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

320 M.M. Simonian
24.2 Communication Modes and Reimbursement
24.2.1 Face to Face Communication and the Office Visit
The traditional relationship between a family and pediatrician is in direct
consultation: a face-to-face systematic history to discover symptoms and health
problems and a physical examination to assess signs and abnormalities that corroborate
or contradict the history, provide clues to diagnoses and direct further tests.
In addition to the traditional office or clinic visit, house calls offered the pediatrician
additional information about the patient and family within the context of the
home environment.
Data collected from a patient encounter is transcribed into the patient’s medical
record for future reference. The record additionally may store other clinical and
administrative information, including written communications: sequential clinic
notes, correspondence, prescriptions, consultation reports, test results, procedure
summaries, and billing. Extended communications with patients (such as family
conferences or discussions about complex care) are usually face-to-face, as thirdparty
reimbursements are linked to specific office and inpatient encounters.
24.2.2 Telephone and Fax: Traditional Communications
Tools Facilitating Care
Telephone facilitates communication between families and pediatricians (and their
office staff) without a specific face-to-face encounter. In fact, most telephone consultations
do not require office visits (or house calls) and may be used to triage those
that do. Facsimile, or “fax,” extends the electronic power of telephone to written
communication between patients and providers (school forms) and between practitioners
and other health care professionals, such as pharmacists (prescriptions),
consultants and schools (reports) for the cost of the equipment and a telephone line.
In most cases, services linked to fax communications (prescriptions, preoperative
reports, and school forms) must be linked to a previous face-to-face encounter that
documents a history, physical examination with evaluation and management.
In other domains (such as law), fees for telephone consultation are billed
directly to clients rather than through insurance. In primary care, telephone and
fax services have traditionally been uncompensated, which, in addition to medicolegal
requirements for a bona-fide patient–physician relationship (usually linked
to a previous direct encounter) and the fact that considerable time is already spent
on the telephone, has probably contributed to resistance to promote or extend their
use in routine care. 1,2 Third-party payors, however, have begun to recognize the
value of telephone care and are beginning to reimburse it (although at rates lower
than equivalent office-based services). 3 The increasing prevalence of ICT in patient
care (including the use of electronic mail) has prompted professional organizations