Catch That Bug!

A telemedicine system in Rochester, N.Y., day-care centers works so well that local schools want to add the equipment to their facilities.

by / August 31, 2005
As a single mother of three, Ericka Haines has dealt with her share of illnesses interrupting her work and school schedule. Haines remembers being pulled from class at a local community college in New York because her daughter, then 5 years old, was sick with strep throat and needed a visit to the doctor.

With public transportation as her means of travel, Haines said being called to pick up a sick child included frustrating hours of traveling and waiting.

Some say this is simply a fact of life for parents. Others insist it doesn't have to be that way.

Five child-care centers in Rochester, N.Y., participated in a two-year program, called Health-e-Access, designed to gather statistics on how virtual doctors' visits can help minimize young children's absences due to illness by catching and treating communicable illnesses quickly.

Health-e-Access also provides relief to parents whose children are sick but may not be contagious and could remain at the child-care center until the time they're usually picked up.

Before telemedicine, a child with an ear infection would have been sent home to seek medical attention, requiring a parent to leave work. Now telemedicine can quickly assess and diagnose the problem without parents setting foot out of the office.

As a result of the child-care centers' success with telemedicine, schools in the Rochester City School District are signing up for Health-e-Access.

Get With the Program
Health-e-Access originated in May 2001 at the University of Rochester's Strong Memorial Hospital through the efforts of pediatrician Dr. Kenneth McConnochie and his colleagues.

In the beginning, five day-care programs participated in the test study from January 2001 to June 2003. The program is now in the middle of a major expansion, adding two urban child-care centers, nine elementary schools and four suburban child-care centers.

The expansion also includes new doctors -- a dozen pediatric primary care physician groups have agreed to provide telemedicine services for their patients.

"Expansion into Rochester-area elementary schools is under way, but we are still in the training and technology rollout stage there," said McConnochie.

When the school district first considered the benefits of telemedicine in schools, two senior administrative leaders and a school board member went to the Carlson Downtown YMCA Children's Center to see the program in action.

"They wanted to see how it worked and understand how it could be used to address health problems in schoolchildren," McConnochie said.

Distance Diagnostics
The primary equipment for telehealth assistants includes a camera with specialized attachments for ear, throat and skin examination, and an electronic stethoscope to capture sounds from the heart and lungs. With these tools, a telehealth assistant captures fixed images, video clips and audio files to send to a participating pediatrician before a telemedicine visit is scheduled to occur.

The assistant does not need training in health care, said McConnochie, but needs to complete approximately 40 hours of training from Health-e-Access on using the equipment. The assistant uses symptom-driven protocol and electronic forms to paint a picture for the doctor prior to the visit, including the child's medical history.

During a visit, the pediatrician, assistant and child interact through video conference over a high-speed Internet connection. The software is supplied by Tel-e-Atrics Inc., which specializes in software and consultation services supporting telemedicine.

In some cases, a visit isn't even necessary. A common skin rash, such as impetigo or ringworm, need only be diagnosed by a clear image sent to the pediatrician by the telehealth assistant.

Private to Public
Telemedicine is not a new technology. The Center for Telemedicine and Telehealth at the University of Kansas Medical Center performed a pioneer rollout, called the TeleKidcare program, in elementary schools in 1998.

"At first, there was some hesitation on the part of school administrators and pediatricians due to uncertainty about how the innovation would work, but now the service is well demonstrated and continues to grow," said Ryan Spaulding, associate director of the center.

The school-based service was the first to provide urgent care and behavioral health care through telemedicine to children while at school, Spaulding said.

This new frontier caught the attention of McConnochie and his colleagues. Unlike the program in Kansas, pioneers of the Health-e-Access program approached day-care centers first because children in day-care environments are generally more susceptible to illness, said Sean Tracy-Hamilton, operations director of the Early Learning Center of Wilson Commencement Park -- a participant in the original program study.

"Their bodies aren't used to being around lots of children," Tracy-Hamilton explained.

This can cause an increased level of common acute problems, McConnochie said. "We're not talking about life-threatening issues, but colds, ear infections and gastroenteritis," he said.

Because of this increased risk, and the ensuing absences, Health-e-Access could clearly show how telemedicine helped keep children in day care and parents at work.

Under the Microscope
In a report generated by the program, 940 telemedicine encounters occurred during the initial two-year study. Only 7 percent of telemedicine encounters resulted in the child being sent home, and less than 3 percent of the children examined were advised to see a doctor in person. Prescriptions were delivered to facilities by participating pharmacies.

"We have success stories every day," said Tracy-Hamilton. "Every day we have a sick child, and we can diagnose [ailments] so the child can stay in the program and get the medicine here."

Parents surveyed felt that approximately 91 percent of telemedicine incidents allowed them to remain at work and nearly 94 percent of telemedicine-treated illnesses would have previously meant going to the doctor's office or emergency room for treatment.

"Some parents say they have been unable to keep a job because of small children, and with the reduction in absences due to illness -- which we measured at 63 percent -- telemedicine has made the difference between their being able to keep a job and not," McConnochie said, adding that keeping kids healthy so they can stay at child-care centers means parents can clock more hours at work.

Telemedicine also prompts increased communication between parents and caregivers.

"Before, parents would come in knowing their children were sick, knowing they can't take off work and just praying we wouldn't call," said Tracy-Hamilton. Now, she explains, parents actually notify the caregivers when their children are feeling under the weather, and often request that their children be seen by the doctor.

Tracy-Hamilton believes that schools should recognize the benefits of telemedicine. "This is a wonderful opportunity for the [school] nurses. I don't think they should look at it as a threat, but as an opportunity to grow," she said.

Bonnie Graff, school nurse for Rochester's Lincoln School No. 22, said she is already seeing the benefits. She remembers an instance in which a child with a bee sting developed cellulitis, but the mother didn't know how to treat it or whether a doctor needed to be seen. Rather than having to miss work, the mother had her child treated via telemedicine and was impressed, according to Graff.

"The parent population today is busy, and parents have a problem trying to juggle doctors' appointments," Graff said, noting that sometimes parents believe their children will be fine without visiting a doctor -- which sometimes isn't the case -- and getting a parent to pay attention to a school nurse's advice for treatment can be tough. "Having the physician's stamp of approval on it, it works a lot better."

Lincoln was the first school added in the expansion, and Graff observed that parents were guarded at first. Initially only 65 of 458 students signed up for telemedicine, but now that number is close to 200.

In addition to treating illnesses, Graff suggests telemedicine would be a great way to perform dental screenings as well, stating that 75 percent of kindergartners in her building have not been to a dentist.

Primary Goal
Telemedicine's possibilities are copious. In Kansas, it's already being used for several different purposes.

"In TeleKidcare, services for children with special needs and urgent care are provided," said Spaulding. Ailments treated include ear, nose and throat problems, eye-related complaints and respiratory illnesses.

"We envision this in every pediatric office, every child-care program, every elementary school in upstate New York," explained McConnochie. Hopefully every child will connect with his or her own primary physician, he said.

With telemedicine, parents can be assured their children will receive immediate care without a visit to the emergency room for non-urgent matters. All proponents agree that catching and treating illness early is key.

Haines said she and her kids benefit from telemedicine, noting that before telemedicine, treatment required missing a whole day of work. Now her children don't have to be out in all kinds of weather, toted from location to location to get the treatment they need.

"Telemedicine helps a parent become more of an asset to a business," said Haines.
Sherry Watkins Contributing Writer