A mode of medicine traditionally reserved for patients with limited access to healthcare is now being used in urban and suburban childcare centers, and many of the centers are within a few miles of a healthcare provider. Telemedicine is bridging the gap of geography in Rochester, New York, childcare centers. A patient's physical distance from a healthcare provider is no longer the principal determinate for the mode of health care provided. Telemedicine urban style is designed to enable treatment for common medical conditions that disrupt a child's attendance at childcare. The University of Rochester Medical Center's Golisano Children's Hospital, in conjunction with TeleAtrics, Inc., deployed a telemedicine network in Rochester. The Health-e-Access telemedicine network is designed to reduce childcare and school absences resulting from illness. By making healthcare for urban and suburban children readily available, the Health-e-Access program allows childcare centers and doctors to work together to integrate telemedicine into existing day-to-day healthcare practices (Strong Health, n.d.).

WHAT IS TELEMEDICINE?

The term telemedicine derives from the Greek tele meaning "at a distance" and the word "medicine," which itself derives from the Latin mederi, meaning "healing." The American Telemedicine Association (n.d.) Web site defines telemedicine as the "the use of medical information exchanged from one site to another via electronic communication for the health and education of the patient or healthcare provider and for the purpose of improving patient care." A search of the literature reveals that telemedicine as a practice has been in place since the early 1960s. Until the mid 1960s, telemedicine was primarily conducted using land-based technology. One of the first telemedicine programs in the United States to use more advanced technology was established between Massachusetts General Hospital and Logan International Airport Medical Station in 1967. The cooperative relationship provided occupational health services to airport employees and delivered emergency care and medical attention to travelers. Physicians at Massachusetts General Hospital provided medical care to patients at the airport using a two-way audiovisual microwave circuit. Evaluation, diagnosis, and treatment of the patients were made by participating personnel and independent physician observers. Analysis was also made of the accuracy of microwave transmission. Inspection, auscultation, and interpretation of roentgenograms and microscopic images were also performed. Necessary hands-on procedures were performed by the medical station nurse-clinicians (Brown, 1995).

The practice of telemedicine has expanded to include a full spectrum of health sciences including rehabilitation occupational therapy, physical therapy, speech-language pathology, audiology, pharmacy, health promotion, dentistry, nursing, as well as medicine. The technology of telemedicine can be subdivided into four general areas: (1) medical support, training, and teleconferencing services for doctor-to-doctor consultation; (2) involves a disparate set of applications using communications for medical services such as centralized intensive care unit monitoring and shipping radiology images around the world for analysis which is also considered to be under the umbrella of telemedicine; (3) chronic care home-monitoring technology; and (4) the telemedicine which can best be described as a system platform application of telemedicine with all necessary software based workflows and system support for providing real-time and/or store-and-forward capabilities for providing acute care.

Two important factors influenced the expansion of telemedicine beyond its early applications for patients with remote access to health services using telephones or microwave circuit technology. First, the personal and professional use of highspeed, high-bandwidth telecommunications systems has become commonplace-low-cost, high-resolution, Internet-based video conferencing systems are available for purchase online or in electronic chain stores. …