Andersons pediatric cardiology 2310
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currentlymandatedinalmosteverystateandisadriverfortheestablishmentof
telemedicinelinksbetweencommunityhospitalsandtertiarycarepediatric
cardiaccenters.23–25Telemedicinecanprovidetimelyaccesstopediatric
subspecialistsincardiologyandneonatologyforassessmentandtreatment
recommendationsifapositivescreenisobtained.Thereisanargumentthat
false-positivepulseoximetryscreenscouldincreasethenumberofteleechocardiograms,pushingupcostsandoverburdeningpediatriccardiologists
providinginterpretation.However,arecentstudyshowsthattheadditional
increaseinechocardiogramsfrompulseoximetryscreeningisnegligiblewhen
comparedtothenumberoffalse-positiveechocardiogramsgeneratedbyheart
murmurs.26
FetalTelemedicine
Fetaltelemedicinecanincreaseprenataldetectionofcriticalcongenitalheart
disease.Sharmaetal.27reportedthatadequatescreeningforfetalheartdiseaseis
feasibleandcommunityacceptancefortelemedicine-assistedfetalcardiac
screeningandcounselingisnotadverselyaffectedbyalackofdirectpersonal
contactwithaspecialist.Prenataldetectionofcongenitalheartdiseasehasbeen
showntoimprovepostnatalsurgical28–30andhearttransplantationoutcomes.31
Fetaltelemedicineisalsousedacrossalllinksofthereferralchain,fromthe
primaryobstetrician'sofficetothequaternaryfetalhealthcarefacility.Itis
routinelyperformedbyobstetricians,maternal-fetalmedicinespecialists,and
pediatriccardiologiststoscreenforcongenitalheartdiseaseandfetal
arrhythmias.Ifpathologyissuspectedordetected,theseproviderscanrefer
patientstoahigherlevelofcare.Becauseaccesstofetalcardiacexpertiseis
limitedforpeopleinremoteorrurallocations,fetaltele-echocardiographycan
beespeciallyhelpfulinthesepopulations.Theuseoffetalultrasoundtodetect
congenitalheartdiseasecanalsohelppediatriccardiologistsandmaternal-fetal
medicinespecialistsworktogethertopreparefamiliesfordeliveryandtreatment
options.32–34
Fetaltelemedicinecanalsobediagnosticforfetalarrhythmias.Inthecaseof
fetalbradycardiasecondarytoatrioventricularblock,tertiarycarefetalhealth
centerscanusefetaltelemedicinetoguideandmonitorpharmacotherapyand
deliveryplanning,whichisparamountforpatientsthatarelikelytoneedan
urgentpacemakerafterbirth.35Fetaltelemedicinecanalsoplayanimportant
roleindiagnosingandtreatingfetaltachycardia.Transplacentalordirectfetal
antiarrhythmiatreatment,follow-upevaluations,anddeliveryplanscanbe
appropriatelydetermineduponreviewoftheimages.Therearecurrently
commercialandFDA-approvedhand-heldDopplerfetalheartratemonitors
availableforpatienthomeuse.Prospectiveparentscanpurchasethematlow
costontheInternet.Thesedevicesholdpromise,especiallyiftheyhave
Bluetoothornetworkconnectivity.However,moredataisneededtoassessthe
utilityofthesedevicesforfuturehomemonitoring,36Theimportanceof
physicianinputiscritical,asinappropriateuseofhomemonitoringcandomore
harmthangood.37
IntensiveCareUnit/CardiacIntensive
CareUnit
Telemedicinehasmanyapplicationsinthepediatricintensivecareunit,cardiac
intensivecareunit,38–43andemergencydepartment,44–46usingabroadrangeof
applicationstoassistinthecareofhospitalizedchildreninavarietyofclinical
scenarios.47,48Thereisincreasingacceptanceandevidencethatproviding
pediatriccriticalcareandtelecardiologyconsultationstoremoteemergency
departmentsforchildrenwithsuspectedorknowncardiovasculardiseaseis
feasibleandaddsclinicalvalue.44,46,49Telemedicinecanbeusedinanondemandorcontinuousmodelforsupportofcriticalcarepatients.Intheformer
model,physicianconsultations,nurseandphysicianmonitoring,andmedical
oversightcanbeprovidedonanas-neededbasis.Apediatriccardiologistor
intensivistcanevaluateandproviderecommendationsondiagnosticstudies,
medications,orothertherapies.38,41,42Theotherendofthespectrumintegrates
continuousoversightviamonitoringandproactivemedicaldecisionmaking.50
Allmodelsrequirecompliancewithbestcriticalcarepracticesandmaintenance
oftraining,includingadvancedlifesupportcertificationsandparticipationin
qualityassuranceprograms.
Useoftelemedicineinavarietyofcriticalcareprogramsaroundtheglobe
havedemonstratedimprovementsinclinicaloutcomes,includinglengthofstay
andmortalityandincreasedproviderandparentsatisfaction.38,41,42,51,52
Reductionsinhealthcarecostsoccurduetomoreappropriatetransport
utilizationanddecreasedutilizationofcostliertertiaryintensivecareunit
beds.43,47,53–55Patientsincriticalcaresettingswithaccesstotelemedicinecan
bemorequicklyevaluated,stabilized,andtriagedtodeterminetheneedfor
transportandmoreadvancedtreatment.56Munozetal.reportedona
telemedicine-supportedcardiacintensivecareunitcollaborationbetween
PittsburghandBogota,Columbia.41,42,57Thisprogramincludedawebinterface
ofphysiologicmonitorsandvideoconferencingviaamobiletelemedicinecart.
Face-to-facevideoconferencing,sharingofmedicalimages,andreviewof
rhythmdisturbancesresultedin71recommendationsin53patientsincluding
managementofarrhythmiasandsurgicalandcatheterizationplanning.
