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UPMC international telemedicine program helps pediatric cardiac patients

Cardiac specialists in Pittsburgh are helping pediatric patients in Colombia through the UPMC international telemedicine program.

While many health care providers are still struggling to implement telemedicine technology and provide care to rural and underserved populations within the U.S., at least one organization is taking its telemedicine program across the border.

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Children's Hospital of Pittsburgh of UPMC started its international telemedicine program about 2 years ago, said Ricardo Muñoz, M.D., chief of UPMC's cardiac intensive care division and medical director for global business and telemedicine in an interview.

There's a great need for cardiac services around the world, as there aren't too many specialists who are board certified in both pediatrics and cardiology, Muñoz said. Even in the U.S. there's a shortage of pediatric cardiac specialists, but the need for these services abroad is greater.

Muñoz sees telemedicine as a way to deliver care around the world, limited only by access to the internet. He'll get a chance to spread that message at UPMC's 2012 International Telemedicine Symposium in Brussels, Belgium, where experts will gather to discuss the use of telemedicine services both locally and globally.

Beginning its international telemedicine program in 2010, Children's established an agreement with Hospital Valle del Lili, Cali, Colombia to provide consultative services.

After exploring satellite and cable options, the organization decided to provide telemedicine services via the internet. Using a secure, encrypted line, cardiac specialists at UPMC Children's perform daily rounds with the physicians in Cali, and also help with specific cases as needed. The high-definition cameras make it easy for the providers in Pittsburgh to see everything -- the monitors, the attending physicians and even the patients -- allowing them to provide accurate clinical advice, Muñoz said.

In most cases, the physicians in Cali were pleased with and agreed with the advice given by the specialists in Pittsburgh.

Ricardo Muñoz, M.D., Chief, Cardiac Intensive Care Division, Children's Hospital of Pittsburgh of UPMC

It's important to note, he added, that the specialists in Pittsburgh are not actually providing care directly to the patients in Cali -- they are only advising the physicians who are attending to them. It's up to the physicians in Cali to decide if they want to accept the advice provided by the specialists.

In most cases, the physicians in Cali were pleased with and agreed with the advice given by the specialists in Pittsburgh, according to Muñoz. More details of the UPMC international telemedicine project are available in a case series published in the official journal of the American Telemedicine Association. Physicians from the case series reported "no technical difficulties were experienced during the monitoring of the patients."

The traditional fee-for-service model clearly does not work when implementing international telemedicine services, so the two institutions have established a formal agreement that covers the cost of equipment, infrastructure and the provision of consultative services on an ongoing basis, Muñoz said.

There are, however, some regulatory challenges to overcome when setting up an international telemedicine program. UPMC Children's had to ensure it was in compliance with Colombian laws regarding the use of telemedicine services, which can be performed only with approved or accredited health care institutions, according to Muñoz. Each country may have different policies or laws, he added, so UPMC Children's investigates them thoroughly before engaging in telemedicine programs with other countries.

To date, UPMC Children's has established agreements with three hospitals in Colombia to provide advisory services via telemedicine, and is looking to expand its program to a hospital in Mexico City and another in Italy. If they continue providing telemedicine services at the current rate, said Muñoz, they will perform approximately 800 interventions per year.

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