FL Children’s Medical Services

UM TeleHealth is collaborating with the Florida Department of Health, Children’s Medical Services (CMS) Southeast Florida Region to provide real-time telehealth consultations for Children with Special Health Care Needs (CSHCN) in pediatric nutrition and dermatology. In this program, an Advanced Registered Nurse Practitioner (ARNP) is co-located with the patient and their family in the examination room at the CMS clinic and “presents” the patient to the provider at UM by videoconference.

Since 2005, monthly pediatric teledermatology clinics have been conducted between the CMS Fort Pierce Clinic and the UM pediatric dermatologist, accompanied by senior dermatology residents. The pediatric teledermatology clinic involves presentation of the history and other relevant findings by the CMS nurse presenter and remote dermatologic examination by the dermatologist. The UM pediatric dermatologist discusses her diagnosis and recommendations with the patient and his or her parents and the CMS nurse presenter. Afterward, the consulting dermatologist’s report is sent to the CMS primary care provider, who is responsible for implementing recommendations and follow-up. A 2007 review of the program determined the most frequent diagnoses to be atopic dermatitis (27%), post-inflammatory pigment alteration (20%), ichthyosis (13%), acanthosis nigricans (13%), verruca (7%) and molluscum contagiosum (7%). One-third of the patients were serologically positive for human immunodeficiency virus. Follow-up was recommended with the primary care provider (PCP) in 33% of cases, 27% with the UM pediatric dermatologist, 13% were referred to other specialty clinics, and 27% did not require follow-up.

In April 2007 the UM Miller School of Medicine launched a joint effort with the CMS Southeast Florida Region, to provide live interactive telenutrition consultations for CSHCN and their families in rural, remote and medically underserved areas of Southeast Florida. CMS eligible children from zero to twenty one years of age, with a variety of diagnoses including overweight/obesity, underweight, immunodeficiency, food allergies, feeding problems, enteral nutrition (tube feeding), and gastrointestinal disorders, are referred for nutrition consultation.  Nutrition assessment and counseling is provided on a weekly basis by a pediatric Registered Dietitian (RD) from the Miller School of Medicine who reviews the medical, nutritional and growth history of patients attending clinic.  The RD then interviews the patient and caregiver, and provides them targeted education so that they may be more effective in meeting the health goals identified during consultation.  Patients receive consistent follow-up care as seen appropriate by the RD.

Currently, we are in the process of expanding the services that we provide to CMS via telehealth. This includes the expansion of the numbers of sites that receive pediatric teledermatology services, and the addition of two new clinical services — telegentics as well as child and adolescent psychiatry.