Pediatric Associates

Jennifer Berkovich

The world of telehealth has moved at lightning speed over the last two years. The world of pediatric telehealth limped behind its adult counterpart but has been catapulted to the front line as a result of the pandemic.

Despite increased utilization, many pediatricians continue to be wary of relying on telehealth beyond the acute use cases that COVID provided. How much can really be done virtually? How can we make sure that standards of care are being met? How can we use telehealth to our advantage? As pediatricians began asking these questions, studies came out pointing to the gaps in care when direct-to-consumer telehealth was used. A frequently cited study showed an increased use of oral antibiotics compared to in-person visits, while another showed frequent prescriptions for controlled substances.

The solution to many of these issues lives within the medical home. Using a truly integrated model of care helps close gaps in care while maintaining the high levels of clinical standards that patients have come to expect from their pediatrician. This model is built on a dedicated team of telehealth clinicians hired, trained, and supported by the patient’s medical home. This also means that all telemedicine visits are documented in the home chart and that the telehealth clinician has full access to the patient’s record. In addition, having a virtual front office/ancillary team allows for scheduling follow-up visits, both in person and via telemedicine. Full access to the record and the ability to schedule follow-up visits decreases the number of prescribed antibiotics. The “watchful waiting” that is often the standard of care for frequent pediatric pathology is now very easy to achieve. Finally, 24/7 availability allows patients to have a one-stop-shop they can rely on for visits day and night. Self-scheduling and on-demand visits give patients autonomy and decrease barriers to care like having to call, wait and schedule a visit.

"The key to a high quality and evidence driven telehealth experience must be the relationship to the medical home"

We’ve learned from this model that low acuity and chronic follow-up visits lend themselves well to the virtual world. Seeing chronic and medically complex families in their home environment increases the scope of care that we provide. We can make recommendations on the layout of their home and address things like safety and anticipatory guidance in a very concrete way. This also means that we can focus our efforts not just on diagnoses and treatment but on true preventative care and disease management. As the world of pediatrics moves along the fee-for-service spectrum and closer to a value-based care model, telehealth becomes the solution to many goals. ER diversion increased compliance, hospital follow up, and even remote patient monitoring to decrease hospitalized length of stay can all be solved in the virtual world.

The key to a high-quality and evidence-driven telehealth experience must be the relationship to the medical home. By adopting this patient-centric model, we can continue to provide excellent care for our tiniest and most vulnerable patients.