Telemedicine in Pediatric Cardiology

Satou GM, Rheuban K, Alverson D, et al., on behalf of the American Heart Association Congenital Cardiac Disease Committee of the Council on Cardiovascular Disease in the Young and Council on Quality Care and Outcomes Research.
Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017;Feb 13:[Epub ahead of print].

The following are key points to remember from this American Heart Association Scientific Statement about telemedicine in pediatric cardiology:

  1. Various terms related to telemedicine have been used interchangeably in the literature. For the purposes of this document, telehealth is defined as the use of technology to bridge distances in any aspect of medicine. Telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically.
  2. Tele-echocardiography is the most common telemedicine application used within the field of cardiology. It is the process in which a provider or technician obtains cardiovascular ultrasound images which are subsequently transmitted to an off-site location for interpretation by a cardiologist.
  3. Telecardiology may play a role in the assessment of infants with positive pulse oximetry screens. Telemedicine can provide access to pediatric subspecialists after a positive screen. Assessment of infants with positive pulse oximetry screens is relatively high yield. Critical congenital heart disease is identified at a rate of 1 diagnosis per 6.8 echocardiograms performed for a positive pulse oximetry screen, as compared with a rate of 1 complex lesion identified per 100 echocardiograms performed for murmur.
  4. An important component of telemedicine is the training of local sonographers to perform a triage echocardiogram. As adult sonographers may not be comfortable with suprasternal notch and subcostal views, these should be an area of emphasis in training programs.
  5. A structured plan is important in the development of tele-echocardiography sites. There are generally three components of such a plan. The first includes identification of information technology support and planning for sonographer education. The next component is development of the clinical care model, including providing intake data to the referral center and establishing a mechanism of reporting results back to the local center. Finally, the plan should include ongoing quality assessment including establishment of quality metrics and report dissemination.
  6. A key component of telemedicine programs involves the development of relationships between community and pediatric cardiologists at the referral centers. This includes education regarding the role of echocardiography in the diagnosis of cardiac disease.
  7. A common use of telemedicine in the pediatric cardiac catheterization laboratory is for early career interventional cardiologists to seek consultation from senior faculty, often at remote centers.
  8. There has been interest in developing technology for the remote diagnosis of heart murmurs using tele-auscultation. However, technical limitations have limited its use and it has not proliferated in practice. There is potential for the use of computer-aided auscultation interpretation using digitally recorded heart sounds, which has been shown to be highly sensitive and specific.
  9. Telemedicine services are currently reimbursed by federal, state, and private payers, although there is significant variability in policies of reimbursement based on type of payer and geographic location.
  10. Advances in technology and the rapidly changing healthcare environment have moved the field of telemedicine towards realization of its full potential. Additional policies to standardize various aspects of telemedicine will be required at the level of state and local governments, as well as private and public payers.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Congenital Heart Disease, CHD and Pediatrics and Imaging, Echocardiography/Ultrasound

Keywords: Auscultation, Cardiac Catheterization, Diagnostic Imaging, Echocardiography, Heart Defects, Congenital, Heart Murmurs, Heart Sounds, Local Government, Oximetry, Pediatrics, Telemedicine, Triage

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