Telemedicine beyond the pandemic: challenges in the pediatric immunology clinic.

INTRODUCTION: Telemedicine and electronic medical records (EMRs) have revolutionized healthcare in recent years, offering numerous benefits that improve the delivery of care and the overall patient outcomes. AREAS COVERED: Telemedicine allows providers to diagnose and treat patients remotely, often eliminating the need for face-to-face visits. Its benefits include improved access to care, convenience for patients, and reduced costs both for patients and providers. When used with remote patient monitoring and remote therapeutic monitoring, continuous care becomes possible. EMRs allow providers to store, access, and share patient information more efficiently than paper charts. The benefits of EMRs include improved patient safety, increased efficiency, and reduced costs. EXPERT OPINION: The combination of telemedicine with EMRs makes it possible to envision the advent of computer-assisted diagnosis (CAD). This technology uses artificial intelligence and machine learning algorithms to analyze medical information including images, clinical and physiologic data, test results and remotely obtained information to support healthcare providers in making accurate diagnoses. By providing providers with what is essentially a second opinion, CAD systems can help prevent misdiagnoses and improve the quality of care. Such systems are not meant to replace healthcare providers, but rather to support them in making more informed and accurate diagnoses.

The Regulatory Environment of Telemedicine After COVID-19.

The COVID-19 pandemic has created many barriers to providing health care, yet it also has created new opportunities. Although telemedicine was a nascent means of health care delivery before COVID-19, it now is one of the principal means for doing so today, and it is likely to remain so. Whether this will happen may depend in part on continued relaxation of regulations that hampered it before the pandemic. Whereas enforcement of compliance with Health Information Portability and Accountability Act will most likely resume, platform operators and providers have had an opportunity to prepare for this. State licensure requirements may also resume; however, the regulations were in the process of becoming more liberal before COVID-19 so that process might continue. There is no reason to anticipate that payment for telemedicine services including check-ins, remote physiologic and therapeutic monitoring, and relaxation of location and service requirements will end. For these reasons, telemedicine therefore is likely to continue as an important part of medical practice.

A Review of Patient and Provider Satisfaction with Telemedicine.

PURPOSE OF REVIEW: The purpose of this review is to describe the determinants of satisfaction with telemedicine (TM) and how they compare with in-person visits from both the perspective of patients and of providers. RECENT FINDINGS: The use of TM will expand only if patients and providers are at least as satisfied with it as they are with in-person visits. Since deviations from expected care can result in reduced satisfaction regardless of the quality of the visit or objective medical outcomes, it is important to understand and to help form those expectations when possible. Patients consistently report 95-100% satisfaction rate with TM when compared with in-person appointments. They tend to cite the convenience of decreased travel times and costs as the main drivers for satisfaction with TM. Providers tend to be satisfied with TM if they have input into its development, there is administrative support, the technology is reliable and easy to use, and if there is adequate reimbursement for its use. Satisfaction with TM is necessary for adoption of this new technology. To improve satisfaction it is important to consider factors that drive it both for patients and for providers.

Benefits and risks of incorporating virtual visits into an allergy/immunology practice.

Telemedicine (TM) involves the use of technology to overcome the patient care barriers of distance and time. Asynchronous TM can be used to monitor patients remotely and for providers and patients to communicate with each other without needing to be online at the same time. Synchronous TM can include direct-to-consumer visits in which patients use their own equipment to communicate with a provider or facilitated visits in which a patient travels to a clinic to use the clinic's equipment with a facilitator. The advantage of the latter is that a physical examination can be performed. Although some patients and providers may prefer in-person visits, patients who are seen by TM report satisfaction that it is as good as or better than that of an in-person visit. TM can be used in the outpatient setting, in the hospital to perform consults, or in the school. The convenience of TM makes it likely that more patients will adopt TM as their preferred mode of obtaining health care. It is important for allergists to become familiar with this new technology because patients will demand it.

Telemedicine and emerging technologies for health care in allergy/immunology.

Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic face-to-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference.

Telemedicine for Allergy Services to Rural Communities.

Telemedicine (TM) involves the use of technology to provide medical services to patients who live at a distance. It can be used asynchronously for interpretation of test results (spirometry, skin tests imaging studies), and for communication of information when the simultaneous presence of provider and patient is unnecessary. Synchronous encounters can either be unscheduled and initiated on demand by patients or be facilitated substitutes for in-person visits. The latter results in asthma outcomes that are as good as those for in-person visits while reducing the cost and inconvenience of travel from rural communities to urban centers. Facilitated visits can be done in the ambulatory and emergency department settings, and they can be used for inpatient consults when allergy specialists are not readily available. Both patients and providers experience high degrees of satisfaction with this type of visit. In addition, virtual visits performed using TM are cost-effective. TM offers a solution to the shortage of specialty care that is present in rural communities.

The Medical Virtualist: Is Pediatric Patient Care Using Telemedicine, a New Specialty?

Telemedicine (TM) is undergoing unprecedented growth that is being driven by numerous factors, one of which is patient preference. Providers who use this tool to deliver health care tend to be early adoptors of new technology, but do they also represent a nascent specialty of pediatric virtualist? We believe that such practitioners, although exhibiting characteristics common to all early adopters, represent the cutting edge of what will become routine medical care. They tend to engage in less small talk with patients, focus more on efficient problem-solving, and collect less data while achieving patient outcomes and satisfaction that are as good as, or possibly even better than, their colleagues who practice in traditional settings. In doing so, they are leading the way for all providers to deliver care to patients using this new technology. Eventually, we feel that medical encounters using TM will be referred to simply as "patient care." [Pediatr Ann. 2019;48(6):e243-e248.].

Telemedicine: a Primer.

PURPOSE OF REVIEW: Due to rapid advancements in quality of real-time, interactive, audio-visual, and digital technologies as well as impressive gains in internet speed and capacity, medicine delivered over distance is happening faster than many healthcare providers and leaders can grasp. RECENT FINDINGS: Depending on which market report you ascribe to, industry projections for the global compounded annual growth rate of telemedicine are between 13 and 27%, with valuation growing to over 20 billion US dollars in the next several years. The Mayo Clinic has reworked its entire telemedicine interest to a model with centralized operations, one virtual technology platform, standardized training, and connectedness for all of its locations. The National Quality Forum spent 2016 and 2017 formulating 70 some pages of recommendations for expanded measures to valuate telemedicine over the foreseeable future. There are so many patient experience studies indicating high satisfaction with telemedicine, that professionals in the industry accept it as fact. Telemedicine is leaving novel to the past. This short, informative piece of writing includes expert opinion and research findings about what is telemedicine, why one should practice telemedicine, and how one should approach implementation; a primer from which to grow.

Telemedicine is as effective as in-person visits for patients with asthma.

BACKGROUND: Access to asthma specialists is a problem, particularly in rural areas, thus presenting an opportunity for management using telemedicine. OBJECTIVE: To compare asthma outcomes during 6 months in children managed by telemedicine vs in-person visits. METHODS: Children with asthma residing in 2 remote locations were offered the choice of an in-person visit or a telemedicine session at a local clinic. The telemedicine process involved real-time use of a Remote Presence Solution (RPS) equipped with a digital stethoscope, otoscope, and high-resolution camera. A telefacilitator operated the RPS and performed diagnostic and educational procedures, such as spirometry and asthma education. Children in both groups were assessed initially, after 30 days, and at 6 months. Asthma outcome measures included asthma control using validated tools (Asthma Control Test, Childhood Asthma Control Test, and Test for Respiratory and Asthma Control in Kids) and patient satisfaction (telemedicine group only). Noninferiority analysis of asthma control was performed using the minimally important difference of an adjusted asthma control test that combined the 3 age groups. RESULTS: Of 169 children, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all 3 visits. All had a small, although statistically insignificant, improvement in asthma control over time. Telemedicine was noninferior to in-person visits. Most of the telemedicine group subjects were satisfied with their experience. CONCLUSION: Children with asthma seen by telemedicine or in-person visits can achieve comparable degrees of asthma control. Telemedicine can be a viable alternative to traditional in-person physician-based care for the treatment and management of asthma.