This Issue: Telemedicine

Some visionaries have ideas too far ahead of their time to be practical. Dick Tracy’s wrist watch, with its two-way radio capability, could not be made when his comic strip was popular — the vacuum tubes would have been a bit big. Now, one can purchase a watch with both video and audio capability. Jack Northrup, the legendary and innovative airplane designer and builder, could not construct his flying wing aircraft at the time of his original conception in the mid-20th century. Despite the many advantages seen by the wise Mr. Northrup, the design had many inflight stability challenges not easily solved by the technology of his day. Now, with modern advances in computer technology, the Northrup Grumman B-2 bomber is the most effective and feared bomber in the world.

To those who would say that telemedicine represents an impractical idea, such as Dick Tracy’s watch or the flying wing, or something that provides little to assist the practicing pediatrician or pediatric patient, I invite you to read the articles in this issue of Pediatric Annals. In this issue, authors from four different continents present telemedicine programs providing care to children living on every continent in the world. The authors come from different backgrounds — general pediatricians, subspecialty pediatricians, nurses, and educational specialists. We even have a British Lord (Roger Swinfen) and a Lady (Pat Swinfen) as contributing authors.

The first article, “Tele-education: Linking Educators with Learners via Distance Technology” (see page 550), comes from Christopher E. Smith, MD, a colleague at Arkansas Children’s Hospital, as well as Karen Fontana-Chow, RN, and her colleagues at The Hospital for Sick Children in Toronto. Each of these centers has established excellent tele-education programs, where practicing pediatricians and nurses obtain continuing education credit. The authors explain the way they currently use tele-education and the way tele-education can and will be used in the future.

The second article, “Telemedicine and Neonatal Regionalization of Care — Ensuring the Right Baby Gets to the Right Nursery” (see page 557), comes from Julie Hall-Barrow, PhD, and two of her colleagues at Arkansas Children’s Hospital. These authors describe a unique program linking every nursery capable of intensive newborn care in their state. Telemedicine linkage allows for an accurate bed census for each nursery. Babies needing transport are directed to the nursery closest to their home that provides the level of care needed for their illness. The same telemedicine tools facilitate back transports.

“Telemedicine for Children in Need of Intensive Care” (see page 562), comes from James Marcin, MD, and colleagues at the University of California-Davis, as well as two colleagues from Australia. They describe the use of telemedicine to provide consultation for critically ill children and newborns in rural areas without access to local pediatric intensive care specialists or neonatologists. They discuss how telemedicine provides better assessment than the telephone. Based on more accurate assessment, a child may receive expedited care before transport to the referral center or, in some cases, even remain in the community hospital.

The fourth article, “Practical Applications of Telemedicine for Pediatricians” (see page 567), comes from Neil Herendeen, MD, a general pediatrician at Golisano Children’s Hospital in Rochester, New York, and G. Bradley Schaefer, MD, a geneticist at Arkansas Children’s Hospital. These two physicians not only fulfill the promise of the article’s title, they also present data showing how these interventions are cost-effective for insurance companies, keep children in preschool, and let parents stay at work. Better care for children with less cost — it would be hard to argue against that goal.

The fifth article, “Telehealth: Necessity is the Mother of Invention” (see page 570), comes from Karen Rheuban, MD, the Medical Director of the Office of Telemedicine at the University of Virginia and the current president of the American Telemedicine Association. Dr. Rheuban provides a history of telemedicine and describes how telemedicine is uniquely positioned to improve access to care and address affordability. Furthermore, the article discusses the work being done by various government agencies to promote telemedicine and envisions how telemedicine will be used in the future.

“Telemedicine and Child Abuse” (see page 574) comes from Randell Alexander, MD, PhD, of the University of Florida, and Karen Farst, MD, PhD, from the University of Arkansas for Medical Sciences. The authors describe the many advantages of a telemedicine network devoted to helping child abuse victims: better care and better access to care for victims, better standardization of care among child abuse experts, and legal testimony and evidence strong enough to have never been contested. Certainly these programs represent a marvelous application of telemedicine.

“International Pediatric Telemedicine and eHealth: Transforming Systems of Care for Children in the Global Community” (see page 579) comes from Dale Alverson, MD, the incoming President of the American Telemedicine Association, and colleagues from four different continents. This article describes an ambitious vision encompassing every aspect of care for children around the globe and shows how telemedicine can be used to achieve this vision.

The final article, “New Ideas in Nursing: Telehealth” (see page 586), comes from Sarah Rhoads, DNP, APN, her colleagues at the University of Arkansas for Medical Sciences, and Theresa Bubenzer, MSN, FNP, with the Indian Health Services in New Mexico. This article confirms that telehealth is useful to nurses and all other health professionals.

Telemedicine is a tool that can address every area of pediatric medicine. Access to patient care, quality improvement of patient care, education for providers, enhanced referrals, healthcare costs, healthcare inequities, global pandemic readiness, terrorist and environmental disaster response… the list goes on and on, limited only by the imagination of the user. The authors in this issue of Pediatric Annals invite you to explore the field of telemedicine and to help expand all our imaginations. Borrowing from a package delivery company’s tagline, we invite you to ask, “What can telemedicine do for you?” We promise that you will be surprised and pleased with the answer.