If you are like me, your telehealth experience went from 0 to 100 quickly last spring when clinics were shut down due to the COVID-19 pandemic. I think in the span of a week or two we were up and running on a telehealth platform and all of us learned quickly how to do the basics of a virtual visit. This State-of-the-Art Review, published in this month’s Pediatrics (10.1542/peds.2020-047795), provides helpful guidance on how to continue effective telemedicine in the future.
As noted by the authors, the complexities surrounding implementing a successful telehealth program in your practice or hospital are numerous at even the most basic levels. Patients can be challenged by even accessing telehealth unless they have devices connected to high-speed internet. Physicians need to choose a telehealth platform and create a workflow to balance in-office and telehealth visits in a busy practice. Practice administrators need to make sure that mechanisms are in place to be able to bill for telehealth services. Policy makers need to ensure that payment is equitable and there aren’t issues practicing across state lines. And all of these issues need to be addressed before even figuring out how to do a high-quality telehealth visit. The pediatric community needs to still work out which conditions are amenable to telehealth visits (i.e. don’t need a detailed physical exam) and which ones really need an office visit.
I commend the authors for encouraging practices interested in implementing telehealth to address the “people, training, processes, and tools” required to be successful. While it seems like “Practice Transformation” has been the go-to phrase for the past decade, making sure that telehealth is effectively and safely implemented will require true practice transformation as the challenges and barriers at each level of implementation must be addressed. I recommend anyone who is currently using telehealth to carefully review this published state-of-the-art review.