Clinical Value of Real-Time Tertiary Fetal Ultrasound Consultation by Telemedicine: Preliminary Evaluation

Abstract

Congenital fetal abnormalities are major causes of perinatal mortality and morbidity. The performance of ultrasound in the diagnosis and assessment of fetal anomalies varies enormously between tertiary referral centers and general units. Telemedicine offers a chance for tertiary realtime ultrasound consultations using standard telephone lines for remote sites. Preliminary investigations by our group have shown that real-time transmission of fetal ultrasound images over long distances via telephone (integrated systems digital network [ISDN]) lines is technically feasible. A live link of up to 2 Mb/s was established between Mater Mothers Hospital in Brisbane and Kirwan Hospital for Women in Townsville, which are 1,500 km apart. The objective of the current study was to evaluate the clinical value of a tertiary teleultrasound consultation service. Patients requiring tertiary ultrasound consultations were recruited from North Queensland. Clinicians from the referral site established an initial diagnosis and management plan. Using standard ISDN lines, the real-time ultrasound images were transmitted to the maternal fetal medicine subspecialists in Brisbane. The ultrasound examination was completed under the direction of the subspecialist. The subspecialist explained the findings to the patient at the end of the session, and discussed the diagnosis and management plans with the clinicians involved. Any diagnosis and management variations were classified into minor and major upon agreement by the two teams of clinicians involved. The clinicians and patients in Townsville rated the value of the consultation, and the subspecialists rated the confidence of their diagnoses on five-point scales. Pregnancy outcomes were obtained and the data analyzed. Over a 3-month period, 24 teleultrasound consultations were carried out. The indications for referral were: assessment of growth restriction/fetal wellbeing in the third trimester (6); detailed assessment for high-risk patients (5); evaluation of markers for anomalies (5); isolated fetal anomalies (1); and complex fetal problems such as twin/twin transfusion, multiple anomalies, etc. (7). Overall, the consultations resulted in some modifications to the clinical diagnosis in 45.8% of the cases, and modifications to the management plan in 33.3% of the cases (about half of which were minor variations). The clinicians rated the teleconsultations highly (mean rating 4.7, SD 0.44). The patients also rated the consultations highly, and were comfortable that their privacy and confidentiality were maintained during the consultation. The subspecialists were confident in making their diagnoses by telemedicine (mean score for confidence 4.2, SD 0.43). All the pregnancies have now been completed, with all antenatal diagnoses confirmed to be correct postnatally. Tertiary real-time ultrasound consultation by telemedicine is not only technically feasible, it is welcomed by the clinicians and patients involved. It also contributes to diagnostic and management differences. Larger scale clinical t...

Assessing the Quality of Teleconsultations in a Store-And-Forward Telemedicine Network

“…Most previous quality studies have been retrospective reviews, such as that conducted by Mahnke et al (11). There have been few attempts to measure the value to the clinician, although Chan et al investigated this in a real-time teleconsultation network in a high-income country (12). …”

The Fetal Tele-Ultrasound Project in Queensland

“…The clinical experience of the project has been previously reported (Chan et al, 2000;Chan et al, 2001). Of the initial 120 consultations, some modifications to the clinical diagnosis were made in 41% of the cases, and modifications to the management plan in 40% of the cases.…”

Intelligent Health Systems and Third Millennium Medicine in Australia

“…Haywood and Mitchell 41 take an equally critical approach in examining the wide range of outcomes that are potentially achievable when introducing a tertiary level radiology service within a massive sparsely populated state, South Australia. Yogesan et al, 42 Chan et al, 43 and Olver and Selva-Nayagam 44 all detail different clinical applicatio ns in long distance telem edicine services. Yogesan et al 43 examined the use of a hand-held fundus camera.…”

“…Yogesan et al, 42 Chan et al, 43 and Olver and Selva-Nayagam 44 all detail different clinical applicatio ns in long distance telem edicine services. Yogesan et al 43 examined the use of a hand-held fundus camera. Contrary to other reports in literature, they conclude that the reduction in image quality caused by the digitizer attached to the camera lead to images that were relatively impaired compared to those shown on the camera's screen.…”