Nine-month-old David was born with a heart problem -- a rare deformity known as an unbalanced atrioventricular canal defect. At a surgical conference held in Duke University Hospital the day before David was scheduled to undergo surgery, the youngster's pediatric cardiology team gathered to review his case.

The physicians watched intently as a shifting black-and-white echocardiogram revealed the malformed chambers of David’s heart, enhanced with Doppler imagery that turned his disturbed cardiac blood flow into a cascading mosaic of color. Team members then offered their interpretations and discussed possible surgical interventions.

All fairly standard procedure, except for the fact that one of the participants wasn't in the Duke conference room at all, but in Roanoke, Virginia, a few hundred miles away. A pediatric cardiologist at Roanoke Community Hospital saw and heard her Duke colleagues as they discussed her young patient on a large video screen -- the Duke team saw and heard her the same way. The diagnostic images were displayed simultaneously at both sites.

The use of communications technology in medicine has grown dramatically over the past decade, and even many people who aren't directly involved with it have probably heard the term "telemedicine" by now. Yet the term still most often refers to distance learning applications -- the delivery of continuing education to health professionals in remote areas. The Duke pediatric cardiology team's use of the technology stretches the definition of telemedicine to a whole new level.

"This project is a rare, possibly unique, instance of live, real-time, pediatric cardiology teleconferencing in North Carolina,” says Rene Herlong, MD, former medical director of pediatric echocardiography at Duke.

The Duke pediatric cardiology telemedicine program is composed of a live video conferencing system that transmits visual information such as echocardiograms, EKGs, chest x-rays, and Doppler. It allows for video communication between the Duke physicians and caregivers at other facilities, and it also allows the Duke team to share data and discuss cases with pediatric cardiologists in remote locations.

"Instead of just receiving a synopsis of our discussion and a conclusion, our community-based colleagues become part of the team,” says Herlong. “In turn, they provide us with information about each family's background -- an important factor when there are risk and quality-of-life issues to be considered."

Duke doctors use the system's video capabilities to communicate with pediatric cardiologists in Raleigh and Fayetteville, and they transmit visual readings to and from physicians and technicians at six community hospitals around North Carolina. The system's devices, which either sit on desktops or carts, are also highly portable and thus very easy to use.

"You can wheel the computer up to the bedside, plug into a phone jack, and take an echocardiogram right at the infant's bedside," says Herlong. "The system allows us to view and interpret echocardiograms being performed in outlying hospitals on infants and children with suspected heart disease."

All the physicians at Duke who read echocardiograms have similar systems in their houses. "So if somebody calls at midnight from a hospital in Laurinburg, they can get someone right away rather than having someone drive to the hospital and set up the system," says Michael Camitta, director of telemedicine for the Duke Children's Heart Program.

The system allows Duke doctors not only to observe, but actually to guide the diagnostic tests that are under way. "Sonographers [imaging technicians] in outlying communities typically have experience scanning adult hearts, which are all anatomically pretty much the same," Herlong explains. "But they have little experience with congenital heart defects. This technology allows us to help the sonographer perform a complete and thorough study.”

In 2007, Duke doctors added another education component to the program, inviting stenographers from remote sites to visit Duke for a live demonstration of pediatric echocardiography. "Now when we talk to them over the telemedicine system and direct them on how to look at something, they've seen it done here and they have a better understanding of the process," Camitta says.

According to Herlong, many infants who are suspected to have heart disease don’t, and even those who do may not require immediate transport. “Previously, the community hospitals wouldn't always be able to determine which scenario they were looking at,” Herlong says. “They would have to provide tapes of the echocardiograms they'd taken, or, often, send us the babies themselves. Now we can direct their caregivers on site and help stabilize the child before transport.”

By providing more information and minimizing disruptions, Herlong says, the teleconferencing technology benefits the entire family of an infant with a suspected heart disorder: “We can help keep families together, with less premature or unnecessary separation."