But there are tradeoffs. Take technology: Cash-strapped hospitals must invest in the necessary equipment, then train enough staff in its use.

“You can’t just flip a telemedicine ‘switch,’” says Gogan. “Hospital administrators tend to underestimate the amount of training needed for people to get comfortable with the technology. There’s also a lot of advance effort required to change clinical processes and practice those new processes as a team. For example, if a critically ill patient must be seen quickly by the hub hospital specialist, then the patient intake process needs to be revised.”

Another reality is that once community hospitals gain expertise in caring for critical pediatric patients, they become more confident and use telemedicine less. While having that knowledge is a plus for those hospitals and their patients, the consequence is investing significantly in technology that may be used for only a short time.

The business concerns extend to the reimbursement of off-site doctors, which remains an open question. Moreover, telemedicine specialists need practice privileges at the community hospitals — a problematic scenario, particularly when collaborations cross state lines.

“Telemedicine is still largely handled on a state level,” says Gogan. “So doctors would have to hold licenses in each state and be credentialed at each participating hospital.”

Real Life, Real Practice The Bentley team hopes that, ultimately, its work will help save more patients like little Joey.

“By identifying both the business and the nonbusiness issues of telemedicine, these studies should help hospitals reduce costs, improve the interactions of virtual teams, and improve patient care,” says Gogan, noting that the team has written a working paper and submitted several papers for presentation at conferences. Two papers are under review at journals.

“A lot of academic research tends to be more theoretical,” adds Baxter. “But this is real life, real practice. I have four children, and if I ever need to take them to a community hospital in an emergency, I would want that hospital to have telemedicine capabilities and to do it well.” Maura King Scully

synchronous, where health care providers and patients

in different locations interact in real time by phone or video;

and asynchronous, where remote providers review patient data

captured at an earlier time.

Synchronous telemedicine, which the Bentley team studies, is vital in

situations where a patient is critically ill and treatment decisions must

race against the clock. Asynchronous telemedicine is likely to benefit

a far larger population of patients. One common application

enables surgical patients to recuperate at home where,

studies show, they recover more quickly and avoid

complications from hospital-born infections. Home health

agencies install specialized modems connected to a

scale, blood pressure cuff and digital thermometer.

Patients receive an automated phone call at

regular intervals that guides them through a

vital-sign check. Off-site nurses review the

readouts and can call patients or send a

visiting nurse if the readings are amiss.

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OBSERVER