title: Live transmission of neonatal echocardiograms from underserved areas: accuracy, patient care, and cost.
abstract: OBJECTIVE
  Echocardiography is an important tool in the diagnosis and management of critically ill neonates. The authors hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from underserved areas would improve management, prevent unnecessary transports, enhance sonographer proficiency, and result in monetary savings.
  
  
  METHODS
  Using personal computers capable of real-time transmission of echocardiograms over three integrated services digital network (ISDN) telephone lines, pediatric cardiologists interpreted echocardiograms, suggested views to sonographers, and made recommendations to neonatologists 200 miles away. Analyses of accuracy, management, echocardiogram quality, time, and costs were carried out prospectively.
  
  
  RESULTS
  Sixty studies were transmitted over 7 months. Indications for echocardiography were suspected congenital heart disease (n = 29), suspected patent ductus arteriosus (PDA) (n = 27), and hemodynamic instability (n = 4). Diagnoses were critical congenital heart disease (n = 4), noncritical heart disease (n = 8), PDA (n = 21), ventricular dysfunction (n = 5), persistent pulmonary hypertension (n = 3), and normal (n = 19). Videotape review confirmed all telemedicine interpretations. The echocardiogram led to immediate change in management in 25 cases (42%), and echocardiogram quality was improved in 53 studies (88%). Time from request to completion of echocardiography was 43+/-30 min. Monetary savings from five avoided transports exceeded all expenses.
  
  
  CONCLUSIONS
  Live transmission of neonatal echocardiograms over three ISDN lines is diagnostic, improves patient care and echocardiography quality, and is cost effective.
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Sable
authors.forename: T
authors.initials: T
authors.lastname: Roca
authors.forename: J
authors.initials: J
authors.lastname: Gold
authors.forename: A
authors.initials: A
authors.lastname: Gutierrez
authors.forename: E
authors.initials: E
authors.lastname: Gulotta
authors.forename: W
authors.initials: W
authors.lastname: Culpepper
mesh_terms: D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000191:economics / Q000379:methods; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D008145:Louisiana; D008507:Medically Underserved Area; D019114:Remote Consultation / Q000191:economics; D014743:Videotape Recording