Potential of Telemedicine in Pediatric Primary Care

Abstract

1. Kenneth M. McConnochie, MD, MPH* 1. *Professor of Pediatrics and Director, Health-e-Access Telemedicine Program, The University of Rochester School of Medicine & Dentistry, Rochester, NY Invalidating assumptions about space and time, telemedicine holds profound implications for health care. Much about the current structure and organization of health services reflects the assumption that patient and clinician must be in the same place at the same time. Yet telemedicine commonly eliminates geography as a barrier to access, and much exchange of information need not occur synchronously. The potential for specific telemedicine applications to enable quality health care has been demonstrated using commercially available technology. The opportunity for children, families, and primary care pediatricians to gain from the access and effectiveness proffered by telemedicine hinges on its acceptance and adoption in the health-care system. Adoption, in turn, depends on successful organizational innovation, especially reimbursement from insurance organizations. This discussion emphasizes the potential benefits of telemedicine in primary care pediatric practice and the challenge of integrating this tool into that setting. In our view, the greatest promise for benefiting children and families lies in integrating telemedicine into primary care. Telemedicine is defined by the American Telemedicine Association (ATA) as “the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care.” Although encompassing many applications beyond our purview (eg, teledermatology, telepathology, educational teleconferences, telecardiology, telemental health, virtual critical care units), (1) this broad definition is notable from the perspective of the primary care pediatrician because it rightfully includes practice via telephone. From a clinical perspective, telephone practice and more advanced forms of telemedicine are close kin because a required competency for both is the ability to judge whether available information is sufficient for diagnosis and management. As in telephone practice, the need to refer to a traditional, in-person care setting for hands-on, laboratory, or imaging evaluation is always …