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Abstract
Telehealth has improved delivery of health care worldwide by improving access to and the quality of health care and by improving the global shortage of health professionals through collaboration and training. Although many telehealth efforts have been reported in adult health care settings, it is important to examine telehealth efforts in the pediatric setting. Children who are most commonly ill and malnourished are often those of underserved populations of the developing world. This article examines current uses of pediatric telehealth in a global setting and discusses key approaches to how telehealth may become successfully integrated and scaled in those settings.
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Affiliation(s)
- Julianna C Hsing
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, Stanford, CA 94305, USA; Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA.
| | - C Jason Wang
- Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Paul H Wise
- Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
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Robertson TE, Levine AR, Verceles AC, Buchner JA, Lantry JH, Papali A, Zubrow MT, Colas LN, Augustin ME, McCurdy MT. Remote tele-mentored ultrasound for non-physician learners using FaceTime: A feasibility study in a low-income country. J Crit Care 2017; 40:145-148. [PMID: 28402924 DOI: 10.1016/j.jcrc.2017.03.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 03/29/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Ultrasound (US) is a burgeoning diagnostic tool and is often the only available imaging modality in low- and middle-income countries (LMICs). However, bedside providers often lack training to acquire or interpret US images. We conducted a study to determine if a remote tele-intensivist could mentor geographically removed LMIC providers to obtain quality and clinically useful US images. MATERIALS AND METHODS Nine Haitian non-physician health care workers received a 20-minute training on basic US techniques. A volunteer was connected to an intensivist located in the USA via FaceTime. The intensivist remotely instructed the non-physicians to ultrasound five anatomic sites. The tele-intensivist evaluated the image quality and clinical utility of performing tele-ultrasound in a LMIC. RESULTS The intensivist agreed (defined as "agree" or "strongly agree" on a five-point Likert scale) that 90% (57/63) of the FaceTime images were high quality. The intensivist felt comfortable making clinical decisions using FaceTime images 89% (56/63) of the time. CONCLUSIONS Non-physicians can feasibly obtain high-quality and clinically relevant US images using video chat software in LMICs. Commercially available software can connect providers in institutions in LMICs to geographically removed intensivists at a relatively low cost and without the need for extensive training of local providers.
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Affiliation(s)
- Thomas E Robertson
- Department of Medicine, University of Pittsburgh Medical Center, 200 N Lothrop St, Montefiore N715, Pittsburgh, PA 15213, United States
| | - Andrea R Levine
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW, Pittsburgh, PA 15213, United States
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States
| | - Jessica A Buchner
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States
| | - James H Lantry
- Uniform Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Alfred Papali
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Baltimore, MD 21201, United States
| | - Marc T Zubrow
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; Program in Trauma, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, United States; University of Maryland eCare, University of Maryland Medical System, 110 S. Paca St., 5th Floor, Baltimore, MD 21201, United States
| | - L Nathalie Colas
- Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti
| | - Marc E Augustin
- Department of Medicine, St. Luke Family Hospital, Port-au-Prince, Haiti
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 110 S. Paca St., 2nd Floor, Baltimore, MD 21201, United States; University of Maryland School of Medicine, Department of Emergency Medicine, 110 S. Paca St., 6th Floor, Baltimore, MD 21201, United States.
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Satou GM, Rheuban K, Alverson D, Lewin M, Mahnke C, Marcin J, Martin GR, Mazur LS, Sahn DJ, Shah S, Tuckson R, Webb CL, Sable CA. Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e648-e678. [PMID: 28193604 DOI: 10.1161/cir.0000000000000478] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kim EW, Teague-Ross TJ, Greenfield WW, Williams DK, Kuo D, Hall RW. Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality. J Perinatol 2013; 33:725-30. [PMID: 23579490 PMCID: PMC4138978 DOI: 10.1038/jp.2013.37] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality. STUDY DESIGN This prospective study used obstetrical and neonatal interventions through TM consults, education and census rounds with 9 hospitals from 1 July 2009 to 31 March 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality and morbidity before and after TM use. Arkansas Health Department data and χ(2) analysis were used to compare infant mortality. RESULT Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043). CONCLUSION TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.
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Affiliation(s)
- Elizabeth W. Kim
- Department of Pediatrics/Neonatology, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas
| | - Terri J. Teague-Ross
- Department of Obstetrics and Gynecology, Center for Distance Health, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William W. Greenfield
- Department of Obstetrics and Gynecology, Center for Distance Health, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - D. Keith Williams
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dennis Kuo
- Department of Obstetrics and Gynecology, Center for Distance Health, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard W. Hall
- Department of Pediatrics/Neonatology, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas
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Alverson DC, Dion D, Migliorati M, Rodriguez A, Byun HW, Effertz G, Duffy V, Monge B. Center for Telehealth and Cybermedicine Research, University of New Mexico Health Sciences Center: A Model of a Telehealth Program Within an Academic Medical Center. Telemed J E Health 2013; 19:368-72. [DOI: 10.1089/tmj.2012.0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dale C. Alverson
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Denise Dion
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | | | - Adrian Rodriguez
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Hannah W. Byun
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Glen Effertz
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Veronica Duffy
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Benjamin Monge
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M. Comparative performance of seven long-running telemedicine networks delivering humanitarian services. J Telemed Telecare 2012; 18:305-11. [DOI: 10.1258/jtt.2012.120315] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Seven long-running telemedicine networks were surveyed. The networks provided humanitarian services (clinical and educational) in developing countries, and had been in operation for periods of 5–15 years. The number of experts serving each network ranged from 15 to 513. The smallest network had a total of 10 requesters and the largest one had more than 500 requesters. The networks operated in nearly 60 countries. The seven networks managed a total of 1857 cases in 2011, i.e. an average of 265 cases per year per network. There was a significant growth in total activity, amounting to 100.3 cases per year during the 15 year study period. In 2011, network activity was 50–700 teleconsultations per network. There were clear differences in the patterns of activity, with some networks managing an increasing caseload, and others managing a slowly reducing caseload. The seven networks had published a total of 44 papers listed in Medline which summarized the evidence resulting from the delivery of services by telemedicine. There was a dearth of information about clinical and cost-effectiveness. Nevertheless, the services were widely appreciated by referring doctors, considered to be clinically useful, and there were indications that clinical outcomes for telemedicine patients were often improved. Despite a lack of formal evidence, the present study suggests that telemedicine can provide clinically useful services in developing countries.
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Affiliation(s)
- Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, University of Tromsø, Norway
| | - Antoine Geissbuhler
- Department of Radiology and Medical Informatics, Geneva University, Switzerland
| | | | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Donald A Person
- Pacific Island Health Care Project, Tripler Army Medical Center, Hawaii, USA
| | | | - Paolo Zanaboni
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Maria Zolfo
- Clinical Sciences Department, Institute of Tropical Medicine, Antwerp, Belgium
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Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M. Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output. Bull World Health Organ 2012; 90:341-347D. [PMID: 22589567 PMCID: PMC3341689 DOI: 10.2471/blt.11.099143] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To summarize the experience, performance and scientific output of long-running telemedicine networks delivering humanitarian services. METHODS Nine long-running networks--those operating for five years or more--were identified and seven provided detailed information about their activities, including performance and scientific output. Information was extracted from peer-reviewed papers describing the networks' study design, effectiveness, quality, economics, provision of access to care and sustainability. The strength of the evidence was scored as none, poor, average or good. FINDINGS The seven networks had been operating for a median of 11 years (range: 5-15). All networks provided clinical tele-consultations for humanitarian purposes using store-and-forward methods and five were also involved in some form of education. The smallest network had 15 experts and the largest had more than 500. The clinical caseload was 50 to 500 cases a year. A total of 59 papers had been published by the networks, and 44 were listed in Medline. Based on study design, the strength of the evidence was generally poor by conventional standards (e.g. 29 papers described non-controlled clinical series). Over half of the papers provided evidence of sustainability and improved access to care. Uncertain funding was a common risk factor. CONCLUSION Improved collaboration between networks could help attenuate the lack of resources reported by some networks and improve sustainability. Although the evidence base is weak, the networks appear to offer sustainable and clinically useful services. These findings may interest decision-makers in developing countries considering starting, supporting or joining similar telemedicine networks.
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Affiliation(s)
- Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Munoz RA, Burbano NH, Motoa MV, Santiago G, Klevemann M, Casilli J. Telemedicine in pediatric cardiac critical care. Telemed J E Health 2012; 18:132-6. [PMID: 22283363 DOI: 10.1089/tmj.2011.0090] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe our international telemedicine experience in pediatric cardiac critical care. MATERIALS AND METHODS This is a case series of pediatric patients teleassisted from the Cardiac Intensive Care Unit (CICU) at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, to the CICU at Hospital Valle del Lili, Cali, Valle, Colombia, between March and December 2010. An attending intensivist from the CICU in Pittsburgh reviewed cases, monitored real-time vital signs, and gave formal medical advice as requested by the attending physician in Cali. The network connection is a Cisco (San Jose, CA)-based Secure Sockets Layer virtual private network via the Internet that allows access to the web-based interface of the Dräger(®) (Lübeck, Germany) physiological monitor system. The videoconferencing equipment consists of a standard component on a custom-made mobile cart that uses an APC(®) (West Kingston, RI) uninterruptible power supply for portable power and 3Com(®) (Hewlett-Packard, Palo Alto, CA) for wireless connectivity. A post-intervention survey regarding satisfaction with the telemedicine service was conducted. RESULTS Seventy-one recommendations were given regarding 53 patients. Median age and weight were 10 months and 7.1 kg, respectively. Ventricular septal defect, transposition of the great vessels, and single ventricle accounted for most cases. The most frequent recommendations were related to surgical conduct, management of arrhythmias, and performance of cardiac catheterization studies. No technical difficulties were experienced during the monitoring of the patients. Satisfaction rates were equally high for technical and medical aspects of telemedicine service. CONCLUSIONS Telemedicine is a feasible option for pediatric intensivists seeking experienced assistance in the management of complex cardiac patients. Real-time remote assistance may improve the medical care of pediatric cardiac patients treated in developing countries.
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Affiliation(s)
- Ricardo A Munoz
- Department of Critical Care Medicine, Division of Pediatric Cardiac Critical Care, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224, USA.
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Mahnke CB, Jordan CP, Bergvall E, Person DA, Pinsker JE. The Pacific Asynchronous TeleHealth (PATH) system: review of 1,000 pediatric teleconsultations. Telemed J E Health 2011; 17:35-9. [PMID: 21214304 DOI: 10.1089/tmj.2010.0089] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact on pediatric care of the Pacific Asynchronous TeleHealth (PATH) system, a provider-to-provider teleconsultation platform utilized by military medical facilities throughout the Pacific Region. This review focuses on access to care, quality of care, and cost savings for the Department of Defense as a result of ongoing development of the PATH system from 2006 to 2009. METHODS This is a retrospective review of 1,000 consecutive teleconsultations occurring from January 2006 to March 2009. Three pediatric subspecialists reviewed the characteristics of each teleconsultation and the ultimate outcome. RESULTS The PATH system processed > 300 pediatric teleconsultations in 2009 from 20 hospitals and clinics throughout the Pacific Region. The number of teleconsultations has grown significantly since 2006. Median teleconsultation response time was 14.5 h with 97% of teleconsultations answered within 1 week. The majority (75%) of teleconsultations came from areas without host nation pediatric subspecialty resources. Most teleconsultations (72%) involved diagnostic questions, whereas 21% were primarily for treatment issues. Teleconsultations originated predominantly from outpatient clinics (90%), with question resolution in 60% of cases without a face-to-face subspecialty evaluation. Fifteen percent of teleconsultations resulted in patient transfer to our center for definitive diagnosis and treatment. The diagnostic and/or treatment plan was modified in 74% of teleconsultations. PATH precluded patient transfer in 12%-43% of teleconsultations (annual savings: $208,283-$746,348 per year) and generated an average of 1.7 relative value units per teleconsultation. CONCLUSIONS PATH provided patient access to pediatric subspecialty expertise via provider-to-provider asynchronous teleconsultation. Internet-based pediatric subspecialty teleconsultation provides fast, convenient, cost-effective, quality pediatric care to populations of patients who might otherwise require transfer to a distant medical facility for more advanced care. PATH serves as a model for future asynchronous teleconsultation platforms in both the military and civilian healthcare arenas.
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