by Jordan Scott
Telehealth can increase access to care, which is especially valuable in pediatrics where traditional appointments may require parents to take off work and children to miss school.
At the American Telemedicine Association’s ATA2022 conference in Boston, pediatric specialists discussed ways in which telehealth has benefited pediatric care and how the modality could be improved, in panel sessions titled “Telehealth in Pediatric Population Management” and “Telehealth for Our Next Generation: Pediatric Models of Care.”
The Benefits of Virtual Care for Pediatrics
“What has changed since the beginning of the pandemic is that we’ve realized the value of virtual care. Some prefer it, and it becomes substitutive, while some prefer hybrid or in-person visits,” said Dr. Lindsay Jubelt, chief population health officer at Mass General Brigham.
Jubelt explained that telehealth can provide access to care for people who would have to travel far for an in-person visit. Virtual care also can be used to bring care management teams into schools or into the home after a hospitalization.
“We can integrate care across environments typically not part of the medical experience,” she said.
Dr. Jennifer Berkovich, medical director of telehealth at KidzDocNow, said virtual care has provided more flexibility. Many appointments to refill medications or follow up on an existing condition can be done virtually, which increases access to patients. KidzDocNow has partnered with a behavioral health organization to enable the on-demand transfer of patients to a behavioral health coordinator if an urgent evaluation or treatment is needed, rather than having to wait a month or more.
“We’ve really focused on being creative about the types of visits we provide for brick-and-mortar primary care physicians,” Berkovich said. “The future of pediatrics is probably a hybrid care model. We need to look at what the patient and families want and make sure we have adequate care access across all platforms.”
Abigail Crawford, a telemedicine nurse practitioner at West Virginia University Health System, says WVU Medicine now has six telemedicine hubs in West Virginia to provide better access to people in rural and remote areas. Her organization is assessing which specialties are utilizing telehealth most and focusing on expanding the capabilities of each telemedicine hub.
Telemedicine can also facilitate complex care by making it easier for children to be seen by multiple specialists when needed, sometimes in one visit. In addition, Berkovich pointed out that telehealth can drive down unnecessary ER visits by triaging a patient’s condition and determining whether it could be handled in a virtual visit or requires immediate in-person care.
A tighter window of opportunity for early intervention is unique to pediatrics, said Dr. Saima Aftab, vice president of organizational initiatives and Nicklaus Children’s Pediatric Specialists chief of neonatology at Nicklaus Children’s Hospital.
“Pediatric patients need development assessments with their primary care physicians to ensure their milestones are on track,” Aftab said. “As a parent, delays in access to care can be stressful. In our community in Miami, there are challenges to accessing care,” including transportation, lack of access to primary care physicians, social determinants of health and more.
Telemedicine has the ability to overcome distance barriers and better match children’s needs, she said.
Gigi Sorenson, corporate director of telehealth at Shriners Children’s, added that not all of a health system’s locations will have the same level of providers, and telehealth enables the sharing of resources across locations.
How Can Pediatric Virtual Care Be Improved?
In the past, many pediatric and general healthcare providers delivered care without understanding the needs of the patient, said Jubelt.
“There’s a huge opportunity for us to redesign the care delivery experience. Right now it’s still a visit-based experience,” she said. “However, families and patients want a more continuous experience. They want to send a message and get a message back and schedule visits on demand. We need to switch to have more of a relationship and on-demand experience instead of an episode- or visit-based approach.”
She also emphasized the importance of partnerships.
“Larger organizations tend to think they can build things and solve everything themselves, but it’s better if they don’t do that,” she said. “Stop being so inward-focused and be outward-focused, both with patient needs and by being a better partner.”
Dr. Eduardo Fox, associate medical director of the IMPACT DC Asthma Clinic at Children’s National, said that it’s vital for healthcare organizations to assess not only who is using telehealth, but also who isn’t, and to identify those barriers to access.
A school-based telehealth system could also make a major difference in the ability to care for children. Three-way visits could include the clinician, the school nurse and child, and the child’s parents to provide more flexibility.
However, figuring out reimbursement after the COVID-19 public health emergency ends will be key to ensuring the long-term success for virtual care in pediatrics, and healthcare in general. Jubelt said it’s important to consider whether or not virtual care adds additional costs or could lead to an increase in visits.