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Correspondence |

Tele-Medicine and Point-of-Care Ultrasound: A New Paradigm for Resource-Constrained Settings FREE TO VIEW

Andrea R. Levine, MD; Thomas E. Robertson, MD; Alfred Papali, MD; Avelino C. Verceles, MD; Michael T. McCurdy, MD
Author and Funding Information

CORRESPONDENCE TO: Andrea R. Levine, MD, University of Pittsburgh Medical Center Health System, Ringgold Standard Institution, Pulmonary, Allergy, and Critical Care Medicine, 3459 Fifth Ave, Pittsburgh, PA 15213


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1580-1581. doi:10.1016/j.chest.2016.03.052
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We read with interest the article by Zaidi and Koenig in a recent issue of CHEST (February 2016). The intersection of tele-medicine with point-of-care ultrasound (PCUS) in clinical decision-making represents an exciting frontier that can improve access to dynamic diagnostic modalities. Remote mentorship by a tele-medicine specialist allows physicians and nonphysicians alike to obtain high-quality, clinically useful images with PCUS.

Unfortunately, establishing a comprehensive tele-medicine system, especially the video hardware and software components, can be cost-prohibitive for resource-constrained settings. We propose a novel method whereby successful remote tele-monitored PCUS can be achieved despite the cost barrier.

We recently demonstrated that ubiquitous video chat software (ie, FaceTime for Apple) can facilitate high-quality PCUS via live mentorship. Although performed in a nonresource-constrained setting, this pilot study remains eminently feasible and applicable to environments with limited resources. In resource-constrained settings overseas, ultrasound is often the only available modality of diagnostic imaging. Many providers in these environments lack expertise in image acquisition and interpretation. Smartphones, tablets, and other mobile computing devices are widely available, even in developing countries., With free or inexpensive software and a reasonable Internet connection, live, two-way audiovisual communication from nearly any region worldwide is possible. Thus, inexpensive technologies that people already carry in their pockets can be transformed into powerful mobile tele-medicine platforms through which high-quality PCUS can be captured locally and interpreted remotely.

This approach still requires careful study to determine privacy, reliability, and cost-effectiveness implications. Given its simplicity and practicality, however, the use of commercial video chat software involving remotely located experts may greatly augment the utility of PCUS as an effective diagnostic tool worldwide.

References

Zaidi G. .Koenig S. . Merging two worlds: point-of-care ultrasonography and telemedicine. Chest. 2016;149:605-606 [PubMed]journal
 
Levine A.R. .McCurdy M.T. .Zubrow M.T. .Papali A. .Mallemat H.A. .Verceles A.C. . Teleintensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care. 2015;30:871-875 [PubMed]journal. [CrossRef] [PubMed]
 
Levine A.R. .Buchner J.A. .Verceles A.C. .et al Ultrasound images transmitted via FaceTime are noninferior to images on the ultrasound machine. J Crit Care. 2016;33:51-55 [PubMed]journal. [CrossRef] [PubMed]
 
Papali A. .McCurdy M.T. .Calvello E.J. . A “three delays” model for severe sepsis in resource-limited countries. J Crit Care. 2015;30:861.e9-861.e14 [PubMed]journal. [CrossRef]
 
How many iPhones have been sold worldwide? About Tech website.http://ipod.about.com/od/glossary/f/how-many-iphones-sold.htm. Accessed August 1, 2015.
 
Apple announces 225M iPads sold to date, 675,000 iPad apps in the App Store. VentureBeat website.http://venturebeat.com/2014/10/16/apple-announces-225m-ipads-sold-to-date/. Accessed September 20, 2015.
 

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References

Zaidi G. .Koenig S. . Merging two worlds: point-of-care ultrasonography and telemedicine. Chest. 2016;149:605-606 [PubMed]journal
 
Levine A.R. .McCurdy M.T. .Zubrow M.T. .Papali A. .Mallemat H.A. .Verceles A.C. . Teleintensivists can instruct non-physicians to acquire high-quality ultrasound images. J Crit Care. 2015;30:871-875 [PubMed]journal. [CrossRef] [PubMed]
 
Levine A.R. .Buchner J.A. .Verceles A.C. .et al Ultrasound images transmitted via FaceTime are noninferior to images on the ultrasound machine. J Crit Care. 2016;33:51-55 [PubMed]journal. [CrossRef] [PubMed]
 
Papali A. .McCurdy M.T. .Calvello E.J. . A “three delays” model for severe sepsis in resource-limited countries. J Crit Care. 2015;30:861.e9-861.e14 [PubMed]journal. [CrossRef]
 
How many iPhones have been sold worldwide? About Tech website.http://ipod.about.com/od/glossary/f/how-many-iphones-sold.htm. Accessed August 1, 2015.
 
Apple announces 225M iPads sold to date, 675,000 iPad apps in the App Store. VentureBeat website.http://venturebeat.com/2014/10/16/apple-announces-225m-ipads-sold-to-date/. Accessed September 20, 2015.
 
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