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Is telemedicine too limited for ED use?
Although a recent study at the University of Rochester (NY) seems to indicate that telemedicine could eliminate many pediatric ED visits, a pediatric ED physician with extensive experience with telemedicine believes that its applications are not broad enough to have a significant impact on ED overcrowding.
"Our group actually worked with telemedi-cine as far back as 10 years ago," says Michael Gerardi, MD, FAAP, FACEP, director of pediatric emergency medicine and an emergency physician at Morristown (NJ) Memorial Hospital. "I think we are looking for a solution [to overcrowding], but this is not it."
While calling the Rochester research "a good, novel study," Gerardi adds that it paints a picture of parents of telemedicine patients as people who tend to use doctors more — "a bunch of 'nervous Nellies' who were coming to a doctor for nonemergency cases."
But many parents don't do that, he says. "They may think the patient really does have meningitis, or maybe they have abdominal pain, and you can't asses that with telemedicine," he notes.
Gerardi says he is doing more than just offering an opinion. "I worked telemedicine, and you certainly cannot diagnose otitis media unless the kid is really cooperative, and the only way to diagnose UTI [urinary tract infection] is to have a urine sample," he notes. Those diagnoses don't take a great deal of provider time, he adds, "but the kids need to be checked in person."
However, Gerardi says, he is not totally dismissing the potential use of telemedicine in regard to pediatric emergency medicine. "In the right hands of a big clinic like Kaiser [Permanente], which has lots of resources, you could pull some utility out of it," he notes.