No boundaries to care: Technology lets specialists diagnose children from afar

Hector Rodriguez Leon’s parents, Hector and Erika, and his caregivers at Silver Cross Hospital in south suburban New Lenox were concerned. Just hours after his birth, Hector was breathing rapidly, had a grayish cast to his skin and his blood oxygen level was low. Tiny Hector was put on a ventilator and, as the hospital does not have a pediatric cardiologist on staff, a call was made to Ann & Robert H. Lurie Children’s Hospital of Chicago to arrange for a tele-echocardiogram of his heart.

While the ultrasound scan would originate at Silver Cross, one of Lurie Children’s partner hospitals, the moving images of his heart would be sent over a special phone line to be reviewed in real time by a cardiac sonographer and cardiologist at  Lurie Children’s in downtown Chicago. The cardiologist would be in direct communication with the suburban hospital’s medical staff with the scan’s results, assisting them in guiding Hector’s care. 

Diagnosing children at remote locations

The Division of Cardiology is one of several programs at Lurie Children’s that make widespread use of telemedicine, which utilizes telecommunication and information technology to enable the hospital’s specialists to diagnose children initially seen at other area medical centers. Telemedicine is a broad term that incorporates a variety of forms. Examples include the ability of the Department of Medical Imaging’s pediatric radiologists to “read” diagnostic scans within moments of their being uploaded to Lurie Children’s imaging database from a remote location; cardiologists and other staff being able to monitor in real time imaging studies originating – as in Hector’s case -- from another location.

As the sonographer at Lurie Children’s viewed the images of Hector’s beating heart, she became alarmed, and asked a staff cardiologist to confirm what she saw. The cardiologist agreed that Hector had an obstructed total anomalous pulmonary venous connection (TAPVC) – a life-threatening condition that required immediate surgery. Lurie Children’s Regenstein Cardiac Care Unit (CCU) was immediately alerted and ambulance transport from New Lenox to downtown Chicago was ordered. Hector arrived at Lurie Children’s around 2 p.m., and underwent surgery that evening to repair his heart. After recovering in the hospital’s CCU for two weeks, baby Hector went home in good health. 

“Sending our baby to Lurie Children’s was the best decision,” says Hector’s father. “Otherwise, the results could have been tragic.”

“This just saved a child’s life”

Sonographer Lynne Brown, manager of Lurie Children’s echocardiography program and laboratory, says most echocardiogram studies of newborns indicate either normal function or common congenital conditions that do not need immediate intervention. “Then you look at a study and see something like TAPVC, and you’re reminded of why you do what you do,” she says. “You think, ‘This just saved a child’s life.’”

Each year, Lurie Children’s 16 cardiac sonographers perform more than 13,000 echocardiograms. Of those, nearly 900 are tele-echocardiograms. The hospital’s pediatric tele-cardiology program was one of the first in the nation, and since 1994 about 14,000 of the remote scans have been performed at the hospital. Luciana Young, MD, medical director of the echocardiography lab, says telemedicine offers numerous advantages.

“In the past, area hospitals without staff cardiologists routinely transferred children with non critical issues to Lurie Children’s,” she says. “Thanks to tele-echocardiography, babies who don’t need to be transported are not, allowing them to stay with their mothers rather than being separated shortly after birth, and avoiding costly transports that are not medically indicated. Children with critical heart defects are diagnosed more quickly, resulting in fewer complications and shorter hospital stays.”

Special expertise in telemedicine imaging

Lurie Children’s Medical Imaging team uses telemedicine to review approximately 55,000 diagnostic imaging scans each year that originate at locations that don’t have a Lurie Children’s pediatric radiologist on site 24/7. The telemedicine service is available at four of Lurie Children’s outpatient centers and four outreach partner hospitals. Images from CT scans, ultrasounds, MRIs and x-rays and other diagnostic tests are transmitted from the remote location to Lurie Children’s secure image archiving database, where they can be instantly called up and read by one of the Medical Imaging physicians.

“If a medical center that doesn’t have a pediatric radiologist on staff is performing imaging for children, it may not be providing the optimal service to the patient,” says Cynthia Rigsby, MD, Lurie Children’s Vice-Chair of Medical Imaging. “Children are not ‘little adults’ when it comes to illnesses, and interpreting these images requires the expertise of a pediatric imaging specialist. Having the telemedicine program allows the Lurie Children’s Medical Imaging team to help care for these children in their communities.”

Virtual exams for patients with brain injuries

The hospital’s commitment to expanding telemedicine services throughout the hospital is exemplified by the soon-to-launch telemedicine program between the specialists in Lurie Children’s Ruth D. & Ken M. Davee Neurocritical Care Program and partner hospital Lurie Children's at Northwestern Medicine - CDH in Winfield. The subspecialists in the neurocritical care program care for children with brain injuries and neurologic complications.

According to Mark Wainwright, MD, PhD, director of the neurocritical care program, when the 24/7 interactive telemedicine service goes online as the first program of its kind in the U.S., Lurie Children’s neurocritical care specialists will be able to participate virtually in real time examinations via a closed-circuit video connection with their counterparts at the suburban hospital. They’ll even be able to remotely control a robotic device to assist in examining patients.  

“It just makes sense to have telemedicine as an option for children with brain injuries, and we would like to eventually become the designated pediatric neurocritical care provider for community hospitals throughout Illinois,” says Dr. Wainwright.