title: Remote diagnosis of congenital heart disease in southern Arizona: comparison between tele-echocardiography and videotapes.
abstract: OBJECTIVE
  We report our experience with tele-echocardiography and echocardiograms recorded digitally or on videotape (recorded-echos) at The University of Arizona from August 2006 to December 2010 and compare their quality and diagnostic accuracy.
  
  
  METHODS
  Tele-echocardiograms (tele-echos) were transmitted from the Yuma Regional Medical Center to The University of Arizona via a T-1 and aT-3 line at a bandwidth of 768 kilobits per second. Recorded-echos were shipped for interpretation to The University of Arizona by overnight mail. Diagnostic accuracy was assessed by comparing tele- and recorded-echos with electrocardiograms performed by a pediatric cardiologist (PedsCard-echos).
  
  
  RESULTS
  Three hundred forty-six tele-echos in 260 patients and 455 recorded-echos in 406 patients were performed (median age, 6 and 8 days, respectively). Indications included possible congenital heart disease (CHD), patent ductus arteriosus (PDA), and persistent pulmonary hypertension of the newborn. Diagnostic categories included complex CHD, non-critical disease, PDA, and other. PedsCard-echos were available for 27% of the tele-echo and 30% of the recorded-echo patients. Comparisons between tele- and PedsCard-echo yielded no discrepancies in 12 (23%), expected resolution of condition in 26 (49%), and minor in 14 (26%). One (2%) major discrepancy was detected. Comparisons between recorded- and PedsCard-echo showed no discrepancies in 28 (40%), expected resolution of condition in 14 (20%), and minor discrepancies in 28 (40%) patients. No significant difference with respect to discrepancies was detected between tele- and recorded-echos. There was significant (p<0.01) improvement in tele- and recorded-echo study quality by 2010.
  
  
  CONCLUSIONS
  (1) Tele-echocardiography can be performed successfully with excellent accuracy. (2) The quality of tele- and recorded-echo studies improved toward the end of the analysis period. (3) Although initially tele-echo studies were more accurate than recorded-echo studies, there was no difference between these two types of studies by the fourth year of the study. (4) Both tele- and recorded-echos were indispensible in the remote diagnosis of CHD.
authors.affiliation: Section of Cardiology, The University of Arizona, Tucson, AZ 85724, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haley
authors.forename: Scott E
authors.initials: SE
authors.lastname: Klewer
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Barber
authors.forename: F John
authors.initials: FJ
authors.lastname: Meaney
authors.forename: Richard L
authors.initials: RL
authors.lastname: Donnerstein
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Weinstein
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krupinski
authors.forename: Gregory
authors.initials: G
authors.lastname: Warda
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Lopez
authors.forename: Daniela
authors.initials: D
authors.lastname: Lax
mesh_terms: D001130:Arizona; D016507:Cardiology Service, Hospital; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit; D019114:Remote Consultation / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D014463:Ultrasonography; D014743:Videotape Recording