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Telemedicine Gives Rural Children a Lifeline to Specialist Care

Children's Mercy Kansas City's telemedicine platform offers 26 specialties to children and their families across Missouri and Kansas. It's an example of how a connected care platform can deliver critical healthcare to rural communities.

Source: ThinkStock

By Eric Wicklund

- In America’s heartland, large cities and health systems are few and far between. So if a child needs a healthcare specialist, telemedicine may be a literal life-saver.

At Children’s Mercy Kansas City, 26 of the hospital’s 47 pediatric specialties are now offered via a telemedicine network that reaches out across Kansas and Missouri, connecting with families who would otherwise have to drive several hours to see a specialist. The 367-bed hospital operates three fully owned telemedicine clinics staffed by trained nurse facilitators, with a fourth due to go on line shortly.

All told, these clinics serve about 150 children a month, giving them access to some of the country’s most in-demand doctors.

“Telemedicine is a lifeline,” says Morgan Waller, MBA, Children’s Mercy KC’s director of telemedicine. “And with demand just starting to exceed the need, it’s only going to get bigger.”

Perhaps the best example of this lies in immunology, asthma and allergy. Children’s Mercy sees as many as 30 children a month, most diagnosed with asthma, through the telemedicine platform. Each visit includes a remote physical examination using digital tools, a medication check-up, and a discussion of an “asthma action plan” that encompasses home, school, day care and any other caregivers and locations that might be affected should the child have an asthma attack.

READ MORE: mHealth Gives Children a Reason to Smile

It’s a legitimate fear. Of the 6.3 million children nationwide diagnosed with asthma, or almost 9 percent of the pediatric population, close to 60 percent suffer a serious attack within a year’s time, according to the Milwaukee-based American Academy of Allergy, Asthma and Immunology. And roughly 200 die from such an attack each year.

Those attacks don’t conveniently happen in the doctor’s office, so it’s important that healthcare providers gain insight into how these children live their lives each day. A telemedicine platform that connects the hospital to the children and their caregivers means many more “touches,” and many more chances to identify triggers, spot trends and adjust care plans. And possibly save a few lives.

“There are less than 400 certified pediatric rheumatologists in the country,” says Waller. “What are the chances we’d have enough in Kansas City [to handle 30 children per month]? … These [children] need access to specialty care, so we have to bring it to them.”

More statistics: According to the Centers for Disease Control and Prevention and, asthma is the number one cause of school absences, and the most common chronic disease in those under 18 years. It’s also responsible for 6.5 percent of all office-based physician visits and 1.6 million ER visits, costs about $3,300 per person per year in the U.S., and eats up more than $60 billion in annual healthcare costs.

In this case, Children’s Mercy Kansas City has proven its platform. In a study published last September in Annals of Allergy, Asthma & Immunology, Waller and fellow physicians Jay M. Portnoy, MD, Stephen De Lurgio, PhD, and Chitra Dinakar, MD, found that telemedicine visits “can achieve comparable degrees of asthma control” compared to in-person visits."

READ MORE: The Benefits and Challenges of Telehealth for Specialists

The study, involving roughly 170 children over six months, found that a virtual platform equipped with digital stethoscope, otoscope and high-resolution camera worked just as well as an in-person checkup, with little different in asthma control over time. In addition, Waller and her colleagues reported that children and their caregivers were “satisfied with the experience.”

Waller – who expects the number of pediatric asthma cases to triple in the coming year, in line with national estimates – now has big plans for this platform. She’s put in a request to test an mHealth-enabled inhaler, she’s adding staff, and she’s looking to expand the health system’s outreach efforts into schools, where doctors could collaborate via telemedicine with school nurses.

That’s a viable plan in Missouri, whose telemedicine laws now include schools as an originating site – meaning students can be treated via telemedicine in the nurse’s office or clinic. But it’s a dream in Kansas, where current laws restrict originating sites to healthcare locations (Kansas lawmakers are reviewing proposed legislation that would expand those sites).

“The bureaucracy isn’t keeping pace with the technology,” says Waller, who envisions someday having school-based telemedicine clinics that cover emergency care, daily monitoring of students with chronic conditions, even telemedicine-enabled public health programs for the entire community. “There’s so much more that can be done with this technology than we’re allowed to do right now.”

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: Factors Behind the Adoption of School-based Telehealth

“We’re very rural,” she says.  

That’s why it’s important to place clinics in smaller communities two to four hour away from Kansas City, where a parent or caregiver can take a child for a check-up that’s much more detailed than the visit to the family doctor.

And while Children’s Mercy currently owns and operates its own clinics, making the hospital both the hub and the spoke in a telemedicine network, Waller envisions other locations and new partnerships, pushing that envelope a little farther to make healthcare more easily accessible for more people.

“It’s just common knowledge out here that people love telemedicine,” she says. “We’ve all seen how it works.”


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