Ryann Duncan

Annotated Bibliography

SOURCE

ANNOTATION

THOUGHTS/CONNECTIONS

Hooshmand, Mary A., "Comparison of

Telemedicine to Traditional Face-to-Face
Care for Children with Special Health
Care Needs: Analysis of Cost, Caring, and
Family- Centered Care, Family Cost
Survey, Caring Professional Scale,
Measure of Processes of Care 20-Item
Scale" (2010). Open Access Dissertations.
Paper 408.

Children with Special Health Care Needs

(CSHCN) are extremely common in todays
world. Having a CSHCN requires much more
time and money due to their need for pediatric
specialists. Telemedicine offers a possible
alternative choice to traditional face-to-face
care. Telemedicine includes high resolution
video conferencing along with medical
instruments such as otoscopes, digital
stethoscopes, and opthalmoscopes. In this
Scholarly Repository an experiment was done
to compare telemedicine care to face-to-face
care by analyzing the cost, care, and familycentered care of Children with Special Health
Care Needs. Studies proved that there were
no differences in family costs when
telemedicine was offered locally, however,
when telemedicine was not offered locally,
costs were significantly higher. As far as
difference in care quality, the families felt no
difference. This meant that the families did not
feel that face-to-face provided better care
quality. When looking at the results of familycentered care, the group of families that were
participating in the telemedicine care felt that
that type of care was more family-centered
than the traditional face-to-face care. Overall,
research has shown positive feedback for the
patient/caregiver interaction along with less
financial burden for families with CSHCN when
implementing telemedicine services.
Therefore, technology should be further used
in the healthcare field.

This particular source laid the foundation for my

research and interest into the topic. It opened my
eyes to the idea that telemedicine is an effective
alternative to traditional face-to-face healthcare.
Additionally, one would always think that the faceto-face interaction is a necessity but after reading
this research I realized that with the advancement
in technology, this is not a necessity. Specifically, it
also helped me to realize how much telemedicine
could benefit Children with Special Health Care
Needs. The financial burden along with the burden
of transportation to many specialists could
definitely be minimized with telemedicine.

Ryann Duncan
Annotated Bibliography

SOURCE
Study: Six Major Telehealth Benefits for
Rural Kids with Special Needs. (2015,
July 24). Retrieved from http://
www.telequality.com/study-six-majortelehealth-benefits-for-rural-kids-withspecial-needs3.

ANNOTATION

THOUGHTS/CONNECTIONS

Rural children that need a specialists care

were used in a study to determine the quality
and effectiveness of telemedicine. The
American Academy of Pediatrics conducted a
study in June of 2015. The study proved six
benefits for children with special needs that
live in rural areas. The first benefit was
increased all-inclusive care. Other benefits
include better efficiency with clinicians when
specialists and primary care doctors need to
communicate before a needed face-to-face
meeting along with better specialists referrals.
Additionally, telemedicine benefited especially
when specialists are in short supply. It led to
less diagnostic redundancy leading to quicker
and more efficient care. Last but not least,
telemedicine was a large benefit in the fact
that it led to a huge reduction in expenses and
time due to less transportation, parents not
having to miss work, and children not having
to miss school. Although the study proposed
many strengths of telemedicine, it also
proposed a few obstacles. These obstacles
include financial reimbursement to the
providers and a development of a third party
telemedicine industry that could cause harm in
patient care. In order to prevent this, it is
recommended that physicians be offered
incentives for implementing telemedicine,
further research to further prove a reduction in
healthcare costs, and greater regulations be
required for telemedicine to make sure the
new technology is being used in the most
beneficial way for children.

This source was really helpful because it was short

and to the point. It gave me bullet points of specific
benefits which really helped with my research.
Additionally, it not only gave pros of telemedicine,
but it also gave a few cons. Along with the cons it
offered an expert opinion of how to minimize or
eliminate the cons. Having pros and cons is
essential to my research so I can make a fair
judgement to develop a thesis for my paper. This
source makes me want to find a credible expert to
inter view telemedicine for Children with Special
Health Care Needs.

Ryann Duncan
Annotated Bibliography

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ANNOTATION

THOUGHTS/CONNECTIONS

Robinson, S. (2003). Use of Telemedicine

to Follow Special Needs Children.
Telemedicine Journal and E-Health, 9(1).

The estimated percentage of children that have

some type of special needs is in between
10-15%. The technological assistance (i.e.
breathing tubes, ventilators, feeding tubes)
required by these children is a huge financial
burden for the families. Not to mention, providing
the best care for CSHCN requires teamwork
among the families, teachers, and multiple
healthcare providers. Telemedicine ties them all
together and allows this effective communication.
Two remote telemedicine clinics were opened to
help treat CSHCN. One was opened in 1996 at
Lamar Universitys School of Nursing and the
other was opened in 1997 at Stephen F Austin
Universitys School of Nursing. The main goals of
these clinics were to improve patient care for
children with special needs in underserved areas
by improving the communication methods
between the families and care providers. They
also wanted to evaluate how effective the use of
telemedicine was when treating CSHCN. A
survey was conducted and results proved that
treating patients over a distance was very
satisfactory. The health care providers reported
they were very confident and satisfied in
evaluating and recommending treatment. The
convenience of not having to travel far distances
proved to be the favorite aspect of the patients
and families. Not only did it save money, but it
allowed for the children to have much less
anxiety and nerves due to being much more
comfortable with the remote clinics. This issue
was published in 2003 and the clinics were still in
business.

This source gave proof that telemedicine can work.

It may not be fully in effect yet, and people may
not be fully knowledgeable about telemedicine, but
it can be turned into reality. Additionally, it can be
of large benefit to the CSHCN and their families.
Once again I was reminded about it being much
cheaper due to not having to commute far
distances and pay the expensive copays. It also
surprised me that the healthcare providers (i.e.
pediatrician, physical therapist, speech therapist,
etc) reported that they were highly satisfied and
confident in their ability to evaluate the patients
and recommend treatment through telemedicine.

Ryann Duncan
Annotated Bibliography

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ANNOTATION

THOUGHTS/CONNECTIONS

Harper, J. (2012, July 24). Pros and Cons

of Telemedicine for Today's Workers.
Retrieved from http://health.usnews.com/
health-news/articles/2012/07/24/pros-andcons-of-telemedicine-for-todays-workers.

The convenience aspect of telemedicine is one of its

greatest qualities. People are constantly on the go and
whether it is an issue because the patient is disabled
or whether he/she needs a quick doctors appointment,
telemedicine can really help with that. Additionally, over
half of doctors visits can actually be completed over
the phone and millions of people have used
telemedicine. The article went on to list 6 benefits
experts explain as the best. The first benefit was
convenience. If one has been going to the same
physician for years it is much easier for them to use
video or a phone call to follow up on a prescription refill
rather than scheduling an hour and a half traditional
doctor visit. Secondly, there is no time spent in the
waiting room. Thirdly, the expert named cost efficiency.
Not only does it save money with doctor visits costing
less money, but it costs less money in travel expenses
for people that live in rural areas. Communication was
the next bullet point. No longer are in-person visits and
the post office the only way to get second opinions.
Telemedicine can really help benefit communication
not only between patient and doctor, but also doctor to
doctor. Lastly, the article mentions privacy assurance.
This is a huge risk that people associate with
telemedicine, however it can be an advantage.
Telemedicine works along HIPAA laws that ensure
privacy and security with important documents. Just
like anything else, telemedicine also has it downsides.
A few include, electronic errors, some physician
hesitation, and the impersonalization. Technology is
not always reliable so obviously that will have glitches
sometimes. Physician resistance is another downside.
Some doctors are anxious to take on the new
technology, however many are excited to expand their
abilities to help the rural areas. Obviously, not being
hands-on is a challenge of telemedicine.

I really liked how this article listed out their pros

and cons in a easy to read way. I feel like I definitely
took important information from this article. I
decided to research telemedicine as more of a broad
topic in this particular resource. I just wanted some
background information about how telemedicine is
benefiting/challenging everyone, not just special
needs children. While reading this article, I noticed
that most of this information also applies to
CSHCN. Cost efficiency along with convenience are
benefits I have seen in every source thus far. Now, I
think I need to further investigate each benefit/
challenge on more specific terms for further
explanations.

Ryann Duncan
Annotated Bibliography

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ANNOTATION

THOUGHTS/CONNECTIONS

Capello, F., Naimoli, A, E., Pili, G. (2014).

Overtaking the Distances: The Child with
Special Needs. In Telemedicine for
Childrens Health (pp. 61-68). Cham, NY:
Springer.

Children with disabilities are at a much greater

disadvantage than children who are not. Often
times many disabilities are perhaps
overlooked or not taken seriously causing
bullying, etc. Disabilities or special needs such
as autism, genetic syndromes, and depression
are all extremely serious and can greatly
impact a childs way of life. With an increasing
number of people using social media and
social networking to communicate and to
search their own issues in search engines; we
are forced to look at the negatives that
internet-based technologies offer. They lead to
internet addiction, cyberbullying, and easy
access to inappropriate content. A governed
net could be implemented in order to construct
a safe online environment for children. It could
be used to monitor discomfort when children
are too afraid to ask for help themselves. It
could offer them a way to communicate with
other children their age that have a similar
disability. It could prevent cyberbullying by
providing links to real professionals that can
help when abuse or bullying is being
suspected. In fact, a child could use online
games to build their net so that the child can
be better helped. Additionally, it can also be
used to improve the parents knowledge of the
disability. A governed net could really be
beneficial in linking everyone together in order
to make the children feel like they don't even
have a disability at all.

Chapter five of this book offered me somewhat of a

new perspective when viewing telemedicine. Before
reading this chapter, I was stuck on making myself
decide if I was for telemedicine or if I was against it.
This chapter helped me to realize that I can prove
why I believe telemedicine can improve childrens
lives that have special needs. I dont necessarily
have to pick telemedicine over face to face
healthcare or vice versa.

Ryann Duncan
Annotated Bibliography

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ANNOTATION

THOUGHTS/CONNECTIONS

Telemedicine Services. (n.d.). Retrieved

October 14, 2015, from http://
www.floridahealth.gov/alternatesites/cmskids/families/health_services/
telemedicine.html.

This website compacts a bunch of services

CSHCN have available to them. All of the offered
programs are family-centered and assess all
different kinds of disabilities. One of their
featured programs is the CMS Telemedicine
Program. Often times there is a specific doctor
that a child with special needs, needs. This
program allows children that are hours away to
be able to receive the care they deserve. The
way it happens is a family, a CSHCN, and a
Registered Nurse meet at a remote site to
speak with a specialist located at the hub site.
The actual examination is completed at the
remote site, but with the Registered Nurses
help, a correct diagnosis is able to be made. A
AMD General Exam Camera with 50x
magnification and a Leisegang colposcope are
often used. The website also offers a list of
benefits. The first list of benefits explains why it
would benefit the child. The list includes a
reduction in travel time which saves money,
better access to specialists, and a more efficient
way to diagnose and help children. It will benefit
members of the community by a greater quantity
of children have access to the help they need
while also promoting partnerships among
businesses as they join together to help children.
It helps the professionals by increasing the
number of patients they can see and reducing
their travel time which in turn also saves money.
It ensures it is extremely safe and private as only
the child, family, nurse, and doctor at the hub
site will be able to see what is happening.

I found this .gov website and was instantly

interested because it is a functioning net work.
Additionally, there are comments written by
parents offering their love telemedicine. One says,
I love telemedicine! I get to see the doctor right
here where I live. It's like the doctor is here in the
room. The best thing is I don't have to travel and it
saves time. This emphasizes that there definitely
must be some good to telemedicine. I also liked that
it had some of the same benefits for the children I
have found in my previous research, but it also lists
a few reasons why telemedicine can benefit the
professionals. I think now I should try and find
more specifics about how a hypothetical
telemedicine visit would go.

Ryann Duncan
Annotated Bibliography

SOURCE
Lombardo, C. (2015, January 26). 10
Major Pros and Cons of Telemedicine |
NLCATP.org. Retrieved from http://
nlcatp.org/10-major-pros-and-cons-oftelemedicine/.

ANNOTATION

THOUGHTS/CONNECTIONS

Telemedicine can be very beneficial, but it

also has a few negatives. It is beneficial
mostly due to its convenience for all of the
parties involved. However, there are a few
negatives that telemedicine brings to the
table. Due to it being technology, there is
always a chance that the telemedicine is
going to be down. This could be a result of
bad weather or just glitches in the system.
Also, it is possible for different places to
have different types of software which can
cause possible connection issues. The cost
to implement the high resolution technology
telemedicine requires can every expensive.
Additionally, telemedicine lacks that
personable person to person connection. It
also can be hard for doctors to tell if the
patients are following the directions of the
doctors. Diagnoses can be difficult to make
when its more extensive than reading a lab
report. Lastly, privacy can be a big concern
to parents. Although there are strict laws in
place (HIPAA) to protect online records, they
still have the possibility of being hacked.

After I completed Blog Post #5 I realized that I had

found some information on the cons of telemedicine
but that I needed more. This source focused on some
of the cons of telemedicine. It provided a short video
which also really helped my understanding.
However, I think these cons can be worked through
and I still believe that telemedicine can really be of
benefit to CSHCN.

Ryann Duncan
Annotated Bibliography

SOURCE
Ferrini, C. (2009, December 21). Feeling
Isolated. Retrieved from http://
www.focusonthefamily.com/parenting/
parenting-challenges/parenting-a-specialneeds-child/feeling-isolated.

ANNOTATION

THOUGHTS/CONNECTIONS

This article describes a first hand account of

a mom raising her son that has special
needs. After learning of her sons diagnoses
and coming to the realization he would
never walk, talk, or learn, Cindi and her
husband felt very alone. Her son required
countless hours of hospital visits, therapy
sessions, along with 24/7 care. Her
questions about his disability and ways to
make his childhood the most normal never
seemed to end. This physically and
emotionally drained Cindi and her husband.
Joey, their son, was extremely sensitive to
noises. He often screamed and caused a
commotion if certain noises bothered him.
This caused them to feel even more alone
as no one seemed to ever invite them over
or invite their son over. If they brought him in
public they were always afraid they would
look like bad parents and that they could not
control their son. The article then goes on to
give advice to other parents with CSHCN.
Cindi and her husband wish they had been
more vocal about their struggles. They have
realized it is okay to reach out and ask for
help because there are many other people
that are going through the same struggles
they are.

This article was very different. It is not the type of

factual article that I will be putting in a research
essay per se; however, it gave me insight on how
challenging it can be to parent a child with special
needs. It was nice to step out of the facts and stats
type research and just try to understand the lives
of the people I am researching. This mom still has to
bathe and shave her son everyday. Her marriage
has been put to the test as time for them to spend
together has been very limited. It also made me
connect the idea that with telemedicine, the
countless hours of Cindi taking off work to go to
hospitals and therapy sessions could be severely
minimized.

Ryann Duncan
Annotated Bibliography

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ANNOTATION

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A day in the life of a special needs child.

(n.d.). Retrieved from http://
www.elkharttruth.com/living/CommunityBlogs/For-the-Love-of-a-Boy/2014/09/03/
A-day-in-the-life-of-a-special-needschild.html.

This blog post offers a personal account of

the life of a mom for who has a special
needs child. Specifically, she discusses the
actions of her son. Her son was diagnosed
with Autism, Sensory Processing Disorder,
Mitochondrial Dysfunction, along with other
medical conditions. She begins by
explaining that her son wakes up at 10 in
the morning. That may seem a little late, but
since he goes to bed extremely late and and
wakes up numerous times throughout the
night, this is pretty standard. He asks for the
same breakfast every single day as if he
doesn't already know its there and he can
have it. He throws fits often and it takes
several attempts to calm him down. He is
easily annoyed when he hears loud noises
and it is hard for him to get through
assignments on his own. However, he is
extremely brilliant at memorizing sports
teams and information that he finds
interesting. The door bell going off causes
extreme chaos and really bothers her son. It
required much effort to get everyone calmed
down including the dogs and the the other
children. She ends by explaining that her
special needs child has a stomach ache and
she will have to go to the doctor tomorrow.

This particular source provided me with insight on

how a day with a special needs child goes. It tends
to require extreme effort on the parents end, but
that effort never seems to compare to the
challenges the child faces. This harsh reality is
often innocently hidden by the parents.
Additionally, there was a specific part of the story
that stood out to me. She mentioned having to go
the doctor tomorrow because of her sons stomach
ache. Telemedicine would be great for a mom like her
who homeschools and has so much on her plate.

Ryann Duncan
Annotated Bibliography

SOURCE
HIPAA and Telehealth. (n.d.). Retrieved
from http://
www.telehealthresourcecenter.org/sites/
main/files/file-attachments/
hipaa_for_trcs_2014_0.pdf.

ANNOTATION

THOUGHTS/CONNECTIONS

The Health Insurance and Portability and

Accountability Act (HIPAA) was passed
August 21, 1996. Its main purpose was to
protect peoples personal health information.
A rule called the Privacy Rule was added
on in 2000 to help mandate who and how
personal health information was to be
distributed. It also focused on the peoples
rights of their own personal health records.
The Health Information Technology for
Economic Clinical Health Act was
established in 2009. No specific section of
HIPAA laws address telemedicine alone.
However, the same laws that apply to a
traditional in-person visit also apply to
telemedicine. If personal health information
is included, then the same set of standards
must be followed. Every business using
telemedicine is required to make sure their
privacy and security features are at
maximum ability prior to possessing any
personal health information. All entities
regardless of whether it is telemedicine
services or in person services must follow
the same strict, thorough, and highly
monitored operations in order to ensure their
compliance with HIPAA.

As I began to put my powerpoint presentation

together for the parents, I tried to think of
everything that would be essential to their
knowing. However, privacy seemed to be the biggest
downside of telemedicine. I began researching to
try and find a specific source that I could provide for
the parents to access if they had doubts. I came
across this source, and I think it will be perfect to
help fulfill my purpose.