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

20 Telemedicine Applications in Pediatrics 287
hospital 5 mi away and a remote referral hospital in Germany. Patients scheduled
for surgery and those who are candidates for surgery are discussed, with all sites
being able to see the same data simultaneously.
A new tele-cardiology application is being piloted involving home health care. 22
The most complex congenital heart defects: hypoplastic left heart, hypoplastic right
heart (tricuspid atresia and pulmonary atresia) and other complex single ventricle
hearts require staged surgeries including: an initial surgical procedure in the first 2
weeks of life (Norwood procedure), a second surgical procedure between 3 and 8
months of life (Glenn procedure) and a third surgical procedure between 18 months
and 3 years of life (Fontan procedure). Improved surgical techniques along with
better preoperative, intraoperative, and postoperative care have led to survival
to hospital discharge approaching 90% for the most complex of these conditions
(hypoplastic left heart) and even higher for other defects. Well over 95% of patients
who reach the second operation survive into adulthood and have excellent quality
of life. This makes it imperative that considerable focus is put upon this vulnerable
period in the first 6 months of life.
Despite vastly improved outcomes, children with single ventricles remain at
high risk during the vulnerable period between hospital discharge and the second
operation with a risk of death up to 15% during this period. They are much more
susceptible to normal child illnesses that cause fever, dehydration, and low oxygen.
Close daily monitoring of simple parameters (formula intake, weight gain, pulse
oximetry) has been shown to almost eliminate this mortality. We are in the process
of instituting a simple home device that will electronically measure these parameters
in this patient population and transmit them to a centralized computer over regular
telephone lines for daily review.
20.4.2 Neurology
Seizure disorders are common in children, especially premature babies. At CNMC,
the remote interpretation of electroencephalograms (EEG) began in 2002, and we
are now connected to three community hospitals. These hospitals have the ability
to perform EEGs on infants and children but not the pediatric neurology expertise
to interpret them. EEGs are now acquired in a digital format and stored on a server
at the remote hospital or transmitted to CNMC. Pediatric neurologists may connect
via a Web client to the server, interpret the EEG and submit the final report online.
Over 500 studies have been interpreted in this manner, with a next business day
turnaround, and the option for stat studies. EEG interpretation lends itself nicely to
a “store and forward” model because the quality of the test has very little dependence
on the interaction between physician and technician.
Telepathology is another tele-neurology application, offered in both “live” and
“store and forward” modes. A formal collaboration between CNMC and hospitals
in Cincinnati and Chicago permits referral of brain tumor pathology cases for
second opinions. Slides of pathology specimens are digitized and send for review