JMIR Publications

ABSTRACT

Background:

Population aging and geographic health disparities challenge healthcare 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 prospective observational study at D Clinic, Taitung County, from April 2020 to May 2022. PoCUS examinations across clinic, home visit, and mobile outreach settings 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:

The 26 patients had a mean age of 79.4 (SD 9.2) years; 15 (58%) were male; 20 (77%) were in the intensive home healthcare tier. A total of 676 PoCUS examinations (defined as single-region imaging studies) were performed by 3 trained physicians in approximately equal proportions: 375 (55.5%) in-clinic, 174 (25.7%) during home visits, and 127 (18.8%) on mobile outreach. Twenty-six teleconsultation sessions were conducted (15/26, 58% home visit; 7/26, 27% mobile outreach; 4/26, 15% clinic), with 13 (50%) involving multi-target scanning (cardiac, pulmonary, and abdominal). Of the 26 sessions, 24 (92%) were completed without technical interruption; 2 (8%) experienced transient 4G buffering but were completed. Monthly PoCUS volume reached a sustained plateau of 28 or more examinations from month 17 of implementation. Four clinical service domains were identified: hospital-at-home acute management, home-based hospice multi-organ support, green channel surgical referral, and chronic disease serial monitoring. NPV analysis demonstrated that wireless PoCUS equipment with proposed (not yet implemented) dual-specialist teleconsultation reimbursement achieved the most favorable projected return (NTD +561,000), requiring only 2.86 monthly cases to break even under 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, though these remain contingent on NHI policy adoption. These findings are hypothesis-generating and require validation through multi-site studies with patient-level outcome measurement before informing national reimbursement policy. Clinical Trial: N/A