Doctors: Growth of telehealth is ‘huge advantage’
“It’s so much more convenient to families. It’s absolutely good medical care.” Dr. Jeffrey Kane Pediatric neurologist with Child Neurology Consultants of Austin
AUSTIN, Texas – It has been a year since telehealth began to be used much more frequently as doctors tried to continue to see their patients while keeping them at home as much as possible during the coronavirus pandemic.
This year has been a learning process for doctors and their patients, and it has made many rethink what has to be done in an office and how they can improve access to care through virtual visits. In Texas, the Legislature is considering permanently lifting barriers to telehealth, such as payment disparities, which were temporarily lifted during the pandemic.
Texas Oncology continues to use telehealth visits for 20% of all new patient consultations as well as 25% of all its visits.
Dr. Debra Patt, executive vice president of public policy and strategic initiatives at Texas Oncology, has used telehealth to diagnose COVID-19 in her patients after receiving lab results. Patt also has made hundreds of medication adjustments by telemedicine, and she has conducted new-patient visits for inflammatory breast cancer.
Through telemedicine, she’s able to see the patients, take note of their symptoms and make adjustments. She also has been able to involve other family members in a patient’s health decisions while not crowding a patient room in the office.
Telemedicine “has been the silver lining of this pandemic year,” she said.
Patt and her colleagues are able to avoid some emergency room visits for their patients by consulting with them virtually and deciding if they need to head to the hospital or if their conditions can be managed in a different way.
It has also saved time for patients. Instead of having to take half a day off work, they can see her virtually during a coffee break.
For many of the patients and their parents seen by Dr. Jeffrey Kane, a pediatric neurologist with Child Neurology Consultants of Austin, telehealth has been a big advantage. Many of his patients live outside Austin, and they no longer have to commute for care. He has been able to continue to see his collegeage patients who now live states away.
“It’s a huge advantage,” he said. “It’s so much more convenient to families. It’s absolutely good medical care.”
For some of his patients who use wheelchairs, it’s also much easier on their parents because no one has to be loaded into cars or public transportation or even medical ambulances to see him just for a medication refill.
It is not a good fit for every appointment, he said: “Sometimes we need to see and lay hands on them, but very often we don’t.”
He likes to look into the backs of the eyes of his patients who have headaches. He also can tell a lot about many of his patients by the way they walk into the room.
What makes him worry is that he will miss something by not physically seeing a patient, which is why he doesn’t think telehealth can be for every visit. For patients who are stable and need a medication refill, “it’s a very low-risk to do telemedicine,” he said.
“We knew from the start that telemedicine is not whole comprehensive care for the patient,” said Dr. Jake Childers, a family medicine doctor at Austin Regional Clinic and medical director for eMDAccess, the clinic’s telemedicine service. “Sometimes you need a ladder; sometimes you need duct tape. With good judgment and the right application, it can take care of so much.”
He knows that if someone is having shortness of breath, there’s no substitute for a chest X-ray or a doctor listening to their lungs. A telemedicine appointment can be used to determine whether patients need to come into the doctor’s office, go first to get an X-ray, or go to an urgent care clinic or hospital. It’s advice and triage, Childers said. At the beginning of the pandemic, ARC was seeing 70% of patients by telehealth. Childers believes visits will continue to be in the 10% to 15% range once the pandemic is over.
“It’s never going to go back to the way it was,” he said.
Telehealth can improve access to care, Childers said, because patients might be more willing to check in more often about things such as blood pressure or diabetes management if they are keeping track of those numbers at home if they don’t have to come into the office as often. There are also options for remote monitoring of patients that can get good results, Childers said.
Some specialties don’t lend themselves as well to telehealth. As a breast cancer doctor, Patt is dealing with a lot of medication adjustments and medication side effects, but a doctor who treats gynecological cancers might need to see a patient for a physical exam.
Telehealth has made it possible for Austin doctors to do more consultation with patients in other parts of Texas and the country.
Small community hospitals in rural Texas who don’t have access to a pediatric neurologist can connect with Kane virtually for their patients.
Doctors expect there to continue to be some virtual visit component to health care.
“I think now that patients and doctors are using it, I don’t think it will go back to where it was before,” Childers said. “They now see the value.”