Telecardiology survives expense, turf wars

The use of telemedicine appears particularly promising in cardiovascular disease.

Several barriers remain, however, not the least of them cost and contentious turf battles.

"It is anticipated that vendors will expand existing radiology PACS to cardiac PACS and telecardiology," said Bernard Crowe of Bernard Crowe and Associates, a Canberra, Australia, consulting firm. "The associated economies of scale should assist in reducing the barrier to cost of entry."

Turf wars between different specialist groups reluctant to shift from established practice patterns are another problem.

"Early cooperative work between radiologists and cardiologists in the development of coronary arteriography has been replaced by contention between cardiologists, radiologists, and vascular surgeons, often driven by economic considerations rather than patient needs," Crowe said.

Nevertheless, the field continues to grow worldwide. A number of manufacturers including Agfa, Siemens, Philips, and GE now offer PACS and telecardiology options.

"This could greatly improve the efficiency of data management for cardiac examinations, including linkage to radiology and hospital information systems and electronic patient records," Crowe said.

A review (Electromedica 2002;70(2):88-91) of the Siemens Sorian cardiology system at South Carolina Heart Center in Columbia found cost savings and procedural efficiencies across seven regional offices in a Web network.

Internationally, a complete telecardiology solution, presented at the Euro PCR 2003 Conference in Paris in May, has been installed by Medcon (Whippany, NJ) at the Institut Cardio Vasculaire Paris Sud. Three Cardiovascular Interventional Centres are linked to seven remote referral clinics around Paris using ISDN lines, providing a remote conferencing and referral service.

In Australia, Barwon Health, an important regional hospital in the state of Victoria, is developing a Medcon cardiology imaging network. The hospital has connected two cath labs and four echocardiology units to a multifunction acquisition station.

"As all the cardiologists at Barwon Health are on call, use is being made of an ADSL modem to the cardiologists' home to allow viewing of echo studies at home in real-time," Crowe said.

The cardiologists will have access to a patient's history in the hospital database and will be able to both report and update the database in a secure manner. The system enables image exchange in AVI format, conferencing, and consultation with remote sites, using the telecardiology option.