Children's Mercy Allergy, Asthma, and Immunology Telemedicine
- Need: To increase access to an allergy/asthma/immunology specialist for children in rural Kansas and Missouri.
- Intervention: Children's Mercy Kansas City offers a telemedicine option for allergy/asthma/immunology visits.
- Results: In 2017, Children's Mercy had 338 encounters from patients in rural counties. Patients and their families report satisfaction with the telemedicine visits, which a six-month study found to be as effective as in-person visits.
Effective (About evidence-level criteria)
Children's Mercy Kansas City is a children's hospital that serves rural and urban patients in Kansas and Missouri. While the hospital is located in an urban area, its three telemedicine clinics offer 26 specialties including Allergy, Asthma, and Immunology to its rural patients, whose families would otherwise need to drive considerable distances to see a specialist.
In 2017, Children's Mercy had 949 patient encounters via telemedicine. Of these encounters, the hospital had the following number of encounters in rural areas:
- 231 encounters from patients in rural Kansas counties
- 107 encounters from patients in rural Missouri counties
An Allergy, Asthma, and Immunology telemedicine visit includes:
- Asthma action plan, which tells families, schools, day care providers, and other caregivers what to do if the child has an asthma attack
- Medication check-up
- Remote physical examination with tools like a digital stethoscope
A telefacilitator (either a registered nurse or respiratory therapist) is present with the patient to operate the remote presence solution (RPS, the telemedicine technology used at the remote clinic) and to perform any needed procedures, such as teaching inhaler techniques.
In total, the three telemedicine clinics serve about 150 rural and urban children each month. The Allergy, Asthma, and Immunology specialty alone serves as many as 30 children each month.
A six-month study of 169 children with asthma showed that a telemedicine visit using a high-resolution camera and a digital stethoscope and otoscope (for examining ears) was just as effective as an in-person visit. Most patients and their families reported satisfaction with the telemedicine visits, especially in terms of being able to clearly hear and see the healthcare professional during visits.
Missouri allows schools to act as originating sites for telemedicine (meaning that students can go to their school instead of a clinic for a telemedicine visit), so Children's Mercy staff are looking to expand their outreach efforts to schools. For the state of Kansas, Children's Mercy will be adding a regional outreach center in rural Junction City and is investigating the possibility of additional telemedicine-only sites.
For more information about program results:
Portnoy, J.M., Waller, M., De Lurgio, S., & Dinakar, C. (2016). Telemedicine is as Effective as In-Person Visits for Patients with Asthma. Annals of Allergy, Asthma & Immunology, 117(3). 241-245. Article Abstract
Kansas legislation does not support schools or homes as reimbursable places of service for telemedicine encounters for Medicaid or commercial payers. In Missouri, a doctor must be licensed in that state in order to practice there. This can be a barrier because getting licensed in multiple states can be a difficult and expensive process.
Although patient sites may rely on the credentialing body of the provider site, many small healthcare facilities have not updated their organizational bylaws to support the opportunity of telemedicine and, even if they have, the interpretations of what the patient sites need to have on file differs and often makes supportive partnerships unnecessarily difficult to establish.
Get buy-in from the providers. If physicians are sold on the idea of telemedicine, they will work to make telemedicine successful.
Put processes in place to coordinate and keep track of all that goes into setting up a telemedicine clinic, such as billing codes, contracts for outside organizations, processes to audit the billing and revenue cycle, and schedule templates. If there are not clearly defined and standardized processes, it is easy for things to fall through the cracks.
Chad Stotler, MHA, NRP, ACHE, Telemedicine Manager
Children's Mercy Kansas City
Children and youth
Chronic respiratory conditions
August 2, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.