Background: Echocardiography is important in examining various cardiac conditions and, in particular to verify heart failure. It is seldom performed in a primary care centre (PHC) setting, especially not in sparsely populated areas. Aim: To develop a concept that enables long-distance real-time echocardiography, preferably in rural PHCs.

Method: A robotic arm (Mobile Robotics AB, Skellefteå) has been developed to which an ultrasound probe is connected. A mobile ultrasound unit is placed at the patient's primary care site. A broadband link between the patient and the ultrasound operator is required in order to view the patient and the exact position of the probe, microphone, monitors and loudspeaker. The operator controls the robot and the ultrasound machine remotely with a joystick with the aid of newly developed software (Alkit Communication AB, Luleå). The ultrasound machine software is also remotely controlled by a virtual keyboard. Consultation between specialist, primary physician, operator and patient is done directly after the echocardiographic examination.

Result: Trials have been completed between the following locations: Luleå-Arvidsjaur (150 km), Umeå-Skellefteå (140 km) and Gothenburg-Skellefteå (1300 km). The procedure has provided satisfying results regarding long distance communication and image quality. However, more tests are necessary to evaluate patient satisfaction, cost-effectiveness and potential benefit for the health care system.

Conclusion: It is feasible to perform real-time echocardiography at a long distance by using present-day information technology (IT) and robotics. Echocardiography and specialist consultation with the patient can be done concurrently. In the future this concept might provide the opportunity for patients in rural areas to get rapid and accurate diagnosis and management of heart diseases.