Login to Access Video or Poster Abstract: MP32-02
Sources of Funding: None

Introduction

Limited research is available evaluating utilization of telemedicine (TM) in pediatric urology. The Pediatric Health Information System (PHIS) database is comprised of claims data from 49 of the largest children’s hospitals in America, providing an opportunity for analysis of the current utilization of TM in pediatric urology.

Methods

Clinical Transaction Classification^TM (CTC) is a proprietary system used by PHIS to categorize hospital billing for clinical, imaging, laboratory, pharmacy, supply, and other services in which Clinical Service Code 599120 is designated for TM. The PHIS database was queried for all patients 18 years of age and younger with CTC 599120 occurring between 2009-2016 for all clinical services using TM including pediatric urology. Variables collected include patient age group, patient ethnicity, clinic subspecialty, principal diagnosis, primary source of payment, and location of clinic. The number of telemedicine episodes observed for our institution and clinic subspecialty in the PHIS database also were compared to our internal chart audit.

Results

Six hospitals in the United States utilized TM in a total of 670 visits with a single hospital comprising 430 (64%) of those visits. Primary diagnoses varied, with only 70/670 (10.4%) episodes comprised of urologic diagnoses such as pyelonephritis, hydronephrosis, urinary calculus, renal cyst, vesicoureteral reflux, neurogenic bladder, urinary tract infection, renal agenesis, bladder exstrophy, gross/microscopic hematuria and others. The majority of encounters 400 (60%) were performed for neonates (<30 days) with none of the other age groups comprising > 15% of the encounters. The majority of visits were performed in Caucasian patients (429, 66%) relative to other ethnicities. Medicaid was the most common primary payment method in 472 encounters (71%). Although no TM encounters were entered into the PHIS database for our institution and service code, our internal audit demonstrated 63 total encounters for our service alone.

Conclusions

Telemedicine appears to be an underutilized tool in pediatric urology and pediatric medicine. Incorrect application of appropriate billing codes may underestimate the actual use of telemedicine in pediatric medicine based upon our institutional experience. Further research is needed to better understand the lack of utilization of telemedicine in pediatric urology as a means to improve on the delivery of healthcare.

Funding

None