Effectiveness of an internet-based store-and-forward telemedicine system for pediatric subspecialty consultation

Background: Pediatric subspecialists are often separated from the children who need them by distance, time, Or socioeconomic factors. The Electronic Children's Hospital of the Pacific is an Internet-based store-and-forward pediatric consultation system established to overcome these barriers. Objective: To characterize the use of the Electronic Children's Hospital of the Pacific and its impact on access to specialty care, the quality of the care provided, and cost savings. Design: Prospective trial Setting: Twenty-two military treatment facilities in the Pacific. Participants: Primary care providers, pediatric consultants, and 5 reviewers. Main Outcome Measures: Consult response time, physician panel review, and evacuation cost avoidance. Results: There were 267 cases from 16 sites. The mean +/- SD response time by a consultant was 32 8 hours. The panel review deemed that the initial diagnosis was changed or modified in 15% (39/267) of the cases, the diagnostic plan. was changed or modified in 21% (57/267), and the treatment plan was changed or modified in 24% (64/267) (P <.01 for all). Routine air evacuations to,a tertiary care medical center were avoided in 32 cases (12%), with an estimated cost savings of, $185408. Conclusions: The Electronic Children's Hospital of the Pacific improved the quality of patient care by providing expeditious specialty consultation. Significant cost avoidance in this military pediatric population was documented. Store-and-forward Internet-based teleconsultation is an effective means of providing pediatric subspecialty consultation to a population of underserved children.