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Topic Suggestion Description

Date submitted: April 5, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
  • Does the availability of telemedicine services improve access to subspecialty care and address disparities in care for children who live in rural or underserved areas?
  • How can telemedicine services best be used to support the family-centered medical home?
  • How can telemedicine services improve the quality of pediatric care at the local and national levels?
  • What is the impact of telemedicine services on utilization, efficiency, and overall costs in pediatric healthcare?
  • To what degree is the variability in state licensing requirements a barrier to the provision of telemedicine services, and to what degree could overall quality of care be improved by coordinating interstate licensing for telemedicine?
  • Are there other medical liability issues that serve as barriers to the use of telemedicine?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Services provided through telemedicine versus in-person care.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Children, ages 0-21 years

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Children with special health care needs

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Telemedicine in pediatrics is the use of electronic communications technology to provide and support health care for infants, children, adolescents, and young adults when distance separates the practitioner from the patient, parent, guardian, or referring practitioner. Recent federal legislation, including the American Recovery and Reinvestment Act of 2009 and the Patient Protection and Affordable Care Act, have recognized the potential for telemedicine services to improve access to healthcare services, particularly in rural areas of the country. When those areas span multiple states, however, the need for healthcare providers to be licensed in multiple states creates a barrier to the provision of such services.

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Developmental delays, attention-deficit hyperactivity disorder, and autism
  • Pulmonary disease/asthma
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Children
Federal Health Care Program
  • Medicaid
  • State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

The Centers for Medicare and Medicaid Services (CMS) in April 2010 published a Notice of Proposed Rulemaking (NPRM) to allow the use of credentialing information from a distant site that is also Medicare-participating hospital to apply to the site of care. The NPRM was written to align with a change in standard from The Joint Commission that went into effect on July 15, 2010. While these changes reduce the credentialing burden on hospitals that wish to offer telemedicine services, they do not address the issue of state medical licensure. The result is the unrealized potential of telemedicine to increase access, address disparities in care, improve the quality of care and reduce overall healthcare costs.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The American Academy of Pediatrics Steering Committee on Clinical Information Technology and Committee on Medical Liability published a Technical Report titled, “Telemedicine: Pediatric Applications” in 2004. The Technical Report recognized the need for future research into telemedicine’s potential applications, particularly related to the following issues:

  • Family-centered medical home
  • Incarcerated youth
  • Genetics and dysmorphology (use of visual diagnosis and counseling)
  • Subspecialty distribution and access issues
  • Ethical issues
  • Educational issues (for pediatric workforce training)

Given recent developments in technology and increased federal funding to support broadband access in rural areas, an evidence report would support a revision of this Technical Report and potentially the development of a Policy Statement to provide recommendations for advocacy efforts related to telemedicine in pediatrics.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is some skepticism regarding the quality of care provided through telemedicine as compared to in-person care.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The American Academy of Pediatrics will use the results of such research to develop updated policies and educational programs for pediatricians.

Describe the timeframe in which an answer to your question is needed.

Ideally, an answer would be appreciated within 6-12 months. However, it is anticipated that any policies developed in the near future will continue to be reviewed and updated periodically.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Telemdicine is expected to improve access to care for children in underserved areas, especially where access to specialty care is limited.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The American Academy of Pediatrics will use the results of such research to develop updated policies and educational programs for pediatricians.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

I was referred through Stephanie Chang when I submitted a request for evidence review.