Virtual visits during COVID-19 pandemic;a pediatrician'sperspective

ABSTRACT

Telehealth is an expanding eld and facilitates the ability to connect with the patients, when physicalencounters are not possible. However, its use in pediatric services remains limited. In light of the COVID-19pandemic, telehealth is the only available option to provide continuity of care. American Academy of Pediatricsalso has issued guidance in order to ensure continued care for children during this crisis. We assess thefeasibility of web-based platforms and explore the challenges and barriers to telehealth implementation in asmall primary care setting. Methods A video-conference using web-based applications is used for historytaking and visual examination to assess child activity in a pediatric practice serving over 400 children. Weasked parents to rate their experience and degree of satisfaction. Results We summarize our experienceintegrating telehealth technology into the practice of pediatrics Limited Evaluation;Although telehealth maybe equivalent to face-to-face evaluation in many regards;it lacks the opportunity to perform a physicalexamination. 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 exceedtime allotted particularly in infants and younger children. Initially it took signicant time to obtain andadequate history. We started pre-brieng regarding virtual visit and what to expect. Technical Challenges Lackof familiarity with telehealth and the equipment is an important challenge, particularly in disadvantagedpopulation. 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 tootitis media;or a fever and cough may be treated as pneumonia. Also, because of the ambiguity of thesituation, 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 betterserved, if they were permitted to use their personal cell phone. Reimbursement An inadequatereimbursement is a most important issue. For sustainability, a sincere effort is needed to establish adequatepayment mechanism for telehealth services. Liability Issues Since telehealth mediated medical care is limitedregarding a physical examination, physicians are anxious whether they are missing certain importantdiagnosis. This raises a concern for medicolegal liability. There is a need to set clear guidelines for liabilityprotections. Conclusion Although telehealth is widely accepted by the parents, it is important to understandthe limitations of telehealth. The nature of such limitations should be conveyed to parents. Since the health ofchildren cannot wait for a normalization of health care delivery;we need to be able to modify, adapt and try todo what is feasible.