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Hard Data Backs up Value of Pediatric Telemedicine Program

Results Help Fuel Expansion, Create New Model of Care for Families

Monday, May 02, 2005

It is a highly efficient way to diagnose and manage the common childhood illnesses that many children get in child care centers or schools, with the added benefit of allowing working parents to stay on the job if they choose.

A telemedicine program based at the University of Rochester Medical Center – using the Internet to connect pediatricians with sick children at inner city child care centers – is making a dramatic difference, more than halving sick-leave absences among children and helping parents avoid taking significant amounts of time-off at work to care for their sick children.

These and other impressive results, published today in the journal Pediatrics, are fueling a telemedicine expansion that pediatricians say could revolutionize the way they and others nationwide diagnose and treat children suffering from common illnesses. In April, the Rochester-based telemedicine program – called Health-e-Access – expands, doubling the number of participating child care centers, and beginning service to 10 city and suburban elementary schools.

In addition, nine private-practice pediatric offices will be hooked into the network for the first time, allowing children to be treated by their own pediatrician without ever leaving the child care center or school. Parents also can remain where they are, whether it’s at work or at home. The Health-e-Access expansion is believed to be the first of its kind in the nation, where a large number of children at different types of locations have the ability to connect to their own pediatrician.

Kenneth McConnochie, M.D., a pediatrician and founder of the Health-e-Access program, says this expansion could significantly change the way pediatric offices nationwide diagnose and treat children suffering from common illnesses.

“Our experience with more than 2,200 telemedicine visits indicates that telemedicine can effectively treat almost all problems that arise in child care settings,” says McConnochie. “It is a highly efficient way to diagnose and manage the common childhood illnesses that many children get in child care centers or schools, with the added benefit of allowing working parents to stay on the job if they choose.

“Now, by integrating primary care doctors into the Health-e-Access network, and having it available where children spend the majority of their time, such as schools and child care centers, we have the potential to reshape the way our nation’s pediatric offices provide care for very common childhood illnesses, the type that account for nearly 75 percent of all pediatric office visits for illness,” McConnochie added.

Eye-opening Effectiveness

In May 2001, pediatricians from the University of Rochester Medical Center’s Golisano Children’s Hospital launched Health-e-Access. Specially designed computer equipment was installed at seven child care sites in Rochester, allowing a trained child care provider to send live video and audio across town to pediatricians at Golisano Children’s Hospital.

Two-way video teleconferencing establishes real-time communication so that doctors and children can interact with each other. The high-speed connection allows information to be transmitted from a specialized camera that provides diagnostic-quality images of the ear drum, throat, eyes, and skin – areas most affected by common childhood illnesses. In addition, an electronic stethoscope captures high quality lung and heart sounds. Doctors at the remote location then make a diagnosis, prescribe treatments, and provide a treatment report to the child’s pediatrician when applicable. Prescriptions are delivered directly to the center that same day so that treatment can begin even before a parent picks up a child.

Since its launch, Health-e-Access has produced astounding results during more than 2,600 long-distance visits. For example, child absences due to illness plummeted by an average of 63% at participating child care centers. An impressive 92% of parents say that Health-e-Access allowed them to stay at work when they otherwise would have taken their child to an unexpected doctor’s visit. Even more – a whopping 94% – say the program helped avoid making a visit to the primary care physician or emergency room. In fact, these parents said that 20% of the time they would have ended up with their child in the emergency room without the telemedicine visit. Parents also said that the presence of a telemedicine service would sway their selection of a child care center, with 94% saying they would choose a child care center with telemedicine over one without the service.

“The benefits of Health-e-Access go beyond providing sound and timely medical care to a sick child,” says Neil Herendeen, M.D., medical director of Health-e-Access, citing research that shows parents and employers benefit, too. “Research shows that across the country 40% of parental absences from work are due to child illnesses. We know from our experience that telemedicine significantly reduces parents’ work absences. While the parent experiences less stress and can remain on the job, employers are getting their money’s worth from an employee who can remain focused on the task at hand.”

Health-e Expansion

Buoyed by its success, the Health-e-Access program soon will grow, thanks to $2 million in grants from two federal entities, the Agency for Healthcare Research and Quality and the Maternal and Child Health Bureau.

Health-e-Access is just beginning a year-long rollout, expanding from serving seven sites to 22, which include suburban child care centers, and city and suburban elementary schools in Rochester. This expansion, which will add an estimated 8,500 to the Health-e-Access network, permanently establishes a way for children to regularly visit their own doctor for very common childhood illnesses, without the child, doctor, or parent leaving their location.

All told, five inner city elementary schools and five suburban elementary schools will be added to the Health-e-Access network. At the end of the year, Health-e-Access estimates about 7,000 elementary age children will be eligible to participate in the program. Five suburban child care centers will be added to the network beginning in July, bringing the total number of participating child care centers to 12, and adding 475 children to the program. In all cases, enrollment in the program is voluntary, and participating children will have the option to be seen by their own pediatrician if available, or by doctors at Golisano Children’s Hospital.

Pediatric practices joining this Health-e-Access program expansion were selected based on their marketshare/geography to give children participating in the Health-e-Access program the greatest likelihood to be seen by their own pediatrician. Researchers believe that participating city pediatric offices provide care to about 75 percent of children attending the participating child care and schools, while the participating suburban offices care for about 60 percent of children attending one of the participating child care centers and schools.

Historically, telemedicine’s impact on the health care field has been largely limited to linking rural populations with specialty medical services, benefiting a relatively small number of people, McConnochie noted. But with the upcoming Health-e-Access expansion, the ability to help large numbers of people in varying stages of life will undoubtedly yield a number of social benefits.

“The costs of these common childhood illnesses are vastly reduced, for example, when we can treat them during the day, and reduce after-hours emergency room visits,” McConnochie said. “From our experience, Health-e-Access allows everyone – children, parents, and employers – to spend more of their time doing what they’re supposed to be doing.”

As part of the expansion, almost all health insurers in the Rochester region have agreed to cover the cost of the visits conducted on the Health-e-Access network, another first for the program.

In addition, Health-e-Access is supplied with HIPPA compliant and FDA registered software from Tel-e-Atrics, Inc., which also provides the hardware and support services. The software features imbedded video conferencing, intuitive operation and incorporates the latest in biometric devices to ensure a secure identification of the user at either end of the connection.

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