Pediatrics: Swap Tongue Depressors against Webcam

21. July 2008

Parents no longer have to drop everything and run whenever their child hurts in day care. In simple cases the computer with internet connection and camera provides first aid. The system does not only function in case of a sore throat but also demonstrably with a low budget in healthcare.

A call from the Kindergarten. "Your child has a sore throat. Do you want to come to pick him/her up? Or should our physician take care of it by telemedical consultation?" In Rochester State of New York/USA, calls like this are not the product of a visionary medical technologist but daily routine. "Health e-Access" is the name of a program founded in 2001 of the pediatric department at the University Hospital Rochester. In the meantime it includes more than 20 daycare centers, elementary schools and pediatricians’ offices in the area.

Every fourth emergency is not what it seems

The patient is located in Africa, the physician in Berlin, Munich or Zurich. Diagnoses, pathologic expert reports or directives are provided across hundreds of kilometers. A study of Kenneth McConnochie at the University of Rochester shows that a telemedicine network pays off in the hinterlands of a medium-sized city as well. The Professor for pediatrics and his colleagues analyzed the files of the emergency room of his hospital and found an "inefficient and expensive disproportion of demand and resources" as McConnochie reports. 28 percent of the cases when parents come to the hospital with their children, the local pediatrician could have taken care of during a "virtual consultation". For Rochester this would result in about 12,000 unnecessary emergency appointments. Because a sore throat or a harmless cold can be treated with easily available drugs from a pharmacy and without the personal attention of a physician. The comparison of the average costs of 50 Dollars for a personal consultation with the physician or at the computer with the septublicate amount in the emergency room results in a considerable amount for the healthcare budget.

Advantages for parents, child and insurance company

At the Joint Meeting of the Pediatric Academy Society in Honolulu/Hawaii a few weeks ago, the Professor for pediatrics presented additional data on his network: If parents had access to the telemedical consultation, they consulted the physician 23 percent more often, but at the same time 24 percent turned to the emergency room compared to parents without digital access. Savings of about 14 Dollars per child per year finally convinced health insurance companies about the advantages of "Health-e-Access". Especially in pediatrics, the Rochester model showed its strengths. After a short training on the device, the kindergarten teacher or teacher is capable of recording images of the ear, throat, eyes or skin of the child with a high-solution camera and send the video clips to the physician at the other end of the line. By means of an electronic stethoscope even heart- and lung sounds can be transmitted. Mostly it’s the familiar pediatrician of the patient who integrates the telemedical appointment in his usual consultation hours contacting the kindergarten or school by video-chat if need be. Only in urgent cases it is necessary to make the parents leave their work. The total number of times absent in school and kindergarten were reduced by nearly two thirds since telemedicine got into the picture. And the parents’ absence from work is limited as well – one of the reasons why they decide for the pediatrician at the computer monitor when the kindergarten calls.

Advantages of the Swiss model

Less stress for the children in the waiting room, less stress for the parents and less costs. With this McConnochie as Member of the Board Business Development and Chief Scientific Officer of "Tel-e-Atrics" wants to push telemedicine not only in Rochester. Meanwhile hospitals and administrations in other US-states are interested in the "quick consultation" next to the classroom or playroom. In Germany, telemedicine wants to gain a foothold mainly in supply of patients with chronic heart- or respiratory diseases. On the other hand, the call and the consultation via computer and telephone has already become a routine in many parts of Switzerland. If the patient commits to calling the call-center prior to seeing the physician, he saves fees. Until now it is only a vision but perhaps in a couple of years we will turn to the computer terminal with an enclosed e-stethoscope first whenever we have a health problem instead of spending hours in the crowded waiting room of a physician.

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