The Prof. Dr. Juan P. Garrahan Pediatric Hospital in Buenos Aires is not only the best in the country, but one of the best in Latin America, which is why people are prepared to travel across the nation—South America’s largest after Brazil—to get to it.
Now, though, Dr. Luis Carniglia, institutional relations coordinator at Prof. Dr. Juan P. Garrahan Pediatric Hospital and the person responsible for its Reference and Counter-reference Program, wants these visits to be extended, to ease the need for travel.
Dr. Carniglia believes that the reassurance his hospital’s doctors provide to parents concerned about their children’s health could just as easily be provided by a regional doctor at a less prestigious hospital, backed up by a Garrahan specialist on a video link.
To find out more about how Cisco technology could help improve patient care with fewer hospital visits, News@Cisco caught up with Dr. Carniglia in Buenos Aires.
What are the main challenges facing healthcare provision in Argentina?
Dr. Carniglia: Argentina is a country that extends a great distance from north to south, similar in some respects to Australia or Canada, and so offers challenges in terms of being able to provide medical consultation in remote areas.
The many medical centers found in the country are mostly concentrated in Buenos Aires. Because the country is more than 3000 kilometers long, avoiding massive journeys is important in terms of human effort, productivity loss, and cost.
Another point is that as the Garrahan Hospital has become more renowned, the number of visits here has increased—and in many cases the conditions that are being treated do not merit the long journey. In fact, about 85 percent of consultations do not require a referral to our hospital.
What are the advantages of implementing telemedicine programs in a pediatric setting?
Dr. Carniglia: In 1997, 10 years after the hospital opened, we created a system dedicated to supporting remote patient consultations using phone, fax, and later e-mail.
We were also lucky enough to receive a donation of a video conferencing system, which enabled us to try out video technology, although at first we only used it for internal management meetings and so on—we had doubts about its effectiveness for patient consultations.
When we eventually did a trial, however, we saw there was a significant reduction in the number of referrals. What was happening in the provinces was that when a consultation reached a given point of complexity, patients were being referred automatically to Garrahan.
The year 2003 saw the introduction of a new system of referrals in Jujuy province, located in the northernmost tip of the country, which involved developing stronger links between us and our colleagues there.
And while there will always be a percentage of cases that cannot be resolved there—because of lack of resources or because we feel the correct treatment cannot be administered in the province—last year we realized many aspects of the work could benefit from teleconferencing.
What made you choose Cisco TelePresence technology for your telemedicine pilot?
Dr. Carniglia: We thought it would be an important measure in reassuring parents, in making them feel their consultation had been attended by one of our doctors ‘in person’.
We provide an initial diagnosis by fax and then we can follow up via teleconference to resolve any outstanding issues.
Cisco helped us to understand the value of this approach by working to understand our challenges, sharing best practice, demonstrating TelePresence and collaborating with us on building a better understanding of the value of face-to-face patient consultation.
«»About 85 percent of consultations do not require a referral to our hospital.»»
— Dr. Luis Carniglia, institutional relations coordinator at Prof. Dr. Juan P. Garrahan Pediatric Hospital
We believe this technology adds important information, enhanced by non-verbal cues, that can help the person doing the consultation.
When we provide a fax, the information is all in writing, but over a teleconference link you can mention aspects of the case that were not covered in the text. The interaction is much richer. We are sure there will be a benefit.
But where we think this will make the greatest difference is in the degree of confidence we can foster between the patient’s family and their doctor.
There are parents who want reassurance in a second opinion from a specialist in addition to the consultation from their local doctor and who have a tendency to take their kids to the Garrahan on the first train.
This system allows our colleagues who are seeing patients in the provinces to bring us ‘in’ and at the same time to provide that reassurance.
When those colleagues are seen to be supported by others it strengthens the bond they can have with their patients’ families, because the families know the doctor will consult with specialists in the event of any complication.
When people say this kind of technology puts distance between the doctor and the patient, it is completely the opposite. What we are able to do is strengthen the image of the doctor in the community. This form of collaboration is really important.
How can telemedicine—including TelePresence—help sick children?
Dr. Carniglia: In cases where it is important to see the patient, for example with dermatological problems, this will have a great impact.
We might even be able to listen to a patient’s chest with a stethoscope in the near future—the only thing we will not be able to do is touch them.
Telemedicine means children will no longer have to miss school so much because of illness, because we can treat them at their local hospital instead of them having to spend a significant amount of time away from class to be treated in Garrahan.
This also means medical treatment will be less disruptive for families and teachers.
Jason Deign
