For Dr. Gene Voskuhl, Medical Director at Resource Center’s LGBTQ Health facility in Dallas, Texas, telemedicine started as a means to help rural patients with the added benefit of shortening his own exhausting commute. He now believes that telemedicine serves a broader purpose. When asked how telemedicine is linked to ending the HIV epidemic in Texas, he responded, “Without a doubt, I am convinced that telemedicine is an option for people who have barriers to medical care. Sometimes it is as simple as transportation, time, sometimes it’s kids or family. I am convinced this will increase retention to care and the number of people in treatment.”
Dr. Voskuhl began exploring telemedicine in 2018 when he was working with the Callie Clinic in Sherman, Texas. He lived in Dallas and commuted to Sherman three days a week while also working part time with the Resource Center as they worked to open a new primary care medical program. He loved the people and the patients at the Callie Clinic and wanted to find a way to continue to work with them even after the new Resource Center LGBTQ Health facility was up and running.
In 2019, Dr. Voskuhl attended a two-day training at Texas Tech that provided IT training for telemedicine. That summer, he created a home-built system, which he now refers to as a bit of a “Frankenstein system,” while the CFO/IT staff at the Callie Clinic pulled the in-house telemedicine equipment together. They used a Zoom platform which had patient health information (PHI) encrypted. Patients at the Callie Clinic would go to the clinic and Dr. Voskuhl was able to see them online from his home. That was the beginning! When the Center’s LGBTQ Health opened, Dr. Voskuhl was able and willing to continue to serve his patients at the Callie Clinic using the telemedicine platform.
Once the coronavirus arrived, things began to change. With more barriers in place for patients to physically attend clinic appointments, it became an easy decision to add telemedicine at Resource Center. They had already been exploring the use of telemedicine for PrEP, so this just put the plan into high gear. Additionally, the Texas Medical Board (TMB) temporarily relaxed some of their previous telemedicine restrictions. Providers are now allowed to conduct video or phone appointments whereas in the past appointments had to be live video (synchronous) calls. Dr. Voskuhl is able to connect to patients at the Callie Clinic through the clinic’s EMR system. Instead of dialing in to the Zoom platform, he can dial into the Callie Clinic directly on his phone and patients have the option of telemedicine via video or telephone. At LGBTQ Health, he starts with a telemedicine visit to do an initial screening and can then have patients come in if he needs to see them in person. When asked if he hopes the TMB will continue to allow phone appointments he said, “Absolutely! Partly because Texas is so big and diverse that coronavirus hot spots will continue to pop up – so allowing me or other physicians to deal with those locally makes the most sense. There is no other way to think about this other than that the flexibility allowed has saved lives.”
Dr. Voskuhl has learned a few lessons, both about himself and about telemedicine.
- Personally, he still requires some face-to-face time with clients and co-workers.
- He has found that it is good for him to be on a schedule while working from home and it is important to go out at times.
- Listening is the most helpful aspect of his telemedicine calls.
- Asking people about their experience with telemedicine and what he can do differently is important. Some people love the telemedicine option and some absolutely hate it – they just don’t feel connected. He believes you can’t force telemedicine on people: “You can support it, but you have to be flexible.”
Dr. Voskuhl goes to the Callie Clinic once a month to see patients who prefer in-person visits, although he is not traveling right now due to the coronavirus.
From a technical perspective, lighting and especially audio are very important. You have to project a little bit more on the camera and be more animated on screen. There are a lot of little lessons to be learned – “like you have to move the mouse around every now and then or the screen goes dark!”
Dr. Voskuhl’s advice for others is, “Don’t be afraid – it seems daunting, but it is really not.” He said, “Hey, we did it, anybody can do it. There are online resources out there, online (TexLatrc.org for example), in-person and on the telephone. Don’t be afraid, because if you don’t know the answers there are people with the answers who can help you figure it out.”
Initially, he believed telemedicine was a way to link rural patients to care. Now, he sees that urban folks have many of the same barriers to accessing medical care. Telemedicine is a good way for many different patients to connect to medical care. When asked if he recommends telemedicine for others, Dr. Voskuhl said, “Absolutely, this is a tool for Texans, for our HIV folks and PrEP, to connect with medical care. One, it is important and two, it’s not that hard!”
Dr. Gene Voskuhl graduated from the University of Oklahoma, where he specialized in infectious diseases and eventually helped launch the University’s HIV Clinic. He later worked at Gilead (the manufacturer of PrEP medication Truvada) as a medical scientist, instructing fellow physicians on how to safely treat LGBTQ patients and prescribe appropriate pharmaceuticals. Volunteering for Resource Center gave him an even deeper insight into the needs of the LGBTQ and HIV populations in North Texas, and further fanned the flames of his passion towards equity in healthcare. He is currently the Medical Director at the Center’s LGBTQ Health facility, which provides affirming and compassionate care in a stigma-free environment.