Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians.
BACKGROUND
Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children's subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies.


METHODS
Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained.


RESULTS
Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists.


CONCLUSIONS
Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems.
1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Kristin N
KN
Ray
1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Jill R
JR
Demirci
1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Debra L
DL
Bogen
2 Department of Healthcare Policy and Medicine, Harvard Medical School , Boston, Massachusetts.|3 RAND Corporation , Boston, Massachusetts.
Ateev
A
Mehrotra
1 Department of Pediatrics, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Elizabeth
E
Miller
D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D057286:Electronic Health Records; D005260:Female; D006297:Health Services Accessibility; D015277:Hotlines; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D000072143:Pediatricians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000458:organization & administration*; D013038:Specialization / Q000706:statistics & numerical data*; D014481:United States
communication; coordination; electronic medical record; pediatrician; physician access hotline; rural; subspecialty; telehealth; telemedicine