Remote diagnosis of congenital heart disease: the impact of telemedicine.
OBJECTIVE
To determine the accuracy of remote diagnosis of congenital heart disease (CHD) by real-time transmission of echocardiographic images via integrated services digital network (ISDN) lines, to assess the impact on patient management and examine cost implications.


METHODS
Prospective comparison of echocardiograms on infants with suspected significant CHD performed as follows: (1) hands-on evaluation and echocardiogram by a paediatrician at a district general hospital (DGH) followed by (2) transmission of the echocardiogram via ISDN 6 with guidance from a paediatric cardiologist and finally (3) hands-on evaluation and echocardiogram by a paediatric cardiologist. The economic analysis compares the cost of patient care associated with the telemedicine service with a hypothetical control group.


METHODS
Neonatal units of three DGH and a UK regional paediatric cardiology unit.


RESULTS
Echocardiograms were transmitted on 124 infants. In five cases scans were inadequate for diagnosis. Of the remaining 119 tele-echocardiograms, a follow-up echocardiogram was performed on 109/119 (92%). Major CHD was diagnosed in 39/109 infants (36%) and minor CHD in 45 (41%). The tele-echo diagnosis was accurate in 96% of cases (kappa=0.89). Unnecessary transfer to the regional unit was avoided in 93/124 patients (75%). Despite relatively high implementation costs, telemedicine care was substantially cheaper than standard care. Each DGH potentially saved money by utilising the telemedicine service (mean saving: pound728/patient).


CONCLUSIONS
CHD is accurately diagnosed by realtime transmission of echocardiograms performed by paediatricians under live guidance and interpretation by a paediatric cardiologist. Remote diagnosis and exclusion of CHD affects patient management and may be cost saving.
Grant
Brian
B
Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Falls Road, Belfast BT 12 6BE, UK.
Morgan
Gareth J
GJ
McCrossan
Brian A
BA
Crealey
Grainne E
GE
Sands
Andrew J
AJ
Craig
Brian
B
Casey
Frank A
FA
D016507:Cardiology Service, Hospital / Q000191:economics / Q000458:organization & administration; D017048:Health Care Costs / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000191:economics; D006767:Hospitals, District / Q000191:economics / Q000458:organization & administration; D006769:Hospitals, General / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020407:Internet / Q000191:economics; D009660:Northern Ireland; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D019112:Teleradiology / Q000191:economics / Q000379:methods*; D014463:Ultrasonography; D019564:Unnecessary Procedures / Q000706:statistics & numerical data