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Telemedicine Helps Day Care Diagnoses

Marilyn Gonzalez worried that her 2-year-old was coming down with an ear infection. Rather than miss work for a doctor visit, the 25-year-old single mother of two dropped her daughter off as usual at the day care and went to work.

Little Jaeda was examined soon afterward by a University of Rochester pediatrician and given antibiotics (search). Using telemedicine (search) tools wielded by a day care staffer, the diagnosis was done through the Internet.

"When I picked her up, everything had been taken care of," said Gonzalez said with a sigh of relief. "At least for those common things like ear infections and strep throat that most kids get, I'm comfortable with the diagnosis. Telemedicine has done wonders for me."

A federally backed project offering "virtual doctor" visits at seven child-care centers in this city of 220,000 has proven so successful since 2001 that it is being expanded this spring and summer to five more centers and 10 public schools throughout the city and suburbs.

The expansion will create the biggest metropolitan network of its kind in the nation, covering 8,500 children in all, and provide a tantalizing glimpse into the future of medicine.

Though there were some technical problems, sickness-related child absences dropped on average by 63 percent at the pilot centers. They serve about 950 children of mostly low-income families with little or no health insurance, according to a study published this week in the journal Pediatrics.

In addition, it said, 92 percent of parents said the hassle-free option allowed them to stay at work when they otherwise would have taken their children to a family doctor or an emergency room.

Telemedicine has evolved since the 1990s chiefly as a way to bring medical care to rural communities across America. Doctors can monitor patients from afar via voice, data and video hookup as well as verbally direct medical procedures.

Aided by school nurses, hospitals already have telemedicine units set up at several schools in Kansas and Texas.

The project here was the first to offer telemedicine at day care centers in low-income neighborhoods where "the need is greatest," Dr. Kenneth McConnochie, a pediatrician at the university's Strong Memorial Hospital and director of the so-called Health-e-Access (search) program.

Launched with $2.6 million in federal grants and another $2 million from mainly nonprofit groups and local businesses, the expanded network will now largely pay for itself.

"Maintaining it, as I see it, should come from the usual sources of reimbursement for health services, which is local insurance organizations," said McConnochie, who is also chief scientific officer of a company that provides hardware and support services for any center that opts to use the program.

More importantly, by catching illnesses promptly and reducing the need for costly after-hours trips to the hospital, telemedicine could help to improve children's health and reduce health care costs, proponents say.

"Having it available where children spend the majority of their time, such as schools and child-care centers, we have the potential to reshape the way our nation's pediatric offices provide care for very common childhood illnesses," said McConnochie.

An employee at each location gets a week of technical instruction in how to operate the equipment — from using a stethoscope to sending live video across town — as well how to swab a throat or clear wax out of a child's ear before inserting an otoscope. The assistants remain under supervision for eight more weeks but do not make medical decisions.

Technical problems or the lack of an assistant forced suspension of telemedicine during several periods for the first three centers. One center terminated the service because it wasn't generating enough child visits.

By year's end, nine private practices will be hooked up to the network, allowing children to be treated by their own pediatrician without leaving their day care or school.

Using an electronic stethoscope and a specialized camera to examine the lungs, ear, throat and skin, doctors have diagnosed mostly everyday illnesses like colds, rashes, asthma, ringworm and pink eye that account for almost three-quarters of all pediatric office visits.

The child's regular doctor is notified of each course of treatment, and any patient with a fever or a contagious disease is sent home.

"When they're really miserable, and the mom really should take time off, it lets them do that guilt-free without getting a whole lot of pressure from their boss," McConnochie said.

If a follow-up visit is recommended, said Gonzalez, an accountant, "I can just schedule it around my time and not have to drop what I'm doing. It's really cool not having to miss work."

Her 5-year-old, Myah, starts school in September, and Gonzalez has begun hunting for a telemedicine-linked school. "That would be a big reason why I would choose that particular school over another one," she said.