Telemedicine gaining popularity in Liberty Hill



Doctors routinely screen patients, but today it’s an increase in screen time between physicians and patients that is becoming more routine.

Telemedicine has been around for a while, but not something relied upon heavily in most doctors offices around the country. But the COVID-19 virus and the protective measures in place to slow its spread have brought the remote appointment tool to the forefront.

At Liberty Hill Pediatrics, March 23 was when they launched their telemedicine capability.

“We weren’t doing any telemedicine until COVID-19 hit,” said Dr. Timothy Spence, a pediatrician with Liberty Hill Pediatrics. “After that spring break week was when everything was kind of coming down the wire with COVID-19 as far as the national response, social distancing and that schools were going to be closed.”

They launched their telemedicine efforts using Zoom and the same medical records system the office had always used.

Dr. Walter Chesshir, who practices family medicine at Liberty Hill Physician Associates, said they also ramped up quickly, working through the tech challenges to make telemedicine appointments an option for patients.

“For us the initial challenge was just figuring out the IT component to get it to work, not just on the patient side but our side as well,” he said. “We were able to get ours up and running fairly quickly, and I take my hat off to our IT team at Cedar Park Regional (Medical Center).”

Helping some patients get set up on the technical side has also been a challenge for offices, recognizing that not everyone has internet service or devices that can accommodate the video calls.

And then there’s the wildcard of the children themselves.

“It’s difficult to do an exam and be 100 percent with it,” Spence said. “The environment can be challenging whether it’s internet connections being hit and miss or a little bit more chaotic when you have a mom with a toddler trying to talk into a camera while the child wants to play with the camera. Your older kids might be more shy, your toddlers might not sit still in front of a camera, and often times those are more of the challenges.”

But he also added that the comfort of being at home on the couch during an appointment can also put children at ease.

For Spence, the option is a great addition, but he said they are still encouraging some in-person appointments due to their importance.

“We are encouraging families to continue to come in for their routine well checks, which seems counterintuitive, but particularly with those younger kids that are needing to get their vaccine series we are stressing that,” Spence said. “Certainly the things the vaccines cover are potentially high-risk concerns themselves.”

The office works to divide the day, bringing children in for those routine checks in the morning.

“What we’ve done is schedule those in the morning, trying to keep your well kids and your sick kids separated, with sick visits in the afternoon,” Spence said.

Both offices have made a point of offering patients the online appointment or an in-person visit.

“Anyone who wants to do a telemedicine visit for whatever reason it is certainly okay,” Spence said. “It kind of comes down to what does the patient or parent want. Are they worried about coming into the clinic and exposing themselves and would rather do the visit at home?”

In situations where the patient is ill, Spence said they use some basic questions to determine if a telemedicine appointment is appropriate initially for the safety of the patient as well as staff in the office.

“When a parent calls in we ask some screening questions,” Spence said. “Do they have fever, cough, shortness of breath? Those are three primary red flags if it is a potential COVID patient or not. If that’s the case then those patients are being limited to telemedicine only visits.”

Just like an in-person visit, patients must show up online with certain information available.

“It’s important that the patient have some things ready, family history, past medical history, current medications and current problems, that way it gives us the information we need to help them,” Chesshir said.

And all that information from patients is all the more critical because telemedicine’s one big challenge is that it takes away a doctor’s ability to conduct a thorough exam.

“A telemedicine visit is not the same healthcare that you’re going to get with an in-person visit,” Spence said. “There are certain decisions that are made based on conversation rather than exams. During the pandemic, when we’re trying to maintain social distancing and keep people safe, we can weigh those sacrifices both on the patient side of things and on the provider side of things.”

Online appointments have their limits, from the obvious emergency situations, to some more complicated diagnosis that require that thorough exam.

“That has been one of the challenges over the years with telemedicine,” Chesshir said. “It could take care of simple things up until now. Where it works well is getting a good patient history. It’s great for follow up visits or if patients have questions they need to ask. It is comforting and reassuring for patients when they can see the provider’s face.”

Spence and Chesshir both said there seems to be a pretty even split right now in on-site and online appointments in their offices. Both see a future with the virtual visits, but neither believes it can replicate or replace the advantages of meeting in person.

“It has become very important,” Chesshir said of the technology. “Will it be part of future medicine? That’s hard to say. I definitely say it is going to continue to play a role in medicine and continue to evolve. But it’s been a blessing to have it through all this.”

Telemedicine is likely to grow in popularity, but unlikely to become primary.

“Long term your office visits are still your best way to practice medicine,” Spence said. “Generally speaking there will be transitions we make to continue on with it for certain visits. The question will be where can we use this to augment our practice, but certainly not to replace what we’re doing day to day. As we get more experience with it and dial in our protocols then I think it could be a very useful tool for the provider as well as for families.”

For now, the added precautions of constantly being in personal protective gear and a steady dose of virtual appointments have made for a strange, sudden new reality that has taken some adjustment.

“It’s definitely a surreal experience that all practices across the country are adjusting to,” Chesshir said. “That’s true especially in primary care where it’s a constant face to face interaction and then all of the sudden it’s not an in-person type of profession. It’s just very different.”