Pediatric Informatics: Computer Applications in Child Health (Health ...

20 Telemedicine Applications in Pediatrics 283
For telemedicine systems that are in regular use, on-site technical support is
required and must be able to work closely with clinicians, equipment vendors, telephone
companies, and connection providers. Ideal services customize telemedicine
solutions that successfully combine real-time videoconferencing, digital reporting,
image storage and management, data base integration, prompt technical support,
and easy implementation of software updates.
Physician champions and administrative leaders are necessary to promote use of
this technology to physicians who may be resistant to change. Advocacy for any
telemedicine initiative must be active on both sides of the connection. Leadership
roles in overcoming barriers to acceptance include removal of technical, organizational
and legal blocks and administrative simplification of legal issues surrounding
telemedicine.
Medical education support is helpful in increasing adoption. The inclusion of
facilitated continuing medical education credits will improve the attractiveness of
telemedicine programs that include distance education. Additional added-value
tools will allow users to acquire and to create content, to incorporate multimedia
and to access evidence easily.
A challenge for a telemedicine practice is to generate sufficient revenue to
be self-sustaining. However, significant funding opportunities are available
( principally through federal sources), especially for programs that provide support
for underserved rural and international areas. A sustainable plan for telemedicine
must include funding for maintenance, user support and upgrading (hardware, software,
connectivity, and education content).
20.4 Pediatric Telemedicine Applications
Clinical pediatric telemedicine applications can be found in almost every
subspecialty, 8 including cardiology, 9 radiology, neurology, 10,11 neonatal care, genetics,
emergency medicine, pathology, 12 mental health, 13 hematology, oncology, 14
dermatology, otolaryngology, ophthalmology, orthopedic surgery, urology, and
general surgery. Telemedicine applications have also been developed for distance
learning, home care, correctional care, international collaboration, humanitarian
assistance, rural health, 15 military health, Native American health, pharmacy, and
consumer health.
20.4.1 Cardiology
The earliest clinical publications on tele-cardiology were reported in pediatric
populations in 1989 and 1993. 16 Live transmission of neonatal echocardiograms is
accurate and impacts positively on patient management including: facilitating timely
transport of critically ill children with heart disease, preventing unnecessary transport
(patients diagnosed not to have heart disease), improving cost-effectiveness