Table 1.

Challenges and solutions to converting multidisciplinary visits to a telemedicine format. For challenges with multiple attempted solutions, we have indicated which solutions were adopted vs. abandoned.

Step	In Person Procedures	Challenges	Telemedicine Solutions
Scheduling	All visits in person	Determination of in-person vs. telemedicine	Triaging visit types—our group developed criteria to help guide optimal visit format, acknowledging need for flexibility In-person: active or perianal disease; nutrition concerns; potential new diagnosis; no in-person visit >1 year Telemedicine: clinically stable on maintenance medication; on new medication with need to reassess symptoms; newly diagnosed with need to discuss treatment options
	Sign-up for MyChart (EMR-based patient portal) encouraged but optional	MyChart access required for telemedicine visits	When calling to schedule telemedicine appointments, administrative assistants assisted families in creating a MyChart account and provided technical support at the time of the visit
	Follow-up visits scheduled at check-out	Scheduling process	Provider sends message to administrative assistant in EMR requesting follow up interval and visit type (in-person vs. telemedicine)
	Clinic templates open 3–6 months in advance	Capacity—templates opened month-by-month	Administrative assistants keep list of patients to be scheduled with timeframe, visit type; contact families when templates open
Pre-visit planning	Chart review completed in person	Virtual processes needed	Chart review completed via secure teleconferencing
	Printed recommendations provided in clinic	Virtual processes needed	Recommendations emailed to provider ahead of patient visit
Visit flow	Sign-out between providers occurred in shared work room	Virtual sign-out process needed. Concerns regarding efficiency of visits, gaps in care, redundant care	All providers remain for entire telemedicine visit (Abandoned) Pros—Prevented redundancy, sign out not necessary, or could sign out in front of patients/caregivers Cons—Not time-efficient, took away from other clinical duties, may be unable to sign out sensitive material in front of patients/caregivers Sequential video visits with electronic sign-outs (Adopted) Pros—More time-efficient, written sign-out via EMR secure chat preferred (also trialed email but was time-consuming) Cons—Written sign-out still time consuming, concerns remain about redundancy/gaps in care delivered
	Providers could ask caregivers to step out of room for private adolescent history	Virtual process needed. Concern about patient privacy, willingness/ability of caregivers to step out	Providers simply asked parents/caregivers to step out of room and faced no challenges
Administration of screening tools	Psychosocial screening forms administered on paper prior to visit	Virtual process needed	Rights to electronic psychosocial screeners purchased, sent to families via MyChart ahead of visit, uploaded into EMR and reviewed at time of visit
Miscellaneous learnings			Telemedicine helpful to share screen with growth curves and labs Telemedicine improved accuracy of medication and dietary histories; provider could ask patient/family to get products from home for review