Dr. MIke Smith (Host): Welcome to Pediatrics in Practice, a CME podcast. I'm Dr. Mike. And joining me today is Morgan Waller, Director of Telemedicine at Children's Mercy. Together, we're diving into an exciting topic, reimagining pediatric care, the future of telehealth. Morgan, welcome to the show.

Morgan Waller: Thank you for having me.

Host: What inspired the integration of telehealth into pediatric care and how has that role evolved over, I guess, really the last maybe five to 10 years?

Morgan Waller: Actually through a partnership with our electronic health record vendor, I met the Director of Telemedicine from Eastern Maine Medical Center, and she was telling me about the way they were meeting kids in rural areas in a geographical situation very close to what we have here in the Midwest. And from that, I met with our chief medical information officer at the time. And out of that came Children's Mercy's Telemedicine Program. There was a hospitalist that devoted time to working with me and launching this amazing way of reaching kiddos that have barriers to getting to Kansas City to get the healthcare that they need.

Host: So, I'm curious, how has the technology then advanced over those 10 years or so? What was it like when it first started? What is it like today to have a virtual appointment?

Morgan Waller: So, it has definitely advanced. We were fortunate to partner with kind of the Ferrari of telemedicine devices in the beginning, because we tried a lot of stuff. And to my previous comment about not wanting to compromise anything and the care that we were delivering, we wanted to make sure that we had great technology. But there were still challenges, especially trying to partner with outside organizations, the firewalls, the security, very difficult and not always having a seamless video experience. You know, there'd be packet losses and squares across the screen. And that has virtually disappeared, literally. Our connections are fabulous.

Host: So, as a clinician, Morgan, and I know most pediatricians would agree with me, when we're introduced to doing something new, doing something a different way, one of the first things we always ask is, "Well, how is this going to improve my patient?" Can you speak to that a little bit? Has pediatric telehealth at Children's Mercy helped to improve patient outcomes or just access to care in general?

Morgan Waller: Well, exactly. I think that, you know, you are going to have a better outcome if you get care at all. And if you are not getting the type of care that you need because there are no pediatricians and particularly no pediatric specialists, then being able to connect with the right provider is going to improve your health and outcomes tremendously.

 And the ability to take kiddos that not only don't have access locally to those types of providers, but can't afford or have, not just financially the role functioning costs of taking time off from school and work to travel to Kansas City, that allows those kids that need every three-month quarterly appointments if you will, and follow ups to keep those, if we can meet them where they are virtually.

Host: How do you ensure that virtual visits maintain the same quality and thoroughness of, you know, traditional in-person appointments?

Morgan Waller: Besides running around and it being my mantra that we will not offer a virtual appointment if we cannot meet the in-person standard of care, we have a culture now that having started telemedicine practice over 10 years ago and using amazing technology at some of our outreach clinics, that's actually high definition digital exam ancillary peripheral devices. We can look inside the ears and hear breath sounds. So, it is a complete exam, not just a visual and audio exam, although we definitely do those in the home as well and that can be totally appropriate also. But yeah, that's how we have a culture that just-- we've always said-- we're not going to do this if we can't match the in-person standard of care through the technology or through the conversational exam.

Host: What kind of challenges did you face with families adopting this approach?

Morgan Waller: As with anything, there are early adopters. There are people that just like to try new things. And you want to grab a hold of those, covet them. Same way with physicians, and our nurse practitioner, get those early adopters. And then, that helps because they share their experiences. And we really like to market those comments of, "Oh, I wish I'd tried this years ago."

Host: And so, when you look at, say, 10 years ago versus today, do you find most families, they understand what telemedicine is, they understand more what the virtual visit is? So, has it gotten easier?

Morgan Waller: Yes, it's gotten easier, and we do thousands of virtual appointments. I hate to say, unfortunately, COVID really made telemedicine more of a-- I don't know if it's a household word yet, but it certainly did make it more common for a lot of people. So, that is true.

Host: I agree with that. You know, so many of us were thrown on things like teams meetings and Zooms. And we had to quickly adapt to that type of encounter, that type of interaction. And so, in a weird way, COVID helped with that. I think you're correct. Are there specific conditions or specialties within pediatrics where telehealth has proven especially effective?

Morgan Waller: Well, certainly, developmental and behavioral appointments lend themselves very well to a virtual platform, especially in the pediatric space because the generations of children that we're treating currently have grown up with devices. So, they're actually more comfortable communicating that way. So, that is something that-- I wouldn't say it's been easy, but the kids like it. It's very convenient for them, very private, they feel very safe. Otherwise, I would say that really anything can benefit from a virtual component, and it's delivery or augmentation of care.

Host: So, I think just to understand the history a little bit more, so earlier on in telehealth, I would assume in, at least in pediatrics, a lot of the original appointments were maybe with children in areas where they couldn't follow up because they were far away, there was no specialist around them, and that's maybe how it first was being used. Has that changed? are we now seeing people use telemedicine just for everyday yearly routine stuff?

Morgan Waller: We started with a clinic model where we have outreach clinics in five locations, six locations in Missouri and Kansas now that where a facilitator, a specially trained RN, would receive the patients and families there in that clinic space where they could have labs done and all of the other types of services that we offer. Then, the provider is remote through this amazing high definition technology and, like I said, the ability to do those ancillary devices and have a full exam. Now, we've broadened out to end the home and we are probably one of the only pediatric hospitals-- certainly, we're in the top three-- where all of our specialties and even microspecialties, if you will, there's a provider in every department that will see a kiddo virtually.

Host: Wow. So, it's definitely being utilized, I mean, compared to 10 years ago, way more now.

Morgan Waller: Absolutely. We had one patient and one doctor practicing when I first started.

Host: That's different now, isn't it?

Morgan Waller: Yes. Now, we see hundreds of kiddos virtually every day.

Host: So, what do you think the future is of telehealth? How do you think it's going to continue to evolve and what role do you think it'll play?

Morgan Waller: Well, you know, if you can imagine it, it'll be there. I'm the big picture. That's my gift. I think technology like holograms could be introduced. Something fascinating that's actually happening now, we actually do some telemedicine in our inpatient space. We do virtual nursing, and those cameras have the ability to detect a patient when they're moving out of bed. So, that is amazing technology to prevent a fall from someone who's not supposed to be getting out of bed, we can detect those movements through the cameras.

Host: And I would have to assume that that type of technology is only going to get better and better and better, right? I mean, the sky's kind of the limit, isn't it?

Morgan Waller: That's right. Truly, the technology develops faster than we can implement it.

Host: So lastly, what advice would you give to other pediatricians or healthcare systems looking to expand their telehealth offerings?

Morgan Waller: I think it's really important to take the perspective of the patient and family into consideration. In healthcare, we often say, you know, "Well, just make an appointment." There's so much that goes into that that can be so stressful for families, and having the ability to reach your patients closer to where they are can alleviate so much stress. It's not just convenience, it's actually removing geographical barriers to access. It's leveling the playing field.

Host: Morgan, this has been fantastic information. Thank you so much for sharing your knowledge and coming on the show today.

Morgan Waller: I really appreciate the opportunity to answer questions about telemedicine. Thank you so much for having me.

Host: For more information, you can visit cmkc.link/cmepodcast. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library. For more topics of interest to you, this is Pediatrics in Practice. I'm Dr. Mike. Thanks for listening.