Heart Disease in Children


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Heart Disease in Children

  1. 1. Developing a Sustainable Program for Tele-Echocardiograms in Rural Pediatrics Thomas K. Chin, MD and Richard Kuebler, BBA University of Tennessee College of Medicine and LeBonheur Children’s Medical Center
  2. 2. Goals: <ul><li>Demonstrate that a Telehealth Program is beneficial for providing Pediatric Cardiology services in rural Tennessee </li></ul><ul><li>Show that the Telehealth Program is sustainable , and potentially profitable for regional sites and the tertiary care center </li></ul>
  3. 3. Why is Telemedicine particularly effective for treating Congenital Heart Disease? <ul><li>Background: </li></ul><ul><li>For every 1000 infants born in the United States, between 5-8 have heart defects. </li></ul><ul><li>Over 85% of these infants are expected to reach adulthood if they receive appropriate medical attention. </li></ul><ul><li>It has only been possible in the past 60 years to treat congenital heart disease in infants and children (surgery and interventional cath). </li></ul><ul><li>To achieve current standards for outcomes, it is necessary to obtain treatment at a specialized medical center with the expertise, facilities and equipment to provide care (tertiary care center). </li></ul>
  4. 4. Why is Telemedicine particularly effective for treating Congenital Heart Disease? <ul><li>Manpower/Resources: </li></ul><ul><li>There are 1,521 (total) board certified pediatric cardiologists </li></ul><ul><li>There are 244 practicing pediatric cardiovascular surgeons in the United States </li></ul><ul><li>110 pediatric cardiology fellows complete training each year. </li></ul><ul><li>(2006 AHA census) </li></ul>
  5. 6. Uncomplicated Heart Defect
  6. 7. Interventional Heart Catherization: <ul><li>Interventional procedures: </li></ul><ul><ul><li>balloon septostomy and valvuloplasty (PS, AS, Coarctation) </li></ul></ul><ul><ul><li>coil embolization (PDA, collaterals) </li></ul></ul><ul><ul><li>Stents </li></ul></ul><ul><ul><li>ASD& VSD closure </li></ul></ul>
  7. 9. “ Stage I” Norwood Procedure
  8. 10. Arrhythmias: Ventricular Tachycardia
  9. 11. Arrhythmia Treatment Using Catheter Ablation <ul><li>Mapping </li></ul><ul><li>Ablations </li></ul>
  10. 13. Telehealth Program at the University of Tennessee <ul><li>The University of Tennessee Telehealth Program was initially developed and maintained using Federal and State grants. </li></ul><ul><li>The program is associated with the University of Tennessee Health Science Center (Colleges of Medicine, Pharmacy and Nursing) </li></ul><ul><li>Located in Memphis, TN (population of 1.3 million) </li></ul><ul><li>Serves a 3 state region: West Tennessee, Eastern Arkansas and Northern Mississippi </li></ul>
  11. 14. The University of Tennessee College of Medicine <ul><li>Affiliated Hospitals: </li></ul><ul><ul><li>Methodist University Hospital </li></ul></ul><ul><ul><li>The MED and MEDPLEX (Shelby County Hospital system, trauma center) </li></ul></ul><ul><ul><li>Veteran’s Administration Hospital </li></ul></ul><ul><ul><li>LeBonheur Children’s Medical Center </li></ul></ul><ul><ul><li>St. Jude Children’s Research Hospital </li></ul></ul>
  12. 15. LeBonheur Children’s Medical Center
  13. 16. Clinic & Tele-Echo Sites = clinic + tele-echo = tele-echo = clinic
  14. 19. Benefits of Telemedicine in Pediatric Cardiology <ul><li>Allows the detection of patients with congenital heart disease (particularly important in the neonatal period) </li></ul><ul><li>Allows access for regional hospitals and their patients the expertise of a major medical center (services would otherwise be unavailable to these patients). </li></ul>
  15. 20. Benefits of Telemedicine in Pediatric Cardiology <ul><li>Allows efficient use of valuable resources: </li></ul><ul><ul><li>Decreased need for hospital to hospital transports (some patients can stay locally) </li></ul></ul><ul><ul><li>Minimizes duplication of services </li></ul></ul><ul><ul><li>Subspecialty physicians can simultaneously serve patients in metropolitan area and underserved regions </li></ul></ul>
  16. 21. Echocardiograms: Memphis Metropolitan Area
  17. 22. Echocardiograms performed in rural sites using telehealth
  18. 23. Sustainability of Telemedicine in Pediatric Cardiology <ul><li>Expenses for set-up and maintenance: </li></ul><ul><ul><li>Set-up fee: $15,000. per site (work-station, software, line installation). </li></ul></ul><ul><ul><li>Line fee: $9,500. per site/year--can be shared </li></ul></ul><ul><ul><li>Referring institutions can bill for the technical component of charges and additional telemedicine charge </li></ul></ul><ul><ul><li>Service institution can bill for professional component of charges </li></ul></ul>
  19. 24. Sustainability of Telemedicine in Pediatric Cardiology <ul><li>Charges and Collections for Telehealth Echos: </li></ul><ul><ul><li>750 studies/yr. </li></ul></ul><ul><ul><li>Charges/yr. referring institutions $2,250,000. </li></ul></ul><ul><ul><li>(collections=$900,000.) </li></ul></ul><ul><ul><li>Charges/yr. serving institution $ 750,000. </li></ul></ul><ul><ul><li>(collections=$300,000.) </li></ul></ul>
  20. 25. Conclusions: <ul><li>Benefits: </li></ul><ul><li>Allows the detection of patients from rural sites with congenital heart disease </li></ul><ul><li>Allows access for rural hospitals and their patients to the expertise of a tertiary care center </li></ul><ul><li>Allows efficient use of valuable resources (fewer transports, less duplication of services, efficient use of subspecialty physicians) </li></ul>
  21. 26. Conclusions: <ul><li>Sustainability and Profit: </li></ul><ul><li>Direct revenue from rural tele-echocardiograms at a moderate size tertiary care center </li></ul><ul><ul><li>is extremely beneficial for rural sites </li></ul></ul><ul><ul><li>is adequate within a single year to offset set-up costs for 6 rural sites, costs for line maintenance for all sites, as well as to generate a profit! </li></ul></ul><ul><li>Additional Indirect revenue from surgical and interventional cath referrals is likely to be significant. </li></ul>
  22. 27. Thank You (opening in Fall 2010)