Introduction to Telecardiology

Telecardiology has been here for a long time. Telephones, and modifications of telephones, have been conceived of and used for auscultating heart and breath sounds for over 70 years. More sophisticated techniques for transmitting heart sounds more accurately have been used since the 1960’s. FAXes are used for transmitting EKGs, and EKG tracings (rhythm strips and 12-lead) can be transmitted easily over phone lines. However, not until the past 10 years has the technology been available for doing echocardiograms -- often the gold standard test for diagnosis -- over a distance.

Store-and-Forward Using Regular Phone Lines

Each year in the U.S. about 4 million patients present to an emergency room with chest pain for which a myocardial infarction ("heart attack") must be ruled out. For 70% of these cases, the problem is non-cardiac in origin or is insignificant enough that it could be treated on an elective, outpatient basis. The problem is: how to quickly separate the wheat from the chaff, so that resources aren’t spent on avoidable tests and in-hospital observation?

Telecardiology in the Negev: The Israel Center Of Telemedicine and Telecare(ICTT)

Israel, almost the size of a Texan ranch (20.000 km²), is densely populated and has a population of 5.5 million, with a doctor /patient ratio of under 1:1000. It is perhaps not the obvious choice for deploying telemedicine. However a closer look at its demographics, its geo-political positioning, and its blossoming hi-tech industry offers an explanation and justification for the development of the newly formed Israel Center of Telemedicine and Telecare (ICTT), based at Ben Gurion University of the Negev and at Soroka Medical Center in Beer Sheva (see map).

The History of Auscultation

The stethoscope was invented in the early 1800’s by Frenchman RenÈ LaÎnnec as a solution to a delicate problem. Hitherto, physicians listened to heart sounds by pressing their ears to the patient’s chest. The young Dr. LaÎnnec was examining a young woman with symptoms of heart disease. As he reported, "The patient’s age and sex did not permit direct application of the ear to the chest." Being desperate, resourceful…and a flutist… he rolled up a sheaf of paper to form a tube. Pressing this instead of his ear against her chest (see photo), he not only preserved her modesty but "was surprised and gratified at being able to hear the beating of the heart with much greater clearness and distinctness than…ever before." The new invention was not quickly adopted. Early stethoscopes had only a bell chest piece. Acoustic stethoscopes are, of course, limited in their ability to transmit and amplify sound.

Beyond the Technology of Teleradiology

Jim Logan, M.D. is President of Logan & Associates, a strategic and tactical consulting firm for telemedicine projects around the world. He is board-certified in aerospace medicine through NASA. He is currently serving as the Telemedicine Clinical Director for the U.S. military’s AKAMAI Telemedicine Project, based at Tripler Army Medical Center in Honolulu, HI. One of his tasks has been to help figure out low-cost ways of providing radiology services over the Pacific Basin, a sparsely populated area that covers a third of the planet’s surface.