Telehealth solutions to enable global collaboration in rheumatic heart disease screening.
Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Eduardo Lv
EL
Lopes
2 Children's National Health System, USA.
Andrea Z
AZ
Beaton
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Bruno R
BR
Nascimento
2 Children's National Health System, USA.
Alison
A
Tompsett
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Julia Pa
JP
Dos Santos
2 Children's National Health System, USA.
Lindsay
L
Perlman
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Adriana C
AC
Diamantino
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Kaciane Kb
KK
Oliveira
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Cassio M
CM
Oliveira
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Maria do Carmo P
MDCP
Nunes
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Leonardo
L
Bonisson
1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
Antônio Lp
AL
Ribeiro
2 Children's National Health System, USA.
Craig
C
Sable
D001938:Brazil; D000067917:Cloud Computing; D016494:Computer Security; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D006801:Humans; D007318:Inservice Training; D008403:Mass Screening / Q000458:organization & administration*; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis*; D017216:Telemedicine / Q000458:organization & administration*; D013997:Time Factors
Telecardiology; remote consultation; telehealth