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NCE plenary speaker lays out pros, cons of telehealth :

November 9, 2015

Telemedicine can help pediatricians reach patients in underserved areas, but experts say it also raises questions about quality of care when used outside the medical home.

James Marcin, M.D., M.P.H., FAAP, chief of pediatric critical care at UC Davis Children’s Hospital, discussed the issue during a plenary address at the AAP National Conference & Exhibition titled “Online Virtual Pediatric Providers: Warp Speed in the Wrong Direction.”

“I do think while there are threats to this technology and how it’s being used, there are also opportunities and it’s incumbent upon us, we have the opportunity to do the right thing, to … be able to use this technology in the medical home as opposed to outside the medical home,” he said.

Last year, there were roughly 20 million telehealth consultations, which could rise to more than 150 million by 2020, according to Dr. Marcin, a member of the AAP Sections on Telehealth Care, Critical Care, and Advances in Therapeutics and Technology.

Telemedicine has the potential to provide effective, timely and equitable care for patients.

“When we’re able to reach those living in rural or underserved communities, the potential for telehealth is very very good,” Dr. Marcin said.

However, major insurance companies, retail-based clinics and commercial telehealth providers all have started using a direct-to-consumer telehealth care model in which they connect people to doctors that typically aren’t their primary care providers.

Dr. Marcin said convenience and cost savings make this model attractive to patients and payers.

“If you’re able to do this and avoid a visit to the emergency department, urgent care clinic or primary care provider’s office, the payers of health care are going to save money,” he said.

Proponents estimate that savings could total $6 billion if health care visits that didn’t need to be addressed in person were done using this technology instead.

These direct-to-consumer telehealth provider say they can treat a variety of ailments, including colds, influenza, bronchitis, ear infections, yeast infections, sore throats, asthma and rashes, but Dr. Marcin is skeptical about diagnosing some without a physical exam.

“Even as an intensivist, I occasionally use my stethoscope,” he said drawing a laugh from the crowd.

These providers also may be limited in their access to medical records and diagnostic testing, and the findings often aren’t communicated with the primary care provider.

Several studies have found overprescription of antibiotics by direct-to-consumer telehealth providers, although data are limited.

Earlier this year, “use of telehealth to extend the pediatric medical home” ranked third on pediatric leaders’ list of priorities at the Academy’s Annual Leadership Forum.

“We have to organize ourselves to be able to do this in an effective manner,” Dr. Marcin said.

He has seen his own hospital use the technology to help a mother in the Sierra Nevada breastfeed her baby with a cleft lip and palate. Palliative care providers also have used it to see bed-ridden children in their own homes.

However, there also are hurdles like convincing insurance companies to pay for physicians to see their own patients virtually.

For more advice, he pointed pediatricians to two AAP reports released earlier this year:

  • the technical report from the Section on Telehealth Care titled Telemedicine: Pediatric Applications,, and
  • the policy statement from the Committee on Pediatric Workforce that he authored titled The Use of Telemedicine to Address Access and Physician Workforce Shortages,
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