Are Online Pediatrician Appointments the New Normal?
Virtual doctor visits skyrocketed during the pandemic out of necessity. Providers and parents say this shift could have lasting benefits for both sides.
In the socially distanced world of the pandemic, telehealth technology has revived the bygone idea of medical providers treating patients in the comfort of their own homes—and doctors and parents are embracing the change.
Telehealth and telemedicine are sometimes used interchangeably, but according to the American Academy of Family Physicians, they are separate, though related, tools. Telehealth, it states, “refers broadly to electronic and telecommunications technologies and services used to provide care and services at-a-distance,” while telemedicine is “the practice of medicine using technology to deliver care at a distance.”
Neither idea is new. The technology grew from research in the late 1950s to find better ways to serve rural patients, according to eVisit, an Arizona company that markets a telemedicine platform.
But in 2016, the American Academy of Pediatrics noted that only 15 percent of pediatricians were using telehealth systems—partly due to payment and billing issues that became barriers to wider adoption.
COVID-19 changed all that.
With the initial surge of the disease in the spring of 2020, state and federal regulators issued waivers to permit wider use of the technology at a time when everyone was encouraged to stay at home. Now, the same telecommunications advances that made it easier for people to work from home (think Zoom) have popularized this underutilized medical tool.
Dr. Celina Labrec-Salmons, who practices internal medicine and pediatrics with Central Ohio Primary Care in Grove City, says telehealth wasn’t frequently used before the pandemic, “and then it was all we could use for a while.”
“We had to scramble to find the best way to reach our patients” after the statewide stay-at-home order was issued in March 2020, says Dr. Maria Courser, who practices internal medicine and pediatrics in the Mount Carmel Health System.
She says Mount Carmel developed a telehealth solution within a few weeks of the order, taking advantage of relaxed restrictions on such systems. “It was very, very strange in the beginning—almost bordering on uncomfortable,” she says of her early experiences. Now, past the learning curve, Courser calls telehealth a very valuable tool. “We’ve all seen the benefits of this.”
Use of Telehealth Takes Off
Nationwide Children’s Hospital experienced a spike in telehealth encounters, with more than 502,000 logged between March 2020 and September 2021. Behavioral health visits accounted for 55 percent of the total.
Jennifer Reese, a clinical pediatric psychologist with Big Lots Behavioral Health Services at Nationwide Children’s, says the hospital was using telehealth in a limited capacity before the pandemic. Then, in 2020, it logged more than 165,000 such visits for behavioral health issues, training upwards of 600 providers to use the system. Pre-pandemic, there were only two behavioral health providers using telehealth. “For us, what began out of necessity is making clear to us that it will have some lasting benefits,” Reese says.
The Centers for Disease Control and Prevention says telehealth can reduce the risk of transmission of COVID-19 since patients don’t visit a doctor’s office or hospital setting. That also conserves medical supplies and reduces the strain on health care facilities and providers.
The convenience of the system is also appealing. “It’s nice because getting a sick child into the car and to the pediatrician’s office is a chore,” says Jamie Schaadt of Westerville. She says her three kids—ages 5 to 9—have had virtual visits several times. She appreciates the ease of use, as well as avoiding wait times in the doctor’s office and being able to keep kids at home where they can stay bundled up in bed. “It makes the kids more comfortable, it makes me more comfortable, and I’m sure it makes the office more comfortable knowing you don’t have all those germs in the waiting room,” Schaadt says.
Telehealth's Impact on Behavioral Health
One area where telehealth systems shine is behavioral health, including treatment for such diagnoses as attention deficit hyperactivity disorder and depression, according to the AAP.
“What’s great about telehealth is that people with mobility issues can get the care they need at their residence or home,” says Shane Harphant, a counselor who works with kids and adults at Boundless, a Columbus-based nonprofit that focuses on intellectual and developmental disabilities and behavioral health challenges. “It definitely opens up more access to a lot more people in rural areas and people with limited mobility. It offers a wide range of access to people that might not otherwise be able to get it.”
Harphant says the service “allows us to mitigate the barriers for people to receive services in order to reach their full potential.”
Doctors say that seeing behavioral health patients in their home environment is a big plus. “We’ve realized more benefits than barriers for sure—for behavioral health specifically,” says Reese. She says she’s able to see things she might not during office visits. “With younger children, they’re more relaxed versus an office setting.”
In fact, about 75 percent of Nationwide Children’s behavioral health patients surveyed since August 2020 say telehealth is equal to or better than in-person care. “I have a couple of teens that I see for depression, and they seem much more open and relaxed when they’re at home,” says Labrec-Salmons. “I think I get more out of them in that scenario than I do in the office.”
By the same token, telehealth has its limitations. “There’s obviously some things you can’t do,” says Labrec-Salmons. “I can’t examine an ear for an infection. I can’t really examine your joint or your foot to make sure it’s not broken. It’s not ideal for that situation.
“I still have parents that prefer to be in the office. I don’t think it can ever replace putting my hands on a patient and doing the physical examinations necessary for certain things.” But Labrec-Salmons hopes to continue using the technology where she can. “I think the convenience factor is huge.”
Virtual visits also generally are not appropriate for behavioral health patients who are at risk of harming themselves. “Those are the patients we’re still seeing in person for sure,” Reese says.
While the pandemic caused an unforeseen explosion in telehealth usage, that phenomenon may not continue. Unless something changes, the clock will run out on Ohio’s relaxed restrictions on telehealth visits at the end of 2021. A spokesperson for the State Medical Board of Ohio said it continues to monitor the situation, including proposed legislation at the federal level and in the Ohio General Assembly. Rules were scheduled to revert in September following the lifting of the governor’s state of emergency order in June, but the board extended the waiver period due to the surging Delta variant.
“We enjoy using it, and we’ll keep on using it as long as it’s an option just because it’s so convenient,” Schaadt says. “Being able to see the doctor on our own time is wonderful.”
“I don’t see telehealth going anywhere anytime soon, regardless of the restrictions,” Harphant says.
This story is from the Winter 2021 issue of Columbus Parent.