University of Rochester

For many parents, particularly those in impoverished, inner-city communities, the emergency department is their only access point for medical care for children with acute illnesses.

However, limited primary care access often leads to exorbitant costs for non-emergency conditions, and for care that is frequently inconvenient, impersonal, and inefficient. To ultimately change this paradigm, the University of Rochester piloted the Health-e-Access program over the course of nine years, beginning in 2001. The program enables children with acute or ongoing health care needs to be evaluated by a remote clinician via telemedicine in convenient, community-based access sites, which include childcare programs and schools. The program facilitates early access to care within a primary care medical home, and reduces unnecessary and costly emergency department visits. This in turn allows working families and single parents to more effectively balance their personal and professional needs. Previous research shows that the Health-e-Access model cuts down on workplace absences due to sick children by 63%, retains 87% of primary care medical home patients, and reduces health system costs by 22% due to fewer emergency department visits. A grant from NYHealth in January 2009 enabled the University of Rochester to expand the Health-e-Access program and reach more patients.

More than 6,400 telemedicine visits have been completed to date in those settings through the HeA Program. The service fosters high-quality, cost-effective care and is accepted by families and clinicians. It has been proven to reduce school/program absenteeism for illness by 63% and reduced costly emergency department visits by 24%. This project expanded a successful program to increase health care access for children in four inner-city Rochester neighborhoods. HeA is newly available after-hours and on holidays and weekends (when schools and day programs are closed) in convenient community sites such as 24-hour pharmacies, fire stations, and community centers. The primary care practices currently participating in HeA provide approximately 75% of the primary care for inner-city children, and additional physicians are encouraged to join. HeA trained physicians to manage telemedicine visits from home and were reimbursed for these services.