Ressources
John Finley : jfinley@iwkgrace.ns.ca
Alain Cloutier : alain.cloutier@chuq.qc.ca

Distance diagnosis

Congenital heart malformations are present in 1% of live births. Fifty-one pediatric cardiologists and 12 cardiovascular surgeons are specialised in diagnosis and treatment of congenital heart defects in children throughout the entire Canadian country. Therefore, very often patients have to travel long distances to access such services or sometimes, physicians themselves participate to outreach clinics in different remotes areas.

A telemedicine solution has been developed in Nova Scotia for the Maritimes and in Quebec to improve health care accessibility to Pediatric Cardiology services for children and their family, in particular to newborns for urgent consultations. The telemedicine model consists of distance echocardiography and consultations for congenital heart defect. The link between the regional center and the pediatric cardiology service allows real time visualisation of the echocardiography examination with direct assistance and audiovisual communication with the parents and the regional medical team with the pediatric cardiologist. Collaboration between physicians and health care professionals has been developed to improve quality and accessibility of care for the entire population. The experience has clearly demonstrated the importance of such transmissions to safe transfer of patients, support the physicians in remote areas, and improve accessibility to health care.

The Canadian Pediatric Cardiology Association strongly supports the development of the telemedicine network to improve the accessibility to speciality care for all Canadian children.

Finley, J. P., G. P. Sharratt, et al.. Paediatric echocardiography by telemedicine--nine years' experience. J Telemed Telecare 3(4), 1997 pp 200-4.
Cloutier, A, J-P Fortin,: Telemedicine : an Implementation Model, The Canadian Journal of Continuus Medical Education, 13 (7) July 2001 pp 101-109
Cloutier, A, The Quebec Pediatric Telehealth Network, Telemedecine Today 8 (3), July 2000 pp 20-21,

Tele-education

Within their own hospital, Pediatric Cardiologists are also responsible for teaching and research in their speciality. By creating links between regions and speciality services and between the speciality services themselves from coast to coast, it will be easier for the heath care professionals to fulfill their role in health care delivery, teaching and research in each province.

A teleformation network allows a now the Pediatric Cardiology Resident Program. Teaching sessions are offered on a regular basis for trainees as well as for al physicians curious to learn more about Pediatric Cardiology. From one site, which varies from time to time, a presentation is given to an audience spread in 6 to 8 different centers in Canada, followed by a period of questions,

This is repeated 6 to 8 times per year and is also a unique occasion to participate to teaching of the trainees everywhere in Canada, to offer continuous medical education and to share among the Canadian community the visit of a prestigious visitor.

Finley, J. P., M. J. Beland, et al.: A national network for the tele-education of Canadian residents in pediatric cardiology. Cardiol Young 11(5), 2001: 526-31.

Future development

The development of the information highway and the progress accomplished in the acquisition, the analysis and the transfer of medical images and other diagnostic data open new perspectives: namely to allow a better match of supply and demand for health care providing. Concurrently, those progresses allow for the development of new means for expertise sharing, research and development communications, access to knowledge, as well as, medical training.

In order to generate the expected spin-off effects, a significant number of health professionals is needed to constitute a critical mass that will be putting together the results of clinical practice, research and medical knowledge. In Canada, for a medical speciality such as pediatric cardiology, the critical mass cannot be achieved without the creation of a national network of physicians and researchers.

The networking activities that will allow the achievement of those objectives are as follows:

• The connection of all members to a Telemedicine Network capable of teleconsultation, telediagnostic and sharing of diagnostic intervention on significant medical cases.
• The exploitation of the telemedicine network in order to ensure efficient person to person communication between members using point to point or multi-point videoconference, remote workshops, conferences and/or live education, etc.
• The creation of a collective database, using a common format and lexicon, that will allow the recording of multimedia diagnostic data and patient files of cases representing various pathologies encountered in the practice.
• The creation of a secure Internet web site giving access to common data (databases; news to the members; medical and pharmaceutical news; schedule of seminars, conferences, education sessions and workshops) as well as access to tools for the coding and the storing of new cases in the databases. Part of this web site could be accessible to the international medical community and another section to the public in general.
• The widening of clinical and research activities to groups of members sharing specific interests and which could be organised in sub-network regardless of geographic constraints.
• The establishment of a database of pre-recorded conferences, seminars and courses, as well as live or recorded Tele-education sessions.
• The capability to connect to the network of secured sub-network servers allowing members to share information on specific clinical activities or research projects.