Despite the large role that technology plays in our society, delivery of health care continues to mostly occur in a face-to-face setting between doctor and patient. Telemedicine offers the opportunity for providers and patients to communicate remotely via video interfacing and mobile technology while still allowing for accurate diagnosis, quality doctor-patient interactions, and monitoring for complex medical needs. As healthcare providers, we must acknowledge that this form of interaction allows physicians to easily follow a patient’s progress, and save time and resources for our patients.
Telemedicine currently provides care in nontraditional settings such as childcare centers and schools. This is important, particularly for children with special healthcare needs and their families, given the time and potential risks for adverse events involved with transporting patients to the doctor’s office. Children with special healthcare needs represent 16% of the population under 18 years of age but account for nearly 50% of all children’s medical expenses.
A group of investigators at the University of Rochester Medical Center assessed the safety and effectiveness of acute illness evaluation provided to children in child care and schools using telemedicine, comparing outcomes of children with special healthcare needs to children without special needs. Of the 483 telemedicine visits among 300 children with special healthcare needs and 10,008 telemedicine visits among children without special needs, visits were completed for 98.1% and 97.6%, respectively. Children with special healthcare needs had a slightly lower incidence of emergency department visits for related medical issues after telemedicine encounters, compared to children without special healthcare needs. Thus, the study concluded that provision of acute care by telemedicine to children with special healthcare needs results in effective and safe care with outcomes similar to children without special needs attending childcare centers and schools.
The AAP recognizes that barriers to telemedicine expansion include legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. In order to make a difference, pediatricians in Texas must play an active role in the rulemaking process for HB 1623 which seeks to use the benefits of telemedicine to increase access to care for children with special healthcare needs. One issue is that providers need to be eligible for Medicaid reimbursement for the use of home telemonitoring services for Medicaid patients. Robust telemonitoring services at home could reduce many of these patients’ emergency department visits.
I strongly encourage pediatricians to educate legislators regarding the benefits of telemedicine’s widespread implementation, keeping in mind that patient safety is first and foremost, whether care is delivered in person in a clinic setting or via the use of telehealth technology.
Raul Montiel Esparza, MD.
References.
- American Academy of Pediatrics. (2015). Telemedicine for Children with Special Healthcare Needs. AAP Grand Rounds, 34(3), 32-32.
- Burke, B. L., Hall, R. W., Dehnel, P. J., Alexander, J. J., Bell, D. M., Bunik, M., & Kile, J. R. (2015). Telemedicine: Pediatric Applications. Pediatrics, 136(1), e293-e308.
HB 1623 links:
Pediatric Advocacy 