Virtual Care: Arkansas Childrens Hospital to pilot pediatric telemedicine around the state

A growing population and shortage of physician specialists has Arkansas Children’s Hospital looking at technology as a way to bridge the gap, particularly in rural areas.

Dr. Robert Steele, a pediatrician and chief strategy officer for ACH, is passionate about the possibility telemedicine holds. Steele defines telemedicine broadly as using video and audio conferencing to accomplish a doctor-to-doctor or a doctor-to-patient meeting. He believes telemedicine will be an effective way of delivering care to remote Arkansas areas. ACH delivers care to children in all 75 counties of Arkansas.

Laying the foundation for telemedicine doesn’t come cheap. Steele said ACH has invested about $500,000 in the past year on infrastructure to deliver telemedicine from the Little Rock hospital, and in about a year that will connect to ACH Northwest when the hospital opens in Springdale in January 2018.

Steele said ACH is piloting a telemedicine program to deliver pediatric care in public schools with a higher than average level of economically disadvantaged students — referred to as a Title 1 school. The program is funded by two federal grants valued at $700,000. ACH Foundation plans to raise $300,000 in matching funds for the program that will connect 42 schools during the next three years.

In-School Pilot
Angie Grant Elementary in Benton is the first school connected. Steele is the pediatrician for the school and is on-call for any medical situation that might arise. For instance, if a child goes to the nurse with a sore throat, the nurse can dial up Steele on video. Using the nurse, Steele can diagnose the issue with help of special cameras that allow a close look at the child.

He said the parent has to give consent to see a child by telemedicine, and in most cases the parent can dial into the exam and see and hear everything that happens. If a prescription is needed, Steele calls a pharmacy of choice for the parents.

“A recent patient I diagnosed at Angie Grant needed a prescription but wasn’t contagious and could remain at school,” he said. “The parent didn’t have to leave work and take her to the doctor. The parent was able to pick up the prescription after work and told us it was her first day at her new job. She was grateful not to have to ask for time off and still have their child’s medical needs attended to.

“Another student had a rash, but it wasn’t contagious. Her mom was a teacher at the same school, and the telemedicine also meant that the mom [and] teacher could also remain at school that day.”

Northwest Arkansas
When asked if Northwest Arkansas was in the targeted area, Steele said Kathy Grisham, executive director of Springdale-based Community Clinic, was already working with school clinics in local Title 1 schools.

“There is no need for us to duplicate services, but outlying areas of Madison and Carroll counties are in our targeted area,” Steele said. “Perhaps ACH might be able to work with Community Clinic in Northwest Arkansas in the future should a specialist be needed.”

Community Clinic operates seven local in-school clinics. Grisham said there are three in Springdale at Jones, Elmdale and George elementary schools, one in Fayetteville at Owl Creek Elementary and one in Prairie Grove, Lincoln and Siloam Springs.

“These in-school clinics provide medical care for kids that might otherwise fall through the cracks,” she said. “They are staffed with an APRN [Advanced Practice Registered Nurse] who collaborates with a physician and can diagnose and prescribe medicine on their own. The APRN can take medical care beyond that of a traditional nurse.”

Lagging Law
Grisham likes the idea of using telemedicine in each of the Community Clinics, but state laws have not caught up with the technology. There is now no method for reimbursement, and that doesn’t work with the CC model. But she applauds the work Steele is doing with federal grants because laying the groundwork is important for when the laws do catch up.

Under previous Arkansas regulations, patients could not be treated virtually unless they already had an in-person visit with that doctor. In August, the Arkansas Rules and Regulations Subcommittee of the Arkansas Legislative Council approved the Arkansas State Medical Board’s amendment of Regulation 2.8. It now allows the use of real-time audiovisual technology for the first-time establishment of the doctor-patient relationship, rather than requiring the doctor and patient to first meet in person.

However, Steele said laws need more updates to better facilitate telemedicine. The American Telemedicine Association has ranked Arkansas last among all states for its telemedicine practice standards. He said the ACH pilot program can only be optimal if the necessary laws get passed by state legislature.

“We have the confidence the law will catch up. For now we are running this program just like any other in terms of payment for our services. The most challenging aspect with the school program is securing the necessary consent forms. The school administration has to be willing to help with that process,” Steele said.

From his iPad or his phone Steele can conduct a telemedicine visit as long as he is in a HIPAA compliant place. Steele said that can be challenging in rural areas. He said the school pilot program also requires that pediatricians are willing to sign on as the school doctor in the targeted areas.

Other Applications
Steele said there are other ways telemedicine can be used by ACH. He said children in Northwest Arkansas who have had urology surgery at ACH in Little Rock could get a postoperative visit via telemedicine at the ACH clinic in Lowell. Steele said this saves a family from making a three-hour trip to Little Rock for a routine visit.

Steele believes telemedicine could eventually be the norm for managing chronic diseases like diabetes in remote areas like south Arkansas, where there is a higher-than-normal diabetic rate and fewer doctors per capita. Steele believes telemedicine will also be helpful to doctors in local emergency rooms.

“Emergency room doctors tell us they see lots of children, and rather than err on diagnosis, they don’t hesitate to send them to Arkansas Children’s in Little Rock,” he said. “Telemedicine could help the local emergency room doctors assess the children with the help of a pediatric specialist in Little Rock regardless of time day or night.”