Table 2.

Potential Impact of Telemedicine on Pediatric Subspecialty Processes and Patient-Centered Outcomes

DOMAIN	DEFINITION	QUOTES
Processes
Accessing subspecialty care	Use of telemedicine to replace or augment in-person visits	But I think [telemedicine] would be much more convenient, especially for people who are traveling really far to get to the hospital or people who just can't make it or, you know, if your kids are deathly ill and you don't want to take them out of the house and don't have to, so I think that would make a huge difference.
Scheduling/triaging visits needs	Use of telemedicine for a triage encounter to determine need for subspecialty care, urgency, appropriate subspecialist, and optimal modality (i.e., in-person visit versus telemedicine)	It's very difficult, it's a long wait for [specific subspecialty]. And I think, you know, an evaluation during that long wait period via the Internet would be a fantastic tool for that department, because if they do feel it's serious enough they could bump ‘em up. You know, it's like kind of weeding it out. Triaging in a different way.
Care coordination at the time of subspecialty visit	Use of telemedicine to incorporate additional family members or physicians into a subspecialist visit	It would be fabulous if they could exchange information easily [through telemedicine] … Because at this point it just doesn't seem like that's how it is. You know, it just seems like that's just not the way it is…. I'm like, “Hey, can you connect with his surgeon and figure out the best way to get him to physical therapy,” or whatever. But like, they just look at you like, “Well, we don't contact them. You contact them.” And that's just the way it is. So it would be great if there was a way that they could more easily interact so that they would be more likely to.
Communication with subspecialist between visits	Use of telemedicine to facilitate communication with subspecialists for questions or changes in status between visits	Let's say … you needed an extra appointment and your therapist only had twenty minutes, but you could actually look at them in the face and talk to them via video, like that might just help you get over that whatever little issue you're having instead of having to book a whole new appointment. You know what mean? I do feel like it could help you in the gaps between when you see them face to face.
Relationship with subspecialist	Impact on relationship between subspecialist and patient/family, potentially improved due to increased communication or potentially worsened due to reduced continuity	Definitely not for their regular check-ups; their regular meeting of the specialists—a lot of specialists will see you back in three months, on a regular basis—I don't think that's a good time [for telemedicine].
Outcomes
Opportunity costs	Potential reduction in opportunity costs by reducing travel time and allowing waiting time to be spent doing other tasks	I can't think of many parents who wouldn't be anxious to do [telemedicine] because of … people worrying about travel time and missing school and missing work, and all those complications that parents have.
Family burden	Potential reduction in stress associated with travel and with waiting with children in a stressful environment	I think that, especially when it's these kind of follow-up appointments where I basically go to an appointment and they say, “How's she been doing? She looks great. Okay, keep doing what you're doing; we'll see you in six months,” and I had to sit in a waiting room for an hour with a child who's screaming and hitting themselves, and having an anxiety attack—yeah. If I could not do that, that would be so great. It would really—it would actually change our lives.
Health outcomes	Potential improvement in health outcomes through increased access to care and coordination; potential worsening health outcomes due to lack of exam	[Telemedicine] might not be as accurate only because they're not—he's not there for the doctor to physically see him. If there's new symptoms or change in care then, maybe, that wouldn't be the best.
Parental anxiety	Potential impact on parental anxiety, including reduced anxiety due to increased communication/access as well as increased anxiety due to increased reliance on parental report	I think in that case, a video chat would be wonderful, because it's not a—you know, it reassures the patient. It would reassure the parents. “Yes. This is absolutely common for [child condition]” … or “That also really needs to be looked at.”