P1008 - Implementation Study: Challenges of Rapid Telemedicine Implementation into a Small Community Pediatric Allergy-Asthma Practice

Telemedicine is utilized in the United States, but its acceptance has been limited. In the environment of a pandemic, the healthcare industry is forced to alter the delivery of care to contain the virus’ spread. Utilizing telemedicine in small community settings may ensure continuity of care and deliver healthcare advice while reducing the risk of exposure.
Program Goals: review the challenges, benefits, and limitations of rapidly implementing telemedicine into one small Pediatric Allergy practice in response to the COVID-19 pandemic. Implementation resources included education via online webinars and online research.
Evaluation: Care was delivered by a physician and nurse practitioner via real-time audiovisual teleconference. Platforms utilized included Zoom and Doxy.me. Preparation included evaluating telemedicine platforms, staff training, and patient education in the setting of quickly changing regulatory and financial policies. During the first month of telemedicine implementation, clinicians perceived several frustrations. These included reviewing test results without parents possessing the test result copies. Concerns of HIPAA privacy limited document sharing with families. Parents were also visualized writing their child’s results which may have impaired their ability to absorb information provided by the clinician. It was also perceived that direct interaction with the pediatric patient was decreased due to a lack of engagement with the child. Many younger children were distracted by their home setting and did not stay focused on the conversation. Adolescents did actively engage.
Despite these limitations, within 2 weeks, the office successfully provided care for disorders including food allergy, allergic rhinitis, asthma, urticaria and atopic dermatitis. Partial physical exams were conducted, including assessments of patient appearance, quality of conversation, face/eyelid/skin, chest excursion & chest wall symmetry, respiratory effort, mental status, and mood/affect. Counseling, education and gross patient assessments were effectively accomplished with parents expressing satisfaction with remote care.
Limitations were noted in the setting of an acute asthma exacerbation. These included restrictions in patient assessment, such as vital signs and auscultation of breath sounds. Despite counseling and medication prescription provided via telemedicine, the patient later sought emergency care via ED.

Discussion: rapid deployment was achieved in a community small-office setting. Successes included effective patient counseling and education and delivery of patient care for non-emergent conditions. These could be accomplished with the partial physical exam available through audiovisual interface. Limitations included decreased engagement of younger children and the lack of document sharing, which can be addressed via other HIPAA-compliant technology platforms. Asthma exacerbation was not effectively managed and illustrates the limitations of remote healthcare in acute situations. However, many patient encounters can be effectively managed with the assistance of telemedicine and may allow for maintaining healthcare delivery in the setting of an acute pandemic.