Pediatric Telehealth Best Practices

232 Pages·2022·7.253 MB·English

by  American Academy of Pediatrics (AAP)

Pediatric
Telehealth
Best Practices
American Academy of Pediatrics Publishing Staff
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Mark Grimes, Vice President, Publishing
Laura Underhile, Editor, Professional/Clinical Publishing
Jason Crase, Senior Manager, Production and Editorial Services
Leesa Levin-Doroba, Production Manager, Practice Management
Peg Mulcahy, Manager, Art Direction and Production
Mary Jo Reynolds, Marketing Manager, Practice Publications
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: [phone]
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists,
and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents,
and young adults.
While every effort has been made to ensure the accuracy of this publication, the American Academy of Pediatrics does
not guarantee that it is accurate, complete, or without error.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of
medical care. Variations, taking into account individual circumstances, may be appropriate.
Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes
only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for
the content of external resources. Information was current at the time of publication.
Every effort is made to keep Pediatric Telehealth Best Practices consistent with the most recent advice and information
available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
Special discounts are available for bulk purchases of this publication. Email Special Sales at [email protected]
for more information.
© 2022 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior written
permission from the publisher (locate title at https://publications.aap.org/aapbooks and click on © Get Permissions;
you may also fax the permissions editor at 847/434-8780 or email [email protected]).
Printed in the United States of America
9-478 1 2 3 4 5 6 7 8 9 10
MA1065
ISBN: 978-1-61002-628-4
eBook: 978-1-61002-629-1
Library of Congress Control Number: 2021925597
Equity, Diversity, and Inclusion Statement
The American Academy of Pediatrics is committed to principles of equity, diversity, and inclusion in
its publishing program. Editorial boards, author selections, and author transitions (publication succession
plans) are designed to include diverse voices that reflect society as a whole. Editor and author teams are
encouraged to actively seek out diverse authors and reviewers at all stages of the editorial process.
Publishing staff are committed to promoting equity, diversity, and inclusion in all aspects of
publication writing, review, and production.

V
Contents
FOREWORD
S. David McSwain, MD, MPH, FAAP ....................................................................................................................VII
SECTION 1
Pediatric Telehealth Guidance and Strategies
Breaking Down Telehealth Barriers in Your Practice .............................................................................................. 3
How to Prepare Families for a Telehealth Visit ....................................................................................................... 7
Minimizing Telehealth Technology Barriers in Rural and Underserved Communities ........................................ 11
Ensuring Equitable Access to Telehealth for Diverse and Underserved Communities ........................................ 15
Telehealth and Adolescent Health Care: What Can Pediatric Clinicians Do? ...................................................... 19
How to Sustain Telehealth Within Your Pediatric Practice .................................................................................. 23
SECTION 2
Guidance for Parents and Caregivers
Telehealth Services Start With Your Pediatrician ................................................................................................. 29
Telehealth: Frequently Asked Questions ............................................................................................................... 33
Telehealth and Mental Health Care ....................................................................................................................... 37
How to Have a Telehealth Visit From College ....................................................................................................... 39
Telehealth Visits for Children Who Need Hearing or Vision Help ....................................................................... 41
SECTION 3
American Academy of Pediatrics Publications
Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits .............................................. 45
From Pediatrics
The Current Pediatric Telehealth Landscape ........................................................................................................ 57
From Pediatrics
Electronic Communication of the Health Record and Information With Pediatric Patients and
Their Guardians ...................................................................................................................................................... 67
AAP Policy Statement
Guiding Principles for Team-Based Pediatric Care ............................................................................................... 75
AAP Policy Statement
How to provide good care using telehealth and reduce medical liability risks ..................................................... 83
From AAP News
Pediatric mental health experts share tips to make the most of telehealth visits ................................................. 87
From AAP News
Pediatric Telehealth in the COVID-19 Pandemic Era and Beyond ....................................................................... 89
From Pediatrics
VI Contents
Rapid Implementation of Telehealth Services in a Pediatric Pulmonary Clinic During COVID-19 ................... 101
From Pediatrics
Strategies for Evaluating Telehealth ..................................................................................................................... 111
From Pediatrics
Technology improves pediatric patient engagement, outcomes .......................................................................... 115
From AAP News
Telehealth and Autism: Treating Challenging Behavior at Lower Cost ............................................................... 119
From Pediatrics
Telehealth Home Monitoring and Postcardiac Surgery for Congenital Heart Disease ...................................... 129
From Pediatrics
Telehealth: Improving Access to and Quality of Pediatric Health Care .............................................................. 139
AAP Policy Statement
Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care ........................................... 145
AAP Technical Report
Telemedicine for Evaluation of Retinopathy of Prematurity ............................................................................... 157
AAP Joint Technical Report
SECTION 4
Forms and Tools
Checklist for Families/Caregivers Who May Require Language Accommodations ............................................ 177
Community Questionnaire ................................................................................................................................... 179
Sample Physical Exam Documentation ................................................................................................................ 181
Tools for Sustaining Telehealth ........................................................................................................................... 183
SECTION 5
Appendixes
Additional Resources and Reading ...................................................................................................................... 187
Health equity in telehealth ................................................................................................................................... 189
From Telehealth.HHS.gov
Legal considerations .............................................................................................................................................. 191
From Telehealth.HHS.gov
Telehealth for school-based services .................................................................................................................... 193
From Telehealth.HHS.gov
Telemedicine Services .......................................................................................................................................... 199
From Coding for Pediatrics 2022
Tips for Providing Breastfeeding Support Via Telehealth ................................................................................... 209
From Breastfeeding Telephone Triage and Advice, 4th Edition
Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic—United States,
January–March 2020 ........................................................................................................................................... 213
From Morbidity and Mortality Weekly Report
Index .....................................................................................................................................................................219
VII
Foreword
Telehealth and virtual care have long been promis- These collected works cover a wide range of impor-
ing emerging technologies to aff ect the care of our tant topics including the nuts and bolts of setting up
patients and families and the practices of pediatri- and sustaining telehealth services in your practice,
cians and pediatric specialists. With the onset of payment and coding issues, state and federal policy
the COVID-19 global pandemic in 2020, the use of considerations, provision of telehealth for complex
these technologies immediately became critical to populations, and the future of telehealth and virtual
the practice of medicine throughout our health care care as part of an integrated health care system. We
system. While we were fortunate to have such modal- start with specifi c guidance and strategies for the
ities available to us, the sudden massive adoption of provision of telehealth services in a pediatric prac-
telehealth across the country and around the world tice. Pediatricians are the linchpin of the pediatric
also highlighted key issues and barriers that present patient-centered medical home, regardless of whether
challenges to accessing and utilizing these technol- care is delivered in person or virtually, and so it is
ogies eff ectively, particularly for some of our most critical that pediatric practitioners lead in the devel-
vulnerable and complex populations. opment of optimal approaches to integrating these
services into health care practice. Next, we provide
The American Academy of Pediatrics has developed
guidance and education to patients and families on
and partnered on dozens of resources addressing
the use of telehealth services in diff erent contexts
many aspects of integrating telehealth and virtual
and locations. We compile the latest research and
care into the practice of pediatrics through the work
thought leadership on state-of-the-art approaches to
of the Section on Telehealth Care (SOTC), the Sec-
telehealth provision, evaluation, and policies. Finally,
tion on Administration and Practice Management,
we provide tools, forms, and reference materials from
the Supporting Pediatric Research on Outcomes and
multiple sources covering a range of telehealth activi-
Utilization of Telehealth research subcommittee of
ties and issues.
the SOTC, the Payer Advocacy Advisory Committee,
and the Supporting Providers and Families to Access Telehealth and virtual care are an integral part of
Telehealth and Distant Care Services for Pediatric the future of our health care system. We have the
Care grant supported by the US Health Resources and opportunity to shape that future to the benefi t of all
Services Administration. This work represents the of our patients, families, practitioners, and care team
collaborative eff orts of numerous passionate national members. Practiced at its highest level, telehealth
experts and innovators across multiple institutions and virtual care can function as key ingredients to an
around the country, dedicated to promoting safe, integrated and seamless model of care for even our
high-quality, equitable, coordinated care for our highest-risk and most disadvantaged populations. It
patients and their families, no matter their location. is up to us to ensure that bright future is achieved.
These eff orts have resulted in a tremendous collec-
S. David McSwain, MD, MPH, FAAP
tion of policy statements, technical reports, research
Professor of Pediatrics, Chief Medical Informati cs Offi cer,
studies, patient and family guidance, and other edu-
University of North Carolina, UNC Health
cational materials. As chair of the SOTC, I am excited
Chapel Hill, NC
to introduce this compilation as a means of consoli-
dating this wealth of knowledge and expertise into a Chair, American Academy of Pediatrics Secti on
single, comprehensive resource for anyone looking to on Telehealth Care
integrate telehealth and virtual care into the provision
of care to their patients.

1
SECTION 1
Pediatric Telehealth
Guidance and Strategies
This section’s contents will help position your practice for the successful utilization of telehealth,
including overcoming known barriers to its execution. You will also fi nd guidance for assisting
specifi c populations as well as tips for keeping your telehealth program running smoothly
and eff ectively.
Contents
Breaking Down Telehealth Barriers in Telehealth and Adolescent Health Care:
Your Practice................................................................3 What Can Pediatric Clinicians Do? ...........................19
How to Prepare Families for a Telehealth Visit ..........7 How to Sustain Telehealth Within Your
Pediatric Practice .......................................................23
Minimizing Telehealth Technology Barriers
in Rural and Underserved Communities ...................11
Ensuring Equitable Access to Telehealth
for Diverse and Underserved Communities .............15