The evolution of pediatric tele-echocardiography: 15-year experience of over 10,000 transmissions.

BACKGROUND: Telemedicine transmission of echocardiograms, either in real-time or using store-and-forward technology, is used to evaluate infants with suspected heart disease. The impact of Internet protocol (IP) technology on telecardiology utilization is unknown. This study evaluated the impact of IP expansion on telecardiology utilization and mode of scanning. MATERIALS AND METHODS: The telemedicine database from 1998 to 2012 at our institution was reviewed. Tele-echocardiography transmissions between 1998 to 2012 were identified. IP technology was introduced in 2006. The database was reviewed to compare telecardiology utilization and mode of scanning of transmission (live, store-and-forward, or both). As a secondary aim, indications for telemedicine echocardiograms, outcomes of studies, effectiveness, and efficiency were recorded. RESULTS: Between 1998 and 2012, 11,890 telemedicine transmissions were performed. After IP expansion, telecardiology utilization increased significantly with no adverse effect on efficiency or diagnostic accuracy. IP expansion paralleled a change from live transmissions to store-and-forward transmissions. Abnormalities were detected in over 40% of studies. The average from time of request to completion of teleconsultation was under 30 min. Over 90% of echocardiograms were performed during the videoconference in the first 2 years. This fell to under 60% during the 2 most recent years of the program without impact on accuracy. CONCLUSIONS: Use of IP technology at a single center corresponded to a dramatic increase in volume of telemedicine echocardiograms, with no significant differences in efficiency.

Single-ventricle palliation for high-risk neonates: examining the feasibility of an automated home monitoring system after stage I palliation.

Strategies to reduce interstage morbidity and mortality for patients with single ventricle following stage I palliation include, standardized care protocols, focused high-risk outpatient clinics, dedicated teams that focus on the unique needs of these fragile patients and use of home surveillance monitoring. Use of telemedicine devices for home monitoring has been shown to improve outcomes in adults. These devices allow for a more automated approach to home monitoring that have many advantages. We describe our program that utilizes a web-based telemedicine device to capture and transmit data from the homes of our patients during the interstage period. Our early data suggest that home telemedicine is feasible, provides a more systematic data review and analysis and supports the assertion that patients using home surveillance have significantly better nutritional status than those not using home monitoring.