Not only is geography a health determinant, but the quality of and access to healthcare can be determined by ZIP code.

Children's hospitals are collections of providers that have specialized in pediatric medicine and then specialized again in specific disorders of childhood and adolescence. These are rare, highly sought after, exceptional professionals that are only located in very large metropolitan areas.

When audio-visual, digital technology and networks reached a level of quality and affordability to allow for the delivery of specialty care over distance without sacrificing standard of care, Children's Mercy Kansas City in Missouri saw this as an opportunity to help level the field and overcome barriers to access and quality related to the rural ZIP codes of the Midwest.

PROPOSAL

After an exhaustive search and trials of many technology offerings, Children's Mercy Kansas City selected telemedicine technology from InTouch Health as the best fit for the level of complexity of its patients and the organization's quality of care. InTouch Health offered reliability in areas of Kansas and Missouri with questionable networks, said Morgan Waller, director of telemedicine business and operations at Children's Mercy Kansas City.

"Their mobile units with high-definition, pan-tilt cameras and support for digital exam devices worked with Internet speeds slightly better than dial-up but far from high-speed," she explained. "The technology coupled with highly trained RN tele-facilitators enabled our providers to administer Level 3 and 4 new patient exams while meeting or exceeding standards of care."

The hospital started delivering sub-specialty healthcare to children closer to their homes. Families that were forgoing referrals to Kansas City started to accept them when the barrier of travel was removed. Parents of children with chronic conditions started changing their follow-up appointments to the telemedicine option closer to home.

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.

MEETING THE CHALLENGE

Distance is not the only barrier to specialized medicine, but for Children's Mercy Kansas City's initial telemedicine program it was the biggest. The telemedicine technology connects the provider with the patient/family and RN tele-facilitator via a monitor with cameras and the ability to support digital exam devices from AMD, Horus and PCP-USB. The devices run on WiFi or wired connections and their proprietary connectivity services maximizes available bandwidth to ensure a high-quality experience for both patient/family and providers.

"Our patient/family experience surveys are between 98 percent and 100 percent positive, with comments like, 'It was just like having the provider in the room with us."

Morgan Waller, Children's Mercy Kansas City

"The RN tele-facilitators receive training on the equipment and troubleshooting as well as each specialty they support," Waller said. "They are hired for and report to telemedicine. We have buy-in from the beginning. The partnership between the providers and the facilitators while using the telemedicine technology as the conduit is our secret."

RESULTS

The number of telemedicine consults has grown 73 percent annually over the last five years. In the same amount of time, Children's Mercy Kansas City has increased the number of specialties practicing with telemedicine from three to 30.

"Our patient/family experience surveys are between 98 percent and 100 percent positive, with comments like, 'It was just like having the provider in the room with us,'" Waller said. "We have 47 providers on average practicing with telemedicine each month and it has been 56 days since our last provider issue. They can hear and see their patients every time."

Waller will be speaking on the subject of telemedicine at HIMSS19 in a session titled "Telehealth 301: Beyond the Basics." It's scheduled for Tuesday, February 12, from 3-4 p.m. in room W207C.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com