Telemedicine in Primary Care Pediatric Practice
Inner city families, whose children are most burdened by morbidity and whose reliance on childcare is most important to their ability to improve economic circumstances, are those least equipped to deal with the challenge of illness in childcare and schools. Using commercially available information technology, we have developed Health-e-Access, a telemedicine network that enables both real-time and store-and-forward remote access to physician or nurse practitioner evaluation from any site with broadband internet connectivity. Health-e-Access is a novel yet logical and efficient approach to a serious problem of national, as well as local, significance. Evidence based on 6 years of experience in 22 child sites (childcare centers and elementary schools) and over 5000 telemedicine visits firmly supports high levels of acceptance and satisfaction with this innovation on the part of parents and childcare programs. Reduction in child absence due to illness has been dramatic (63% reduction). We anticipate that employers, too, will recognize the value of this program because 40% of work absence in parents with preschool children is attributable to childhood illness.
Goal of Health-e-Access
The overarching goal of Health-e-Access is to use telemedicine to enable healthcare when and where you need it, by people you know and trust. Thus, in addition to enabling ready access to care in convenient, neighborhood sites, Health-e-Access also enables visits by clinicians in the patient’s own primary care medical practice. With additional funding beginning in 2005, the telemedicine network has been able to add 10 different urban and suburban primary care practices. For children using the participating practices, continuity of care for telemedicine visits has exceeded our goal of 85% continuity. Of note, prior to initiation of Health-e-Access, 75% of parents using participating childcare sites indicated that their child’s primary care practice directs them to use the ED if they call about an illness in the afternoon.
The Future of Health-e-Access
Additional, developing applications for the current telemedicine infrastructure include use in day programs and group homes for developmentally delayed children and adults, screening for early childhood dental caries, evaluation of children’s behavior and developmental problems and guidance in their management, and use in retail-based and other community settings (where 24/7 neighborhood access could be assured). In stark contrast to the retail-based clinics that are developing rapidly in the U.S., Health-e-Access preserves the potential for continuity with the medical home.
Keys to expansion and long term sustainability of Health-e-Access are physician acceptance and insurance reimbursement. Participating physician response has been positive. General physician acceptance can be anticipated if appropriate reimbursement is available and telehealth services can be integrated efficiently in primary care practice. Insurance reimbursement can be anticipated if telehealth services can be shown to reduce healthcare costs. We are involved in several studies of this health services model that are focused on integration in primary care practices, acceptance of telemedicine by clinicians and parents, continuity of care via telemedicine, health care cost impact, and economic benefits for parent, schools, childcare programs and employers.