Cuneo BF, Olson CA, Haxel C, et al. - A fetal telecardiology program was appraised in a medically underserved area via assessing a prospective case series of pregnant women at 18–38 weeks of gestation with risk factors for fetal congenital heart disease. The women underwent fetal echocardiograms (local site) performed by obstetric ultrasonographers; these were read in real-time. At a children's hospital 243 miles and two mountain passes away (distant site), a fetal cardiologist provided the results to the mothers. Fetal telecardiology program was evaluated in five domains: 1) education of obstetric ultrasonographers before initiation of telecardiology services, 2) process and efficiency, 3) patient satisfaction, 4) economic effects, and 5) accuracy of cardiac diagnosis and success of risk stratification. The first 37 months of the program are described in this work. As per analysis telecardiology did not reduce either diagnostic quality or patient satisfaction. The program was thus identified as feasible; it empowered the local healthcare providers and ultrasonographers, gave strong economic advantages to families, and offered the benefit of timely standard-of-care, face-to-face consultation without travel.