Expanding telehealth through technology: Use of digital health technologies during pediatric electrophysiology telehealth visits

• DOI: 10.1016/j.cvdhj.2022.07.003
• Publication Date: 2022-07-21T17:24:23Z
• Authors: Lisa Roelle; Juliana Ocasio; Lauren Littell; Eli Fredman; Nathan Miller; Tracy Conner; George Van Hare; Jennifer N. Avari...
• Keywords: Telehealth

Key Findings•A digital health (DH) technology kit was assembled and mailed to patients prior their pediatric electrophysiology telehealth (TH) visit.•Use of these technologies during the study demonstrated that had increased confidence in TH visit; providers agreed incorporation DH visit did enhance experience.•Patients expressed high likelihood schedule repeat if were included.•This type loaner program could be used increase outreach potential.•Electronic medical record integration data is integral long-term sustainability this model.IntroductionTechnology has become increasingly prominent healthcare field, ranging from consumer-based evolving programs. Importantly, programs have been reported as quality safe, access located geographic regions with limited resources.1Olson C.A. McSwain S.D. Curfman A.L. Chuo J. The current landscape.Pediatrics. 2018; : 141Google Scholar,2Schweber Roelle L. Ocasio et al.Implementation early experience a program.Cardiovasc Digit Health 2022; 3: 89-95Abstract Full Text PDF PubMed Scopus (1) Google Scholar In field cardiology, underwent exponential growth COVID-19 pandemic limit exposure both providers.3Chowdhury D. Hope K.D. Arthur L.C. al.Telehealth for cardiology practitioners time COVID-19.Pediatr Cardiol. 2020; 41: 1081-1091Crossref (22) fundamental importance video-based teleconsultations linked reduced travel costs; however, there remains significant concern about viability programs, given absence vital sign measurements, physical exam, routine cardiac testing.4Patel P. Dhindsa Eapen D.J. al.Optimizing potential cardiovascular care (in era COVID-19): will tell.Am J Med. 2021; 134: 945-951Abstract (3) Recent advancement wearable may offer solutions limitations.5Tarakji K.G. Silva Chen L.Y. al.Digital patient arrhythmia: what every electrophysiologist needs know.Circ Arrhythm Electrophysiol. 13e007953Crossref (8) Although improvements capacity expand practices, inconsistent reliability device burden hospital system are limitations widespread adoption.5Tarakji ScholarThis aims create cardiothoracic (both prescription direct consumer) by providing augment visit, including pulse oximetry, electrocardiography (ECG), cardiopulmonary auscultation, assess provider usability preferences devices.MethodsAfter receiving approval Washington University School Medicine Institutional Review Board, met inclusion criteria contacted via telephone research team verbal consents (and assents, <18 years old) obtained. Inclusion follows: scheduled clinic (EP) at University, (2) valid mailing address, ability use smartphone, (4) MyChart application EPIC electronic (EMR) (if not access, assisted patient/family obtaining access). Exclusion included following: non-English-speaking patients, who wards state, preterm newborns. performed thorough literature review available variety technologies; unavailable, in-house testing completed using study.Demographic data, diagnosis, zip codes collected chart enrolled patients. After consent obtained, appointment, "technology kit" (via FedEx) patient. There 2 kits, which serially cleaned sent part study. Kits contained real-time collection chargers cables. Six included: an iPhone SE app use, 3 ECG devices (Apple Watch Series 6, Coala monitor, AliveCor Kardia monitor [single lead]), oximeters 6 iHealth oximeter), stethoscopes (Coala Stethee Pro device) (Figure 1) addition, also printed copy keep, prepaid shipping label, survey, user guide visit. Patients asked ensure all charged initiation appointment connect local wireless internet connection. At start member ensured connected Bluetooth preloaded iPhone. instructed on each Typically, visits began stethoscopes, lung auscultation recordings, then uploaded patients' respective dashboards, accessed provider. Pulse oximetry obtained device, reporting results (preloaded kit"); AW6 result. Finally, tracings either exported iCloud Notes (KardiaMobile AppleWatch) or company-specific dashboard (Coala). These reviewed discussed visit.Upon termination separately filled out satisfaction/usability survey. responses quantified Likert scale, 1 5 (1 = strongly disagree agree).Statistical analysisDescriptive analyses frequencies percentages. Where appropriate, mean averages provided (with range).ResultsDemographic dataThirty study; 55.7% (17/30) female. Average age 11.6 (range 0.4–20 years) 70% (21/30) between ages 10 20 years. most frequent diagnoses supraventricular tachycardia / atrial (15/30, 50%), family history inherited arrhythmia syndrome (4/30, 13.3%), syncope near (3/30, 10%). appointments conducted 4 EP St. Louis Children's Hospital (Table 1).Table 1Demographic dataValue (N 30 patients)Sex Female17 (56.7%) Male13 (43.3%)Age range 0–5 years4 (13.3%) 6–9 years5 (16.7%) 10–14 years10 (33.3%) ≥15 years11 (36.7%)Primary diagnosis SVT tachycardia16 (53.3%) Family Hx syndrome4 Syncope near-syncope3 (10.0%) Inherited genetic mutation2 (6.7%) Sinus pause2 Inappropriate sinus tachycardia1 (3.3%) Abnormal ECG1 Palpitations1 (3.3%)Distance clinic, average (miles)115.6 miles(12.6–222.6 miles)ECG electrocardiogram; history; tachycardia. Open table new tab Equipment costsThe total cost equipment per $2127.98, 64GB ($399.99), case ($9.99), Apple ($599.00), charger ($29.00), ($414.00), ($499.00), oximeter ($59.99), KardiaMobile Monitor ($89.00), Carry Pod ($29.00). round-trip $18.13 $8.83–$42.05) FedEx account.Data qualityData assessed postvisit For devices, high-quality 2) (62%; 18/29), (93%; 28/30), (86%; 24/28), no physician preference used. Assessment found heart sounds 52% (15/29) 69% (20/29) vs 67% (18/27) 74% (20/27) Pro. Navigation dashboards easy, 78% (18/23) 84% (21/25), respectively, equally easy 3A).Figure 2Comparison across different ages.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Provider survey results. A: Device satisfaction responses. Statements shown along x-axis percentage response y-axis. green bars represent statement. Yellow neutral, red represents disagreed disagreed, gray blank N/A. B: Data quality. regarding Same color representation 4A. 6; N/A applicable.View (PPT)Provider resultsFrom 90% (26/29) those counseling (20/30 responses). Providers real 86% (25/29) time. 63% (19/30) visits, helpful decision-making enhanced 3B).Patient resultsA 98% (29/30) families applications ease 97% (28/29) 100% (29/29) oximeter, (30/30) 4A), any category 4B). All made them more confident Of 9 previous in-person electrophysiologist, (9/9, 100%) good 87% (26/30) responders they would likely used.Figure 4Patient Patient preference. Responses number use. (PPT)DiscussionDH kits reduce readmission following surgery; our knowledge, first returnable EP.6McElroy I. Sareh S. Zhu A. al.Use after surgery.J Surg Res. 2016; 204: 1-7Abstract (25) demonstrate technologies, incorporating into experience. Additionally, clinics again included. suggest adopted larger scale clinic's potential.Integration acquired EMR essential moving forward. Previously, we described method direct-to-consumer devices.7Roelle Dalal A.S. Miller N. Orr W.B. Van Hare G. Avari J.N. impact wearables clinics: real-world series.Cardiovasc 1: 169-171Abstract While incorporated patient's EMR, like necessitate incorporation. We observed report (including rate, systolic diastolic time, etc) scannable QR code, links audio file pulmonary auscultation. This added and, ideally, allowing long-term, longitudinal follow-up data. addition files particular monitoring progression murmurs, valvar insufficiency stenosis. artificial intelligence–assisted now inexpensively noninvasively assess, potentially prognosticate, clinical valvular disease, failure, other structural functional disease. Continued investigation heterogeneous cohort useful determining substrates.Based creating program, it prudent consider implementing "rental agreement" support high-volume staff needed manage maintenance. Reimbursement issues, historically adoption TH, issue when kits. unaware CMS modifier account assessment information visits. add barrier such forward.Study limitationsAn important limitation reliance patient-accessible Wi-Fi networks, coupled working knowledge technologies. younger often incomplete set, attributable poor contact small anatomy. Inconsistent availability device-specific owing firewalls inhibit Lastly, none against gold-standard counterparts, so accuracy can made, though studies supported population.8Gropler M.R.F. G.F. J.N.A. Can smartphone ECGs accurately intervals pediatrics? A comparison mobile standard 12-lead ECG.PLoS One. 13e0204403Crossref (41) Scholar, 9Kobel M. Kalden Michaelis al.Accuracy iECG children without congenital disease.Pediatr 43: 191-196Crossref (6) 10Paech C. Kobel single-lead recordings pre-term neonates.Cardiol Young. 1-5Crossref 11Nguyen H.H. Use cardiology.Trends Cardiovasc 26: 376-386Crossref (43) 12Nguyen Rudokas Bowman T. SPEAR trial: Smartphone Pediatric ElectrocARdiogram trial.PLoS 2015; 10e0136256Crossref (36) ScholarConclusionDH modified examination diagnostic tools. Our shows widely accepted Expansion provide increasing equity specialized care. model. •A IntroductionTechnology devices.