title: Care Offered by an Information-Rich Pediatric Acute Illness Connected Care Model.
abstract: Prevailing regulatory and financing issues constrain dissemination of connected care despite evidence supporting acceptability, effectiveness, and efficiency. In this analysis we describe care provided over a 12-year period by Health-e-Access, an evidence-based, information-rich, connected care model designed to serve children with acute illness. We demonstrate the broad clinical capacity of this care model and key components imparting this capacity.
  
  
  
  Since 2001, Health-e-Access has been used in childcare, elementary schools, neighborhood after-hours sites, and a school for children with severe disabilities in Rochester, NY. With Health-e-Access, videoconference (preferably) or telephone enables parent, patient, and provider engagement. Technology includes the capacity for acquisition and exchange of a broad range of clinical observations, qualifying Health-e-Access as an information-rich model and differentiating it from multiple other connected care models commonly labeled telemedicine. Primary diagnoses recorded for completed visits were classified according to resources (technology, personnel, examination type) required to complete encounters appropriately.
  
  
  
  Among 13,812 Health-e-Access visits initiated through June 2013, 98.2% were completed. Capacity for ear-nose-throat examination and close inspection of eye and skin were sufficient to identify positive findings supporting 95.2% of primary diagnoses. Videoconference and stethoscope were considered essential for observations required to rule out serious conditions often presenting in similar fashion to these 95%.
  
  
  
  Health-e-Access included technology essential for establishing diagnoses, ruling out more serious conditions, and identifying problems beyond its scope. Regulations enabling and financing incentivizing replication of similar connected care models would benefit families and communities substantially. Observations challenge regulatory bodies and payers to support connected health services of comparable value.
authors.affiliation: 1 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: McConnochie
authors.affiliation: 2 Emergency Medicine Research, University of Rochester , Rochester, New York.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Wood
authors.affiliation: 1 Department of Pediatrics, University of Rochester Medical Center , Rochester, New York.
authors.forename: Carol
authors.initials: C
authors.lastname: Alarie
authors.affiliation: 3 The Center for Child Health and Policy, Case Western Reserve University School of Medicine and UH Rainbow Babies and Children's Hospital , Cleveland, Ohio.|4 Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine and UH Rainbow Babies and Children's Hospital , Cleveland, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ronis
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D039602:After-Hours Care / Q000458:organization & administration; D002648:Child; D002654:Child Care / Q000458:organization & administration; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010358:Patient Participation; D019114:Remote Consultation / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration; D013689:Telephone; D049269:Videoconferencing / Q000458:organization & administration*; D055815:Young Adult
keywords: information management; pediatrics; policy; telemedicine