**Author details**

Sunshine Arnold1 and Debra Esernio-Jenssen2

1 Team Coordinator of the Child Protection Team, University of Florida, USA

2 Medical Director of the Child Protection Team, Department of Pediatrics, University of Florida, USA

## **References**


[6] Maguire, S, Mann, M. K, Sibert, J, & Kemp, A. Are there patterns of bruising in child‐ hood which are diagnostic or suggestive of abuse? A systematic review. Arch Dis Child (2005). , 90, 182-186.

**7. Conclusions**

118 Telemedicine

**Author details**

Sunshine Arnold1

Florida, USA

**References**

385-402.

and Debra Esernio-Jenssen2

hospitals. Pediatrics (2009). , 123, 223-228.

nals October (2009). , 38(10), 574-578.

changing a paradigm. Pediatrics (2008). SS12., 10.

1 Team Coordinator of the Child Protection Team, University of Florida, USA

2 Medical Director of the Child Protection Team, Department of Pediatrics, University of

[1] Menard, K. S, & Ruback, R. B. Prevalence and processing of child sexual abuse: a multi-data-set analysis of urban and rural counties. Law Hum Behav. (2003). , 27(4),

[2] Tsai, S. H, Kraus, J, Wu, H. R, Chen, W. L, Chiang, M. F, Lu, L. H, Chang, C. E, & Chiu, W. T. The effectiveness of video-telemedicine for screening patients requesting emergency air medical transport (EAMT). Journal of Trauma (2007). , 62, 504-511.

[3] MacLeod KJMarcin JP, Boyle C, Miyamoto S, Dimand RJ, Rogers KK. Using teleme‐ dicine to improve care delivered to sexually abused children in rural, underserved

[4] Berkowitz, C. D. Child abuse recognition and reporting: supports and resources for

[5] Alexander, R, & First, K. Telemedicine and child abuse examinations. Pediatric An‐

Telemedicine has proved to be a very useful method in conducting child abuse assessments to rural areas in the absence of local child abuse experts. The increases in child abuse reporting and lack of experts qualified to medically assess abuse cases further support the use of telemedicine. A variety of applications and uses provides a wide range of possibilities at varying costs that can be adapted by other child welfare programs throughout the world and have been demonstrated nationwide in the U.S. Telemedicine assessments and evidence obtained during the examinations have been successfully used in criminal and civil court without legal challenge. The use of telemedicine in child abuse will ensure accurate diagnosis by an expert, appropriate treatment and follow up, and reduce risk of future maltreatment.


**Section 2**

**Telemedicine: Present and the Future**

**Telemedicine: Present and the Future**

**Chapter 7**

**Update on the Most Rural American Telemedicine**

As previously published (1) the Avera Health system launched its telemedicine program by offering consultation by video connectivity from the main tertiary hospital in the largest city of the multi-state North Central Region of the United States to some of its smallest partner clinics and hospitals. Between 1993 and 2004, medical providers and patients learned what it was like to practice medicine and receive care via a telemedicine connection. A major growth spurt in Avera's rural telemedicine program came in 2004 after the initiation of a virtual ICU service staffed by intensivist physicians and critical care nurses; Avera *e*ICU CARETM1. Since 2004, Avera has initiated and rapidly expanded multiple other telemedicine programs to meet demand for additional services and coverage. These around-the-clock, always available services are unique as stand-alone programs, but combined provide one of the most robust

In the previous report, the goals, expectations and consequences of the Avera *e*ICU CARE program were described. Avera *e*ICU CARE initially started with the system's tertiary hospital, Avera McKennan Hospital & University Health Center, serving as the hub location for the provision of twenty-four hour per day remote patient care and monitoring of seriously ill patients in three medium-sized rural hospitals. Over time it evolved to include several more hospitals of that size called "Rural Regional Hospitals." Additionally, remote Critical Access Hospitals (CAHs) began to request *e*ICU coverage. Intensivist-led medical supervision and

> © 2013 Zawada Jr et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2013 Zawada Jr et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Program — The Present and Future**

Edward T. Zawada Jr, Dana Buus, Don Kosiak,

Additional information is available at the end of the chapter

**1.1. Review of previous experience and accomplishments**

Pat Herr and Michael Heisler

http://dx.doi.org/10.5772/56589

telemedicine platforms on the planet.

1 Avera eICU CARE is a registered trademark of VISICU, Inc.

**1. Introduction**
