Advancements in technologies are paving the way for many healthcare providers to connect with patients outside their hospitals more quickly and efficiently. For cardiology departments, technologies that allow for video collaboration, rapid transmission of scans and images and other forms of telemedicine are supporting the initiative to improve productivity, an initiative many are striving for as the U.S. healthcare landscape continues reform.
Bringing Rural Patients to the Experts
Telemedicine, or telecardiology when speaking specifically about the specialty, is gradually making waves in a variety of forms. From use within a single hospital to implementation in a regional network of medical centers and clinics, it is allowing clinicians to provide patients with more efficient and convenient care in an era where “time is money,” said Richard Marcus, M.D., cardiac ultrasound lab director at Iowa Heart Center (IHC) in West Des Moines, Iowa.
At IHC, Marcus is leading a telecardiology program that provides echocardiography in rural areas. These remote ultrasound examinations are facilitating a faster and easier diagnosis for patients who may not live within reasonable driving distance of an expert cardiologist, Marcus said. He gave a presentation on the Iowa program, called CyberCardiology, at the 2013 annual meeting of the American College of Cardiology (ACC), where he outlined the program’s rationale and how it operates.
In CyberCardiology there are 24 outreach sites in Iowa that have partnered with IHC, where patients with various heart ailments can undergo an ultrasound exam. These exams are then sent to the central hub in West Des Moines, where expert cardiologists evaluate them for proper diagnosis and subsequently offer a treatment plan. Patients benefit from not having to drive long distances to an urban center to receive quality diagnostic testing and consult with a physician; they can simply present to their nearest clinic — whether in rural Iowa towns such as Corydon, Audubon or Bloomfield — to do the exam.
Another benefit CyberCardiology offers to referring physicians and patients in its network is the use of Doppler echocardiography, which Marcus said is the method of choice for cardiovascular examinations today and can offer more information than a typical stress echo. The program’s technicians use Doppler ultrasound from Esaote to image patients and then send the data securely — whether by a fiber optic cable that connects with IHC, or by DVD — to the main server in West Des Moines.
The program is an entirely integrated operation, Marcus said, that tracks all components of the process — from the time of ordering, to data acquisition and interpretation, to delivering the reports to referring physicians and patients, to final billing. Every step is funneled through an electronic administrative system, run by GE Healthcare’s Centricity Patient Management, and data is downloaded directly into the electronic health record (EHR). Finally, the report is complete with patient and referring physician information, and fields are automatically populated with the study’s findings without extra typing required. “The product that goes back to the physician is an easily digestible, standardized comprehensive echo report,” he explained.
Marcus said CyberCardiology has been running for several years and is well developed, and with the changing state of healthcare, this type of program will soon be necessary. In many regions, and also around the world, there is a need for centralization of cardiology services that leaves many underserved areas without the same level of access to care. But as information technology advances and bandwidth speeds increase, it is now possible for outlying clinics to send their patients’ information and imaging scans to an expert cardiologist in the city for immediate review.
Improving Collaboration and Productivity
At a hospital in London, cardiologists are using video collaboration technology to allow teams to consult with one another and make informed decisions regarding pediatric patients undergoing surgery. The goal is to collaborate in a quick and efficient manner — even if one of the consultants is not present in the operating room (OR).
Officials at Evelina London Children’s Hospital said with the volume of operations performed by surgeons each year, it is difficult for expert cardiac consultants to be physically present at each one. In order to examine live ultrasound feeds of the surgery and offer advice should the need arise, senior consultants would have to make their way to the OR and scrub in. Now, using video conferencing from telepresence company Polycom Inc., the cardiology department coordinates intra-operative collaboration between the OR team and consulting cardiologist even if the latter is attending to care in another part of the hospital.
Combining a Philips Healthcare ultrasound cart with Polycom’s RealPresence Group 500, the hospital’s telemedicine system saves working hours for physicians, giving them more time to see other patients, and more importantly, reduces the length of time pediatric patients are under anesthetic in the OR, improving their roads to recovery.
Deployment in Medical Outreach
Telecardiology is also being deployed in developing regions around the world, where some populations may lack basic access to cardiac care. A partnership between GE Healthcare and the American Society of Echocardiography (ASE) brought a team of ASE sonographers and physicians to rural northwest India to help enhance ultrasound training of local doctors, first in 2012 and again in 2013. Led by Partho Sengupta, M.D., of The Mount Sinai Medical Center, who is also the India liaison for the ASE International Relations Task Force, the trips to Gurgaon, India, not only brought point-of-care ultrasound to underserved villages but also connected the underserved to consultants from around the world.
Using tools such as GE’s Vscan pocket-sized ultrasound and Vivid ultrasound systems — and in the 2013 trip, specialized EchoBox video conferencing systems from StatVideo — the teams of sonographers from ASE and from Gurgaon-based medical institute Medanta — The Medicity were able to provide training for local physicians in order to improve their ability to detect disease early and triage patients, as well as providing free imaging to pre-identified patients. Telecardiology consultation took place with expert physicians from locations worldwide such as the United States and Saudi Arabia.
Whatever the form of telecardiology, it is an evolving practice that requires investment in the right technologies and tools, as well as collaboration on everybody’s part. According to Marcus, with a changing mentality in healthcare — in which every patient, no matter where they live, expects quality care from their doctors — it is important for physicians to provide “diagnostic excellence” to even geographically remote regions.