Telemedicine reduces barriers to pediatric subspeciality care

West Virginia may be a small state, but some families have to travel up to four hours to access the care they need due to the unique geography of the state. Many patients have turned to telemedicine as a solution to this problem.

WVU Medicine offers telemedicine for patients of all ages, but WVU Medicine Children’s Pediatric Telemedicine reduces the barriers to care for its youngest patients by allowing them to visit advanced practice providers (APP) at clinics close to their communities and virtually meet with subspecialists.

“It allows us to see patients without people having to drive to Morgantown,” Margaret Jaynes, MD, WVU Medicine Children’s pediatric telemedicine chief, said. “Their parents might have to take the day off of work just to be able to drive up to Morgantown and back home. This also means they have to arrange childcare for their other children or arrange for someone to make sure they get on and off the bus. Telemedicine makes it much easier for parents to have their children seen by specialists.”

WVU Medicine Children’s has offered pediatric telemedicine since 1996, starting with a consulting line for physicians and evolving into direct appointments with patients.

“Pediatrics has led the way in outreach since the beginning,” John Brick, MD, WVU Medicine neurologist and associate dean of rural outreach, said. “We started telemedicine with the MARS line, which was available 24 hours a day for doctors to consult with specialists. The inability to see the patients was a problem, so we worked with other facilities to set up a network that allowed us to do video consults. But it was expensive to fund, and grants were limited. Our Psychiatry and Pediatrics departments kept it going using the internet, and it has grown from there.”

The program has grown as video conferencing technology and accessibility has grown. The first WVU Medicine Children’s multi-specialty telemedicine clinic was opened in 2018, and there are now clinics in Martinsburg, Wheeling, Vienna, Summersville, Princeton, and Weirton in West Virginia and LaVale in Maryland.

Pediatric telemedicine patients can access specialists from:

• Adolescent Medicine
• Cardiology
• Craniofacial Plastic Surgery
• Endocrinology
• Gastroenterology
• Genetics
• Hematology
• Infectious Diseases
• Neonatology
• Nephrology
• Neurology
• Neurosurgery
• Orthopaedics
• Rheumatology
• Pulmonology
• Sleep Medicine
• Surgery
• Urology

“In addition to travel and childcare expenses, some children have medical conditions that make driving for several hours challenging. They may have to stop frequently for feeding, medication, or other care needs,” Abigail Crawford, APRN, WVU Medicine Children’s Martinsburg pediatric telemedicine advanced practice provider (APP) lead, said. “By providing the ability for our patients to see their doctors closer to home, we not only help them receive the care they need but make it an easier experience.”

When patients arrive at their appointment, an APP, such as a nurse practitioner or a Physician assistant that has been trained in the specialties the clinic covers, obtains the patient’s medical history, performs a physical examination, and then reviews the case with the specialist over a secure video conference. Then, the specialist is brought into the patient room via video conferencing to consult with the family.

The specialist is able to gain further information on the patient’s case through the use of electronic stethoscopes, digital otoscopes, and handheld cameras with the assistance of the APP. If patients need further testing, such as MRI, x-ray, or colonoscopy, the patients are either referred to their nearby WVU Medicine facility or WVU Medicine Children’s Hospital. Their results are then viewable by the specialist and APP through the EPIC medical health record system.

“We want everyone to have access to subspeciality care,” Audra Rouster, MD, WVU Medicine Children’s pediatric gastroenterologist, said. “Patients in rural states and underserved areas often have limited access to subspecialty care because of a lack of subspeciality trained physicians. We want the patients of our state to be able to access the best possible care, and telemedicine helps us do that.”

Patients who are under the care of multiple specialists are often able to schedule those appointments on the same day to avoid having to make additional trips to the clinic. This makes it more convenient for parents like LaWanda McGee, from Martinsburg, whose son, Terry Glover, 19, sees specialists in gastroenterology, nephrology, and pulmonology.

“The clinic isn’t far from our house, so it makes it a lot easier to go to all of his appointments with him,” McGee said. “At big hospitals, you don’t always see the same people before you talk to your doctor, but we always see the same person at our clinic for our visits. We’ve been able to get to know them, and they know how Terry is doing.”

For McGee, seeing the same provider for all of Terry’s appointments helps with communication between his subspecialists.

“When you go to different doctors, they don’t always talk to one another between your appointments,” she said. “Having the same person in the room for all of his appointments helps because they can share information from his other appointments to help the doctors work together better.”

For more information on WVU Medicine Children’s, visit WVUKids.com.