Table 4.

Anticipated barriers and identified opportunities

Anticipated barriers	Future opportunities
Patients might not have an appropriate device to engage in telemedicine	•All patients in our practice had access to an acceptable phone or computer device. •Patients may have access to computers or tablets at school, through other community programs, or via family members. •Centers for Medicare and Medicaid Services and private payers could expand reimbursements for telephone only encounters •Consultations could occur directly in a primary care providers’ office with clinic equipment
Technology literacy gap within a family may lead to decreased engagement with caregiver (e.g., an adolescent may be comfortable with telemedicine, but the parent is not)	•Initial consultations could be completed in office with training for family members. •Technical support could be provided in the form of online tutorials or phone support.
Patients may reject telemedicine because of lack of connection with providers or limits of care.	•As telehealth was well received, it could be used to reduce geographic and travel-related financial barriers to care (gas, missed work, and so on) and expand subspecialty care for wider populations.
Language barriers could limit engagement in telemedicine	•Standard phone interpreting services can be directly integrated in the telemedicine platform.
Reimbursements may be low or unavailable for telemedicine	•State, federal, and private payor expansions of telemedicine coverage were ongoing during the pandemic and may provide opportunities for future telemedicine reimbursement