Telemedicine Based Ultrasound for Detecting Neonatal Heart Disease in Babies at Remote Military or Native American Health Care Facilities

摘要

Our partnership of investigators from Madigan Army Medical Center at Fort Lewis, Washington, and Oregon Health & Science University in Portland, is testing the hypothesis that trained primary care practitioners or nurses can, with telemedicine supervision, perform cardiac ultrasound exams on neonates at risk for heart disease, and thereby impact time to diagnosis and outcomes. This study is targeted at Military Medical Facilities within TRICARE West and Western Regional Medial Command. It will also include two large Alaska Native Health Care Centers. Echocardiography has had major impact in the management of neonates suspected of having congenital heart disease. The expensive, specialized equipment and significant expertise to adequately perform and interpret these studies usually is present only in tertiary level medical centers with a pediatric cardiologist on staff. Initial results of a National Multicenter Neonatal Telemedicine Echo Outcomes Study, developed by the Principal Investigator, suggest that telemedicine-implemented diagnosis positively affects outcomes in infants suspected of having congenital heart disease. Our partnership has trained 37 non cardiologists to perform neonatal echo and has installed a high bandwidth telecommunications link using the military version of Internet2, NIPRNET. As of the end of 2008, we have been overseeing neonatal echo exams from 3 military installations in the NW and in Alaska, as well as a large Alaska Native Health Center in Anchorage. We have also upgraded the scanners used in our network to the latest architecture from Sonosite(Registered): the fully digital phased array handheld ultrasound scanner, the MicroMaxx(Registered), and implemented the capability of having the supervising expert run the scanner remotely via IP connection.