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Heart Disease in Children
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Heart Disease in Children


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