title: Screening fetal echocardiography by telemedicine: efficacy and community acceptance.
abstract: OBJECTIVE
  Our aim was to assess whether tertiary level screening fetal echocardiography can be extended to primary care facilities with telemedicine assistance.
  
  
  METHODS
  Assessment of image quality and the adequacy of fetal echocardiograms recorded after random transmission at 128, 384, or 768 kbits/s was performed. Live fetal echocardiograms were transmitted at 384 kbits/s (3 integrated services digital network lines) from the remote primary care center. Patient satisfaction was assessed by surveys obtained after office-based and telemedicine consultations.
  
  
  RESULTS
  A total of 58 recorded normal studies had similar image quality and adequacy on transmission at 384 and 768 kbits/s (P =.08 and.49, respectively) and were significantly better than 128 kbits/s (P <.01). During live screening transmitted at 384 kbits/s from the primary care center, 3 of 34 fetuses were diagnosed with heart disease. Surveys from patients with direct physician contact and by telemedicine showed a high satisfaction with telemedicine-assisted screening and counseling.
  
  
  CONCLUSIONS
  Adequate screening for fetal heart disease is technically feasible at or above data transmission rates of 384 kbits/s. Community acceptance for telemedicine-assisted screening and counseling is not adversely affected by a lack of direct personal contact with the specialist.
authors.affiliation: Department of Pediatrics, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Sharma
authors.forename: Ira A
authors.initials: IA
authors.lastname: Parness
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kamenir
authors.forename: Helen
authors.initials: H
authors.lastname: Ko
authors.forename: Susan
authors.initials: S
authors.lastname: Haddow
authors.forename: L Gary
authors.initials: LG
authors.lastname: Steinberg
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
mesh_terms: D001519:Behavior; D019058:Community Networks; D003625:Data Collection; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007089:Image Enhancement; D008429:Maternal Welfare; D015588:Observer Variation; D010349:Patient Compliance; D017060:Patient Satisfaction; D011247:Pregnancy; D011320:Primary Health Care; D011787:Quality of Health Care; D011897:Random Allocation; D017216:Telemedicine; D016216:Ultrasonography, Prenatal