Telemedicine is expanding rapidly and there and every year there are additional proposals to further expand its use. Many of the opponents question whether the quality of care will suffer via telemedicine. Telemedicine has been shown to be of value in remotely assessing psychiatric patients, radiological studies, and dermatological conditions. Previously many opponents also argued the technology was inadequate, expensive, difficult to use and unreliable. With recent advances and wide spread use of inexpensive technology, many of these arguments may not be valid.
This study in the March 2016 issue of Pediatrics by physicians at Yale University looked how well physicians were able to assess patients via telemedicine versus beside. Specifically they employed telemedicine to diagnose seriously ill children with fevers and respiratory distress and they found they did almost as well as clinicians who were bedside, according to a prospective observational study published online February 5 in Pediatrics.
This study used the [Yale Observation Scale] YOS to predict serious underlying illness of respiratory distress and fever in pediatric patients, thought to one of the more difficult populations to evaluate. They used iPads with readily available FaceTime apps “to study a technology that is economically feasible to acquire and has greater potential for widespread implementation.”
This study demonstrated a high degree of reliability between telemedicine and the bedside evaluation of patients. The highest degree of agreement between bedside and telemedicine observers was with the clinical impression of respiratory distress and lowest with intercostal retractions. The authors surmise that perhaps low camera speed was an issue.
This article certainly supports the viability of telemedicine in evaluating seriously ill pediatric patients.
The YOS tool assigns each item a score ranging from 1 to 5; cumulative scores higher than 16 predict such serious illness as pneumonia and meningitis.