Table 2 Advantages and Limitations of Telerheumatology
Advantages | |
Increased access to specialist opinion for families living in rural/remote areas [12] and ability for MDT members to join from different locations in same visit | |
Reduced travel time (caregivers and physicians) Reduced missed work (caregivers) [13], | |
Reduced missed school (patients), Cost savings (families) [1] | |
Video visits can be efficient especially when the provider links directly to the patient | |
Some EHR systems provide ability for families to complete questionnaires beforehand | |
Education and training. Trainees, including residents, fellows, allied health and medical student teaching could be incorporated to improve exposure to pediatric rheumatology at training centres where this expertise in not available. | |
Potential for outpatient or inpatient e-consults to remote hospitals where pediatric rheumatologists are not on staff | |
Limitations | |
Subtle exam findings can be missed. A potential solution is the use of a trained telepresenter (e.g. family doctor, pediatrician, physiotherapist or nurse) or training parents to facilitate the examination. | |
Families express preference for in-person visits, even when travel is inconvenient [2] | |
Challenges in developing rapport especially with new patients | |
Complex or medically serious visits need in person assessment [14] | |
Participation in research studies which historically have required in person evaluations (might require creative solutions) | |
Shortfalls in network, hardware and software capabilities, either on the provider or patient end can cause inability/ difficulty with connecting, or poor video resolution | |
Equipment and training of providers is often costly and time-consuming, with decreased provider acceptance [15]. | |
Equity issues: Limited access for some families with poor or no internet access or limited data plans, low bandwidth capacity, limited language proficiency, health literacy and technological literacy [15] | |
Lack of or inadequate insurance coverage Geographic boundaries may be bound to different telehealth rules based on government and hospital restrictions | |
Internet and software platforms may not have security to ensure privacy of video or healthcare data [15]. |