the System Usability Scale (SUS) questionnaire and specific questions related to adequacy and user experience. Efficiency was evaluated by estimating execution time using the Keystroke-Level Model (KLM). General usability was assessed based on the conformity of the systems to a set of e-health specific usability heuristics. The results of this comparison provide a first indication that a structured report (SR) input mode for such a system is more satisfactory and efficient with a larger conformity to usability heuristics than free-text (FT) input. User satisfaction using the SUS questionnaire has been scored in average with 58.8 and 77.5 points for the FT and SR system, respectively, which means that the SR system was rated 18.65 points higher than the FT system. In terms of efficiency, the completion of a findings report using the SR mode is estimated to take 8.5s, 3.74 times faster than using the FT system (31.8s). The SR system also demonstrated less violations to usability heuristics (8 points) in comparison to 14 points observed in the FT system. These results provide a first indication that the usage of structured reporting as an input mode in telecardiology systems may enhance usability. This also seems to confirm the advantages of the usage of structured reporting, as already described in the literature for other areas such as teleradiology.
Collapse
Affiliation(s)
- Thaisa Cardoso Lacerda
- Brazilian Institute for Digital Convergence - INCoD, Informatics and Statistics Department, Brazil
| | | | - Aldo von Wangenheim
- Brazilian Institute for Digital Convergence - INCoD, Informatics and Statistics Department, Brazil.
| | - Isabela Giuliano
- Cardiologist, Pediatrics Department, University Hospital Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| |
Collapse
|