Introduction
There is good evidence that remote diagnosis of congenital heart disease (CHD) is accurate. However, it is recognised that telemedicine applications are limited by a lack of long-term studies including cost-analyses. The aims of this study were to examine the continuing accuracy, impact on patient management and cost implications of a long-standing paediatric cardiology telemedicine service.

Methods
Prospective comparison, over eight years, of echocardiograms on infants with suspected significant CHD performed as: (1) hands-on evaluation and echocardiogram by paediatrician at district general hospital (DGH) followed by (2) transmitted echocardiogram via ISDN 6 with guidance from paediatric cardiologist and finally (3) hands-on evaluation and echocardiogram by paediatric cardiologist.

Results: Echocardiograms were transmitted on 132 infants. In five cases scans were inadequate for diagnosis. Of the remaining 127 tele-echocardiograms, a follow up echocardiogram was performed on 116/127 (96%). Major CHD was diagnosed in 42/116 infants (36%) and minor CHD in 49 (42%). The tele-echo diagnosis was accurate in 97% cases (κ = 0.90). Unnecessary transfer to the regional unit was avoided in 99/132 patients (75%). Despite relatively high implementation costs, telemedicine care was substantially cheaper than standard care. Each DGH potentially saved money by utilising the telemedicine service: mean saving £728/patient.

Conclusions: CHD is accurately diagnosed by real time transmission of echocardiograms performed by paediatricians under live guidance and interpretation by a paediatric cardiologist. Remote diagnosis and exclusion of CHD affects patient management and may be cost saving.