Accuracy of remote cardiology consults equals face-to-face examination

Greenville 30 April 1998 At the East Carolina University (ECU), a double-blind study has been organized during one year to test the effectiveness of teleconsultation in the evaluation of paediatric heart patients. The research project has been set up to convince cardiologists that modern videoconferencing tools are just as reliable as live patient consultation to obtain a correct diagnosis. It might even save costs by helping the physician decide to suppress the production of superfluous echocardiograms. Although the study showed an almost 100% accuracy for the remote diagnoses, the ECU researchers insist that it is not proven whether telemedicine offers the same quality of service as face-to-face examination. Due to insufficient transmission speeds, acoustic and image data are inferior to the real-time echo and stethoscope outcomes.

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At the East Carolina University (ECU), a double-blind study has been organized during one year to test the effectiveness of teleconsultation in the evaluation of paediatric heart patients. The research project has been set up to convince cardiologists that modern videoconferencing tools are just as reliable as live patient consultation to obtain a correct diagnosis. It might even save costs by helping the physician decide to suppress the production of superfluous echocardiograms. Although the study showed an almost 100% accuracy for the remote diagnoses, the ECU researchers insist that it is not proven whether telemedicine offers the same quality of service as face-to-face examination. Due to insufficient transmission speeds, acoustic and image data are inferior to the real-time echo and stethoscope outcomes.

The clinical faculty of the ECU was invited to participate in the university's teleconsulting research. The medical centre is responsible for the rural population in a region of 10.000 square miles in the eastern part of North Carolina. The ECU offers basic health care to these medically underserved people by means of a 12-site telemedical network but has experienced severe difficulties to find enough physicians to staff the sites. Especially in the field of paediatric cardiology, the distant referral clinics were unable to keep up with patient demand. In addition, cardiologists were very sceptic about the clinical validity of interactive teleconsultation for diagnostic evaluation.

In an attempt to free the physicians from their initial anxiety, Dr. Michael McConnell, professor of paediatrics at the ECU, designed a double-blind test, in collaboration with ECU telemedicine director David Balch, with use of internal funding. A number of selected patients was first submitted to a standard examination by a physician, residing at one of the remote referral clinics. Next, the patient was taken to a teleconferencing room for distant consultation with Dr. McConnell by means of a connection with the ECU at a transmission speed of 384 Kbps over a half T1 link. Neither of the two doctors knew anything about the other one's findings. Both diagnoses were compared by a third physician. In case echocardiograms had been ordered, they were performed by different clinicians.

A number of 21 children, of which 17 under the age of five, passed the two medical examinations. Nineteen times, the diagnoses were exactly the same. In the two other cases, the teleconsulting doctor missed a small hole in the patient's heart but it had already closed during a next visit and was not considered to be serious. Anyhow, the telemedical approach allows to save money in two ways. Instead of ordering an expensive echocardiogram for each single patient, the physician can first listen to the heart sounds by means of an electronic stethoscope. Second, the programme helps to detect heart disease in a very early stage because the cardiologists are able to perform frequent controls among children who run a greater risk. Since the start of the ECU research project, already five sites in the network offer paediatric heart consults.

Still, the data transfer rates for teleconsults ought to be optimised, according to Dr. McDonnell. A telemedical echocardiogram is only transmitted at 15 frames per second, and thus largely outperformed by a live echo vision. The same goes for the auditive quality of electronic stethoscopes. In spite of the excellent results of the double-blind study, possible mistakes or overlooks are never excluded. More news on this ECU research is to be found in an article, written by Kathy Kincade, for the Telemedicine and Telehealth Networks magazine.


Leslie Versweyveld

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