[Jacqueline Magill]

Telehealth use by APRN’s would be very beneficial for the pediatric population. As I have observed in working with mainly immigrant minor patients this summer, there is a great need for increased education, transcultural care, quicker diagnosis of acute illnesses for improved outcomes, and greater follow-up to prevent the development of chronic diseases.
Model and why: I would use a combination of several models to improve care. RPM, mHealth, and videoconferencing would assist in the care of the pediatric population. Videoconferencing would allow visits remotely to improve access, decrease transportation difficulties and costs, and increase compliance and patient and family knowledge. RPM would be useful to send secure patient data to providers, such as spirometry levels, asthma questionnaires, food diaries, vitals, and more. Patients’ families often overuse the emergency room due to inability to be seen quickly or get appointments when ill. mHealth would additionally be useful in allowing self-scheduling and messages to be relayed more efficiently to providers. Therefore, again, the type of equipment needed for this combination model would be RPM, mHealth, and videoconferencing.
The type of population that I believe would greatly benefit are immigrant children. This population has unique language, psychiatric, and educative needs. Particular healthcare issues that I believe could especially benefit from telehealth would be outpatient follow-up appointments regarding asthma, hypertension, obesity, diabetes, and developmental issues. These topics have a particular need for greater education and vigilance.
Things that would be measured include outcomes, frequency of use, and patient satisfaction. Legal issues might include proper consent, consent or assent of the child participating, HIPAA and secure devices, conflicts of interest, and emergencies that may arise.
Other professions that I believe should be involved in this program include the following: speech therapy, developmental specialists, ENT, nutrition counseling, social work, among others. Speech therapy would permit increased attendance and also help child participation by having them be in an environment that feels safe. Social work would have greater impact by addressing more social determinants of health and assisting families to improve access. Nutrition counseling could provide greater awareness in a convenient setting especially where transport is an issue to give more education on diet matters such as constipation, diabetes, hypertension, celiac, and more. ENT specialists often take months to see. Perhaps improving and expanding accessibility through telemedicine could improve wait times for children suffering from recurrent ear infections or sleep apnea. Developmental specialists as well could be very useful in decreasing wait times for diagnosis and ensuring patients receive the help they need.
I would develop protocols such as a late policy for patients who do not show up on time or those who do not show at all. I would also develop a cancellation policy. I would ensure training on keeping a professional workplace for the background, a limit to the number and type of telehealth visits permitted, some form of evaluation or shadowing/audits to ensure proper care, and coaching protocols before initiating telehealth sessions.
I would get consent through calling ahead through the phone to ensure delivery of the form to the patient’s email. I would also broach the acceptance and willingness for telehealth at a routine visit and then follow up via phone call. I would have the front desk staff check for signed consent, and include in the document any possible failures, as well as benefits of its use, confidentiality and privacy clause, and the purpose and any risks or inabilities.

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