Andersons pediatric cardiology 2313
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AssociationJournal,Khanandcolleaguesrecommendthatphysiciansshould
stillconfirmrestingheartrateswithmedical-gradeequipment.Buttheydo
appeartobesupportiveofthenotionofwearabletechnologybysayingthatby
useofwearabledevice–basedtelemedicine,thewearertakesavoluntarystep
towardimprovinghisorherhealth.106
PatientCareConferences/Second
Opinions
Whilemostofthepublishedtelemedicinedataisonclinicalapplications,the
mostprevalentusecasemaybemultimodalityvideoconferencingandsharingof
imagesviacloudtechnology.Manyprogramsconductmultiplepatientcareand
educationalconferenceseachweekthatincludephysicianswithinthepractice,
referringphysicians,andtraineeswhoconnectviatelemedicine.
Echocardiograms,angiograms,MRIs,andCTsaresharedalongwithrelevant
patientdataforclinicaldecisionmakingwithinputfromamultidisciplinary
team,manyofwhomarenotavailabletoattendthesemeetingsinperson.Many
oftheseimagesaresharedinadvanceviacloudserverforsystematicreview.
Secureloginandencryptionisutilizedtoprotectpatientconfidentiality.
Participantswhoconnectremotelycandosofromtelemedicineroomsthathave
beensetupatremotesitesaswellaspersonalcomputers,tablets,andsmart
phoneswithinstalledvideoconferencingprogramsandapplications.Additional
technologyenablesaconnectionbetweenthevideoconferenceandcollaboration
toolssothatthosewithoutdirectaccesstothevideoconferencingprogramcan
connectviaasecurewebsite.Teleconsultationbetweencardiologistsfor
complexcasescanthusextendtheconcentratedexpertiseoflargetertiary
facilities.63,107
RemoteMonitoring
Homemonitoringincorporatesautomatedtelemedicinetechnology108forawide
varietyofdiseasesinadultsincludingdiabetes,109chronicrespiratorydisease,110
congestiveheartfailure,111andhypertension,108aswellaschildrenwith
asthma.112Thesedevicesareusuallytabletsizedandconnecttoavarietyof
peripheraldevices(hard-wiredorwireless,usuallyBluetooth)includingscales,
heartrateandpulseoximetermonitors,bloodpressuredevices,glucometers,and
peakflowmeters.Manyvendorsarenowintegratingdirectlywithcommercially
availabletabletsandsmartphones.Thesedevicescancombinestandardized
managementwithpatientandparenteducationmodules.Thesedevicesthen
transmitdata(cellularnetworkorwiredorwirelessInternetconnection)andcan
bereviewedwithsoftwarethatallowsforserialcomparisonsandredflagsfor
outlyingormissingdata.Hometelemonitoringprogramsforadultswith
congestiveheartfailureusingautomateddailycaptureofweight,bloodpressure,
heartrate,andoxygensaturationandtransmissiontoanursepractitionerresulted
infeweradmissions,shorterlengthsofstayduringadmissions,lowerhealthcare
costs,andimprovedqualityoflife.113Ameta-analysisofhometelemedicine
monitoringofpatientswithcongestiveheartfailureshowedreducedmortality,
decreasednumberofhospitalizationsandtheuseofotherhealthservices,and
improvedqualityoflife.111
Infantswithsingleventriclephysiologyareatahighriskofmortalityand
morbiditybetweenstagesIandIIofpalliationaftertheyaredischargedfromthe
hospital.114Interstagemortalityhasbeenshowntobereducedbyhomemonitoring.115TheBostongrouppresentedtheirdataattheAmericanCollegeof
Cardiologymeetingin2013showingimprovedsomaticgrowthwithnoincrease
ininpatientresourceutilization,andareductioninreoperationusinghomemonitoringforinterstagechildren.Telemedicine-basedhomesurveillance
devices,likeatabletPC,arenowroutinelyused.Telemedicinewiththepowerof
cloudserversanddatawarehousesprovidesecureandnearlyinstantaneous
transferofpatientinformation.Heartcentershavetrainedinterstagemonitoring
teamswiththeexperienceandresourcestotriageandaddressmultiplepatient
alertsthatcometothemdaily.Patientshaveexpressedapreferenceforthiskind
oftabletPCmonitoringoverthenotebook-basedlogformonitoring
overwhelmingly.116Prominentleadersinourfieldarecallingforconsolidation
