Pediatric Informatics: Computer Applications in Child Health (Health ...

284 C. Sable et al.
without increased echocardiography utilization and reducing length of stay. 17 Live
transmission of fetal echocardiograms has also been shown to be diagnostic at
bandwidths of 384 Kbps. 18 Use of “store and forward” telemedicine for emergency
echocardiography consultation during weekend, evening, and overnight hours to
assess ventricular function, ischemia, pericardial effusions, valvular disease, and
heart donor status in adult patients was reported in 1996. 19
One percent of all newborns have a congenital heart defect and a significant
number require urgent medication and surgery. 20 It may take 3–5 days for the
circulation to transition from the fetal pattern to the newborn pattern, which can
mask a potentially life threatening heart condition. Symptoms may not occur
until after the baby has left the hospital. Most community hospitals have access
to echocardiography, but no immediate access to a pediatric cardiologist who can
make an expedient interpretation. In 10 percent of cases of a newborn with an
audible murmur does the child require urgent intervention. Prior to telemedicine,
in community hospitals without pediatric cardiologists, echocardiograms could
be performed, but needed to be sent by courier for interpretation. Problems with
this approach include: suboptimal quality of the echocardiogram, delays in timely
diagnosis and intervention and unnecessary transports (resulting in higher costs and
emotional stress to the family) in the case of a benign condition.
Telemedicine has streamlined the approach to newborns with suspected heart
disease. Real-time transmission of echocardiograms to a pediatric cardiologist
provides an immediate interpretation and recommendations. Benefits of this
approach include:
Increased echocardiography quality and sonographer proficiency and efficiency
through the interactions between remote pediatric cardiologists and local
technicians
Reduced unnecessary transports, resulting in decreased morbidity and direct
financial savings from prevention from timely diagnosis and management
Shorter hospital stays, and avoidance of the burdens of travel and lost wages on
the patient’s family
A multicenter study, supported by an American Society of Echocardiography grant
(Table 20.4), found that patients with access to telemedicine were transported less
often, had shorter hospital stays, and were less likely to receive unnecessary invasive
management than diagnosed-matched control patients. 21
At the Children’s National Medical Center (CNMC) in Washington, DC, the
pediatric tele-cardiology program uses live videoconferencing over three bonded
Table 20.4 American society of echocardiography multicenter study: patients with mild or no
heart disease
Telemedicine (n = 338) Control (n = 338) p value
Transported to tertiary
care hospital
5% (n = 15) 10% (n = 32) 0.01
Total length of stay 1.0 ± 6.8 days
2.6 ± 11 days
0.005
Range: 0–102 days Range: 0–96 days