UPMC Children's delivers remote care
When researchers at UPMC's Children's Hospital of Pittsburgh reviewed more than 1,000 pediatric consultations offered in Latin America via telemedicine, they found that physicians in those countries were highly satisfied with the service and believed telemedicine had improved patient outcomes.
The study, led by Ricardo A. Muñoz, MD, chief, Cardiac Intensive Care Division, at Children's, was published online in the July issue of Telemedicine and e-Health.
"Lack of skilled physicians is a widespread problem, particularly those with expertise in patients with complex medical problems, such as congenital heart disease," said Muñoz, in a news release. Muñoz is also the medical director of global business and telemedicine at Children's. "The use of telemedicine services within pediatric cardiac intensive care units can be used as an assisting technology, allowing more expertise and knowledge to be shared with remote centers in need."
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"Little is known about the optimal method of telemedicine service delivery in the international setting," added 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.
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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, according to Children's. 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 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 healthcare for children around the world."