Three telemedicine programs were highlighted at the AHRQ 2008 Conference held September 7-10 in Bethesda Maryland. Kenneth McConnochie, MD., Professor of Pediatrics at the University of Rochester’s Golisano Children’s Hospital directs the Health-e-Access telemedicine program in Rochester N.Y.
The program provides internet-based healthcare visits to diagnose and treat routine childhood symptoms and has successfully managed 6,500 telemedicine visits since 2001. More than 22,000 pediatric emergency department visits have proved manageable by using telemedicine technology and currently 4701 children are enrolled.
Rochester’s inner city has many children and families that fall below the poverty level and many children for the first two years have a number of health problems. These inner city children have five times greater rates for being hospitalized especially for asthma and this means that their mothers have to take a considerable amount of time off from work.
Dr. McConnochie explained that the Health-e-Access telemedicine program uses video conferencing in the schools between the primary care telemedicine clinician and the school nurse to communicate and look at sick children. Results show that 90% of the time, parents with children seen using telemedicine technology, avoided a primary care or emergency department visit. Many of the parents said they would always choose child care that has telemedicine capabilities.
Dr. McConnochie said “parents aren’t the only ones who stand to benefit from the use of telemedicine for their children, since the technology also serves insurers and the community as well and delivers better quality care at a lower price.” Typically insurers have been wary of embracing the technology fearing it would drive up costs, but a study suggests the exact opposite and points out that insurers would realize cost savings.
In the future, the program hopes to add access for developmentally challenged children and adults, teledentistry, behavioral health, chronic illness prevention, primary care for deaf population, and elder care.
In another telemedicine program operating in New Mexico called Project ECHO. Sanjeev Arora. MD, Professor, and Executive Vice Chairman, Department of Medicine, University of New Mexico directs the program. The program provides care to thousands of cases of hepatitis using telemedicine.
Hepatitis is particularly difficult to treat in the state since the state is very rural with just two million people, has a high poverty rate, only 20% of the doctors practice in rural areas, there are few hepatitis specialists in the entire state, and it is difficult to obtain specialty care because there is inadequate medical insurance for the residents. Dr. Arora, explained that treating hepatitis C is a complicated medical process and it takes many years to develop the expertise.
The ECHO system works by having the patient’s information without the patient present discussed during an ECHO Hepatitis C clinic visit using video conferencing technology. The information is presented on a number of patients one by one and information can be given for any disease. The patient’s medical background is discussed in terms of alcohol usage, weight, smoking and other health issues. At this time, if there aren’t any complicating issues that need to be immediately addressed, the treatment plan can be given to the provider so that the patient’s treatment can be started.
The ECHO program also uses a knowledge network to educate and create a learning loop. By using the network, the program is able to collect data and monitor outcomes centrally, determine costs, and access the effectiveness of the program.
James Marcin, Associate Professor, Director of Pediatrics Telemedicine at UC Davis Children’s Hospital in Sacramento California, reported that the university telemedicine program now has 85 sites up and running in the state. The FCC program and funding will really help to establish more sites and will eventually hook up 350 hospitals with high speed access in the state.
Dr Marcin is very concerned with treating children in emergency rooms since 40% of emergency departments lack 24/7 access to pediatricians. Telemedicine consults in small rural hospitals can have a big impact as these hospitals generally treat few children. To ease the problem, robots with doctors on the screen located in a distant location are now moving around on the floors and are able to confer and help in the hospitals. Plus satellites are also being used to provide remote triage systems.
The realities of the UC telemedicine program is that money has been saved, a financially sustainable model has been developed, family members are connected with sick children in the hospital, and most importantly, a number of hospitals and clinics are now linked to video interpreting services.
