Patient Access to Care

One of the most immediate expected benefits of telehealth is the ability to increase patient access to care by delivering it when and where patients need it. The AAP policy statement notes that there exists a significant disparity in the distribution of pediatricians and subspecialists across the United States, leading to underserved regions. Apart from overcoming geographic barriers, parents are also likely to consider telehealth options that could prove more convenient around their work schedules or be more time efficient. A recent survey asked what treatment options consumers would consider for middle-of-the-night care, and 30% of parents with children in the home would select a video visit compared with only 18% of adults without children.

Pediatric care has been shown to be particularly amenable to telehealth services. A telehealth model demonstrated that approximately 85% of acute visits to ambulatory pediatric clinics could be managed as telehealth encounters, even if they required such procedures as simple in-office laboratory testing or albuterol treatments. Subspecialty teleconsultations have proved to be effective for various types of encounters including autism evaluation, cardiology, dermatology, and retinopathy of prematurity screening. Given the scarcity of many pediatric subspecialists, telehealth services might be a less expensive or time-consuming option for patients in remote underserved areas.

In addition to certain telehealth services proving to be as clinically effective as in-person encounters, patient satisfaction with such services is also reported to be high. A systematic review of patient satisfaction with telehealth services found that all 32 examined studies showed good levels of patient satisfaction. Another benefit for patients is that such improved access to care can also help lead to better, safer care by supporting the patient-centered medical home (PCMH). By offering telehealth services, primary care providers can help avoid fragmentation of care by patients seeking services at standalone walk-in clinics or urgent care centers. Keeping care within the PCMH leads to a more complete medical record, better continuity of care, and closer follow-up by a patient’s primary care provider.

Provider Outreach

Just as patients are expected to benefit from increased access to care, telehealth technology enables providers to offer more services and higher quality care to their patients. Because only 5% of US hospitals are children’s hospitals, most children receive care in nonpediatric specialized hospitals. Telehealth services can help extend the expertise of pediatricians and subspecialists at children’s hospitals and large tertiary care centers by enabling them to reach providers and community hospitals in remote settings. This can in turn empower those providers to care for their patients without having to refer them to other specialists or transfer them to other hospitals. Interviews conducted in 2013 with rural pediatricians showed that they were strongly supportive of multiple telehealth strategies, so long as the goal was to enhance rather than replace relationships between rural pediatricians and subspecialists.

Several studies have examined how telehealth extends the abilities of providers in the delivery of care in intensive care unit (ICU) and emergency department (ED) settings to provide better, safer care. The use of remote-controlled, robotic telehealth technology for rounding in a neonatal ICU was shown to be effective at managing patients and could help provide complementary support to underserved neonatal ICUs. Teleconsultations between pediatric critical care specialists and remote providers in adult ICUs caring for children led to similar severity-adjusted mortality rates, and improved adherence to pediatric critical care best practices and treatment guidelines. Similar teleconsultations between pediatric critical care specialists and providers in nonpediatric EDs were also shown to be useful in dealing with seriously ill patients and, in one study, even improved patient safety by leading to fewer physician-related ED medication errors.

Patient, Family, and Provider Education

Telehealth technology can also provide new ways to educate patients and their families on managing diseases themselves, and provide continuing medical education (CME) for providers. Streaming videos and interactive websites can be used to engage patients in learning about self-management of chronic conditions. The use of telehealth technology to provide patient education for such diseases as asthma and diabetes has led to increased patient knowledge of their disease and improvement in objective measures of clinical outcomes. The use of mHealth text messaging programs to educate people about human immunodeficiency virus/AIDS in the developing world has resulted in increased disease awareness and rates of human immunodeficiency virus/AIDS testing.

Providers can also benefit from educational offerings that can reach them in remote locations. Online educational sources can include academic lectures, clinical conferences, journal clubs, or other CME programs. Lectures can be delivered synchronously via videoconferencing and thus allow providers to have discussions with other colleagues. Such interactions with clinical content experts and subspecialists can help providers develop greater expertise to manage complex patients on their own, and promote networking among medical professionals. Storing such programs online would enable asynchronous delivery of these materials so that providers could use them at their own convenience and still benefit from them. Results from a pediatric medicine telehealth educational program in the state of Arkansas showed that online delivery of CME materials was well received by participants who believed the materials were relevant to their professional needs, increased their knowledge, and would influence their clinical practice.

Resource Utilization

Since the passage of the ACA, there is greater pressure on the health care system to find new ways to provide high-quality care more efficiently. Telehealth services have the potential to meet that goal by reducing costs through better communication of patient information. Not only is information relatively inexpensive to transmit compared with the physical transport of patients, but telehealth also provides additional savings to patients, their families, and society apart from direct health care costs.

A direct financial benefit of telehealth’s ability to overcome the distance between patients and providers is the avoidance of the costs of transporting patients between health care facilities. Given that the transportation of medically complex patients requiring life support and close monitoring is expensive and not without risk, a telehealth service that could extend the reach of experts at lower cost and without endangering patients would seem to provide cost savings and more efficient care delivery. A pediatric ICU telehealth program providing pediatric critical care expertise to rural adult ICUs demonstrated an ability of such an intervention to keep more patients in house and avoid unnecessary transports. This resulted in large cost savings from the difference in ICU costs between hospitals and avoided transport costs, which accounted for two-thirds of the annual savings of the telehealth program.

Telehealth services can also lead to better use of limited resources, such as the availability of subspecialist appointments, by providing a more efficient way to communicate between providers. Telehealth programs that offer a means for providers to discuss patient cases with subspecialists have been shown to provide many benefits and cost-savings. The ability to obtain specialist input on a patient can lead to early initiation of diagnostic testing and treatments by the primary care provider while the patient waits to be seen by the subspecialist, increasing the efficiency of care delivery. This can also lead to avoidance of unnecessary and redundant diagnostic procedures if the subspecialist can direct the work-up at a distance. An unexpected benefit of such telehealth programs is that it can actually avoid the need for the patient to even visit the subspecialist, avoiding the financial and time costs of unnecessary referrals and thus reduce the wait times for patients who do need subspecialty care visits.

Such efficiencies and cost savings are not only gained by the health care system, but also by patients and, in pediatrics in particular, the entire family. By one estimate illnesses for children in daycare can lead to 40% of parental missed workdays. Services that can offer parents a means of obtaining medical care, without having to miss work, are thus a potentially huge benefit for families and society in terms of recovered workforce productivity. An urban pediatric telehealth program was shown to reduce the number of child absences caused by illness by more than 63%. This telehealth program was well accepted by families, who most liked it for the convenience, time saved, and the ability to stay at work. Such a program would thus allow parents to go to work, and reduce the burden on primary care clinics and EDs that are often used in these acute illnesses.