O1130: Improving the Bioethics of Pediatric Telemedicine in the United States During COVID-19

Background: The COVID-19 pandemic has led to an unprecedented increase in telemedicine usage across the country as a method of maintaining social distancing for medical staff and patients. While there have been numerous benefits, telemedicine also has the potential to bring significant risks, including many challenges unique to the pediatric setting. We aimed to evaluate the state of telemedicine in our pediatric healthcare system to better understand how it has been affected by the pandemic and to delineate the benefits and pitfalls with a focus on ethical considerations.

Methods: After IRB approval was obtained, an anonymous survey was distributed via email to all healthcare providers within our children’s hospital medical group. The survey contained Likert scale and free text questions regarding the use of telemedicine before and during the pandemic, impressions of whether adequate training in telemedicine procedures was provided, impact on medical decision making and patient care including missed diagnosis, misdiagnosis or delayed diagnosis or care due to the limitations of telemedicine, and ethical considerations including witnessing unsafe environments, breach of patient confidentiality, and uncertainty of proper billing practice. Consent by disclosure acknowledgement was obtained from all respondents.

Results: Seventy-one physicians responded, representing more than 30 pediatric subspecialties. The majority of participants reported using telemedicine in their current practice, but not prior to the pandemic. Most participants reported general satisfaction with telemedicine from providers and patients with 52% reporting telemedicine had both positive and negative impacts on their practice. Approximately 35% experienced at least one negative outcome that they specifically attributed to telemedicine, such as misdiagnosis or delayed patient care. Approximately 73% of participants experienced at least one ethical dilemma including witnessing an unsafe environment for the patient or the parent driving during the telemedicine visit. Most respondents did not feel they had proper guidelines for handling many of the ethical dilemmas caused by telemedicine.

Conclusion: As expected, telemedicine usage increased dramatically in our pediatric healthcare system due to the COVID-19 pandemic, bringing both numerous advantages and significant change to normal practice methods for physicians. For this reason, deeper discussion on mitigating risks and preparing for ethical dilemmas is necessary to improve the use of this modality for best patient and family care. In this survey, we began to highlight and categorize some of the issues associated with this form of healthcare delivery. It is the responsibility of those practicing or recommending telemedicine to begin to examine and address these potential issues with educated, ethical approaches. Next steps will include working to provide further training and education to our physicians in order to more effectively navigate the practice of telemedicine and establish better-defined ethical practices to minimize negative outcomes.