Author: Justin Pick
Introduction: Access to specialty care is not evenly distributed throughout the United States often leading to disparities in health care outcomes. Telemedicine can be used to facilitate access to care by using two pieces of portable technology: an EKG and electronic stethoscope. This pilot study will demonstrate the feasibility of telemedicine in remote locations to help physicians treat patients in a fiscally responsible manner. Methods: General pediatricians (n=16) were provided smart phone compatible electronic stethoscopes and ECGs (Thinklabs stethoscopes and ECG Check Monitors, respectively) for bedside data transmission of heart sounds and ECGs to a pediatric cardiologist in a store-and-forward fashion. The consults were provided free of charge. Pediatricians were surveyed mid-study to determine the convenience of the technology. A cost analysis evaluating the savings/earnings to pediatricians, pediatric cardiologists, patients, and insurance company was calculated based on the Medicare reimbursement standards for electrocardiograms, echocardiograms, and face-to-face pediatric cardiology consultations. Results: During a 9-month trial 18/18 potential in-person consultations were avoided. Insurance companies saved a total of $8,448 due to the avoidance of unnecessary echocardiograms. Pediatricians accrued $261 due to billing for a single lead EKG. Patients saved via travel expenses. Distant Pediatric Cardiologists accrued $360. Survey results demonstrated moderate difficulty using the devices but a strong willingness to use telemedicine if shown to be beneficial. Conclusion: Our study has shown that store-and-forward telemedicine technology can be used to enhance access to specialty medical care in distant, underserved communities in a cost effective manner beneficial to both patients and providers.
Co Author/Co-Investigator Names/Professional Title: Anjan Batra, MD MBA Chief of Pediatric Cardiology, University of Calironia Irvine Medical Center, Orange, CA.