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CASE STUDY

Jackie is a working mother of five children who works as a teacher's aide and cooks for the childcare center that her youngest two children attend. Three of her kids have asthma, and her youngest has recurrent otitis, which added together have required 15 medical visits (pediatrician, pulmonologist, emergency department) in a three-month period. As with many low-paying service jobs, Jackie does not get paid if she is not at work and feels caught in a no-win situation. She either feels guilty for being a bad mom if she doesn’t take her children in for their medical appointments or lets her family down by not getting paid when she takes off work but then doesn’t have enough money at the end of the month to pay her bills. Her childcare center director appreciates her dilemma and is excited to tell her about a new telemedicine service that will allow her children to see their primary care medical home without having to leave school or the childcare center. Jackie can now stay at work and have her kids get the medical attention they deserve. She still has to come to the hospital for her specialist visits and well-child visits but is able to schedule those for later in the afternoon after her breakfast and lunchtime duties at the childcare center are completed. So far, her youngest has avoided getting pressure equalization tubes with careful management by her primary care provider, and her older children with asthma have improved their attendance at school with better asthma control and an earlier response to exacerbations.

Children younger than 18 years of age in the United States made 127.5 million office visits in 2012 for problem-focused concerns. 1 These visits account for 75% of all office visits for children and represent the leading cause of parents having to miss time from work. 1,2 Fewer than 50% of working women in the United States believe that they can avoid conflict between family and work responsibilities the next time one of their children is sick. 2 Clearly, the social and economic burden associated with caring for ill children is substantial, but there may be opportunities to rethink how and when children receive medical care. Telemedicine offers new options for evaluating and treating children with both acute and chronic illnesses with potential efficiencies for patients, parents, providers, and payors. 3

Telemedicine models for schools and childcare centers have evolved as the technology and connectivity have improved in the new millennium. State regulations and insurance company expectations have tried to keep up with the growing direct-to-consumer telemedicine applications, and terms like “face to face” have been replaced with “real-time video interaction” to distinguish virtual connections from in-person physical interactions. The idea of telemedicine providing an “in-office equivalent” visit allows providers to choose a telemedicine platform that allows them to conduct a history and physical that is the same as what they would ...

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