President-elect candidates discuss telemedicine :

The AAP National Nominating Committee has named Michael T. Brady, M.D., FAAP, and Colleen A. Kraft, M.D., FAAP, as candidates for AAP president-elect. The winner will serve as the 2018 AAP president. Voting begins on Oct. 21 and concludes on Nov. 21.

 The candidates were asked: What are the pros and cons of the emerging trend of telemedicine?

Cincinnati, Ohio

Telehealth plays a prominent role in the future of health care delivery. I consider current applications of telehealth to represent exploration and experimentation in the use of technology for medical advice, clinical support and direct patient care.

Some examples of using technology in this manner have been extraordinarily helpful. Consider advice given when an acutely ill child presents to a small office or hospital emergency department, which is efficient and life-saving. Telehealth for acute visits performed with a school nurse using the otoscope or stethoscope provides necessary access for children in low-income areas.

Telehealth has its challenges as well. Urgent care performed at school should communicate with the child’s medical home, and I have heard pediatricians who are frustrated with this new fragmentation of care. Dangerous and disruptive examples of telehealth come from organizations that promote “24-7” access to a doctor who will provide prescription medication without examining the child. Incentives to families include convenience as well as zero co-payment for this poor use of telehealth.

Our challenge is to incorporate telehealth into our medical homes; an e-visit from a doctor to a family after hours could be helpful in triaging a rash or fever or other acute illness. Speech therapy provided via telehealth in the home could improve attendance and outcomes for children. The role of the AAP, particularly the Section on Telehealth Care, should be to identify promising practices, disseminate information on replication and advocate for appropriate payment for these service performed in a safe, family-centered manner.

Columbus, Ohio

The great promise of telemedicine for pediatricians is the creation of a kind of “digital medical neighborhood” with the medical home at the center. Primary care providers are able to link electronically with hospitals and subspecialists in many telemedicine models. But a digital medical neighborhood would enable quick consultation between the medical home and a number of essential providers such mental health, social services, nutritional services, home visitation and others.

Access to those services would be important for any medical home but is particularly valuable for primary care providers in underserved areas. In fact, telemedicine may represent the only efficient way for a primary care provider to regularly engage with those services.

If we consider that schools may also be part of this neighborhood — education professionals who spend large portions of time with children can work with the medical home to identify physical, behavioral and mental health issues — telemedicine has the potential to greatly affect overall health.

There is a risk, though, that telemedicine could fragment the medical home. A family using telemedicine for health care services that are independent of the medical home may undermine the coordination that a medical home provides and result in duplication of services.

The development of telemedicine should be driven by health care providers focused on better health outcomes and cost-effectiveness, not entrepreneurs concerned about rapid return on investment. Provider expertise and time (and appropriate compensation for that expertise and time) are crucial to enhancing care delivery and avoiding fragmentation in telemedicine.