McConnochie Kenneth M, Wood Nancy E, Alarie Carol, Ronis Sarah
1 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
2 Emergency Medicine Research, University of Rochester , Rochester, New York.
Telemed J E Health. 2016 Jun;22(6):465-72. doi: 10.1089/tmj.2015.0161. Epub 2015 Dec 24.
Prevailing regulatory and financing issues constrain dissemination of connected care despite evidence supporting acceptability, effectiveness, and efficiency. In this analysis we describe care provided over a 12-year period by Health-e-Access, an evidence-based, information-rich, connected care model designed to serve children with acute illness. We demonstrate the broad clinical capacity of this care model and key components imparting this capacity.
Since 2001, Health-e-Access has been used in childcare, elementary schools, neighborhood after-hours sites, and a school for children with severe disabilities in Rochester, NY. With Health-e-Access, videoconference (preferably) or telephone enables parent, patient, and provider engagement. Technology includes the capacity for acquisition and exchange of a broad range of clinical observations, qualifying Health-e-Access as an information-rich model and differentiating it from multiple other connected care models commonly labeled telemedicine. Primary diagnoses recorded for completed visits were classified according to resources (technology, personnel, examination type) required to complete encounters appropriately.
Among 13,812 Health-e-Access visits initiated through June 2013, 98.2% were completed. Capacity for ear-nose-throat examination and close inspection of eye and skin were sufficient to identify positive findings supporting 95.2% of primary diagnoses. Videoconference and stethoscope were considered essential for observations required to rule out serious conditions often presenting in similar fashion to these 95%.
Health-e-Access included technology essential for establishing diagnoses, ruling out more serious conditions, and identifying problems beyond its scope. Regulations enabling and financing incentivizing replication of similar connected care models would benefit families and communities substantially. Observations challenge regulatory bodies and payers to support connected health services of comparable value.
尽管有证据表明关联式医疗具有可接受性、有效性和效率，但现行的监管和融资问题限制了其推广。在本分析中，我们描述了Health-e-Access在12年期间提供的医疗服务，这是一种基于证据、信息丰富的关联式医疗模式，旨在为患有急性疾病的儿童提供服务。我们展示了这种医疗模式的广泛临床能力以及赋予这种能力的关键组成部分。
自2001年以来，Health-e-Access已在纽约州罗切斯特市的日托中心、小学、社区非工作时间场所和一所重度残疾儿童学校中使用。通过Health-e-Access，视频会议（最好是）或电话实现了家长、患者和医疗服务提供者之间的互动。该技术具备获取和交换广泛临床观察结果的能力，使Health-e-Access成为一个信息丰富的模式，并使其有别于其他通常被称为远程医疗的多种关联式医疗模式。根据完成诊疗所需的资源（技术、人员、检查类型），对已完成就诊的主要诊断进行分类。
在截至2013年6月发起的13812次Health-e-Access就诊中，98.2%完成了诊疗。耳鼻喉检查以及眼部和皮肤的仔细检查能力足以识别支持95.2%主要诊断的阳性结果。视频会议和听诊器被认为对于排除通常以类似方式出现的严重病症所需的观察至关重要，而这些严重病症占95%。
Health-e-Access包含了用于确立诊断、排除更严重病症以及识别超出其范围问题的必要技术。能够使类似关联式医疗模式得以复制并提供融资激励的法规将极大地造福家庭和社区。这些观察结果促使监管机构和支付方支持具有同等价值的关联式健康服务。
