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Children's Mercy Allergy, Asthma, and Immunology Telemedicine

Summary 
  • 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 2018 to date, Children's Mercy has had 320 Asthma/Allergy/Immunology encounters from patients in rural counties. Patients and their families report a 98% satisfaction rate with the telemedicine visits, which a six-month study found to be as effective as in-person visits.

Evidence-level

Effective (About evidence-level criteria)

Description

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 four telemedicine clinics offer 35 specialties and services including Allergy, Asthma, and Immunology to its rural patients, whose families would otherwise need to drive considerable distances to see a specialist.

In 2018, Children's Mercy has had 1,500 patient encounters across all specialties via telemedicine. Of these encounters, the hospital had the following number of encounters in rural areas:

  • 433 encounters from patients in rural Kansas counties
  • 184 encounters from patients in rural Missouri counties

Services offered

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 tele-facilitator (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.

Child receiving Allergy, Asthma, and Immunology telehealth service

Results

In total, the four telemedicine clinics serve about 200 rural and urban children each month. The Allergy, Asthma, and Immunology specialty alone serves as many as 50 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 has added 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

Barriers

In recent months, Kansas and Missouri legislatures have expanded the approved and billable originating sites to include a broader range of places. However, the new rules and regulations have not been fully interpreted and implemented. In Kansas and Missouri, a doctor must be licensed in that state in order to practice medicine 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.

Replication

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.

Contact Information

Chad Stotler, MHA, NRP, ACHE, Telemedicine Manager
Children's Mercy Kansas City
816.234.9494
ccstotler@cmh.edu

Topics
Children and youth
Chronic respiratory conditions
Telehealth

States served
Kansas, Missouri

Date added
August 2, 2017

Date updated or reviewed
August 30, 2018


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.