Pandemic Changes the Delivery of Care

Valerie Higginbotham
Director of Children’s Services, Providence Health Care

What do dogs, skateboards and swimming pools have in common? Pediatric virtual visits.  Puppies jumping on children, dogs barking, siblings photobombing, and a patient jumping in a swimming pool during a visit are a few of the interruptions pediatric providers experience while conducting virtual visits during the COVID-19 pandemic.

How is care delivered when families need to shelter-in-place? In mid-March, like clinics around the state, providers at Sacred Heart Children’s Hospital and Providence pediatric clinics asked this question and committed to creating a digital technology solution that could be implemented quickly, ensure quality visits, and reduce the risk of exposure to COVID-19.

Within days of the shelter-in-place order, 900 Providence adult and pediatric providers in eastern Washington had active Zoom accounts, laptops and video cameras, and began reviewing schedules for appointments appropriate for virtual visits. Staff contacted parents offering a virtual visit in lieu of coming to the clinic. Other appointments moved to either a “fever” clinic or well-child location. Childbirth, infant CPR, and NICU care conferences moved to Zoom; telehealth was implemented for outpatient lactation consultations.

In a six-week period, Providence Medical Group in Spokane completed 10,641 virtual visits. Of those, 614 were pediatric primary care and 1363 were pediatric sub-specialty. Ronda Martin, who manages two busy pediatric primary care clinics, said “Families appreciated the services and the efforts to keep everyone home and safe during these unprecedented times.”

Pediatric sub-specialists cared for patients throughout the region, including many patients who live in remote areas. There were challenges that required creative solutions: one mom who lives in a rural area had to drive towards town to find internet service so that the virtual visit could be completed in her car. A pediatric neurologist created a neuro exam specific to virtual visits. Parents-to-be, who were initially leery of childbirth classes via Zoom, quickly became comfortable with the virtual classes.

Will we return to traditional medicine or are virtual visits here to stay? Becker’s Hospital Review recently quoted Seema Verma, administrator of CMS, who said “I think the genie’s out of the bottle on this one, it’s fair to say the advent of telehealth has been completely accelerated, that it has taken a crisis to push us to a new frontier, but there’s absolutely no going back.”

Now that expectations have changed, how do we move forward post COVID-19?  It will require different aspects of health care working together, as well as advocacy for payment parity and quality measures. Digital technology, in collaboration with traditional in-person visits, will become the new practice of medicine.

Editor’s note: Fortunately in January 2021, telemedicine parity becomes law for commercial insurance in Washington state and Medicaid already has telemedicine parity. The 2021 law does not cover telephone parity, so we will need to advocate for this parity especially for families who do not have equitable access to video care.

Editor’s note: WCAAP has telehealth resources for pediatric primary care providers, which you can find on this page: