Telemedicine Effective in Delivering International Cardiac Care
After studying more than 1,000 pediatric consultations offered in Latin America through telemedicine, researchers at Children’s Hospital of Pittsburgh of UPMC found that physicians in those countries were highly satisfied with Children’s service and believed telemedicine had improved patient outcomes.
“Lack of skilled physicians is a widespread problem, particularly those with expertise in patients with complex medical problems, such as congenital heart disease,” said Dr. Muñoz, also medical director, Global Business and Telemedicine, at Children’s. “The use of telemedicine services within pediatric cardiac intensive care units (CICUs) can be used as an assisting technology, allowing more expertise and knowledge to be shared with remote centers in need.”
Although a growing body of evidence suggests that telemedicine is associated with improved patient outcomes, the technology remains a relatively new tool in health care, particularly in pediatric critical care. In surveying the Latin American centers, the Children’s researchers hope to design a common approach for future tele-consultations.
“Little is known about the optimal method of telemedicine service delivery in the international setting,” said Dr. Muñoz. “Ideally, a consistent approach should be used for centers with similar organizations, skill level and patient populations. One size does not fit all.”
The study showcased Children’s unusual multicenter experience in telemedicine at three hospitals in Colombia and one in Mexico from July 2011 to June 2013. Children’s physicians provided 1,040 consultations for 476 patients, with a real-time intervention taking place in 23 percent of those encounters, including echocardiography, adjustment of pacemaker settings and pharmacologic therapy. In 6 percent of the tele-consultations, a different diagnosis was suggested based on the interpretation of cardiac or imaging studies.
The number and type of patients seen by Children’s e-CICU were selected by local physicians at each hospital. Although Children’s physicians in Pittsburgh did not have remote access to the children’s electronic medical records, relevant patient data was provided in a secure database and telemedicine hardware was used for real-time consultations. A CICU physician from Children’s participated in all the encounters, with some being joined by other specialists, including cardiac surgeons and neonatal intensivists.
Based on anonymous surveys of physicians participating at the international centers, 96 percent of respondents reported being satisfied or highly satisfied with the telemedicine service, while 58 percent rated the promptness and time dedicated by the tele-intensivist as very high. Physicians reported that they changed their clinical practice sometimes in relation to the telemedicine encounters, with changes in surgical management noted most frequently.
“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Dr. Muñoz. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education. With continuing improvements in telemedicine technology and our own practices, we will continue to expand access to the world’s best health care for children around the world.”
Children’s Hospital is leading the way in the development of telemedicine services to meet the needs of young patients regionally and around the world. The state-of-the-art video conferencing technologies provide complex pediatric cardiac care through remote and virtual examinations — whenever and wherever expertise is needed. Experts from Children’s CICUs currently oversee international programs and provide consultations and care management in Cali, Bucaramanga and Medellin, all in Colombia, as well as in Mexico City, Mexico.