With telemedicine, doctor is in, but patient stays home

Tim Pollock, 5, meets with his speech therapist, Liz Willis, for a half-hour each week. But the pair have met just once in person. For more than a year, they have both logged in online at a designated time through Therapy Connect, offered through the Chester County Intermediate Unit.

The arrangement works well, said Tim's mother, Rebecca, especially considering that Tim is the seventh of nine kids between the ages of 1 and 14, who are all home-schooled. Taking him to the therapist would mean bringing several of his siblings along. In addition, one of his brothers was fighting leukemia and couldn't be out in public while undergoing chemotherapy.

Telemedicine was the solution, for all these reasons and more.

"Because he's shy, it was a good fit," said Rebecca Pollock, from Coatesville. "I didn't have to convince him to sit in a room with 10 other kids he didn't know. And the logistics of putting on shoes for nine kids, socks for nine kids, walking everyone in, dropping him off, walking everyone back out, putting their seat belts on – for those reasons I thought, let's try it."

At first skeptical of whether he would develop a rapport with the therapist online, Pollock was pleasantly surprised. "The therapist was very warm, relational, personal," she recalled. "Tim connected with her right away and was motivated by her praise."

Tim has made such great strides that when he starts kindergarten next year, he will no longer need speech therapy.

We bank, shop, and communicate online, so why not see our doctor or therapist that way, too? Telemedicine keeps medically fragile patients from having to travel, offers more choice for patients who live far away from preferred doctors, and lets therapists work with more patients due to decreased travel time.

When done correctly, "video-delivered treatment is engaging, the alliance and satisfaction scores are very high, and the outcome data is fairly compelling," said Mary Alvord, a Maryland psychologist and volunteer public education coordinator with the American Psychological Association.

Recent studies show that using telemedicine for psychological issues, including obsessive compulsive disorder, attention deficit disorder, and anxiety disorders, has been especially effective, she said, and new guidelines are coming out soon for telemental health treatment by video with children and adolescents. Using telemedicine is also helpful with a person who is hearing impaired or speaks a different language, as a signer or interpreter can be brought in by  video.

"It reduces barriers and increases access," Alvord said. "And it empowers families to be able to access care for their children."

Better technology is paving the way for increased telemedicine use. "Now most people have much better broadband and bandwidth, the cameras are better and the audio quality, which is the most critical aspect, is better."

Telemedicine is covered by the same state laws as all medical practices, including licensing requirements, Alvord noted. Consumers should always know who they are dealing with, and that the technology is privacy-protected.

The facilitator – the mother, caregiver, or teacher sitting with the patient through therapy – has an important role, too.

"They help access the technology, redirect the student, if necessary, and access on-site materials," said Catherine Doran, supervisor of preschool speech and language services and Therapy Connect at the CCIU.

Plus, she said, "the parent is seeing all of the strategies the therapist uses and can implement those strategies throughout the child's whole day."

Convenience is the biggest advantage to telemedicine, said David Cognetti, codirector of the Jefferson Center for Head and Neck Surgery. "It saves the patient the hassle of driving in to the doctor's office and all the associated costs that go with that, like parking, gas, time, etc.," he said. "You can turn what would be a half-day or day off of work or school into a 15-minute time out of whatever you're doing."

Telemedicine works best for "more predictable" appointments where the physical exam isn't as important – post-ops where the doctor doesn't need to touch the patient, discussions to review a test or prepare for a procedure, and occasions when something unforeseen such as bad weather gets in the way of a physical visit. Now, he sees about 5 percent of his patients online, about 12 each month up from one a month when he started two years ago.

"Both physicians and patients see real value in appropriately selecting patients to this innovation," he said. "It gives you that added face-to-face connection where we can triage whether or not they need to be seen the next day or it's OK to wait a few weeks or they need to see the emergency department."

Of course, not all situations are right for telemedicine, and both sides need to understand the limitations, Cognetti said. "You cannot physically examine a patient over this connection and you can see them, but it's not the best quality and definition," he said.

Still, he said, "this is giving both sides more direct access without the hassles of current-day medicine."

The Carlow family was introduced to telemedicine on a snowy day in February.  Daughter Alyssa, 12, had surgery on a salivary gland in her neck, and was scheduled for a follow-up visit. "I was traveling and couldn't get home to take her to that appointment because I got stranded in the snowstorm, so we rescheduled for an eVisit," said Krista Carlow, of West Chester.

Alongside her father, Alyssa was able to have her follow-up appointment by computer.

"It was quick to download the app onto our smartphone and it was a video conference so [the doctor] could see her neck and how she was healing a week after surgery," Krista Carlow said. "It was like when you Facetime somebody."

The visit was also convenient and stress-free, Alyssa said. "We didn't have to drive all the way down to Philadelphia [about an hour's drive], and though he couldn't feel my neck, we could tell him what was happening," she said.

Since then, Alyssa has alternated in-person and video visits as she prepares for another surgery.

"E-visits allow the doctor to continue checking on her progress and allow us to keep him abreast of what's happening without having to take extra time off school and work and drive into Philly," Krista Carlow said.