Cover: Barriers and Facilitators to Pediatric Emergency Telemedicine in the United States

Barriers and Facilitators to Pediatric Emergency Telemedicine in the United States

Published in: Telemedicine and e-Health, v. 20, no. 11, Nov. 2014, p. 1-7

Posted on 2014

by Lori Uscher-Pines, Jeremy M. Kahn

Research Questions

  1. What is the current state of pediatric emergency medicine?
  2. What factors promote or hinder its success?

BACKGROUND: Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use. MATERIALS AND METHODS: We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States. RESULTS: We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1–30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites. CONCLUSIONS: Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.

Key Findings

  • Some challenges to pediatric emergency telemedicine are common to all telemedicine applications - e.g., credentialing, lack of provider buy-in, misaligned incentives, and technology problems.
  • In addition, telemedicine is seen as interrupting the workflow in a busy ED.
  • Small rural hospitals have a culture of transferring patients to regional centers of excellence.
  • Lack of reimbursement did not appear to be a major barrier.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.