For the past eight years, children with complex congenital heart disease at Fundacion Cardiovascular de Colombia (FCV) have received a second set of eyes from telemedicine specialists at Children’s Hospital of Pittsburgh of UPMC.
The program consists of teleconsultations between experts at Children’s Hospital and cardiologists, surgeons and intensivists of the FCV’s Cardiovascular Institute. Doctors at Children’s have access to the electronic file (SAHI), imaging studies, telemetry-measurement or recording of processes and electrocardiographic events at a distance and video surveillance.
“They can see in real time how the child is doing, review his/her vital signs with remote monitoring and evaluate the electronic medical record. We establish communication with the experts and through a high definition monitor and camcorder, we discuss their clinical condition. This way we review each case together. Every day we connect, it might be for ten minutes or two hours depending on the complexity of the patient we are dealing with, but we do it every day,” explains Javier Castro Monsalve, MD, pediatric cardiologist at the FCV.
The application of this technology included remote monitoring of the 24 beds situated at the pediatric Cardiovascular Intensive Care Unit. In this way, FCV and doctors at Children’s choose difficult cases for the daily discussions.
For Alejandro López Magallón, MD, physician of the Cardiac Intensive Care Unit and Telemedicine at Children’s Hospital, the most representative achievements since consolidating the alliance between this institution and the FCV have been evidenced in the advance of the capacity of the local team for the management of neonates with critical congenital heart diseases, including surgeries and interventions. He states that there has been a significant decrease of the length in hospital stays after the program started. Also, he notes that overall mortality in the Cardiac Intensive Care Unit, which in 2011 was 10.7% has declined to 3.7% in 2015.
On the other hand, he added that the project has contributed to the medical progress of the team at FCV around the implementation of their program of extracorporeal membrane oxygenation (known as ECMO) in critically ill pediatric patients with present or imminent cardiopulmonary collapse. It has also promoted the improvement of their results in the use of prolonged mechanical ventricular assist techniques, as a bridge for heart transplantation or for patient recovery.
“Their progress in this field has been such that FCV has become a regional reference center, and even outside Colombia, for patients who otherwise would not have an expectation of survival,” he says.
It is worth clarifying that although telemedicine does not replace local work, it operates as a complement in the improvement of medical care.
“The doctors at Children’s Hospital help us to review our behavior from the perspective of a specialist who is in a center of the highest quality in the world,” says Dr. Castro Monsalve.
The tool also allows us to increase the scientific performance of the personnel according to Cristian Rodríguez Martínez, MD, a resident doctor of pediatric cardiology at the FCV. This initiative is consolidated as a teaching journey, which facilitates the exchange of information on diagnoses, treatments and evaluations in patients.
The alliance strengthens the training of the medical and care teams in areas such as pediatric cardiac critical care, transplant, pathology, anesthesia, surgery and diagnosis of the pediatric cardiovascular service.
To date, UPMC has shared its clinical and organizational experience through a “reliable, safe and cost-efficient model” according to Dr. López. The FCV has contributed on their part by having a disciplined and versatile work team. The organization, which has been provided with a sophisticated technological base for the execution of the program, has adapted the model of care in Colombia, taking into account the cultural, legal, economic and health differences of both countries, framed by high ethical standards.
For more information, please visit www.chp.edu/international-services/telemedicine-services.