This case study examines the TeleStroke telemedicine program and evaluates the feasibility of expanding its services to pediatric patients. The paper considers the financial, logistical, and regulatory challenges of broadening a highly specialized stroke consultation platform into a more general pediatric care setting. Four possible courses of action are weighed, and the paper argues that creating a formal institutional proposal — encompassing budget, scope of services, provider roles, and appropriate case selection — is the most prudent path forward. The analysis draws on Gogan and Garfield's (2012) case research to support its conclusions.
The TeleStroke platform at the hospital has been successful under the direction of Shawn Farrell because its scope and procedures were extensively researched before they were implemented. Rapidly expanding the telemedicine offerings at the hospital is not something that can be done easily; each new project and department will require an equal amount of research and development.
First and foremost is the concern that the expanded use of telemedicine in pediatrics might not be financially feasible. Emergency pediatric conditions are less common than stroke and may not justify the cost (Gogan & Garfield, 2012, p. 9). Additionally, the checklist for stroke consultations is far less complicated than it would be for a broader array of pediatric concerns. Because stroke represents a single condition, pricing for a consultation may be far easier to determine than it would be for a general range of pediatric cases.
Even the existing stroke consultation system required extensive analysis of participating hospitals, the likely number of cases, and other data to ensure that care was adequately compensated. It is uncertain whether comparable data can be compiled for a pediatric department. There is also concern about balancing the use of telemedicine technology between stroke victims and pediatric patients, which could necessitate difficult triage decisions.
Merely denying the nurses' request (Action A) to explore the possibility of using telemedicine to treat pediatric patients is unwise, given the potential to do much good and to potentially generate profit from offering such services. However, Action B — assuming a consulting position — is not currently feasible, as Farrell lacks the full range of knowledge necessary to augment current services. Those services were specifically designed to offer a very particular form of care to a very particular type of patient.
Even if cost and workflow allocation issues were resolved, whether telemedicine is feasible as a general service for pediatric patients remains uncertain, and more research is needed. The field is also still maturing, and more data than simple anecdotal evidence may be required to satisfy current regulations and insurance requirements. Contacting a manager at Partners' Center for Connected Health, another option considered, does not address the central concerns of the case — namely, whether hospital administrators can fund the new service and how the workload of pediatric intensive care specialists would be managed.
Of all the options, Action D — doing the necessary work to create an institutional proposal to augment telemedicine consultation — appears to be the most desirable. This proposal should include a budget, likely costs, the full range of services to be offered, and the roles of all involved service providers. There should also be a discussion of which conditions are not appropriate for telemedicine treatment.
"Formal proposal answers key unanswered questions"
Gogan, J. & Garfield, M. (2012). Telemedicine: Opportunity or distraction? Case Research Journal, 32(2): 1–19.
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