Inside Pediatrics Summer 2019

Telenephrology program broadens specialty health care footprint

W ith only six pediatric nephrologists in the state of Alabama, families must often drive hundreds of miles – and many times stay overnight – for appointments with Children’s of Alabama physicians. In fact, 48% of the hospital’s transplantation patients come from more than 100 miles for each appointment, and 32% from more than 200 miles, said Daniel Feig, M.D., Ph.D., who directs the pediatric nephrology and renal transplantation program. “It’s more than a slight challenge to get here,” Feig said. “It entails missed school and work and the cost of getting back and forth.”

And that, in turn, can compromise the quality of care or even lead to missed opportunities for care. Now, however, families can “see” a doctor just a few miles from home thanks to the practice’s new telenephrology program. The program, which began in June 2018, builds on the success of the adult telenephrology program for dialysis patients started by

Daniel Feig, M.D., Ph.D, director of the division of pediatric nephrology and medical director of pediatric renal transplantation at Children’s of Alabama, talks to a patient during a telenephrology appointment.

Families Appreciate the Convenience To date, seven patients have been seen a total of 16 times remotely. “Every family said they would like to continue the remote visits,” Feig said. The primary difference in the visits, of course, is that the patient and doctor are not in the same place. Other than that, nearly everything else is the same. Lab and radiology tests are obtained before the visit so the doctor can evaluate them prior to meeting; a high-resolution camera enables the physician to examine the skin, mouth and ears; and Bluetooth technology allows for a heart and lung exam. A nurse in the room facilitates the exam. “What we lose is the physical feel of the belly exam or the pulse,” Feig said. This is why patients chosen for telehealth are those who are most amenable to visual exam evaluations. Still, nephrologists deliberately started the program with renal transplant patients – “the most complex patients possible, said Feig. These patients see a multitude of providers when they come to the on-site clinic, including the pharmacist, child life

and social workers, the transplant nurse and transplant counselor – all of whom participate in the virtual visit. “If we can manage the most complex patients through telemedicine, we can leverage the scale to those who need less in the way of specific practitioners involved in the visit,” Feig said. Moving forward, Feig and Wallace said they plan to significantly increase the number of patients seen, including first-time patients. Challenges include not only the physical infrastructure, but training staff to schedule telehealth visits versus inpatient visits. “A true telemedicine clinic is the goal,” Feig said. Wallace agreed. “For many in Alabama, the reality is that it is telehealth versus no care,” Wallace said. For instance, 17% of families in Wilcox County do not own vehicles. “A big part of telehealth is reaching people who would never have been able to be seen,” Wallace said. Sign up to receive to the Inside Pediatrics Nephrology Division e-newsletter at insidepeds.org .

Daniel Feig, M.D., Ph. D.

Eric L. Wallace, M.D.

Director of Telehealth Eric L. Wallace, M.D. in collaboration with the Alabama Department of Public Health. It involves teaming with the public health department in each of the state’s 67 counties to see patients remotely. “So all families are within 25 miles of a site of care,” said Feig.

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