INTRODUCTION
The novel coronavirus disease (COVID-19) first appeared in China in the
late fall of 2019, and on March 13, 2020, was declared a national
emergency in the United States (U.S.) following the World Health
Organization’s declaration of a global pandemic two days prior. This
event challenged healthcare systems across the U.S. to quickly implement
and sustain new ways to see and treat patients, providing both
challenges and opportunities for healthcare providers. A transformative
moment for telehealth to become mainstream1, rapid
implementation of telemedicine visits became essential to maintain care
for patients while keeping them safe during a rapidly spreading
pandemic.
While the concept of modern-era telemedicine is not new, prior to the
COVID-19 pandemic, telemedicine was infrequently used to provide medical
care in urban tertiary care centers. Telemedicine’s relevance in
pediatrics had been highlighted by the American Academy of Pediatrics in
their statement in 2015 as a care delivery model, educational and
research tool2. An analysis of 28 published studies
about the use of telehealth did not show strong supporting evidence for
its use3.
Similar to many large tertiary care centers, the Children’s Hospital of
Philadelphia (CHOP) had some limited experience with telemedicine
platforms. Prior to March 13, 2020 and the COVID-19 pandemic, the
division of pulmonary and sleep medicine at CHOP had only used
telemedicine in a small pilot program. Discussions had occurred more
than 18 months prior regarding expanding the use of telemedicine in a
subset of patients, but progress was hindered by lack of reimbursement
by third-party payers and interstate medical licensure concerns. Our
first telemedicine video visits were implemented on March 24, 2020 at
the start of the COVID-19 pandemic.
In tandem with our rapid implementation of telemedicine, we conducted a
quality improvement study to assess the feasibility, utility and
favorability of pulmonary telemedicine visits through the use of
provider and patient/family surveys. We hypothesized that telemedicine
is an effective and feasible means of providing medical care to children
and adolescents seeking pulmonary care and is a favorable option to
provide care for children with a wide range of pulmonary diagnoses.