Changing the Way Kids Visit - or Don't Visit - the Doctor

Physicians use "the future of medicine" to diagnose kids across town

November 28, 2001

Physicians at Strong Children's Hospital are using technology in an attempt to revolutionize the way ill and injured children are examined, diagnosed, and treated.

Three child care centers in Rochester are participating in the Rochester Child Care Telehealth Access Network, which allows doctors to diagnose illnesses by using high-tech computer equipment to examine children who are located several miles away. It's reducing the need for time-consuming visits to the doctor's office, and ensuring that children who need medical care receive it in a timely fashion.

The program is consistent with Project Believe, the University of Rochester Medical Center's ambitious initiative focused on helping Rochester become the healthiest community in America by 2020. One of its goals is to improve access to health care.

"We're using technology that has the potential to change the way we practice medicine," says Neil Herendeen, M.D., a pediatrician at Strong Children's Hospital and medical director of the telemedicine program. "Although it may seem futuristic to some, the technology is available to us now. This is a glimpse into the future of medicine."

At the Volunteers of America Children's Center, 214 Lake Ave., a staff nurse is trained to use the telemedicine equipment. One of the cameras attached to the center's computer is an otoscope that is used to examine the eardrum. As the nurse inserts the otoscope into a child's ear, doctors are able to see - in nearly real-time, streaming video - what they would if the child came to their office. Another camera helps diagnose illnesses such as skin disorders. A stethoscope, which allows the doctor across town to hear lung sounds that are essential for the diagnosis and management of asthma, rounds out the telemedicine tool chest. "Using telemedicine, we do everything we normally would except touch the child," Herendeen says. "We rely on the nurses to be our hands."

How telemedicine works

Each weekday, physicians at Strong Children's Hospital provide a telemedicine clinic for the Volunteers of America Children's Center. The majority of the children, age six weeks through 12 years, are impoverished.

Already, more than 100 children with illnesses commonly found among the child care population, including ear infections, ringworm, and pink eye were diagnosed and treated. If employees from the Volunteers of America Children's Center suspect a child is sick, they notify the parents, as they always have. Parents who signed consent forms before the program started have the option of a telemedicine intervention. Employees gather information about the child's behavior and any medications taken.

In an effort to maintain full communication and to provide as complete a medical history as possible, a report of the diagnosis and prescribed treatment is faxed to the child's regular health care provider. Doctors have the ability to capture a high-quality image - for instance, a digital image of a child's middle ear - and e-mail it to their colleagues or the child's health care provider for a second opinion. Once a diagnosis is made, doctors can call in a prescription to a pharmacy of the family's choice.

Within six months, two additional centers will offer telemedicine services. They are the YMCA of Greater Rochester, 444 E. Main St.; and Generations Child Care Inc., 179 Stenson Road, Rochester. Centers contribute heavily to the team effort required to make these services available, providing the staff needed to assist in medical evaluations

Striving for a healthful community

Doctors say the use of telemedicine reduces the need for after-hours doctor's appointments or visits to the emergency department, which may help make kids more healthful and reduce financial and social costs associated with health care.

"Some children may not get treatment because their family lacks transportation, or their parents don't think they can leave work to take them to the doctor," Herendeen says. "Many parents are under a lot of pressure at work. Now, we can make the diagnosis and call in the prescription with little disruption to the daily routine. This technology is allowing us, in many cases, to make a diagnosis without parents having to get out of work, fight traffic, and locate a parking space. The hope is that more children will receive the medical care they need because of the hassle-free option telemedicine provides."

"Some of our parents were forever running their children to the emergency department," says Pam Taylor, director of the Volunteers of America Children's Center. "Some of these kids had no medical home before they were introduced to telemedicine."

The results of telemedicine sessions are encouraging. For example, physicians can often get a better look inside a child's ear via telemedicine, because they can freeze the image on the monitor and examine it closely. During a typical doctor's visit, a child might move around so much that it's hard to get a good look inside the ear. Physicians are finding that telemedicine is advantageous because young children are able to sit still while the daycare nurse examines them. They enjoy watching themselves on the monitor.

Physicians from Strong Children's Hospital know of only one other telemedicine project like this in the country, where physicians at the University of Kansas Medical Center interact with school nurses in Kansas City, Mo.

The major difference is that the Rochester program targets younger children. These children are ill more frequently and are often more difficult to diagnose because their symptoms are often subtle and their ability to understand and cooperate with the exam is limited.

Locally, physicians are also performing an efficacy study of telemedicine. It involves diagnosing children who are seen at the pediatric practice at Strong Children's Hospital. During their visit, a pediatrician makes a diagnosis. At the same time, a second doctor makes a diagnosis using telemedicine, and then the two results are compared. More than 1,000 children will receive dual diagnoses during the study.

"What we're seeing is very encouraging," says Kenneth McConnochie, M.D., a pediatrician at Strong Children's Hospital and director of the telemedicine program. "The long-term objective is to use telemedicine as a sustained program for children in Rochester. We'd also like to develop a model for using it to improve access to care for children throughout the country."

The Rochester Child Care Telehealth Access Network has shown great potential, but there are several issues to be addressed if telemedicine is to be a part of everyday medicine. Community health care providers need to feel a part of the system and understand its benefits. "We've worked hard to make sure this project is integrated with the primary-care system, and we will continue to do so as the Access Network expands," McConnochie says. "We don't want to undermine relationships between families and their health providers. We want to enhance them." Another goal will be to convince local health insurers or the business community that supporting telemedicine is a worthwhile venture, potentially reducing costs and improving employee attendance and productivity.

Community-wide effort

The Rochester Child Care Telehealth Access Network is possible because of a strong partnership between public and private organizations. In addition to support from the University of Rochester Medical Center, the initiative is funded by a $330,000 grant from the U.S. Department of Commerce. Its Technology Opportunities Program funds innovative programs offering new technology to communities.

Frontier Corp., a Citizens Communications Company, is also making a substantial contribution. As the premier telecommunications provider in Rochester, it was well positioned to meet the advanced technical requirements of the telemedicine project. These include the reliability and back-up systems of Frontier's data network; high-speed capabilities using Symmetrical Digital Subscriber Line technology; uncompromised security; and constant technical support.

"Our company is proud to be part of this revolutionary healthcare initiative," says Martin Mucci, Frontier's Chief Operating Officer. "Frontier's deployment of advanced network technologies and round-the-clock technical support has enabled the telemedicine vision to become a viable reality."

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