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COL Charles W. Callahan, MC, USA; MAJ (Ret) Francis Malone, MC, USAR; COL David Estroff, MC, USAR; COL Donald A. Person, MC, USA

Arch Pediatr Adolesc Med. 2005;159:389-393.

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 $185 408.

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.

Author Affiliations: Departments of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, and Madigan Army Medical Center, Tacoma, Wash (Drs Callahan, Malone, Estroff, and Person).

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