More than 25 percent of pediatric emergency visits could be conducted online

May 6 2008

A community-wide study in upstate New York found that nearly 28 percent of all visits to the pediatric emergency department could have been replaced with a more cost-effective Internet doctor's "visit," or telemedicine, according to investigators from the University of Rochester Medical Center.

The Rochester team will present these findings and more at this year's Pediatric Academic Society Meeting, to be held Friday, May 2 through Tuesday, May 6, in Honolulu, Hawaii.

"We learned that more than one in four local patients are using the pediatric emergency department for non-emergencies," said Kenneth McConnochie, M.D., M.P.H., the study's lead investigator and a professor of Pediatrics at the University of Rochester's Golisano Children's Hospital at Strong. "This mismatch of needs and resources is inefficient, costly and impersonal for everyone involved."

McConnochie and colleagues - who direct Health-e-Access, a Rochester-based telemedicine program that provides interactive, Internet-based health care "visits" to diagnose and treat routine childhood symptoms in 19 urban and suburban schools and childcare centers - analyzed data from 2006, tracking all pediatric (younger than 19) visits to the largest emergency department in the city.

Given experience with over 6,000 successfully-managed telemedicine visits that illustrate the extent of technology's capabilities, unique diagnoses from more than 22,000 pediatric ED visits were coded into various categories - first, ailments that virtually always prove manageable by telemedicine, such as ear infections or sore throats; second problems that are usually treatable through telemedicine, but not always, such as asthma attacks; and finally, conditions that were usually beyond the scope of the technology.

Nearly 28 percent of ED visits fell into that first category; had these same problems been handled by telemedicine, this community would have had at least 12,000 fewer ED visits that year.

"This would've not only freed up emergency resources to people who needed them more - it would have afforded smaller co-pays for parents and more timely, personalized care," McConnochie said. (On average, 87 percent of these telemedicine visits are handled by the child's own family pediatrician.)

But parents aren't the only ones who stand to benefit. McConnochie, in related research also being presented at the upcoming meeting, suggests that telemedicine will also serve the ultimate objectives of insurers and the community as well - better quality care at a lower price. Typically, insurers have been wary of embracing the technology, fearing the convenience may lead parents to use medical care more often and drive up costs; but another community study from Rochester suggests the exact opposite - that in the long run, insurers actually would realize cost savings - more than $14 per child per year in that local community.

In that study, researchers analyzed two groups of children that were almost identical - except one had access to their doctor's office, the emergency department, and telemedicine technology for care, and the second had only the first two options. They tracked how often families used services, and which ones.

"We found that the first group of families, which had access to telemedicine for their children, did in fact access care for illness overall nearly 23 percent more often than the second group," McConnochie said.

But since emergency department visits among these children with telemedicine access were nearly 24 percent less common - and since these visits cost about 7-times the cost of a doctor office or telemedicine visit - the telemedicine group ultimately still cost the insurers less per child over the course of a year.

"It's similar to the idea of staying trim by eating healthy. It would be wrong to assume that someone who ate 20 items of food each day - all lean and nutritious - would be less healthy than someone who ate only 12 items - all high-fat, high-calorie, like donuts and fries," he said. "You can see how the logic of only counting food items (or total visits) falls apart. Clearly cost, as well as frequency, plays a role, whether the 'cost' of each unit is measured in calories or dollars."

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