Kenneth M. McConnochie, M.D., M.P.H.

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. Using information technology that enables clinicians to evaluate and treat ill children at a distant childcare site, we have developed Health-e-Access a childcare telehealth access network. Health-e-Access is a novel, yet logical and efficient, approach to a serious problem of national as well as local significance. The service is currently operational in 7 linner-city childcare centers in Rochester. Evidence based on the 3 years of experience in the first 5 centers firmly supports high levels of acceptance and satisfaction with this innovation on the part of parents and childcare programs. Moreover, demonstrated reduction in child absence due to illness has been dramatic (62% reduction) and undoubtedly impacts parent work absence. We anticipate that employers, too, will recognize the value of this program.

Keys to expansion and long term sustainability of Health-e-Access are physician acceptance and insurance reimbursement. 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, impact on utilization patterns, applications of telemedicine and other health information technology in the ongoing management of chronic problems (e.g., asthma). Health care cost impact, and economic benefits for parent, schools, childcare programs and employers.

New funding will allow expansion of this program to include at total of 22 child sites and 10 primary care practices. Expansion will add urban and suburban elementary schools and suburban childcare to the 7 urban childcare centers already participating, and it will encompass over 8000 eligible children. Local insurance organizations have agreed to provide reimbursement for telemedicine visits in this expanded demonstration projected.

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