Andersons pediatric cardiology 2308
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (127.38 KB, 3 trang )
TelemedicineinPediatricCardiology
GarySatou,SanketShah,CraigSable
Abstract
Pediatriccardiologyisoneofthemostprevalentapplicationsof
telemedicine.Multiplepublicationssupportthattele-echocardiographyis
accurateanddiagnostic,improvescare,appropriatelytriagespatients,
preventsunnecessarytransports,iscost-effective,andimproves
sonographerproficiencyandphysicianefficiency.Evolvingtechnology
allowsforseamlessintegrationoftele-echocardiographyintoroutine
practice,makingitthestandardofcare.Near-universaladoptionof
newbornpulseoximetryscreeningforcriticalcongenitalheartdisease
mandatesarenewedfocusontelemedicineformanydeliveryhospitalsin
theUnitedStates.Telemedicinealsoimpactsmanyotherareasofpediatric
cardiologywithinnovativesolutionsforfetalmedicine,outpatient
cardiology,electrophysiology,intensivecareunit,homemonitoring,direct
toconsumertelemedicine,globalhealth,andpatientcareandeducation
conferences.Removalofreimbursement,licensure,andcredentialing
obstaclesisneededtorealizethefullbenefitthattelemedicinecanhavefor
pediatriccardiologypatientsandonthehealthcaresystemingeneral.
Keywords
Telemedicine;echocardiography;remotemonitoring
Telemedicinenowpervadesalmosteveryaspectofthepracticeofpediatric
cardiology.Simplydefined,telemedicinemeansusingtechnologytopractice
medicineatadistance–anditisnowusedonadailybasisforclinicalcare,
education,research,andadministrativetasks.1Useofthecloudtotransfer
images(echocardiogram,angiography,computedtomography[CT],ormagnetic
resonanceimaging[MRI]),remoteattendanceatpatientcareconferences,home
monitoringofinterstagesingle-ventriclepatients,wearabledevicesforrhythm
detection,andremotelogintoviewmonitortracingsforintensivecareunit
patientsareallexamplesoftelemedicine.Thistechnologyisnowaccessibleon
smartphonesandtablets,andmostuserscouldnotimaginepracticingmedicine
withoutit.Thischapterprovidesanoverviewofhowtele-echocardiographyand
othermodalitiesoftelemedicineareusedinpediatriccardiology,withafocuson
howtechnologyandclinicalusehaveevolved.
Echocardiography
Telemedicinehasbecomethestandardofcareinpediatricechocardiography.
Tele-echocardiographycanbecarriedoutvialivevideoconferenceinrealtime
orasstore-and-forwardimagestobeviewedremotely.Initialtelemedicine
studiesutilizedpoint-to-pointIntegratedServicesDigitalNetwork(ISDN)and
Terrestrial-1connectionsforlivetelemedicinewithgoodimagequalityand
acceptabletemporalresolution(frameratesof23to30/second).2–8Rapid
progressionoftechnologyoverthelast10yearshasmadethistechnology
obsolete.Today,InternetProtocol(IP)allowsformultipointnetwork
connectivitythatenablesuseofcodecsorvideoconferencingsoftwarefrom
anywhereonanydevice.Theseincluderoomsystems,desktoporlaptop
computers,tablets,andsmartphones.
Thefieldofpediatrictele-echocardiographyhaspredominantlyevolvedinto
store-and-forwardsolutionsthat,inmanycases,areextensionsofexisting
echocardiographypicturearchivingandcommunicationsystems(PACs)with
specialconsiderationsfordatatransfer.Directpoint-to-pointstudytransmission
optionsincludesecurefiletransferprotocol(FTP)andvirtualprivatenetwork
(VPN).Cloudserversenabletransmissionofandaccesstoechocardiograms
fromanywhereintheworldwithsubsequentdownloadintolocalPACs
servers.9,10Manyphysiciansaccessechocardiogramsviaremoteconnectionto
PACsnetworksthroughclientorweb-basedprograms.Inourhospitals,wehave
amixofallofthesetechnologies,butwepreferthatstudiesbetransferredinto
ourPACssystemforuniforminterpretationandreporting.However,some
partnerhospitalsinsistonusreportingintheirlocalPACsandelectronicmedical
records.Diligentattentiontosecurity,licensure,andcredentialingrequirements,
andcomplianceissuesaswellasaneedfor24/7technicalsupportstaffare
criticalformaintenanceofasuccessfultele-echocardiographynetwork.
Multiplestudieshavefoundneonataltele-echocardiographytobeaccurate
andcost-effective,haveapositiveimpactonpatientcare,preventunnecessary
transports,andimprovesonographerproficiency.3,4,6,11–16Table91.1,modified
fromarecentscientificstatementfromtheAmericanHeartAssociation,
providesasummaryofseveralofthesestudies.1Whennotdiagnosedprenatally,
newbornswithcongenitalheartdiseaseareoftendelivered,orpresenttoa
primarycaresetting,whereexpertcardiovascularevaluationmaynotbe
