A number of recent studies demonstrate that telemedicine — the use of technology to provide and coordinate health care remotely — is particularly effective in serving children with special health care needs. As effective as it is, however, much needs to be done to ensure that local, state, and federal authorities take full advantage of telemedicine’s possibilities.
In one such study, published in the August 2015 issue of “Telemedicine and e-Health,” researchers at the University of Rochester studied the safety and effectiveness of using the Health-E-Access model at schools for children with special health needs.
How the Program Works
The Health-E-Access program, developed jointly by the University of Rochester School of Medicine and Golisano Children’s Hospital, links a sick child and a telemedicine technician at a child care center with a physician or nurse practitioner at Golisano. The connection between the child care center and Golisano is made through a broadband digital communications link.
Facilitating these consultations are kiosks at the child care centers that feature teleconferencing cameras that allow face-to-face communication as well as diagnostic tools. Such tools include stethoscopes that allow physicians or nurse practitioners to listen remotely to the heart and/or lungs of patients, endoscopes for ear, nose, and throat exams, and high-powered cameras that can take and transmit high-quality still images of skin and eye problems.
Objectives of the Study
The purpose of the most recent study was to compare the efficacy and safety of Health-E-Access in schools for children with special needs with its performance in schools for normal children. Researchers note that while children with special health care needs make up only about 16 percent of the school-age population, they account for nearly half of all children’s health expenses. Moreover, getting these special-needs children into a doctor’s office presents a daunting problem for parents, either because of the child’s anxiety and fear over a visit to the doctor or simple logistical problems.
The University of Rochester researchers found that their telemedicine model performed as well or better for children with special health care needs (CSHCN) as for children in regular child care centers or schools (CRS). In fact, there was a 98.1 percent completion rate for telemedicine visits by CSHCN, slightly better than the completion rate of 97.6 percent for visits by CRS.
Few Adverse Events
Adverse events, while low for both groups, registered only 0.3 percent for children with special needs, compared with an adverse event rate of 0.5 percent for children in regular school. For the purposes of their study, researchers defined an adverse event as a visit to a hospital emergency room within three days of a telemedicine visit for a problem presumed to be related.
In the conclusion to their study, researchers reported that their “observations support [the] safety and effectiveness of Health-E-Access telemedicine for both CSHCN and CRS.”
In a 2011 profile of the Health-E-Access program, the Association of Maternal & Child Health Programs, based in Washington, D.C., notes that the program “is targeted to Rochester’s underserved inner-city population and to children with special health care needs throughout the Rochester region.” The profile specified the objectives of Health-E-Access as follows:
- To lessen the health, educational, and economic impact of childhood illness on children and their families.
- To reduce cultural, economic, ethnic, geographic, racial, and social disparities to health care access.
- To decrease the economic impact of childhood illness on the community and its health care system.
In another recent report, this one released by the California-based Lucille Packard Foundation for Children’s Health, acknowledges telemedicine’s great potential for increasing access to care for CSHCN but focuses on what it sees as the barriers to its wider use.
Although the report focuses largely on the current situation in California, many of its observations are universal and supersede state borders.
Roughly one in every seven of California’s children fall into the category of CSHCN, which the reports defines as “children who have, or are at risk for, chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that typically required by children.”
Care Often Tough to Access
Parents of CSHCN are often frustrated in their search for appropriate health care services for their children for a wide array of reasons. These include a shortage of qualified providers in their area, lack of access to specialists, and the lack of affordable transportation to and from the nearest health care providers.
These barriers to health care access for CSHCN are also significant barriers to others in need of affordable health care services. They are, in fact, the main reasons that telemedicine has begun to grow so rapidly in recent years.
Barriers to Wider Use
Despite its almost tailor-made capability of meeting these health care needs, telemedicine has not yet been able to reach all those in need of its services. The report from the Packard Foundation identifies some of the barriers to its wider adoption as follows:
- Many health care providers don’t yet know how best to use telemedicine in their practices, and they also are uncertain about how to bill for such services.
- Despite its rapid growth, many CSHCN families are unfamiliar with telemedicine and have no idea how to access its services.
- Lack of a mechanism that would allow health care providers to easily bill for services delivered via telemedicine.
- Providers are concerned about the steep cost of purchasing and maintaining the equipment necessary to offer telemedicine services.
- Providers — and health consumers as well — have concerns about ensuring patient privacy in the telemedicine environment.
The report goes on to offer suggestions for overcoming these barriers to wider use of telemedicine for CSHCN. Although many of its suggestions refer to specific California programs or agencies, most of the proposals could easily be adapted in other states. Here are the report’s recommendations for increasing CSHCN access to telemedicine:
- California Children’s Services, the program responsible for coordinating care for children with chronic health conditions, should step up its effort to educate providers about the benefits of telemedicine. CCS should also provide training for providers on reimbursement policies, how to bill, and other issues related to the provision of care for CSHCN.
- CCS should also partner with local agencies and providers that routinely work with families of CSHCN to inform them about the availability and suitability of telemedicine services.
- Expand and modify the state’s current list of eligible billing codes so that certain clinical services delivered via telemedicine will henceforth qualify for reimbursement.
- Expand locations eligible for telemedicine payment to include the patient’s home. For many CSHCN, home-based care is particularly critical, thus making it important to change current reimbursement policies to make home care eligible.
- Expand telemedicine modalities that are reimbursable under state programs, such as Medi-Cal and CCS.
- Implement local demonstration projects to identify best practices for how telemedicine can improve care for CSHCN enrolled in CCS.
Photo credit: Cisco Pics
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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