Point-of-Care Ultrasound Integrated With Teleconsultation for Rural Home-Based Medical Care: Pilot Implementation and
Hung-Bin Tsai1,2, Nin-Chieh Hsu1, Sang Ju Yu3
1Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Taiwan.
Background:
Population aging and geographic health disparities challenge health care delivery in rural settings worldwide. Point-of-care ultrasound (PoCUS) combined with teleconsultation may enhance home-based medical care by extending specialist expertise to underserved communities, yet evidence from real-world implementation in Asian settings remains scarce. Taiwan, with its high digital literacy and universal National Health Insurance (NHI) system, provides a unique context for evaluating integrated PoCUS-teleconsultation service delivery.
Objective:
This study aimed to describe the implementation, clinical applications, and financial sustainability of an integrated PoCUS-teleconsultation service within a dedicated home-based medical care practice in rural eastern Taiwan.
Methods:
We conducted a retrospective analysis of prospectively recorded routine care data at D Clinic, Taitung County, from April 2020 to May 2022. PoCUS examinations conducted in the clinic, during home visits, and through mobile outreach were recorded. A business-to-business-to-consumer (B2B2C) teleconsultation model linking on-site physicians with remote specialists via real-time ultrasound streaming was implemented from March 2021. Seven-year net present value (NPV) analyses evaluated financial viability across 24 equipment reimbursement scenarios.
Results:
Among the 26 patients who received teleconsultation, the mean age was 79.4 (SD 9.2) years, 15 (58%) were male, and 20 (77%) were in the intensive home health care tier. A total of 676 PoCUS examinations (defined as single-region imaging studies) were performed by 3 trained physicians in the following settings: 375 (55.5%) in the clinic, 174 (25.7%) during home visits, and 127 (18.8%) as mobile outreach. Twenty-six teleconsultation sessions were conducted (n=15, 58% during home visits; n=7, 27% during mobile outreach; and n=4, 15% in the clinic), with 13 (50%) involving multitarget scanning (cardiac, pulmonary, and abdominal). Of the 26 sessions, 24 (92%) were completed without technical interruption, while 2 (8%) experienced transient 4G buffering but were completed. Monthly PoCUS volume reached a sustained plateau of ≥28 examinations from month 17 of implementation. Four clinical service domains were identified: hospital-at-home acute management, home-based hospice multiorgan support, green channel surgical referral, and chronic disease serial monitoring. NPV analysis demonstrated that wireless PoCUS equipment with the proposed, but not yet implemented, dual-specialist teleconsultation reimbursement achieved the most favorable projected return (NT $882,000; NT $1=US $0.036 in 2021 on average), requiring only 2.72 monthly cases to break even under the modeled assumptions.
Conclusions:
Integrating PoCUS with teleconsultation is operationally feasible in rural home-based care when wireless equipment is adopted. Financial scenario modeling suggests favorable projected returns under proposed reimbursement structures, although these remain contingent on NHI policy adoption. These findings are hypothesis generating and require validation through multisite studies with patient-level outcome measurement before informing national reimbursement policy.
