Telemedicine and the Pediatric Tertiary Care Center Gerard P. Rabalais

Clinical examples of the use of videophones with significant potential cost savings include use in the treatment of tuberculosis by reducing the need for public health nurses to travel to patients' homes in Washington state(1), and direct observation of inhaler use and assistance with exacerbation management in Japanese patients with severe asthma to improve asthma control and reduce hospital admissions(2). For patients with chronic illness, data being sent from the patient's home medical devices such as peak flow meters, blood pressure monitors, scales, or blood glucose monitors to primary care physicians via telephone lines are other examples of the use of store-and-forward telemedicine services. Since the specialist does not need to be present during the transmission of clinical data or images, it is easier to fit into his or her schedule. Clinicians at community hospitals in Iowa benefit from having access to pediatric radiology specialists at the tertiary care center (10), and the Center for Disabilities and Development at the University of Iowa uses telemedicine to provide evaluation by an interdisciplinary team of specialists for the estimated 70,000 children with developmental disabilities in that rural state (11). If the tertiary care center also provides insurance coverage for patients in the area, the use of telemedicine may have financial implications by reducing unnecessary transfers and providing better surveillance of patients with chronic conditions to avoid unnecessary hospitalizations and emergency department visits.