When a child comes into the emergency room at Children’s Hospital in Birmingham with a febrile seizure, it’s an everyday occurrence. But in a rural hospital where there may be no pediatric specialists in the ER, these usually harmless convulsions, triggered by a sudden spike in body temperature, can be pretty scary. Children’s is setting up an unusual telemedicine program in its emergency department to help rural hospitals with pediatric emergency visits. While Children’s ER doctors already field phone calls from their counterparts in other hospitals, the new system will provide high-definition television cameras and screens that will allow real-time videoconferencing via the Internet. “Now, we talk on the phone, and it’s hard for us to get a good mental image of what the patient looks like,” said Dr. Jennifer McCain with the Children’s Hospital Emergency Department, who is heading up the project. “In pediatrics especially, there are a lot of subtleties in how the patient appears that you can get from looking at the patient and from interacting with the family and asking some basic questions.” Children’s, the fourth-busiest pediatric medical center in the United States, has the busiest pediatric emergency room in the Southeast, with nearly 50,000 emergency department visits last year. However, the number of ER-trained pediatric physicians across the state is very low, McCain says. The doctors taking care of patients in the ERs aren’t necessarily trained in taking care of children, often being internists or general practitioners. As a result, she says, it’s not unusual for rural ERs to send young patients to Children’s Hospital. Many times, it turns out that’s not necessary, and after driving several hours, families are sent back home after a short exam. Dr. Peter Glaeser, Medical Director of the Children’s Hospital Emergency Department, was interested in using telemedicine in the ER because he had seen so much frustration on the part of families who didn’t need to come so far. “We also have a lot of chronic kids out there who see our specialists here that may look very sick on their best days,” McCain says. “So if they go to their ER for a pretty minor thing, it could look pretty scary to a physician not used to taking care of children with chronic medical conditions. If we can see them [via the telemedicine system] and see their CAT scans or MRIs and compare it to the records we have here, we may be able to say, ‘Let them go home and keep their regularly scheduled appointment next week.’” Of course, there are times when emergency patients need to be transferred, and the telemedicine system can help with that process, as well. “There are plenty of cases of kids who are in a trauma or seizure or something pretty serious, and we can help resuscitate the kid, and get them to start doing certain things, get us certain tests, while our transport team is on the way,” McCain said. While telemedicine is becoming more common in pediatrics, especially for allowing children in outlying areas to “see” pediatric specialists, using it in an emergency room is more unusual. “We’re trying to emulate the University of Mississippi Medical Center in Jackson,” explained Justin Fincher, Children’s audiovisual engineer. “They’re doing this, but it’s on an adult basis. I believe we’re one of the first in the pediatric field to try to do this.” The schedule calls for the program to be up and running by next spring, initially connecting four hospitals (in Boaz, Alexander City, Sylacauga and Demopolis) to the Children’s ER. There’s a lot of testing to be done between now and then. Children’s will be using Polycom high-definition (HD) HDX video solutions, the same system being used by Medical Missions for Children to implement a Telemedicine Outreach Program in more than 100 countries. At Children’s Emergency Department, there will be a room outfitted with a high-definition plasma TV screen and a camera and microphones for doctors to use when doing these long-distance consultations. The outlying hospital ERs will have a small HDX cart that can be rolled into the examination room and plugged into a high-speed Internet connection. It also includes connectivity to medical peripheral devices so diagnostic and monitoring information can be sent in real time. The high-definition aspect of the technology is important, Fincher says. “The difference between standard-definition TV and high-def is day and night. If our doctors have to look at lesions or some kind of cut or burn, that can make a world of difference.” The first step in getting the telemedicine system implemented involves testing internally, making sure the setup at Children’s Emergency Department works and testing it with one of the remote HDX carts in a patient sim room in the hospital. That should be done by the end of the year. The next step is to do a test outside of the Children’s Hospital network, perhaps at UAB, then another test at an outlying Children’s Hospital facility, such as Children’s South on Altadena or one of the pediatric offices in the Children’s Health System network. Only after they make sure the technology works in those scenarios will they start testing it with the outlying hospitals involved in the program. There are some technical challenges involved, Fincher says, including the speed of the rural area Internet networks, and coordinating with hospitals with minimal or even outsourced IT staffs. On the medical side, McCain says, they will have to deal with the question of how to staff this project when it expands to a larger number of outlying hospitals in the state. December 2007