A pediatric emergency medicine fellow received a call from a rural hospital about a very sick boy. Since the hospital had no pediatric resources, it placed the patient on a helicopter to rush him to a pediatric center. Unfortunately, the boy had an unrecognized head injury and died of herniation. The pediatric emergency fellow was devastated.
With better information prior to transport, the pediatric center could have coached the team at the rural hospital through temporizing measures to save the boy’s life and get him safely to a pediatric neurosurgeon. Unfortunately, the health care system was not engineered to allow remote consultations.
Telehealth can transform the way care is delivered to pediatric patients. It can address geographic barriers and disparities, expanding the reach of general and specialty care, including in emergency and critical care situations.
Implementation of these services, however, requires investment in platforms and adequate financing and infrastructure to address the digital divide. Implementing change also can be challenging, particularly in a system that is deeply rooted in tradition and longstanding practices.
A new AAP technical report describes the state of telehealth and its current and potential applications. It accompanies a 2021 policy statement (https://doi.org/10.1542/peds.2021-053129) that emphasized the need for the highest clinical quality standards and the importance of care continuity and equitable access to digital and virtual care.
The report Telehealth: Opportunities to Improve Access, Quality and Cost in Pediatric Care, from the Section on Telehealth Care, Committee on Practice and Ambulatory Medicine and Committee on Pediatric Workforce, is available at https://doi.org/10.1542/peds.2021-056035 and will be published in the March issue of Pediatrics.
During the pandemic, use of technology to connect with patients skyrocketed as solutions were implemented rapidly to provide care and create workflow efficiencies.
Digital and virtual interactions have become integrated into all levels of care, expanding the reach of pediatric expertise across geographic regions, creating opportunities for collaboration and allowing children — especially those with special health care needs — to receive care in their own homes and communities.
The new technologies present an opportunity to promote child health and transform the health care system.
Virtual technologies such as remote patient monitoring, telehealth for high-risk or technology-dependent patients, and preprocedural evaluation and postprocedural follow-up care can improve quality and efficiency.
Virtual technologies also are helpful for case management conferences, inter-specialty rounds and multidisciplinary care.
All of these new tools, processes and methods can be a pathway toward developing comprehensive, proactive and personalized value-based care for children.
Telehealth can benefit pediatric practices by improving time management and efficiency, documentation of encounters and compensation for remote services. It can reduce the need for office staff to handle real-time interaction as well as meet the demands of families seeking care on nontraditional schedules. In addition, practices can capture visit revenue that otherwise might be lost to outside entities.
The report also reviews the pediatric medical home as the ideal environment for delivering and coordinating remote care, assesses the role of research and outlines the financial impact of telehealth on physician practices in current and future payment models.
Dr. Curfman, a lead author of the technical report, is a member of the AAP Section on Telehealth Care Executive Committee.