Episode 4: Virtual Visits

In this episode of Just Kids Health, our experts will share how virtual visits are transforming how children and families receive medical care—and address common questions and misconceptions about virtual care. You’ll hear from Dr. Andrew Huang Pacheco, a pediatric gastroenterologist, about how virtual visits have helped transform his daily practice during the COVID-19 pandemic, as well as from Rebecca Ohlinger, Children’s manager of virtual care.

Topic Breakdown

1:55 — The growth of virtual care at Children’s — especially during COVID-19
6:07 — Virtual care as a supplement to in-person care
8:55 – Technology and interdisciplinary care with virtual visits
11:57 — Virtual visits as a window into a patient’s home
13:08 — The future of virtual visits at Children’s after COVID-19
17:06 — Making a virtual visit appointment at Children’s

Transcript

Here at Children’s Hospital & Medical Center in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

Rebecca Ohlinger: My name is Rebecca Ohlinger. I am the Manager of Virtual Vare at Children’s Hospital & Medical Center in Omaha. As of this last April, I celebrated my second anniversary with the organization, and I’ve mainly been focused on just working with our providers and our leadership on trying to implement virtual care workflows — which are telehealth, so visits to the home, and telemedicine, which are visits facility to facility.

Dr. Huang Pacheco: My name is Andrew Huang Pacheco. I’m one of the pediatric gastroenterologists here. I have been with the hospital working for pediatric GI for 4 years, and I did my training here, as well, so I have been here for a total of 7 years now. I mostly take care of pediatric patients that have any gastrointestinal diseases.

The growth of virtual care at Children’s — especially during COVID-19

Rebecca Ohlinger: So, you’ve been longer than I have. You know then that virtual care probably hasn’t really been around Children’s for a very long time, and maybe you weren’t even aware that we started to implement that back in 2017. That was before my time. And at the time that it was implemented, the main focus was on delivering pediatric behavioral health services via telehealth across the state. Nebraska is a very rural state, there’s problems with access to care, but also shortages of behavioral health providers.

But like the children we serve, virtual care has grown considerably — especially in light of the pandemic — which has brought dramatic increases and expansions to the number of specialties that we can offer our community and our region for care. The pandemic, if there’s a silver lining, is that it has forced adoption. But most importantly, enabled us to still provide care to our patients. We — pre-COVID — were averaging about 50 visits per week. And now, during the COVID pandemic, we’re averaging anywhere from 1,200 to about 1,500 visits per week, so we’ve seen about an 11-fold increase in our program, which is amazing. And amazing for our families.

Dr. Huang Pacheco: Yeah, that’s incredible. I think that this is a great tool that will provide access to patients that live far from us. I have a number of patients that live right at the border with Colorado, or they live in the panhandle, or they drive about 8 hours to get here. And it is very hard for them — they make a trip to see me for about 25 to 30 minutes and then they have to go back — you know, they miss about 2 or 3 days of work, the parents do, and it’s a long, long trip. I have families that we have experienced telehealth together with, and they’re actually very appreciative that we can provide this type of care and they have access to our services in spite of the current situation.

Rebecca Ohlinger: Yeah, I mean, you talk about satisfaction — we do send out post-visit surveys to our families after their telehealth visits and those surveys are showing that our families are very satisfied. If I were to quote a number, it would be 95% and above that our families are indicating that they’re very happy and pleased with their virtual care.

That said, there’s always going to be naysayers and people that are skeptical. As you know as a provider, there are things that just are not appropriate for virtual care, and there are some things that are appropriate for virtual care. In my experience here at Children’s, we’ve had our early adopters and those providers that are really comfortable jumping into something that’s new and are curious about, “How can we do this? How can we do this better?”

But you’re seeing, actually outside of the healthcare industry, that there are other sectors of our community that are dabbling in the new reality of things going virtual. You’re seeing, for instance, the grocery industry — people ordering groceries online, having them delivered. The banking industry is another good example. So there’s always going to be those things that you have to come in in person for, but I think there’s always going to be that pocket of things that you can see patients virtually for. So do you have any thoughts on that?

Virtual care as a supplement to in-person care

Dr. Huang Pacheco: You know, virtual care is not a — I don’t see it as a replacement for in-person care — I feel that it should be a supplement. It should be a help, it should be an aid, more than anything. There is — you cannot replace being able to see the patient, examine the patient with your own hands, and listen to the patient’s heart or lungs, and do more of an objective examination and assessment of the patient when you’re able to see them in person. As well as doing things like exchanging tubes or obtaining weights that are on the same scale so that we maintain things, you know, appropriate and equal.

So I don’t think that it is a replacement, but I do think that it’s a very big help. Again, especially in situations where patients have to drive quite a bit to get here, their problem is well controlled, and we can help the families improve, even their quality of their day or their week, just by not having them to miss work or drive 3 or 4 hours to get here.

And again, it just depends on what patients we’re talking about. And if it is the right patient, I think that we can — this is a great tool to have. But I don’t think it’s a replacement, I don’t think that we’ll be able to ever go — and I don’t think that that’s our intention — to ever go 100% virtual, because it would be impossible for us. I know that in the community, virtual meetings have become the way of maintaining our social aspect and our social mingling, if you will. I know that even churches are using this, or places of gathering, they’re using this to try to still meet. I know I’ve heard of incredible numbers, 1,000 people in one of those meetings, and I think it’s a great way to still meet and still have contact. To be able to care for people, for our patients. It is an alternative that we need to take advantage of while we are in this situation of the pandemic, and moving forward as well.

Technology and interdisciplinary care with virtual visits

Rebecca Ohlinger: Yeah, and I think, you know, seeing it in other sectors in our community like you mentioned, like in the religious sector and places like that, I think it really speaks from a technical standpoint about how easy it can be to connect. Our patients — they get an appointment reminder that’s a confirmation email that includes a link to a password-protected Zoom video meeting. As long as the patient and the family are able to access their internet connection with either their phone or a tablet or a desktop computer, and they have a camera with some audio, it’s really that easy. Would you agree from a doctor’s perspective that this has been pretty seamless for you to adopt?

Dr. Huang Pacheco: It’s actually very intuitive. There is a learning curve, but it’s very easy to find your way around this type of software and I’ll tell you — I’ve had visits with patients that are Karen speaking, and I can have an interpreter in there while we are having this. I can — I invite my dietitians in, I have invited our residents and medical students in, as well, so we are able to reproduce what happens in the clinic in the virtual setting and I’m able to share even things like the patient’s growth chart, the patient’s labs. I’m able to show the family — there’s an aspect of the software that allows you to draw and explain things, and I’ve been able to do that, as well. So pretty much what I do in clinic, except for the physical examination, I’m able to reproduce in every way.

Rebecca Ohlinger: Yeah, I think it’s definitely opened eyes to other possibilities, like you said. Kind of more of that multidisciplinary team approach to a visit.

Besides GI, I don’t know if you are aware of just how many specialties we currently have utilizing virtual care. We have over 20 specialties right now that are seeing patients virtually, including primary care. We also have rehab utilizing virtual care right now, as well.

Dr. Huang Pacheco: Yes, that’s right. I have been part of — I’m part of two multidisciplinary clinics, food hypersensitivity and the aerodigestive clinic. And for those clinics, we have been doing virtually, as well as in conjunction with the other physicians, so we’re able to, again, mix and match with other specialties to bring and deliver that service to the families.

Virtual visits as a window into a patient’s home

Rebecca Ohlinger: Has there been anything surprising to you about, maybe something that you could see something in the patient’s home that you wouldn’t have otherwise been able to see with them in your exam room? Thinking about different social determinants of health. Has it opened your eyes to being able to be in the patient’s home virtually?

Dr. Huang Pacheco: You know, it does help you understand the environment that they’re in. There have not been any alarming situations or concerning things, but it does give you a better clarity of what the environment is that they’re living in and looking at them in the home setting, it just helps you understand the more global picture of what their day-to-day is.

Rebecca Ohlinger: Yeah, and I’ve heard from several different providers in other specialties that it’s actually increased engagement from some of their kids, in that they’re a lot more comfortable in their home setting. And so they’re able to get a little more out of the visit because of that comfort level.

The future of virtual visits at Children’s after COVID-19

Rebecca Ohlinger: One of the things that we’ve kinda been talking about now that we’re in the midst of this pandemic is, “How is virtual care going to continue to grow, even in the post-COVID world?” One of the things that came about with our pandemic is something called the CARES Act, and that led to a lot of lifting of regulatory barriers quickly, allowing for widespread adoption and reimbursement of virtual care services, which was great. Without that, we wouldn’t have been able to scale the way that we did.

Trying to read the tea leaves for what post-COVID looks like as consumer behavior shifts — I don’t think that we’re going to put the genie back in the bottle. I think the genie’s out of the bottle and it’s here to stay, especially when you look at our satisfaction survey results from our patients. Because as you alluded to, it’s efficient and it’s convenient. Fewer work hours lost, less travel time, less school time being missed for the kids, and they’re getting the care in the home. We’ve talked about how this looks in other aspects of our community with e-commerce, grocery — you know, look at the widespread adoption of Amazon and how many people have Amazon accounts and the reasons that they have those accounts, for convenience — and so what do you think about your use of virtual care post-COVID?

Dr. Huang Pacheco: Well, I’m hoping that this will continue. And as I had mentioned initially, I think that it will be a great opportunity for our families that live far from us. Or even in the setting of, “I need to check up on this patient in a couple days, but I don’t necessarily need to see him or her in person.” And then we can always do a quick virtual visit — make sure that everything’s fine. Or even in the setting of, “This father or mother has a lot of questions, and it’s taking up a lot of back and forth with our families, with our nurses and our families, and another question comes up every single time that they get their questions answered.” So in that setting, I’d rather do a quick virtual visit and have all of their questions answered, and not make them come in. That’s just an example.

My thought is, well, for the bottom line — that will also improve the number of patients that we’re able to care for as well. And I do think that that will improve patient satisfaction and quality because it’s direct care by the physician or provider, and you don’t stay in the back and forth in terms of questions and answers, which sometimes may take half a day to come back — and so forth. So getting it over with, just caring for the family, addressing the issues a little bit faster than having them come into the clinic, especially, again, if they are living far and they just want to have a 20 minute discussion. And driving 4 or 5 hours for that would be completely, I think, unreasonable.

Making a virtual visit appointment at Children’s

Rebecca Ohlinger: One of the ways that our families can connect with us for virtual care, whether it’s primary care or specialty care — we do offer those appointments, like I said, in 20 different specialties. And if you want to, if you’re interested in that, I would certainly encourage families, or you to have that discussion with families, to call their providers and find out if they do offer virtual visits. You don’t have to be an existing patient, we are open to seeing new patients virtually.

Sometimes, this can help with the referral process and maybe avoiding unnecessary referrals or actually in helping enhance that referral, as well. And so, if you’re interested, you can actually visit our website at childrensomaha.org/virtual and there’s a form on there that you can go ahead and fill out to request a virtual visit. You can also call our number 402.955.6799 to schedule a virtual visit.

Thanks everybody for listening to our podcast on virtual care, and I hope that you take the next step if you haven’t had a virtual visit, and reach out to your provider and inquire about that possibility.

Dr. Huang Pacheco: Yes, thank you very much for listening and we’ll be here — hopefully we’ll be able to provide the best care through even this virtual world that we live in now.

For the latest info about COVID-19 visit childrensomaha.org. Thank you for listening to Just Kids Health.

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