The Application of Telehealth The Application of Telehealth in Pediatric Cardiologyin Pediatric Cardiology

Thomas K. Chin, MD FAAP, FACCThomas K. Chin, MD FAAP, FACCDirector of Pediatric Cardiology Director of Pediatric Cardiology

and the Pediatric Cardiovascular Instituteand the Pediatric Cardiovascular Institute

University of Tennessee College of Medicine University of Tennessee College of Medicine and LeBonheur Children’s Medical Centerand LeBonheur Children’s Medical Center

Incidence of Congenital Heart Incidence of Congenital Heart Disease:Disease:

• For every 1000 infants born in the United States, 8 have heart defects.

• Over 85% of these infants are expected to reach adulthood if they receive appropriate medical attention.

Management of Congenital Management of Congenital Heart Disease:Heart Disease:

• It has only been possible in the past 60 years to identify and treat congenital heart defects in infants and children.

• There are approximately 1,521 board certified pediatric cardiologists and 244 pediatric cardiovascular surgeons practicing in the United States (2006 AHA census).

• To obtain accepted standards for outcomes, it is necessary to obtain treatment at a medical center with the facilities and expertise to provide specialized care.

Interventional Heart Catherization:Interventional Heart Catherization:

• Interventional procedures:– balloon septostomy and

valvuloplasty (PS, AS, Coarctation)

– coil embolization (PDA, collaterals)

– Stents– ASD& VSD closure

““Stage Stage I” I”

NorwoodNorwood

““Stage II” Stage II” Norwood Norwood (Glenn)(Glenn)

““Stage III” Norwood Stage III” Norwood (Fontan)(Fontan)

Ventricular TachycardiaVentricular Tachycardia

Arrhythmias: Arrhythmias:

• Mapping• Ablations

Clinical Cardiologists

Non-Invasive DiagnosticsEKG, ECHO, MRI, Stress Testing

Echocardiography expertFetal Echos

Diagnostic Catheterization

Low risk surgery

InterventionalCardiologist

Electrophysiologist

CVICUCardiac

AnesthesiaMedium Risk

Surgery & HybridProcedures

High RiskSurgeries/

ECMO

VentricularAssist

DevicesTransplants

Research Center

Cardiac Institute

PA

TI

EN

T

AC

UI

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Benefits of Telemedicine Benefits of Telemedicine in Pediatric Cardiologyin Pediatric Cardiology

• Allows the detection of patients with congenital heart disease (particularly important in the neonatal period)

• Allows access for regional hospitals and the patients they serve to the expertise of a major medical center (services would otherwise be unavailable to these patients).

Benefits of Telemedicine Benefits of Telemedicine in Pediatric Cardiologyin Pediatric Cardiology

Allows efficient use of valuable resources:– Decreased need for hospital to hospital

transports (patients can stay locally)– Minimizes duplication of services– Subspecialty physicians can

simultaneously serve patients in underserved regions

Benefits of Telemedicine Benefits of Telemedicine in Pediatric Cardiologyin Pediatric Cardiology

Financially beneficial solution– Line maintenance fees can be shared– Acceptable initial start-up costs– Referring institutions can bill for the

technical component of charges and additional telemedicine charge

– Service institution can bill for professional component of charges

– Profitable for service institution!

Telemedicine at the UT/LeBonheur Telemedicine at the UT/LeBonheur Pediatric Cardiovascular InstitutePediatric Cardiovascular Institute

Volume of telecho from representative sites:

Studies performed in a 6 month period (January-June 2007)

JMCGH (Jackson TN)—560NMMC (Tupelo MS) –417Volunteer Hospital (Martin TN)–60

Thank youThank you