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Telemedicine: A Tookit for Pediatricians

The newly developing field of telemedicine is paving the way for greater access to pediatric services and specialists. Defined as the use of medical information exchanged from one site to another via electronic communications, telemedicine can be manifested through two-way video, email, smart phones, wireless tools and other communication tools. As the number of children with chronic diseases continues to rise, and the ratio of children to pediatric specialists continues to shrink, telemedicine has the potential to extend continuity of care without sacrificing the quality of care.

Applications and Examples

Virtually any service can be provided via telecommunications technology, including radiology; mental health; dermatology; cardiology; emergency and transport services; hospital care and family communication; pathology; child abuse; patient education and chronic disease; school health; home health; and other services.

Over 40 years of research has yielded a wealth of information about the cost effectiveness and efficacy of telemedicine applications. According to the American Telemedicine Association, there are over 12,000 citations of published works in PubMed related to telemedicine or telehealth. In addition, there have been over 2,000 studies. Below are just a few applications and examples:

Applications:

Examples:


Technology and Equipment

There are two types of methods currently used to perform telemedicine: real-time communication and store and forward. Real-time, which is more common, involves interactive communication between a practitioner at patient at the same time, but in different locations. It is typically facilitated via secure digital videoconferencing and requires an originating site and a distance site. Store and forward is the transmission of digital images for a diagnosis, commonly used in radiology and dermatology.

Typically, a public internet connection is not sufficient for real-time communication, even when it is possible to encrypt a digital video conference. The alternative is to purchase internet connections designed to support business grade videoconferencing from a telecommunications provider. Check with your local utility company about possible options or rate discounts.

Basic equipment that may need to be purchased::

  • Secure web cam connection with microphone ($60)
  • Computer with speakers
  • Video conference unit with mounted display ($20,000-30,000)
  • High speed, broadband internet connection ($75-100/month)
  • Scopes -- ENT, stethoscope, etc.
  • Encryped software ($150-$250)

National Telehealth Technology Assessement Resource Center includes equipment options (and user reviews) for a wide variety of telemedicine applications.

Reimbursement

A common misperception is that telemedicine is not covered. However, Medicaid covers telemedicine services in most states. Additionally, a number of states require private insurers to cover telehealth the same as they cover in-person services. Even in the absence of a definitive policy, some insurers will reimburse for telemedicine services as long as the rationale for using it is justified to the agency’s satisfaction.

Reimbursement policies vary by state and insurance provider and are constantly evolving. Check with the major insurance companies and the Medicaid program in the state to get a clear understanding of coverage. As of Jan. 1, Minnesota Health Care Programs now cover "medically necessary services and consultation" by licensed health care providers through telemedicine in the same manner as if the service or consultation was delivered in person. This is in accordance with the Minnesota Telemedicine Act, passed last legislative session. Read more here.  

Eligible Originating Sites and Providers

In telemedicine, the place where the patient is located at the time of service is often referred to as the originating site (as opposed to the distant site where the provider is located). Generally, coverage requires that the patient be served from a specific type of health facility, such as a hospital or physician's office. However, many states do not specify a patient setting or patient location as a condition of payment for telemedicine services, and some even recognize schools.

Most states allow physicians to perform telemedicine encounters within their scope of practice. Many states also allow other providers to provide telemedicine services at the originating site, including, but not limited to physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, clinical psychologists, clinical social workers, and registered dieticians.

Specific services and codes

Pediatric telemedicine applications may include outpatient specialty consulations, inpatient specialty consultations, intensive care unit consultations, emergency department consultations, and surgical and trauma consultations. According to Medicaid.gov, states may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.

For examples, see which Medicare services and codes were covered in 2014.

Getting Started

HRSA recommends starting with a needs asssesment, identifying collaborators, and evaluating which resources are needed. A list of FAQs about how to get started is posted on the Telehealth Resource Centers and HRSA websites. In addition, an online toolkit has been developed by the Great Plains Telehealth Resource & Assistance Center.

Helpful websites:

Additional Resources