Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic.

Objective: To assess the rapid implementation of child neurology telehealth outpatient care with the onset of the COVID-19 pandemic in March 2020. Methods: This was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters including 2,093 audio-video telemedicine and 496 scheduled telephone encounters between 10/1/19 and 4/24/2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers. Results: There were no differences in patient age and major ICD10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1200/1286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1144/1286) of encounters. Technical challenges were reported in 40% (519/1314) of encounters. In-person assessment was considered warranted following 5% (65/1285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187/217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent amongst patients in racial or ethnic minority groups. Conclusions: We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine utilization.