[Mili Patel]

As a future FNP, I’m interested in implementing telehealth into my own practice because of my own background growing up in rural Virginia where receiving specialty care was limited. If my family needed anything beyond a general pediatrician or PCP, we were looking at an hour long drive to Richmond, which can be a huge barrier for patients with chronic conditions. My experience growing up in a small town is why I believe it is important to offer telehealth to patients who may not have the resources to physically come into the office. One protocol or program that I would like to build is for pediatric asthma management in rural communities.
For this program, I’d use a combination of videoconferencing, RPM and store & forward. Videoconferencing would cover scheduled follow ups and acute symptom check ins. RPM would allow me to track peak flow readings and symptom logs between visits through a Bluetooth connected peak flow meter or smart inhaler sensor. Store & forward would let families or local clinics send inhaler technique videos or spirometry results for me to review when a live visit isn’t necessary.
As the primary provider, my role would be to manage the patient’s asthma action plans, review RPM and store & forward data, conduct virtual visits and escalate to an in person visit or referral for the ED when needed. I would evaluate the program by tracking ED and urgent care visits, medication adherence, missed school days, RPM data completion rates and how satisfied families are with virtual care compared to in person visits.
Legally, I would need to consider multi-state licensure, HIPAA compliant storage of RPM and store & forward data and documentation standards that match in person visits. For this porgram I would collaborate with a respiratory therapist for technique coaching, a school nurse for day to day updates, a pharmacist for medication access. Protocols would include monitor parameters and critical values, patient eligibility, follow up and ED referral criteria and a backup plan for internet connection issues. I would obtain electronic and verbal consent to treat and for the telehealth visit.

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