title: Barriers and facilitators to pediatric emergency telemedicine in the United States.
abstract: BACKGROUND
  Pediatric emergency telemedicine has the potential to improve the quality of pediatric emergency care in underserved areas, reducing socioeconomic disparities in access to care. Yet, telemedicine in the pediatric emergency setting remains underutilized. We aimed to assess the current state of pediatric emergency telemedicine and identify unique success factors and barriers to widespread use.
  
  
  METHODS
  We conducted a telephone survey of current, former, and planned pediatric emergency telemedicine programs in the United States.
  
  
  RESULTS
  We surveyed 25 respondents at 20 unique sites, including 12 current, 5 planned, and 3 closed programs. Existing programs were located primarily in academic medical centers and served an average of 12.5 spoke sites (range, 1-30). Respondents identified five major barriers, including difficulties in cross-hospital credentialing, integration into established workflows, usability of technology, lack of physician buy-in, and misaligned incentives between patients and providers. Uneven reimbursement was also cited as a barrier, although this was not seen as major because most programs were able to operate independent of reimbursement, and many were not actively seeking reimbursement even when allowed. Critical success factors included selecting spoke hospitals based on receptivity rather than perceived need and cultivating clinical champions at local sites.
  
  
  CONCLUSIONS
  Although pediatric emergency telemedicine confronts many of the same challenges of other telemedicine applications, reimbursement is relatively less significant, and workflow disruption are relatively more significant in this setting. Although certain challenges such as credentialing can be addressed with available policy options, others such as the culture of transfer at rural emergency departments require innovative approaches.
authors.affiliation: 1 RAND Corporation , Arlington, Virginia.
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
mesh_terms: D004059:Diffusion of Innovation; D004635:Emergency Medicine; D006801:Humans; D010372:Pediatrics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000706:statistics & numerical data*; D014481:United States
keywords: emergency medicine/teletrauma; pediatrics; policy; telehealth