Technology and heart disease: Where the two intertwine

Technology and heart disease: Where the two intertwine Dr Sunita Maheshwari, ABP, ABPC (USA) Senior Consultant Pediatric Cardiologist and Chief Dreamer, Teleradiology Solutions and RXDX Clinics Bangalore

India 10000 miles • 1.2 billion people • Total children born with CHD per year: 1.2 million • Max: 400 Pediatric Cardiologists • Max: 50 cardiac centers that deal with children

How does one get a Dx in India? Nearest echo machine and Pedi Cardiologist maybe 300 kms away

PROBLEM #1No diagnosis…no treatment

Telemedicine of today: talk to the patient, hear murmurs, see the ECG

Tele Echo But how to know what is really going on with the babys heart when they are so far away?

How we did it in India: Early days • Trained a tech over 2 months or an internist/pediatrician • Sent back to home town/remote site • Tele echo link established • Pedi Cardiologist available at main site • Diagnosis made, management discussed Ashwini Childrens hospital, Bijapur

Method 1: Live tele echo At the cardiac site

Advantages Disadvantages Real time cardiologist has to be available at the other end to review; Middle of the night-if cardiologist not at telemedicine center cannot review till am 4000 Cardiologists in India, 315 PG seats 400 Pediatric cardiologists, 22 PG seats Cardiologist time precious • One time set up cost • Recurring cost low • Real time echoes-can direct echo from afar, get all views needed • With video camera also see patient and complete consultation

Method 2: Record and store

Advantages Disadvantages • Web based • Echo can be viewed at any time from anywhere with a basic internet connection • Cardiologist need not be at telemedicine site • Can review at home in middle of night • Acts as an archival Echo operator at remote site has to be well trained and experienced If further info needed patient needs to be brought back for a rescan

PROBLEM #2 • Estimated number of children born with heart disease every year in India is 1.2 million (1%). • Real number is possibly much higher due to consanguinity, lack of awareness of the need for preconceptual folic acid, etc. A paucity of doctors trained in diagnosing, treating and counselling these children and families.

The Problem in Training in India What Yale gave me to bring back to India • Those who need training maybe located in areas far away from the trainers • Number of super specialists interested in teaching are limited in number • Energy and time needed for clinical work makes content creation/class delivery a challenge • Quality is variable and different • Different institutions have different protocols/approaches to patient care so no standardisation.

Dictionary: Word-forming element meaning "far, far off," from Greek Tele, combining form of Tele "far off, afar, at or to a distance," related to Teleos (Genitive Telos). Tele Teaching A Solution

Teacher Anywhere, Student Anywhere! One Teacher All PG’s Same Content All Centers

E-teaching program for Pedi cardiology PG’s: 9 years March 2010 — Feb 2019 715 E-classes in Pedi Cardiology • Teachers: India and international • Students: Mandatory for FNB plus • 450 Logins globally • Tues 530 Thurs 8 am • Content portal with recorded E-Lectures • Bi annual Quiz

And now…Hot off the press! • E-teaching @ Kerala NHM Hridayam by Pedi Cardiologists for Pediatricians • Every Thursday at 830 am

Conclusion and thank you! Innovative use of technology such as tele echo and tele training can help obviate the shortage of trained cardiac personnel globally Dr Sunita Maheshwari Dreamer and Pediatric Cardiologist sunita.maheshwari@telradsol.com

Technology and heart disease: Where the two intertwine