Implementation of remote medical device in sick childcare in Japan: A pilot observational study

Sick childcare services support families by caring for children with mild acute illnesses or during recovery, thereby enabling caregivers to continue their employment. However, the requirement of an in-person physician's assessment prior to admission often delays childcare initiation due to travel, waiting, examinations, and medication dispensing. TytoCare® is a novel telemedicine device that integrates video-based consultation with the ability to record and transmit clinical data such as heart and lung sounds, body temperature, throat and eardrum images, and skin conditions1 (Figure 1). Certified in Japan in September 2023, the device allows remote clinical assessment based on pre-shared data. Globally, it has been adopted in over 30 countries for elder care, home-based COVID-19 monitoring, and institutional telemedicine.2, 3 To reduce caregiver burden and improve efficiency, the Department of Pediatrics at Jichi Medical University Hospital implemented TytoCare® for pre-admission evaluation at its affiliated sick childcare facility, “Iris.” Families provided written consent and completed pre-registration. When childcare was needed, caregivers brought their child to “Iris,” where remote consultations were conducted between on-site staff and pediatricians using TytoCare®. Children with fever underwent rapid influenza and COVID-19 testing. If admitted, prescriptions were electronically sent to the family's preferred pharmacy, and medications were delivered to the facility. The research team maintained no commercial affiliation with the manufacturer, and the device was neither donated nor transferred for this study. Ethics approval was obtained (No. 24-020), and funding was provided by JST (Grant Number JPMJPF2403). Between September and December 2024, eight families comprising 20 children were registered. By January 2025, two of these children had received remote evaluations. The first, a 4-year-old boy presenting with mild upper respiratory symptoms, was diagnosed with acute upper respiratory tract infection not requiring medication; childcare began 35 min after arrival. The second, a 3-year-old girl with fever, tested negative for influenza and COVID-19 and was diagnosed with acute pharyngitis; she was prescribed antipyretics and admitted within 30 min. Both cases were completed without any medical complications. As a comparison group, we analyzed 26 episodes involving 11 of the 20 children enrolled in the study who had been using conventional in-person physician assessments for childcare at “Iris” from 2021 through the study period. The median age of these episodes was 2.0 years (IQR: 1.0–3.8). Of these, 24 were admitted; none underwent diagnostic testing, and 16 received prescriptions. The median time from arrival to childcare initiation was 56.5 min (IQR: 46.5–67.8). Two cases were declined due to more serious conditions (streptococcal infection and bronchitis). This pilot study demonstrated that remote consultations using TytoCare® were safe and reduced time to childcare initiation by approximately 30 min. Remote testing and coordinated prescription delivery further enhanced efficiency. Collaboration between pediatricians, childcare staff, and pharmacies proved essential in minimizing caregiver burden. Although telemedicine has been criticized for potential inferiority to in-person evaluations, TytoCare® provided comparable diagnostic accuracy.4 The absence of adverse events in these cases supports its clinical reliability. This study has several limitations. As a pilot study, the sample size was small. We plan to accumulate additional cases and report further findings in future studies. Moreover, some participants in the control group were included multiple times, limiting the accuracy of statistical comparisons. However, since the clinical conditions and ages at presentation varied even among the same individuals, we believe the potential bias is minimal. In conclusion, the use of TytoCare® for remote pre-admission evaluation in sick childcare settings appears to be both safe and effective. Further studies involving larger cohorts are necessary to validate these preliminary findings and to explore broader implementation potential, especially in settings where rapid testing and medication logistics are feasible. T.K. and T.M. designed the study. T.K., Y.I., A.H., Y.Y., and T.M. prepared and conducted the research. T.K. and A.H. analyzed the data. T.K. wrote the manuscript. H.O. and Y.M. provided guidance on the manuscript. Y.M. supervised the study. All authors read and approved the final manuscript. We are grateful to our coworkers at Jichi medical University and sick childcare facility, “Iris.” The authors declare no conflict of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.