How to Read a Heartbeat

Thomas Binder saves lives by teaching doctors around the globe how to analyse pictures of the beating heart  – using internet and mobile devices.

Vienna, 2010: Cardiologist Thomas Binder and his colleague Franz Wiesbauer are having a cup of coffee, relaxing after an exhausting shift at the University Hospital Vienna. Once more, they are discussing the same issue that has kept  them occupied for the last months:  Both doctors have gained reputation for being experts on the field of echocardiography – a widespread medical practice that uses sonograms of the heart for diagnosing cardiac abnormalities.

"But what if doctors don’t know how to interpret sonograms?"
However, the two doctors have discovered that many young and even experienced colleagues do not know how to use the method properly. Some of them have never been trained on echocardiography, others are missing the time to gain in depth knowledge about the life-saving method. The results: Stressed out doctors and wrong diagnosis.

Some months of hard work, sleepless nights and many cups of coffee later: Binder and his tech-savvy colleague Wiesbauer finally come up with the dazzling idea: Making their know-how accessible to colleagues and students all around the world by setting up an e-Learning platform for echocardiography.

123sonography.com - A global success story!
Three years later, 123sonography.com has become the most renowned online resources in the field of echocardiography. The platform teaches doctors all around the world, making the method accessible to regions where the echocardiography could not be performed before, due to the lack of resources or on the job training possibilities.


WSA-mobile: You are teaching doctors and students all around the globe. Why is echocardiography crucial for diagnosing cardiac abnormalities?       

Thomas Binder:  In earlier days, the common way to diagnose heart diseases was auscultation, which basically means listening to the heart with a stethoscope. However, this takes a lot of training and many students do not have the ability to hear the low pitched sounds of the heart. This can result in literally wrong diagnosis. Of course, auscultation is still being practiced but being able to actually see the heart is superior to just hearing it – therefor I think it is the way to go.

Which problems have you encountered when starting to teach people about echocardiography?

Many doctors want to deepen their echocardiography-skills but simply do not have the time to do that. Others just don't have access to the training – for example doctors in so called developing countries. On the other hand, teaching the method in University restricts you to the students who have the chance to actually attend the classes.  So we decided to bring this whole course on the Internet. Now it spreads all over the world and it is amazing to see how people actually respond – even in regions where there is no environment available to provide the people with the training they need. We have about 45 000 users per month. That is a lot, considering that echocardiography is not a topic that concernes the masses. But the actual impact for doctors and patients is enormous.

What do you consider the greatest advantages of using e-Learning?

First of all, e-Learning is much more convenient than conventional lectures. Users can take part in e-Learning lessons wherever they are - at home or even on the train. The second advantage is that e-Learning provides content in small chunks and bits. Users are able to repeat the lectures as many times as they want to. However, teachers have to understand that the way content must be shown on the internet is quite different than the way you would show it on a lecture. You have to attract the users. And you have to understand how students really learn. For example, you have to use emotional formats that are more storytelling to reach the audience.

From an ICT4D perspective: Is echocardiography available in so called developing countries?

The situation has changed within the last years. Some years ago, the machines were large and expensive. But new developments made machines small and inexpensive. You can even find hand-held devices, making the method spread in developing countries too. 123sonography.com works now intensely with doctors in regions like Africa, where the nearest training centre is sometimes hundreds of kilometres away.

Do you rely 100% on Internet and mobile or are you still using offline resources?

Yes, we work 100 percent on the internet and we also make use of mobile. Anybody could see the course on an iPad or an iPhone. At the moment we are not producing any apps, but this is something that might happen soon.

What are your next steps?

We are learning while we are going along and we noticed that echocardiography is not the only one area where it makes sense to train people online. So we are expanding to other fields like emergency echocardiography.


Thomas Binder is professor at the Medical University of Vienna and heads the echo lab    there. He has over 20 years of echo experience. Aside from his scientific work dealing with    topics such as 3D echocardiography, cardiac resynchronization therapy, speckle tracking and    clinical research, he was always strongly dedicated to teaching and has done so for many years.    Over the years he has seen what works and teaches it to his students.