Pre-Covid -19 when our children get sick or hurt the first thing we did was call our pediatrician to see if they can fit us on their schedule. If they couldn’t we would go to the Emergency Department, go to Urgent Care, or wait it out. Fast forward 3 months, and now the first call to action is in the comfort of your own home. In our ever changing new normal, telemedicine has made a fast breakthrough. Throughout Dr. O’s blog, we hope this gives you an understanding of how telemedicine can put your child on the way to recovery and give you piece of mind a little faster. Understanding how telemedicine works, is a great start.
Ideally, most pediatricians like to see kids in their offices when they are sick, but the COVID-19 pandemic fast tracked the process of migration to telemedicine as an adjunct to delivering care. Telemedicine is a great alternative for providing healthcare to children, adolescents and young adults as it helps with recognition of the truly sick who may need immediate medical attention.
What is the difference between telehealth and telemedicine?
Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services. The medical field uses telehealth as an umbrella term to mean using telecommunications to provide health services, nonclinical health education and public health programs for instance hosting an online suppor group, examining a patient’s x-rays, providing a diagnosis from a remote location, or educating a group about a medical issue through an online videoconference
Telemedicine, on the other hand, is a niche within telehealth. Telemedicine involves a healthcare provider using telecommunications to provide healthcare to a patient. This might include having a remote, video visit with a patient or sharing a patient’s medical information and health record with another healthcare provider for a second opinion.
There are generally three types of telemedicine strategies: Store and forward, remote monitoring, and realtime clinical telemedicine. For urgent care clinics, real-time telemedicine using a video conference is by far the most practiced service. At Night-Lite Pediatrics Urgent Care, we utilize video conferencing capability to share information real-time from the physician’s computer screen to another computer or mobile phone which allows us to see and capture the patient and his or her environment as well as take pictures, if necessary.
Is there any difference in telemedicine regulations during the COVID 19 pandemic?
Yes, on March 6, 2020, the President put in place a waiver on certain Medicare telehealth payment requirements during the Public Health Emergency (PHE) to allow beneficiaries in all areas of the country to receive telehealth services. All Medicare patients are now eligible for telehealth services, and this is being honored by commercial insurance companies as well.
The waiver also enables providers to see new patients via telemedicine in contrast to the pre-COVID 19 regulation which allowed providers to see only established patients. Lastly, HIPAA compliance requirements were relaxed but not abrogated.
The duration for which this waiver will be in place and modifications that will be made thereafter remains to be seen.
What type of technology do I need for a telemedicine encounter?
Telemedicine always deals with private patient health information; therefore, telemedicine technology
needs to be secure and HIPAA compliant.
Equipment needed include: a computer or laptop with a webcam and adequate computer audio, iPad or Telephone with Mobile Apps, Internet access with adequate speed and bandwidth, and Secure Email (for Store-and-forward).
With the recent adoption of patient portals and electronic health records, more healthcare providers and patients are using secure email messaging systems to communicate about lab results and update medical conditions. Physicians also use this form of telehealth to share patient medical data, especially photos and recorded videos, with specialists at other locations. For example, a physician might use a secure email messaging system to send a patient x-ray to a radiologist at a distant location for diagnosis.
Can telemedicine be used for all age groups?
Yes, but it is important to note that children are not small adults. Because getting a history on the child is fraught with difficulties, the younger the child, the less risk parents should take with the skill set of the provider. In addition, children less than two years of age are more likely to need hands-on evaluation.
Telemedicine providers should have the experience and training needed to know how to diagnose and treat your child’s condition safely and correctly. At Night-Lite Pediatrics Urgent Care, we provide this type of quality for children, adolescents, and young adults.
Except in special situations where your child can legally consent to his or her own care, a responsible adult such as a parent, legal guardian, school nurse, pediatrician, or other healthcare provider should always be with your child during the telemedicine service.
What are the advantages of telemedicine?
- Convenience- available when doctor’s office is closed.
- Quicker and more convenient than office visits.
- Wait time is much less in most cases. Parents often spend 4 to 6 hours to obtain care in the ED for
- Useful during epidemics/pandemics and national disasters such as hurricanes.
- Less costly for the most part. An ED visit for a problem that can be managed by telemedicine costs
7- to 10-fold more.
What are the limitations of telemedicine?
Not suitable for all cases. You will get a swift evaluation of your symptoms with on-demand telemedicine, but you can’t get a full, routine physical exam. In some cases, such as when you need a Strep or Flu test that requires a swab, a remote consultation may not be sufficient. Your telemedicine provider can arrange for the additional testing. At Night-Lite Pediatrics Urgent Care, we will provide you with an “express pass” to get the test done without waiting in line.
Possible electronic glitches. Because your appointment depends on technology, you are at the mercy of anything that can interrupt your connection — bad weather, loss of power or even outdated software. On some telemedicine platforms, the visit may get interrupted if a call or text is received on the mobile device being used.
Each telemedicine provider will provide you with guidance on the equipment and preferred browser. To avoid the glitches, make sure you get information about how the telehealth visit works before it happens.
Not all visits can be done via telemedicine. Sometimes a telehealth provider may determine that your child needs a more thorough examination or is too sick to be cared for through telehealth, after the telehealth visit has already started. This is an area where pediatric experience is important. In such cases, telehealth providers should know when and how to refer your child to the most appropriate healthcare facility.
Telemedicine providers should have clear guidance on when a virtual visit should be converted to a faceto-face visit. Night-Lite Pediatrics Urgent Care will arrange the transfer of care to one of our centers closest to you. This helps with continuity of care and helps decrease the number of emergency room referrals. Regardless of expertise, a few patients will still need to be referred to the emergency room.
Note: The AAP does not recommend retail-based clinics, telehealth services outside of the medical home, or acute care services without pediatric expertise for children younger than 2 years.
What should I have ready to help speed up my child being seen via telemedicine?
- Weight is essential because medication dosage depends on accurate weight in children.
- Check your child’s temperature and, if possible, his or her respiratory and heart rate over a period
of 30-60 seconds.
- Have a list of medications that your child is on currently and any medication that he/she has taken
within the last month.
- Organize and write down your child’s symptoms in the order in which they started.
- Write down any questions you have, as you might forget them during the telemedicine visit.
- Make sure that the environment (room) is well lit and have a flashlight handy.