P1035 - Virtual Visits During COVID-19 Pandemic; A Pediatrician’s Perspective

Telehealth is an expanding field and facilitates the ability to connect with the patients, when physical encounters are not possible. However, its use in pediatric services remains limited. In light of the COVID-19 pandemic, telehealth is the only available option to provide continuity of care. American Academy of Pediatrics also has issued guidance in order to ensure continued care for children during this crisis. We assess the feasibility of web-based platforms and explore the challenges and barriers to telehealth implementation in a small primary care setting.
Methods
A video-conference using web-based applications is used for history taking and visual examination to assess child activity in a pediatric practice serving over 400 children. We asked parents to rate their experience and degree of satisfaction.
Results
We summarize our experience integrating telehealth technology into the practice of pediatrics:
Limited Evaluation; Although telehealth may be equivalent to face-to-face evaluation in many regards; it lacks the opportunity to perform a physical examination. This is particularly concerning in examining children with medical complexities. It is therefore important to pre-screen which children should be seen, in person.
Time Management: The visits often exceed time allotted particularly in infants and younger children. Initially it took significant time to obtain and adequate history. We started pre-briefing regarding virtual visit and what to expect.
Technical Challenges: Lack of familiarity with telehealth and the equipment is an important challenge, particularly in disadvantaged population. Physicians also facing technical issues as there was insufficient time to prepare.
Concern for Over-treatment: The treatment may simply be based on symptoms such as child touching the ears and attributed to otitis media; or a fever and cough may be treated as pneumonia. Also, because of the ambiguity of the situation, many parents may simply prefer to obtain a prescription for an antibiotic, or other medications.
Threat to Privacy: This issue is more relevant to the adolescent. We believe adolescents would be better served, if they were permitted to use their personal cell phone.
Reimbursement: An inadequate reimbursement is a most important issue. For sustainability, a sincere effort is needed to establish adequate payment mechanism for telehealth services.

Liability Issues: Since telehealth mediated medical care is limited regarding a physical examination, physicians are anxious whether they are missing certain important diagnosis. This raises a concern for medicolegal liability. There is a need to set clear guidelines for liability protections.
Conclusion
Although telehealth is widely accepted by the parents, it is important to understand the limitations of telehealth. The nature of such limitations should be conveyed to parents. Since the health of children cannot wait for a normalization of health care delivery; we need to be able to modify, adapt and try to do what is feasible.