Portland, Ore.

Study investigates whether frontier providers with no access to high-tech echocardiography can help tiniest heart patients through telemedicine assistance

Providing a "virtual presence" to bring medical expertise to rural and frontier regions and improve the health of newborns may sound like Star Wars. Yet the United States Department of Defense has funded a nearly $2 million grant so Oregon Health & Science University pediatric cardiologist David Sahn, M.D., can do just that. Sahn's grant investigates whether cardiac ultrasound guided and supervised from Portland -- yet used to diagnose infants in remote areas -- can improve health. The grant will cover remote Alaska Native Health Centers and military medical facilities across the nation, including Alaska, California, Kentucky, Louisiana and elsewhere. This is the first time beamed medical assistance has been used in this virtual manner.

Telemedicine, the use of real-time consultation and videoconferencing from large and advanced urban hospitals to those offering rural care, is a pioneering way to treat patients while keeping them in their own communities. Sahn, professor of pediatric cardiology, obstetrics and gynecology, and diagnostic radiology in the OHSU School of Medicine, has received national grants in the past for his use of ultrasound in treating cardiac defects.

Sahn's research brings the benefits of echocardiography -- a diagnostic technique usually available only at large hospitals -- to primary care practitioners with basic ultrasound equipment in facilities three or more hours from urban centers. Although echocardiography uses standard ultrasound machines, those trained to perform and interpret echocardiograms are usually specially trained pediatric cardiologists or specialized ultrasound technicians. Now the expertise of OHSU's pediatric cardiologists -- as well as two pediatric cardiologists from Madigan Army Medical Center, Fort Lewis, Wash. -- will be brought to rural facilities through teleconferencing. The ultrasound systems used in the study are cutting-edge and small enough to be handheld, yet sophisticated enough to be remote-controlled through telemedicine technology.

During the study, Sahn will be beamed live to frontier nursery exam rooms staffed by pediatricians, family physicians or nurse practitioners in Alaska and elsewhere. He will simultaneously be able to see the clinician and baby, and review heart images, while remotely guiding the ultrasound equipment from OHSU. "This is the equivalent of someone in California guiding robotic surgery in Japan," Sahn said. "Initially, we'll be using commercial phone lines for these procedures, but we'll also be doing satellite demonstrations across the world. Babies born in Africa, for instance, have heart defects we can never reach. I'd love to be able to touch these children."

Sahn hopes to reach 1,000 newborns during the four-year span of his grant. To quantify whether newborn health actually improves through telemedicine, Sahn's study will compare diagnosis time, patient health and cost of care between telemedicine patients and former patients who suffered the same disorders from identical medical sites. Results will be compared to similar patients from two remote Army bases without access to telemedicine.

Sahn's study hopes to improve the ability of previously untrained medical providers to provide echocardiography, decrease the ultimate cost of care and, most importantly, improve the health and prognosis of the tiniest cardiac patients.