A paediatric telecardiology service for district hospitals in south-east England: an observational study.

The attached article is a Publisher version of the final published version which may be accessed at the link below. Copyright © 2010 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reservedOBJECTIVES: To compare caseloads of new patients assessed by paediatric cardiologists face-to-face or during teleconferences, and assess NHS costs for the alternative referral arrangements. DESIGN: Prospective cohort study over 15 months. SETTING: Four district hospitals in south-east England and a London paediatric cardiology centre. PATIENTS: Babies and children. INTERVENTION: A telecardiology service introduced alongside outreach clinics. MEASUREMENTS: Clinical outcomes and mean NHS costs per patient. RESULTS: 266 new patients were studied: 75 had teleconsultations (19 of 42 newborns and 56 of 224 infants and children). Teleconsultation patients generally were younger (49% being under 1 year compared with 32% seen personally (p = 0.025)) and their symptoms were not as severe. A cardiac intervention was undertaken immediately or planned for five telemedicine patients (7%) and 30 conventional patients (16%). However, similar proportions of patients were discharged after being assessed (32% telemedicine and 39% conventional). During scheduled teleconferences the mean duration of time per patient in sessions involving real-time echocardiography was 14.4 min, and 8.5 min in sessions where pre-recorded videos were transmitted. Mean cost comparisons for telemedicine and face-to-face patients over 14-day and 6-month follow-up showed the telecardiology service to be cost-neutral for the three hospitals with infrequently-held outreach clinics (1519 UK pounds vs 1724 UK pounds respectively after 14 days). CONCLUSION: Paediatric cardiology centres with small cadres of specialists are under pressure to cope with ever-expanding caseloads of new patients with suspected anomalies. Innovative use of telecardiology alongside conventional outreach services should suitably, and economically, enhance access to these specialists.The Department of Health and the Charitable Funds Committee of the Royal Brompton and Harefield NHS Trust funded the project

The Potential for Telehealth Consultations in Cardiology and Dermatology in Newfoundland and Labrador: A Synthesis of Research Evidence

This report provides a synthesis of relevant research evidence on the clinical and cost effectiveness of telehealth technologies for specialist-patient consultations in the fields of cardiology and dermatology. The report is intended to inform and assist decision makers in the Labrador-Grenfell Regional Health Authority, the Newfoundland and Labrador Department of Health and Community Services and the province’s other Regional Health Authorities by providing research evidence surrounding the effectiveness of telehealth consultation as an intervention for cardiology or dermatology patients. The findings of our synthesis are specifically interpreted for the context of Newfoundland and Labrador. Decision makers from other jurisdictions, particularly those with similar features in terms of potential clients, geography and resources, may also find the content helpful. The report includes explanations of research terms and technical language; as such, there is no need to have a specialized medical or health background to understand its content

Diagnosis and Decision-Making in Telemedicine

This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decisionmaking. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients

Healthcare receivers’ acceptance of telecardiology in Malaysia

This quantitative study investigates acceptance towards implementation of telecardiology in Malaysia. The purpose of this study is to explore and understand the potential factors that could be the key elements in cultivating positive behaviour towards telecardiology adoption in Malaysia. Data was gathered by using survey method from 149 patients and publics who use internet service in their daily lives. The questionnaire was developed by integrating Technology Readiness Index (TRI), Technology Acceptance Model (TAM) and Theory of Planned Behaviour (TPB) which consists of 42 items. Descriptive statistics, factor analysis and one-way ANOVA were conducted to analyse the data. The analysis reveals that Malaysians generally hold a positive perception towards implementation of telecardiology with some reservations. Besides that, gender and income of the respondents were found to influence the variables in telecardiology readiness, hence suggesting these two variables be taken into considerations in the adoption of telecardiology. It is our hope that the result of this study provides some useful information for the policy makers and implementers to develop effective implementation strategies that could reduce users’ resistance and adoption barriers in telecardiology adoption

Platform independent web-based telecardiology for connected heart care

Most of the commercial telecardiology systems are platform-dependent and operating system (OS)-dependent. This causes inconvenience to medical officer for retrieving data from database and hence reduce the work efficiency. In this paper, a platformindependent and OS-independent web-based telecardiology system, named VirtualDave System, is proposed based on client-server model and developed in Hypertext Markup Language 5 (HTML5), Active Server Pages (ASP) scripting and C# languages. This system allows users to log on and access the patient medical data from any technology devices that equipped with web browser and internet access. Besides, it also allows targeted users to communicate and get remote medical consultation without long distance traveling and long-time queuing. Verification result shows that this proposed system could be executed in any platform regardless the OS. This web-based telecardiology could significantly help to improve the health care services especially in rural area

Future of Tele-echocardiography

Telemedicine is defined as the ‘delivery of health care and sharing of medical knowledge over a distance using telecommunication systems’. Echocardiography is often used to diagnose and exclude important cardiac diagnoses in adults and children. Evolving telemedicine technology has boosted access to echocardiography and has created a network that offers many possibilities for clinical, research and teaching activities.The two primary modes of telemedicine practise are ‘ store and forward’ and ‘real time’ videoconferencing. Using these technologies, relevant, up-to-date scientific information is instantly available for analysis and interaction. Studies have also shown these to be accurate, cost effective, improves patient care, enhances echocardiography quality and sonographer proficiency and promotes practice expansion.The growing use of technology such as smart phones, laptops and computer tablets as well as newer technologies like cloud computing, picture archiving computer systems(PACS) and the standardization of medical images(DICOM) has fuelled the now accelerating specific demands for tele-echocardiography. However, all these are not without challenges and obstacles. Some of these include lack of standardization of telemedicine components, confusing medico-legal and licensure issues, privacy/confidentiality, poor reimbursement, training issues as well as attitude and acceptance.These issues need to be addressed by all those involved in medical practice. Clinicians must work with sonographers, medical IT experts, hospital management and hospital physicists as well as manufacturers and insurance companies to ensure that the new system is integrated as an extra function within ultrasound consoles. National and international societies such as the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) could play a role in bringing everyone together and define the necessary training programmes. In conclusion, the revolution in digital technology is rapidly changing the world of telecommunications. Tele-echocardiography has a bright future to become an integrated part of our clinical available echocardiographic tool set – in a matter of tim

A Survey of Telecardiology Projects in Italy.

It is estimated that in Italy there are about three million people affected by chronic heart failure. Cardiology is the health care field currently getting the largest benefits from telemedicine. Transmission, using wireless devices, makes possible to achieve virtual hospitalization: it is possible to anticipate the time of discharging and the patient can be remotely controlled by the central station in the ICU of the department of Medicine. Teleconsulting (i.e. a distance consulting between physicians) is applied in telecardiology, it allows the realization of a consulting between cardiology departments and remote services in the same hospital or among far-away hospitals. In this paper some of the most significant cardiac telemonitoring projects in Italy are described. Also reported, the projects involving the applications of implantable cardiac devices which can be controlled remotely. In conclusion, we sketch out the future prospects of telecardiology research and its applications in Italy

The Utilization of Telehealth/ Telemedicine In Cardiology In Rural Areas

Introduction: Telecardiology has been defined as a way of practicing cardiology through the utilization of telecommunications and a more cost-effective way to deliver cardiac care. As a subset of telemedicine, telecardiology has functioned to bring providers to underserved communities through technological mechanisms. Rural regions have turned to telemedicine and tapped into a network of clinical institutions exchanging practitioners and patients to emphasize value-based instead of volume-based care. Methodology: The methodology of this qualitative study was a literature review having used mixed methodologies. Five electronic databases and government websites were utilized, and one semi-structured interview with an expert in cardiology was conducted. There were 34 sources referenced in the literature review. Results: The research demonstrated how the utilization of telecardiology has increased access to care in isolated rural areas via resources such as smartphone apps and outreach sites. Additionally, it was found that the use of non-invasive, wearable technology and other modern communication technologies presented a more cost-effective and efficient solution to expensive health care facilities, while allowing patients to remain comfortable in their home environments. Discussion/ Conclusion: Telecardiology technology has shown to have positive impacts on access to care, the delivery process of care, and financial burdens of care for patients living in rural settings. Through telecardiology services, patients in rural areas have had higher frequencies of interaction with their cardiologist/healthcare provider