Preparing for Your Autistic Child’s Telehealth Appointment

a guest blog post by Bonnie Offit, MD, Office of Digital Health Clinical Advisor, Children’s Hospital of Philadelphia

Despite this wretched new coronavirus spreading disease and fear, there are few good things happening.  I thought I could share one of those silver linings that those of us in healthcare are experiencing: an explosion of seeing patients on video visits: Telehealth.

As we work out the details of social distancing, hospitals and healthcare providers are scrambling to find innovative ways to care for their patients. Of course, we use email and telephone but it is essential for patients to have periodic in-depth check-ins with physicians and therapists. Technology has reached the point in healthcare, though perhaps a little later than other businesses and institutions, where we can use a secure video-conferencing platform embedded right into our patient portals.  Two of the major barriers to using Telehealth were related to strict HIPAA privacy protection rules and reimbursement (doctors getting paid for these visits by insurance).  In this COVID period both barriers have been lowered allowing pediatric hospital systems like ours to convert many visits from in-person to video (telehealth). In some clinical areas, more than half of our patients are being seen over video. Our hospital just went from small departmental pilots trying about 10 visits/week to doing a total 1000 video visits in one day. We even have up to 5 people in one visit- so a feeding specialist, occupational therapist, neurologist, developmental pediatrician and an interpreter can participate one by one or together in one scheduled visit. This happens to be a remarkably efficient and convenient way to receive care. We are learning so much.

As the parent of a patient, all you need is a smartphone (iPhone or Android) or in some cases a laptop with a camera, Wifi  or cell signal, a provider portal and you are all set.   During these visits, providers might assess development, manage medications, provide counseling, suggest resources and treatment options as well as explore other underlying medical or psycho-social contributors. Can we accomplish that over video? Yes, we can. Is the visit as good as in-person?  It is likely to be at least as thorough, however there are a few parts of the normal in person that cannot be replicated. We can’t easily see the back of the throat, we cannot listen to the heart or lungs and we cannot see eardrums. We cannot do a full neurologic exam. For concerns specific to those parts of the physical exam you will have to be scheduled for a follow-up in person. However, there is an exciting new device called Tytocare that has much potential for use in pediatrics.  This device offers remote examination tools to see eardrums and listen to lungs from home. Few facilities are using this platform to date and it costs the family $300 to purchase. But stay tuned for more on that device.

It is important to realize that you and most doctors and therapists are just beginners on how to complete video visits from home.  Anything new and anything with technology will have the requisite frustrations. There are technology challenges on knowing which app to use, how to download the app, log-ins, activation codes, allowing your phone or iPad to use the speaker, what to click and making sure you have a strong enough signal (Wifi is much preferred so you don’t need to use your data plan). We use the telehealth modules that are part of our electronic health care systems which helps but is not without glitches. Everyone needs an extra dose of patience when it comes to Telehealth, but it is worth the struggle.

So what does this new explosion of telehealth really mean? You and your child can have a full encounter with your provider from the comfort of home. If your child fears the office, then this is especially helpful. You will need to have your child in the video visit for at least some portion of the encounter. You may be asked to have your child try certain developmental tasks on the camera.  But most of us are quite comfortable with using Facetime on the phone and this is no different.

This is a good time to ask your provider if they offer telehealth and ask your insurance company if they pay for it. During this stressful COVID period, most insurance companies have agreed to reimburse for Telehealth. I would recommend that you download your provider’s patient portal tool now, obtain an activation code and be ready. Best of luck with your new technology adventure using Telehealth. And be sure to remember patience when you get locked out after forgetting your password on the 10th try. It’s worth it!