Mehta A et al. 2001 "Pediatric tele-echocardiography: evaluation of transmission modalities."

"Pediatric cardiology consultation has been effectively delivered outside the tertiary care setting through the use of tele-echocardiography. This study examined the effectiveness of several tele-echocardiography connections and the satisfaction of the referring physicians using these services. Studies were transmitted via either a shared fiber-optic (DS3) connection (two sites), a dedicated fast-copper (ISDN-PRI) link, or by courier from a nearby (25-mile) or distant (170-mile) site. Time intervals between when echocardiograms were performed locally until they were received, interpreted, and reported were prospectively recorded. Referring physician satisfaction was assessed through a survey. The critical time between when a remote echocardiogram was performed and when its result was reported to the referring physician was primarily determined by the mode of transmission. The time interval between performing an echocardiogram and receiving the study was significantly longer for echocardiograms sent from the 170-mile courier site (2474 +/- 295 min) than either the 25-mile courier site (474 +/- 151 min), DS3 (374 +/- 121 min), or ISDN-PRI (129 +/- 16 min). Regardless of the method of transmission, all referring physicians felt that the service improved their ability to manage children, and they would recommend the service to their colleagues. Those using the courier service from the 25-mile away site were more concerned about the availability of a pediatric cardiologist and image quality, presumably due to the delay in response times. The time interval data provided in this study and the assessment of physician satisfaction provide important data as echocardiography laboratories implement tele-echocardiography services."