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Gulrukh Zaidi, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Gulrukh Zaidi, MD, Department of Pulmonary, Critical Care and Sleep Medicine, Long Island Jewish Hospital, Northwell Health System, 410 Lakeville Rd, Ste 107, New Hyde Park, NY 11042


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


Chest. 2016;149(6):1581-1582. doi:10.1016/j.chest.2016.03.053
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We thank Dr Levine and colleagues for their interest in our letter to the editor and pilot study regarding the use of point-of-care ultrasound (PCUS) through the tele-ICU. Our small pilot study serves as a proof of concept and provides evidence that PCUS images obtained at the bedside can be accurately interpreted by a tele-intensivist.

Tele-ICUs provide a state-of-the-art system that is heavily encrypted and compliant with the Health Insurance Portability and Accountability Act, thus providing a safe communication channel for transmission of the ultrasound images to the tele-intensivist. The intent of our research was to demonstrate that PCUS could be easily integrated into the daily workflow of an established tele-ICU. Because tele-ICUs are rapidly growing across the United States, there is no question that the addition of PCUS will greatly enhance the ability of a tele-intensivist to assess patients and provide timely management.

We read with great interest the study by Levine et al, which used commercially available video chat software (Apple FaceTime) to facilitate PCUS via live mentorship. Conceptually, it makes a great deal of sense to use readily available video chat software in resource-constrained settings. However, these systems offer limited data encryption, which is a concern when transmitting protected patient information. Using this software to perform PCUS on actual patients would violate the Health Insurance Portability and Accountability Act and would not be allowed in the United States. Certainly, one can see the advantage of using this readily available and ubiquitous technology to teach image acquisition and interpretation using nonpatient volunteers that would not violate personal health information protection laws. On the other hand, one could argue that in a scenario in which a patient’s life is at stake, if transmission of ultrasound images over video chat software can make expert opinion available to the bedside providers and potentially improve outcomes, then perhaps protection of private health information should be a lesser concern. Although this set-up may prove impossible in the United States, by applying this technology in a more global fashion, it may be reasonable to think about allowing some deviation from the norm in the interest of improving quality of care. Another potential challenge is that video chat software also requires a reliable wireless Internet or cellular connection, which can be difficult to find in resource-limited settings, especially in the developing world.

Although the integration of PCUS and tele-medicine is an exciting new development in the field, in areas that do not have access to tele-ICU services, the use of video chat software presents an interesting alternative that certainly requires further study.

References

Zaidi G. .Koenig S. . Merging two worlds: point-of-care ultrasonography and tele-medicine. Chest. 2016;149:605-606 [PubMed]journal
 
Zaidi G. .Dhar S. .Chen L. .Chandra S. .Koenig S. . Accuracy of interpretation of point of care ultrasound images in critically ill patients via telemedicine. Chest. 2015;148:331A- [PubMed]journal. [CrossRef]
 
Levine A.R. .Buchner J.A. .Verceles A.C. .et al Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine. J Crit Care. 2016;33:51-55 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Zaidi G. .Koenig S. . Merging two worlds: point-of-care ultrasonography and tele-medicine. Chest. 2016;149:605-606 [PubMed]journal
 
Zaidi G. .Dhar S. .Chen L. .Chandra S. .Koenig S. . Accuracy of interpretation of point of care ultrasound images in critically ill patients via telemedicine. Chest. 2015;148:331A- [PubMed]journal. [CrossRef]
 
Levine A.R. .Buchner J.A. .Verceles A.C. .et al Ultrasound images transmitted via FaceTime are non-inferior to images on the ultrasound machine. J Crit Care. 2016;33:51-55 [PubMed]journal. [CrossRef] [PubMed]
 
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