Daycare for young children is a necessity for millions of working parents around the United States. But children with common childhood ailments are not welcome. Before they can return to daycare, parents must often leave work and spend hours taking their children to a doctor. In Rochester, New York, a group of daycare centers and a hospital are working to let children see a doctor without having to visit the doctor's office. It's done over the Internet, by a process called telemedicine.
Four-year-old Michaela Leer has an earache. She's being examined by a pediatrician. But instead of sitting in his examination room, the patient is in a room at the Volunteers of America Daycare Center, facing a small TV camera ? and the doctor is in his office across town at Strong Memorial Hospital's Golisano Children's Center.
Each can see the other, and as the daycare center's nurse handles the examining instruments, those instruments send the data to the doctor's computer screen, which displays what he'd see if Michaela were in his office.
Doctor Neil Herendeen of the Golisano Children's Hospital says children at this daycare center don't have to be sent home just because they have an earache or pinkeye. "On average, parents are finding it's about four hours less work time missed for these acute illnesses like pinkeye, like a fever, like an ear infection," he says. "That they don't have to then miss as much work. They can have the prescription waiting for them. It really streamlines that whole process."
Doctor Herendeen is the Medical Director for the Rochester Child Care Telehealth Access Network. It now links three daycare centers around the city to the hospital through the internet.
From his office, Dr. Herendeen can talk with sick children at any of the internet-wired centers. With a daycare nurse as his remote assistant, He can examine the youngsters? hear what a stethoscope hears?and peer into ears and eyes through an otoscope. He can record sounds and pictures, enhance them, and store them with a child's medical files like one on the screen in his office. "That's actually a great picture," he says. "It's a nice, shiny looking eardrum. There's no sign of an ear infection. He has a little pinkeye, but that's something we can now call in a prescription to the local pharmacy, and mom can pick that up so there's no extra stop along the way."
Each daycare center in the system has set up a telemedicine room. Each room has about 30-thousand dollars' worth of special equipment, which was paid for with a government grant. Daycare staffers, like Nurse Demina Stewart at the Volunteers of America center, take a 15-hour training course to learn to use the system. After that, they become the doctor's hands. "Looking in the ears and taking pictures for the Doctor to see. And we're here at the VOA (Volunteers of America), and he's at strong live," she says. "And all we have to do?it would be directed by the doctor?is just take the pictures."
Telemedicine has made a big difference at the Volunteers of America Childcare Center. Its Executive Director, Pam Taylor, says she'd never give it up because it makes life easier for her clients and her staff. "The staff aren't all up in arms that there might be a sick child. They're not as concerned as they normally would be, because when a child gets sick, staff gets concerned. That's their job," she says. "To have somebody right here immediately who can look at a child through the equipment and find out if they're really ill or moderately ill or what we need to do, it just makes all the difference in the world for the staff."
And for parent John D'Armiento, whose 5-year-old daughter spends her days at the Volunteers of America Center, telemedicine has been a blessing. "There's no lost time for me. I'm not bringing a sick child from here, upset, to an office to wait in an office an hour and a half sometimes," he says. "She's here. If she's diagnosed contagious, she goes home. If not, she stays here where she feels safe with her friends; her teachers"
The telemedicine room at the Volunteers of America center sees 20 to 30 children a week. The center's management says nine times out of ten, children complaining of an ailment can be dealt with through the telemedicine project, so their parents didn't have to leave work to rush them to the doctor or emergency room, saving families time and money.
Before the project began, two to four percent of the children at the three participating centers had to be sent home each day with a possibly contagious illness. Now, that rate has been cut to less than one percent.
On the strength of those results, Doctor Herendeen says the system is about to expand. "We're just confirming funding from a national source that's going to be matched?local dollars being put into this program will be matched from a national center as well. And that's will allow us to go up to eight more daycare centers. And then what we really hope to do is start bringing on more doctors' offices," he says. "So that it's not just one place, but if you're in a childcare center that's linked up to the Internet like we are, then you can link to your own doctor and have that visit done by your own doctor."
Neil Herendeen is also studying the quality of care children get from these virtual trips to the doctor compared with the real thing. So far, he says there's been little or no difference in the correct diagnosis of common childhood illnesses.