Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community
Telesonography Adaptation and Use to Improve the Standard of Patient Care Within a Dominican Community
The role of teleradiology has far reaching implications for the health of remote and
 underserved populations. The ability to coordinate radiographic evaluation and diagnosis from
 a distance has the potential to raise the standard of patient care throughout the world.
 Perhaps the safest and most cost effective mode of teleradiology today is telesonography. The
 current project attempts to determine the extent that telesonography improves the standard of
 care within a rural government-run primary clinic within the Dominican Republic. The work
 reported herein is intended to compare the use of telesonography to the current standard of
 sonographic examination (referral to government hospital 60km from target clinic). The study
 was conducted by randomly assigning 100 patients with clinical indications for sonographic
 examination into experimental and control groups. Following a 60-day implementation period,
 the following research questions will be addressed: 1) To what extent does the use of
 asynchronous telesonography increase the percentage of definitive diagnoses based on the
 total number of scans (definitive diagnoses / total number of scans)? 2) To what extent does
 the use of asynchronous telesonography increase the continuity of care for patients? 3) To
 what extent does the elapsed time between scanning and final radiological interpretation
 decrease with the use of asynchronous telesonography? This study will also look at the
 history of telemedicine / telesonography and its dissemination into the mainstream practice
 of medicine, explore training protocols that may be used to assist others to establish new
 telesonography programs in a developing nations, and discuss both advances and persistent
 barriers to the implementation of telesonography programs.

 Hypothesis:

 The use of a store-and-forward telesonography system in this setting will increase the speed
 and number of final diagnoses per scan received by the target clinic and will increase the
 continuity of care by increasing the number and speed of follow-up appointments to the target
 clinic.
The aim of this project is comparable to the diagnostic imaging goals of the WHO including 1)
 make safe and reliable diagnostic imaging services available to as many as possible; 2)
 advise, guide and support those working in the field developing and maintaining diagnostic
 imaging services; 3) promote the importance of safe and appropriate diagnostic imaging
 services (WHO, 2007).

 This project will use teleultrasound to rapidly diagnose and rule-out abdominal,
 retroperitoneal, and pelvic pathologies within the sole government-run ambulatory clinic of
 Veron, Dominican Republic. The clinic's patient records as well as the expert opinion of the
 clinic's physicians indicate a need for this diagnostic modality. These sources indicate a
 number of individuals with symptomologies suggestive of abdominal, retroperitoneal, and
 pelvic pathology including fever, abdominal pain, abdominal tenderness, abnormal menses, etc.
 (see appendix D). Given the large number of construction projects and transportation
 accidents within this area, it is not uncommon for individuals to present with blunt
 abdominal trauma. Combine these reasons and other patient indications with the clinic's
 remote location and the difficulty and/or resistance of members within this community to
 undergo timely radiological evaluation, and the utility of telesonography becomes immediately
 recognizable.

 If the use of telesonography within this setting is shown to be feasible through this work,
 future projects will center on the education of native Dominican health care providers
 regarding the use and long-term operation of telesonography. This study could serve as a
 gateway to the permanent establishment of high-quality telesonography within this region of
 the DR. This project could also serve to augment the medical and technological knowledge of
 both the native health care workers and visiting U.S. medical students.

 This study will contribute to the body of knowledge on telesonography by determining to what
 extent this technology can improve the standard of patient care within this setting. The
 results of this study will have implications to the practice of medicine within Veron and
 similar settings within the developing world. The further development of telesonography
 within this setting is important because it may improve the efficiency of health care through
 increased diagnoses, decreased time to diagnoses, and increased continuity of care.

 While this pilot study focuses mainly on transabdominal evaluation of abdominal,
 retroperitoneal, and pelvic structures, long-term use of telesonography at the clinic could
 expand to include regular fetal monitoring, vascular studies, and perhaps interventional
 procedures granted the clinic physicians are provided with the appropriate training. Given
 the majority of health disparities within the DR are related to maternal, pre/perinatal, and
 circulatory pathologies, using telesonography to target these specific abnormalities will be
 the ultimate goal of a continuing telemedical presence.
Inclusion Criteria:

 -  Clinical suspicion of one or more of the following: ascites, blunt abdominal trauma,
 cholelithiasis, cholecystitis, cholangitis, pancreatitis, hydronephrosis, abdominal
 aortic aneurysm, hepatitis, portal hypertension, urolithiasis, abnormal uterine
 bleeding, or ovarian mass or torsion

 Exclusion Criteria:

 -  Urgent condition that requires immediate surgical intervention / transfer to tertiary
 medical center