Every New Year, articles appear chronicling all the devices, institutions, and practices that the new generation will never know, and all the tools they will take for granted. Today’s children will never know a world where there are dial phones, pay phones, and televisions that require you to get up and walk across the room to manually turn a dial. They are living in a world of instant access to information and communication. They use computers, tablets, and smart-phones in school and in their everyday lives. Email, texting, mobile phones, and video chats are all the norm. It is not surprising, therefore, that use of technology to transmit medical information, or telehealth, is a growing force impacting the medical care of these children. As we enter an era of increased focus on health care costs and quality of care, telehealth provides solutions for increasing access, reducing costs, and improving quality of health care. However, the tools used to achieve these goals are not mysterious medical instruments that require years of training to understand. They are tools that our patients and their parents may be even more fluent with than we as their providers are.
The concept of the patient-centered medical home is critical at this juncture in health care. The core tenets are to create expanded access, better communication, and coordinated care, and to do this in partnership with the patient or family. Using the technologic tools that are familiar to them to achieve this is a very logical step, and one that will empower patients and their families to have a vital role in their own health care.
In October 2009, Pediatric Annals published an issue showcasing all the benefits of successful telehealth programs both nationally and internationally. We return to this topic now with a fresh look at how providers are partnering with patients and using telehealth technology to create solutions for the medical home. As Neil Herendeen, MD, MMM, and Prashant Deshpande, MD, FAAP, will discuss, advances in technology are what led care to shift away from the patient’s own home and become centralized in large, state-of-the-art medical centers. Now, with the development of the medical home, there is a need for care to be brought back to the patient, rather than requiring the patient to travel for care. The use of telehealth presents the perfect tool to help achieve this. When it comes to the care of children, a great need exists to bring care to where they are — not only at home, but in school systems, as well. Stephen W. North, MD, MPH, and his colleagues show us how integrating telehealth into school-based health care can help integrate comprehensive care with children’s own providers, as well as with many needed community services. As we move forward with these concepts designed to help bring care to the patient, it is important to remember that the care should be a partnership between patients and their providers. Designing care in such a way as to empower patients to set goals, gain knowledge, and participate in decisions also requires that we use tools that patients will readily embrace. Michael R. Slaper, MHSA, and Kimberly Conkol, RN, BSN, discuss how mobile health (mHealth) devices can be designed in such a way to meet that goal. When the care of the patient extends into the in-patient environment, S. David McSwain, MD, MPH, and James P. Marcin, MD, MPH, explain that telehealth is a valuable tool in bringing together providers, patients, and families in some of the most critical situations. Importantly, telehealth tools also help integrate the critical component of the primary care provider when a patient is hospitalized. The vital role of patients, their families, and the entire in-patient staff in designing care is beautifully illustrated by Stephen Minton, MD, and his team in their unique approach to integrating telehealth into a neonatal intensive care unit. Finally, a practical illustration of how the medical home can be integrated with subspecialty practice is featured by Felissa Goldstein, MD, FAPA, and Kathleen Myers, MD, MPH, FAACAP, as they show us how to bring subspecialty care of psychiatry into the primary care doctor’s office, with the benefits of increased access to services and improved coordination of care.
The goal of resdesigning the health care system is to bring the patient back to the center of everything we do. Telehealth is a valuable tool to achieve these goals in a manner that is cost-effective and efficient. Although many types of technology exist, it is really not about the technology at all. It is about the patient and creating a home that is comfortable, safe, and meets all of their needs.