Deliberation is Needed Before Advocating Telemedicine for Routine Use in Child Neurology After the Pandemic

One year of child neurology telemedicine: a data-driven analysis of 14,820 encounters

“…While ongoing management of pediatric epilepsies lends itself to telemedicine care, several populations are typically considered high risk for telemedicine evaluation, including young children and children with neuromuscular or movement disorders. [13][14][15] We observed a lower rate of telemedicine visits in certain diagnosis groups and specialty programs with a noticeable increase in in-person visits during the ramp-up phase. Although we are unable to determine a unifying reason why a provider or family might prefer in-person visits, limitations such as the inability to complete certain procedures remotely and the ongoing pattern of preferred in-person evaluation emphasize the ongoing need to evaluate specific subgroups of individuals through inperson assessments.…”

“…[9][10][11] Child neurology assessments often rely on physical exams, so providing adequate care using telemedicine can be challenging, exacerbated by the relatively high proportion of rare conditions. [12][13][14] We have previously shown that telemedicine visits in child neurology are adequate for approximately 95% of all visits 15 but, in parallel with other studies, we assessed telemedicine soon after its implementation. As telemedicine use stabilized during the pandemic, new data became evident, such as differences in telemedicine access among underrepresented racial and ethnic minorities.…”

Risk of Admission to the Emergency Room/Inpatient Service After a Neurology Telemedicine Visit During COVID-19 Pandemic

“… 7 , 8 , 9 We saw telemedicine as the silver lining of a disrupted health care during the pandemic, 10 whereas others are not as convinced of its safety and advocate caution. 11 We previously studied the overall safety and quality of telemedicine visits using SPROUT (Supporting Pediatric Research and Outcomes Using Telemedicine) guidelines. 12 Our previously published data 13 suggest that telemedicine is a safe and high-quality option for the vast majority of pediatric neurology patients, with a low cause-specific readmission rate: less than 2.5% within four weeks of a telemedicine visit.…”

“…Telemedicine was launched as a crisis standard-of-care practice in many hospitals and has allowed patients with chronic conditions to maintain continuity of care with their providers. 7 , 8 , 9 , 10 , 11 We believe that it is important to establish “telemedicine standards” that can be applied across specialties and hospitals with varying past experience with telemedicine and nonuniform infrastructural capacity. Establishing universally applicable and acceptable telemedicine standards for various specialties will allow further improvement in quality of care delivered to patients.…”

Follow the Money: Childhood Health Care Disparities Magnified by COVID-19

“…Converting to remote school classes and implementing telemedicine visits are likely to work better in families whose children have individual computers and robust internet access as well as an available adult to monitor the situation. 6 , 7 …”