Pediatric emergency telemedicine: 5 barriers to success

Telemedicine is an underused technology in pediatric emergency settings, where it could "in theory, improve the quality of ... care at small hospitals, facilitate effective triage ... and reduce costs by eliminating unnecessary transport," according to researchers from RAND and the University of Pittsburgh School of Medicine, whose work was published this month in Telemedicine and e-Health.

For the study, the researchers surveyed 25 providers at 20 unique hub sites with either current, former or planned pediatric emergency telemedicine programs, who identified five barriers to success, including:

  1. Difficulties in cross-hospital credentialing, the process by which doctors at "hub sites" receive permission to practice at "spoke sites"
  2. Integration into established workflows, as use of telemedicine can tack on unnecessarily additional time to processes
  3. Technology usability
  4. Lack of physician buy-in, particularly at hub hospitals
  5. Misaligned incentives, which don't necessarily reward hub hospitals. "The hub hospital as a whole has a great deal to lose," one participant told the researchers.

The researchers, however, did not interview spoke sites.

Research published in the same journal in July 2013 concluded that hospitals that used telemedicine technology and referred patients to children's facilities saw their revenue increase significantly. Still, one of that study's authors--James Marcin, director of the pediatric telemedicine program at UC Davis Children's Hospital--called "lack of alignment between reimbursement and providing quality of care" the "biggest barrier to telemedicine.

"We are not paid to keep people healthy," Marcin said. "We are paid to see patients in clinics."

Marcin and colleagues also found that care quality for pediatric patients in rural emergency rooms improved significantly when delivered via telemedicine consultations.

The new study's authors suggested that credentialing policy be updated for the telemedicine era and that incentives be realigned to "make telemedicine more attractive for all stakeholders.

"Payers could create financial incentives for telemedicine use, independent of simple reimbursement," the researchers said.

To learn more:
- here's the study's abstract