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In Pediatric Specialties, Telemedicine Is a Care Management Tool

At Children's Mercy Hospital in Kansas City, Emily Fox is using a telemedicine platform to treat her pediatric rheumatology patients hundreds of miles away. For them, and for her, it's invaluable.

Source: ThinkStock

By Eric Wicklund

- For about 20 children in Joplin, Mo., with chronic illnesses, a video screen offers a chance at a healthier life.

That screen is part of a telemedicine platform run by Children’s Mercy Hospital in Kansas City, 157 miles to the north. On the other end of that connection, Emily J. Fox, MD, checks out those kids four times a year, consulting their electronic medical record, chatting with their parents and taking to an onsite RN telefacilitator to make sure the exam is complete.

“They think it’s fun,” says Fox. “In many cases they think it’s a game.”

But these are children with chronic, and often painful, rheumatic, autoimmune and musculoskeletal conditions, including lupus and arthritis. They’re taking more than one high-risk medication, sometimes several, and need to be examined every few months.

“So it’s very important that we see them,” says Fox, also an assistant professor of pediatrics at the University of Missouri-Kansas City School of Medicine.

READ MORE: The Evolving Role of mHealth in Medication Management and Adherence

Fox’s pediatric rheumatology program is just one of a handful in the country using telemedicine, but it’s part of a much bigger network at Children’s Mercy. The 367-bed hospital offers 27 of its 47 pediatric specialties through telemedicine, reaching out to clinics across Missouri and Kansas to connect with children and their families who would otherwise have a hard time accessing specialist care.

Morgan Waller, MBA, the hospital’s director of telemedicine, won’t rest until all specialties are available via telemedicine. And then she’ll find more services to add to the platform.

“Telemedicine is a lifeline,” she told mHealthIntelligence in an earlier interview. “And with demand just starting to exceed the need, it’s only going to get bigger.”

Fox schedules telemedicine sessions once a month with the Joplin clinic, spending about 45 minutes with each patient and their family. She checks each patient’s medical record ahead of time, talks to the nurse at the other end of the video feed, and talks with the parents. The physical examination follows, aided by the nurse on site.

“Between the two of us, the kids get a very good exam,” she says.

READ MORE: The Benefits and Challenges of Telehealth for Specialists

The visit concludes with recommendations, if any are needed, on changes in medication or treatment.

The program has been well thought-out ahead of time. Every one of Fox’s patients is stable, and was seen in person before transitioning to the telemedicine platform. If there are any complications, any concerns, those children and their parents will be making the two-and-a-half hour drive to Kansas City to meet her in person.

That’s the nature of a successful telemedicine platform: It handles the basic care management aspects of a patient with a chronic condition more efficiently, cutting away the wasted time, effort and money of long trips to and from the hospital. It gives the children and their families a treatment plan that fits better into their lifestyles, improving engagement and, in the long run, health.

“The kids who need this really need this,” says Fox, whose biggest task is the time-honored bane of the pediatrician – getting kids to take their medicine. “It really helps with compliance. That can be really challenging.”

Waller, who has overseen the hospital’s telemedicine program from its inception a little more than five years ago, enjoys her job of “pushing the envelope.” With the nearest pediatric specialists six hours away in St. Louis or 10 hours away in Denver, she says her health system is a lifeline for the greater part of Missouri and Kansas.

READ MORE: Hospital Uses Telestroke Program’s Success to Branch Out to Other Specialties

She says a telemedicine program can be challenging to launch.

“Change is very difficult to lead and manage, yet it is essential to the vitality of organizations,” she says. “Any institution wanting to start a telemedicine program should, in the beginning, focus on evidenced-based change strategies.”

“Everything about a telemedicine program involves to lesser or greater degrees a difference in the model of healthcare delivery that has been around since before World War I,” she adds. “Provider interest and support is essential.  Experts in legal, government relations, revenue integrity, risk management, scheduling and call center solutions, medical education, credentialing, nursing and so on. The barriers and challenges are many, and … implementing a telemedicine program is not for the timid nor for the fain. It is however, so worth the effort.”

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