Child abuse is a common and unfortunate problem in the United States. Approximately one million children are physically or sexually abused each year. The actual number of children presenting to medical facilities for abuse examinations is unknown, however, the number is anecdotally is increasing. Specialized clinics in hospitals, Children's Advocacy Centers (CACs) and Childrens'Justice Centers (CJCs) have been developed in every region to serve the investigative and medical needs of abused children. CACs and CJCs provide the same service, and both are members of the National Children's Alliance. Each clinic, or Center, must perform medical assessments to diagnose and treat the physical aftereffects of abuse, and also document forensic evidence necessary for child protection and possible prosecution. As the only children's hospital with a tertiary care trauma center in the Intermountain West, Utah's Primary Children's Medical Center (PCMC), within the Intermountain Health Care (IHC) system, annually receives and reviews about 1000 child abuse cases submitted from geographically remote locations. A significant amount expertise has developed in the field of child abuse medicine within the field of Pediatrics. The American Board of Pediatrics is currently considering a proposal for Child Abuse Pediatrics to become the newest medical subspecialty of Pediatrics, recognizing the need for highly skilled physicians in this area. Recent studies have shown that in certain areas of child abuse, especially in the evaluation of sexual abuse, less experienced physicians and other medical providers may not provide accurate assessments of physical findings. While failing to recognize abuse has significant morbidity and mortality, over recognition and over interpretation has negative child welfare and criminal repercussions that may be equally devastating. The existing process of child abuse detection and prevention can be improved by providing clinicians and practitioners with secure case communication and collaboration tools. These tools must fulfill the need to create and submit child abuse cases for expert consultation, integrate clinical coding standards (e.g, ICD-9, CPT), manipulate images form multiple sources (e.g., clinical photos, radiographs, histology), preserve archive quality images with non- destructive visual identifiers and protect all information from unauthorized access. 1. Clinical case consultation and collaboration (same-time/different-place, different-time/different-place) for geographically remote users, 2. Customized child abuse prevention workflow designed by Pediatric experts, 3. Secure methods for storing, processing and sharing, accumulated knowledge, 4. Built-in mechanisms for privatizing, accessing and auditing case information.
The overall aim for Phase 2 of this project is to develop, test and implement a web-based product that supports teleconsultation and peer review for diagnosing child abuse. The goal is to develop a web-based application that supports geographically distant providers by providing access to quality review and expertise in tertiary care centers. The web-based application, TeleCAM, is designed to augment existing telemedicine applications and imaging systems through the use of web services protocols. The approach for phase 2 will be to take the results of Phase 1 (feasibility) and usability resulting in a version 1.0 prototype into to a stable end user tested version 2.0. The solution will be a web-based, multi user image-centric collaboration application that supports the workflow requirements of providers (nurse, nurse practitioners and physicians) regardless of geographic location.. Currently, the prototype product named Teleconsulting in Child Abuse Medicine (TeleCAM) has been deployed for beta testing at Intermountain Health Care's (IHC) Primary Children's Medical Center (PCMC) in Salt Lake City, Utah as a service to the Utah Attorney General. Additional sites participating, as early adopters in the TeleCAM beta test include the Children's Justice Centers (CJC) in Alaska (Alaska Children's Alliance) and North East Nebraska Children's Advocacy Center, Ohio Children's Hospitals and Clinics and Children's Hospitals and Clinics of Minnesota. Specifically, Phase 2 of this project will develop the existing prototype into a product, with features such as multi-user different-time/different place information sharing (collaboration), expand the software platform to include same-time/different-place (real-time) collaboration features, role-based virtual teleconsultation room and develop a detailed commercialization plan. Our progress to date in the arena will make it possible to complete the stated objectives (Phase 2 Specific Aims) within the limited scope of Phase 2.
| Frasier, Lori D; Thraen, Ioana; Kaplan, Rich et al. (2012) Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application. Child Abuse Negl 36:149-55 |
