Meeting the Health Care Needs of California's Children: The Role of Telemedicine

This 16-page Digital Opportunity for Youth Issue Brief, Number 3, describes how telemedicine - the application of information and communication technology (ICT) to provide health care services at a distance - is used to improve the health of children living in the state of California, within the
United States, especially those who are low-income or living in medically underserved areas. It also outlines challenges to successful adoption of telemedicine and provides concrete recommendations for action.


As stated in the brief, "common applications of telemedicine and telehealth include videoconferencing between a patient and health care provider for a consultation or among groups of patients or providers for education, support, and care coordination; transmission of data, such as x-rays, photographs, video, and audio files; remote monitoring of vital signs and other health indicators; and internet applications for patient education and disease management." Telemedicine can connect providers with clinics and hospitals, schools, a child's home, a child care centre or juvenile detention centre. It can occur in real time, with simultaneous interaction such as videoconferencing, or "store and forward" transfers of data for review and consultation at a later time.


The authors of the report claim that hardware and software are increasing in their range. Telephone and Integrated Service Digital Network connections have limitations that high-speed and broadband internet connections can circumvent. Optimally, with security measures in place, bandwidth must be sufficient to enable all connection points to send and receive large amounts and complex sets of data quickly and accurately. Technical devices and software can include: videoconferencing equipment; digital cameras; electronic clinical devices, such as digital stethoscopes; disease management and health education software; and wireless devices, such as cell phones and Personal Digital Assistants, to exchange data.


This document provides supporting statistics showing children as an underserved population, particularly in California as compared to the United States' averages for unmet health care needs due to such problems as travel distance, a shortage of paediatricians, especially in subspecialties and tertiary health centres, and low Medicaid reimbursement rates.


According to the authors, ways that telecentres can improve care include:

1. screen, diagnose, treat, and monitor a wide range of paediatric health conditions;
2. treat children in hospitals, especially critically ill children in rural settings;
3. provide dental screenings, treatment, and referrals; screen children for early detection and treatment of vision problems;
4. meet the mental health care needs;
5. help sustain a 24-hour pharmaceutical presence;
6. provide coordination of services for special health care needs, such as autism, genetic diseases, mental retardation, depression, anxiety, and behavioural problems;
7. improve the lives of families of chronically ill children by allowing them to keep their children at home;
8. protect children by conducting child abuse consultations and examinations at a distance;
9. bring interactive learning tools to parents in their home communities;
10. help families stay connected when a child must be hospitalised;
11. manage chronic health conditions;
12. facilitate language translation by bringing translators to the exam room in a short amount of time without needing the translator to be physically present;
13. provide conferences and training without extensive travel for rural health providers; and
14. expands the capacity of schools and child care centers to address the health care needs of children through connecting school nurses with physicians.

The authors cite many challenges to further adoption of telemedicine. They include the weak reimbursements for provider participation in telemedicine, as well as unclear administration and contractual organisation. Provider shortages in subspecialties limit participation, and so does access to adequate bandwidth in the telecommunications infrastructure. Legal barriers such as licensing, credentialing, and liability protections may prevent interstate and interregional telemedicine usage. Little rigourous research to demonstrate telemedicine impact is available as evidence to support its deployment and educate providers and payers about its value.


A policy agenda includes updating payer policies, such as Medi-Cal in California, to provide adequate reimbursement, clarifying and standardising reimbursement laws, ensuring broadband access in rural areas, investing in research, increasing the numbers of paediatric sub specialists, providing access in institutions that care for and educate children, and exploring legal and bureaucratic barriers to extending telemedicine.