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

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prior to case discussions and live review using tele-microscopy is available. CNMC
has provided second opinions in this manner for a hospital in Saudi Arabia.
20.4.3 Radiology
Picture Archiving and Communication Systems (PACS) provide access to imaging
studies throughout many hospitals in a “store and forward” format. Physicians can
review and interpret studies remotely through virtual private network (VPN) connections.
Many physicians worldwide now practice radiology exclusively in this
manner and some practices and hospitals are outsourcing official interpretation
(and billing) of imaging studies to physicians in other countries half way around the
world. At CNMC, radiology is one of the largest users of telemedicine technology
and will continue to increase with the vast increase in use of digital radiology.
20.4.4 Multispecialty Pediatrics
Interpretation of echocardiograms, EEGs, and x-rays have been very successful
telemedicine models, in part because they are based on tests that lend themselves
to telemedicine and are directly reimbursable. However, the need for subspecialty
consultation for infants and children at community hospitals extends to
other subspecialties by teleconsultation. 23 CNMC has established a multispecialty
tele-consultation program with one hospital in suburban Maryland. Digital x-rays,
photographs, video clips, along with a digital medical record that includes history,
physician notes and laboratory tests can be stored and forwarded from a
telemedicine unit at the remote site to a unit at CNMC. A telemedicine consult
coordinator then contacts the appropriate physician to review the case and create
an electronic opinion. A digital medical record is created and can be accessed if the
patient is transferred or returns for outpatient evaluation.
Several specialties including genetics, general surgery, urology, neurosurgery,
and orthopedic surgery are available. Store and forward is ideal for most of these
cases, but live consultation to talk with the family and look at the patient can be
useful, especially for genetic syndromes. Reimbursement for second opinion consultations
are much more difficult to obtain from insurance providers. To sustain
this type of program a contractual agreement with annual fees per specialty service
exists between the two hospitals.
20.5 International Programs
Telemedicine has had a major impact on CNMC’s ability to provide support for
our international partners. CNMC has international partner hospitals in three categories:
charity programs (Morocco, Uganda, Iraq, Serbia/Kosovo), military programs