With the holidays in full swing, accidents and illness may happen at any time. It is always recommended that you try scheduling an appointment with your primary care doctor first. If that is not an option, Cook Children’s Health Care System ensures that our families can access health care at any time through a telehealth visit, an urgent care center, or an emergency department. To prepare for when you need care, know when to use Cook Children’s telemedicine, urgent care, and when to rush to the emergency department.

“For simple fever, cough, and congestion, your child can be seen in urgent care or by their pediatrician,” said Taylor Louden, M.D., medical director of emergency services at Cook Children’s Medical Center- Fort Worth. “Your wait times for simple illnesses will be much longer and visits much more expensive in the emergency department than if your child is seen in urgent care or by their pediatrician.”

He explains that doctors expect a fever to return after the Tylenol/Motrin wears off; however, for fevers lasting more than five days, or if a child appears ill, the emergency department is the appropriate place to be evaluated.  

Urgent Care

When your child needs urgent care for things like X-rays, stitches, and illnesses that are not life-threatening but need medical attention the same day, you'll find the medical care you need at a Cook Children's urgent care clinic.

Cook Children’s Urgent Care clinics are not just kid-friendly; they are kid-only.

When to use Cook Children’s Urgent Care

• Ear infections/pain
• Strep/sore throats
• Cold symptoms
• Flu
• Mild dehydration
• Respiratory illnesses – including respiratory syncytial virus (RSV), bronchitis, bronchiolitis, pneumonia and asthma without severe breathing difficulty
• Sprains and possibly broken bones
• Minor cuts
• Prolonged vomiting
• Persistent diarrhea
• Infected bug bites
• Foreign body removal (marbles, beans and other interesting things)
• Urinary infection symptoms
• Pinworms, ringworm, rashes and pink eye
• Painful muscle strains
• Head injuries without loss of consciousness or vomiting

Virtual Urgent Care

Cook Children's patients with a MyCookChildren's account can video chat with one of our medical experts for non-urgent medical conditions without visiting the doctor's office.

This service is for patients who have minor medical conditions, and not for emergencies.

• Animal and insect bites
• Burns or cuts
• Circumcision check
• Conjunctivitis (pink eye) without other symptoms
• Constipation advice
• Covid-19*
• Diaper rash
• Fever advice
• Flu-like symptoms*
• Ingrown toenail
• Lice
• Mouth ulcers, thrush
• Rashes or skin infections
• Sore throat/strep throat*
• Urinary tract infections*
• Vomiting/diarrhea
• Wound care advice

*Drive-through testing available at Cook Children's Urgent Care locations if medically necessary.

When to use the Cook Children’s Emergency Department

Cook Children’s Health Care System has two medical centers with an Emergency Department for our Fort Worth and Prosper little ones. Parents should take their child to the Emergency Department if their child is unconscious, not responding, a bone is sticking out, or the situation seems critical. Dial 911 immediately for an ambulance. When your child's condition is life-threatening or might cause permanent harm, it is safer for your child to be transported via ambulance.

• Severe bleeding that does not stop after 15 minutes of direct pressure
• Severe allergic reactions
• Difficulty breathing
• Coughing up or vomiting blood
• Sudden severe joint pain with swelling
• Insect stings accompanied by breathing difficulties
• Swallowing poison or choking
• Not being able to move or speak
• Severe or persistent vomiting or diarrhea
• Gaping wound (edges won’t come together)
• Head injury with loss of consciousness, vomiting or causing dizziness/confusion
• Visible broken bones or dislocated joints
• Fever in infants under 8 weeks old
• Diabetes/blood sugar issues

However, Cook Children’s School-Based Virtual Health Program is helping school nurses and parents ease some of that chaos.

“I see the benefit for my own family,” said Erwin, an LVN, IBCLC, and virtual health nurse coordinator with Cook Children’s.

Nurses in the Celina Independent School District now join 14 other school districts in offering virtual health appointments, with no upfront cost, through the school nurse’s office. A parent or legal guardian must register and consent before the visit.

The virtual health services can help diagnose:

• Earaches
• Fevers
• Coughs and colds
• Skin rashes
• Minor skin infections
• Abrasions/cuts/scrapes
• Sore throats
• Flu-like symptoms
• Pink eye
• Head lice

Autumn Morris, an APRN CPNP-PC and a virtual health nurse practitioner, met with Celina ISD nurses to train them on the program before the school year. Each campus nurse is provided with a stethoscope and an otoscope to use during virtual visits to help with diagnoses. Each item plugs into a laptop, allowing Morris to see inside a child’s ear and listen to their heartbeat, for example. In addition, each campus nurse is trained and certified to administer a flu and strep test if needed during the visit.

“It’s nice because then we can get the results right there,” said Allycia Cundiff, Celina ISD lead nurse.

Cundiff looks forward to the partnership and the impact it will have on the community. Morris will be able to determine if a child needs to be sent home or if they can stay in class, helping reduce absences.

Erwin says program data shows 65% of visits are due to a sore throat.

“We meet you where you're at because a lot of times it's really hard to get off work when your kid is sick,” said Morris.

Parents can choose to attend the virtual visit. Following the appointment, Morris will contact parents with information about the visit and post-care instructions. If a child must be sent home, an excuse note is sent directly to the school. A copy of the visit is also provided to the child’s pediatrician. 

Erwin explains that the virtual appointment does not replace a child’s primary care pediatrician but is a collaborative effort. Morris says the line of communication with the pediatrician can help determine if a child may need to see a specialist. 

“We want them to have a primary care physician (PCP) placement, and if they don't have that, we work hard to find them one with Cook Children's,” said Erwin.

Once the visit is completed, Cook Children’s will bill the parent’s insurance provider.

A visit to the nurse’s office

“Kids like it, too, because they think the technology is cool,” said Erwin. “They get to come in, they get to see Autumn on the screen and they get to talk.”

Morris works with more than 100 schools, providing care to them. She and Erwin lead the training with all district nurses in the program.

“I want them to know that I'm not just the provider who's seeing that kid at that moment, but I'm a resource to them (nurses) so they can reach out to me if there are any issues or concerns,” said Morris.

The program has been in place for eight years. Morris describes the partnership as the school nurses being her "hands" as she diagnoses a child's illness. If additional testing or care is required, she is able to refer the child to a Cook Children's Urgent Care or Cook Children's Medical Center Prosper, just a short drive from Celina.

“We always say, you don't just get me, you get a giant hospital system attached to me,” said Morris. “We are passionate employees of the system but we are passionate parents who love our kids.”

It is that confidence and reassurance that makes Cundiff excited for the partnership, not just as a nurse but as a parent herself.

 “We have a lot of parents that work for the district and it is really hard to leave work, especially if you're a teacher,” explained Cundiff.

Anatomy of a visit

A typical visit can last anywhere from two minutes to five minutes. Children will present themselves at the school nurse’s office, and a nurse will determine if a virtual visit may be helpful. If so:

• A parent or legal guardian is contacted for consent.
• The nurse will request a visit with Morris.
• The campus nurse will collect vitals.
• Virtual visit begins

Celina ISD began school on August 13. Parents can register for the program online.

“As two organizations committed to putting children first, this partnership represents a natural alignment,” said Kevin Greene, president of Cook Children’s Medical Center – Prosper. “We’re honored to partner with Celina ISD in our continued Promise: Everything for the child.”

This partnership reflects the spirit of Celina ISD’s guiding motto, Life Connected, by embedding high-quality pediatric care into the daily experience of nearly 6,000 students in one of Texas’ fastest-growing school districts.

“Cook Children’s has cared for generations of children across North Texas, just as Celina ISD has shaped their minds and futures,” said Tom Maglisceau, Ph.D., superintendent of Celina ISD. “Together, we’re ensuring every student is both well-educated and well-cared for.”

What the Partnership Means for Families

Beginning in Fall 2025, students at all Celina ISD campuses will benefit from:

• Access to Cook Children’s Virtual Health through the school nurse’s office, enabling real-time video visits with pediatric providers.
• In-school diagnosis and treatment for common illnesses such as fevers, earaches, rashes, sore throats and pink eye – minimizing classroom disruptions and parent work absences.
• Seamless communication with primary care providers, prescription support and visit summaries.

This proactive model of care ensures kids stay healthier, in school longer, and connected to both learning and healing. Learn more about Cook Children’s Virtual Health program at Celina ISD here.

Left to right: 

• Tom Maglisceau, Ph.D., Superintendent of Celina ISD
• Starla Martin, Director of Student Services at Celina ISD
• Kevin Greene, President of Cook Children’s Medical Center – Prosper.

In the following video, our team answers the questions they hear most frequently, including how COVID-19 has impacted the program.

Learn more on our website.

Widespread change due to the COVID-19 pandemic has swept the nation, which has left many parents struggling to keep essential appointments with, not only their physicians, but with behavioral health specialists as well. Parents are now questioning the safety of the world beyond their windows and this has led parents, as well as psychologists and psychiatrists, to the use of telemedicine.

While Cook Children’s launched the telemedicine program in 2004 before the pandemic gripped the United States, this unprecedented time has pushed the world to embrace telemedicine like never before. While many parents and behavioral health specialists opted to continue in-person visits, parents like Patti Stephens persistently waited for the opportunity.

“Even before the pandemic began, I had hoped to be able to utilize telemedicine when we moved in October 2018. I knew this move would be temporary, so I wanted the continuity of care,” Patti said. “Unfortunately, we didn't qualify for telemedicine services for psychiatry so I drove to Fort Worth for appointments or for behavioral therapy.”

Patti’s family of four children has made countless trips from their home in West Texas to various Cook Children’s locations since 2002, from one child in the NICU to annual well-child visits to family therapy visits. When Patti’s family was finally able to begin using telemedicine, it allowed their family extra time, both in commuting and rounding up all four children at times for one appointment. With telemedicine, Stephens said her children found comfort in being in their own environment and she found flexibility in being able to schedule an appointment whenever she needed.

When the pandemic made it to Texas, Cook Children’s physicians quickly realized telemedicine would need to move to the forefront of their care delivery. Similar to some parents, physicians had to adapt quickly and learn how to use this technology in a way that would benefit each patient.

“When I heard we were going to utilize telehealth, my initial concern was my lack of experience and confidence in using this approach. I became anxious about how to meet the needs of my families best,” Laura Wright, LPC-S Family Therapist, said. “Therapeutic relationship is foundational for therapy, and I was concerned that would be lost in translation using telehealth. I wondered if my patients would be able to focus and attend to sessions in their home settings with all of the potential distractions.”

Concerns around telemedicine faded as patients began to flourish in the comfort of their homes. Parents and physicians may have experienced a learning curve; however, young patients took to the new technology quickly.

“I found rapport to be better unexpectedly. Patients would excitedly show their room or pets, and I felt I knew them better,” Hari Kumarasen, M.D., a psychiatrist at Cook Children’s, said. “It gave me insights into the patient’s personality. Telehealth allowed me to make observations about the child, seeing them in their environment, which I wouldn’t have otherwise been able to make. I also found my anxious and scared children and teen patients are more chill in their own environment.”

Telemedicine allows for long-distance patient/physician relationships, and offers parents options for non-emergent questions if a patient is traveling or not able to make an office visit.

“I have long felt that teletherapy should be an option for both patients and therapists. Especially for parents who have multiple children in therapy. It is so much easier to make and keep appointments via telemedicine,” Patti said. “Also, if we have established a relationship with a particular provider and either the provider or family moves further away, we don't have to start over with building a relationship with someone new.”

When the world begins to feel relief from COVID-19, patients and physicians alike are hoping to incorporate telemedicine into their routines. The ease of access for healthcare has created a positive outcome from an outbreak that has affected society so negatively.

“This is something I would absolutely desire to continue using, if not solely, at least in part. The lack of a stressful commute has been beneficial to my well-being, sparking newfound enthusiasm and creativity in my work,” Stephanie Golden, LPC Family Therapist, said. “As for a majority of my clients, participating in a familiar, safe setting called “home” seems to facilitate a willingness to engage more readily and thoroughly.”

At the beginning of the COVID-19, insurance covered telehealth appointments because patients could not keep their appointments in person. As the pandemic continues, more providers are returning to pre-COVID payment methods, meaning more companies are asking people to pay out-of- pocket for virtual visits. That leaves those who have benefitted from the telehealth concerned that it will go away or become costly for patient families who need it most.

“I am very concerned that we will lose the ability to conduct telehealth services due to insurance coverage limitations. It has proven to be beneficial for many of our patients, especially during this time of a global health crisis with the highly-contagious pandemic,” Golden said. “It certainly is advantageous for parents, giving some peace of mind about keeping their children in a safe space, removing the burden of taking their children away from the classroom and critical learning, and easing the stress of transporting them to and from the counseling office setting.”

The introduction of telemedicine has given families more access to health care focused on the patient experience and allows us to reach a child no matter where they are in the state of Texas. Physicians and health care providers’ willingness to adapt during the pandemic has raised the bar for healthcare delivery systems.

“Several of my patients and parents have shared the hope that telehealth will continue to be offered/available, noting the convenience of the service,” Wright said. “Distance for our remote families, lack of transportation, multiple children’s schedules to juggle, school, commuting, and work are all barriers to mental health treatment. Telehealth breaks down those barriers to reach these families.”

Doing their best to minimize in-person visits, Cook Children’s Primary Care Physicians and Cook Children’s Urgent Care Physicians are partnering to provide telemedicine visits to help provide the quality pediatric care you expect from Cook Children’s.

A Video Visit allows a patient to have a remote visit with a Cook Children's primary care provider for non-urgent reasons. A patient must have a MyChart account to request a video visit.

• Desktop web browsers
• Mobile devices

Click here for tips on how to prepare for a video vist.  

“Many parents have simple questions that can be answered by a quick conversation with a pediatrician and do not require an in-person visit,” said Justin Smith, M.D., a pediatrician and medical director of Virtual Health for Cook Children’s. “This technology allows our pediatricians to help prevent the spread of COVID-19 while still providing high-level care to our patients.”

Patients can access telemedicine at Cook Children’s via two major pathways.

Both require two steps in preparation for a visit:

1. Patients must have active Cook Children’s MyChart accounts.
2. Patients must have the videoconferencing program Zoom downloaded to their device.

After that, parents can choose to either:

• Request a visit with their regular pediatrician by selecting the “Appointments” tab in MyChart or by calling their pediatrician’s office to set up an appointment. These appointments will be available during regular office times. When the time comes for a visit, patients go back to the appointments tab to complete e-check in and start the video visit. Click here to learn more.
• If your child’s regular pediatrician is not available, then you have the option to request a visit with the next available pediatrician by selecting the “Video Visit Now” tab in MyChart. Urgent Care doctors are available to see these visits from 11 a.m. to 9 p.m. every day. Once selecting the "Video Visit Now" button, patients are put in line for the next available provider.

In addition to telemedicine visits, Cook Children’s pediatricians are actively working to help keep patients safe by direct messaging with patient families and providing phone visits when video is not an option. Messages can include a picture or video and can be sent through the MyChart “Messages” tab.

For more on this, view the following:

• Primary Care Video Visits
• Urgent Care Virtual Visits
• Zoom: https://cookchildrens.org/mychart/Pages/video-visits.aspx
• My Chart: https://cookchildrens.org/mychart

Cook Children’s began providing virtual urgent care in summer of 2019 and in March of 2020, services expanded to primary care pediatricians seeing patients virtually as well.

Kari Lipscomb, director of Virtual Health at Cook Children’s, said a lot had to happen quickly to make sure patient families could keep their appointments.

“We needed to increase our ability to see urgent care patients, turn on services for our 127 primary care physicians and 33 specialty departments…all in the span of about six days,” Lipscomb said.

In a time where patients were instructed to stay home as much as possible, it was important to the physicians at Cook Children’s to continue to provide care for their own patients whenever possible.

To provide some idea of how fast things are changing, Cook Children’s completed 316 visits via telemedicine in February, 2020, but by March that number increased to 2,794. Cook Children’s doctors and nurses are on track to complete approximately 10,000 in April.

Within days, primary care physicians were seeing their patients via video during office hours while the Virtual Urgent Care providers continued to see patients throughout the day and evening. Because Cook Children’s is an integrated network, all of their physicians, including primary and urgent care can see the patient’s entire medical record.

Visits with the children’s primary care doctor are primarily being covered by insurance, often with no co-pay necessary. Virtual urgent care visits are a flat $50 fee.

In addition to general pediatric care, specialty clinics and specialty education departments were able to quickly integrate video visits into their offerings for patients. This enabled the physicians to minimize disruption to care for children with chronic conditions and new, complex medical needs.

Kari Lipscomb went on to say, “Of course, it wasn’t easy to get everything up and going, but it was so important, and everyone rallied to make it happen. Physicians, their staff, administration and IT support were all necessary to make it happen. Changing something so quickly, doesn’t happen without a lot of help.”

In addition to new services, Cook Children’s has significantly increased their other remote offerings to patients including direct messaging and telephone triage-all in an effort to provide great care while keeping their patients safe.

The big question now, what happens when COVID-19 is gone? Do things go back to normal?

“Many physicians and patients have really come to enjoy their interactions via video and the convenience for the family is really important,” Dr. Justin Smith, medical director of Virtual Health and Innovation states. “While not everything is able to be done via video, I expect that many of our physicians will continue to offer video visits for certain conditions and situations.”

In addition to telemedicine visits, Cook Children’s pediatricians are actively working to help keep patients safe by direct messaging with patient families and providing phone visits when video is not an option. Messages can include a picture or video and can be sent through the MyChart “Messages” tab.

For more on this, view the following:

• Primary Care Video Visits
• Urgent Care Virtual Visits
• Zoom: https://cookchildrens.org/mychart/Pages/video-visits.aspx
• My Chart: https://cookchildrens.org/mychart

"Your child is here with a sore throat. I know they haven’t had a fever, but strep has been going around."

Whelp, there goes your day. Cancel all your meetings. Call your pediatrician's office. Get an appointment in a few hours. Get your child tested and see what happens next.

But for some families in North Texas, there might be a better way to get treated for illnesses.

Through a partnership with Cook Children's, students in Keller ISD join a growing list of other local school districts who can now see a pediatric provider via telemedicine as part of our School-Based Virtual Health program. All while staying at school.

Children with qualifying conditions such as earache, sore throat, pink eye and many others who present symptoms to their school nurse, connect with either a Cook Children's board certified pediatrician or a certified nurse practitioner via a secure video connection. The school nurse can use devices to show the provider the child's ears, throat, rashes, and other physical findings as well as allow the provider to listen via a digital stethoscope. Students also can be tested for both strep and flu while right there in the office.

The virtual visits are completely covered for children who are on Medicaid. For all other patients, the price of a visit is $65 for new patients and $50 for established patients.

Keller ISD and Cook Children's started a pilot program approximately three years ago in five schools. The success of the program led to the adoption of the program to the full district last fall. Funds from the Grainger Foundation allowed for the purchase of more equipment and marketing information to be distributed.

Enrollment at Keller ISD has increased significantly over time. Although registration can be completed on the day of the visit, there are now over 1,000 students pre-registered for visits. More than 150 appointments have been completed this school year. About half of those visits have allowed the student to stay at school. Staying in school means decreasing lost educational time, faster time to diagnosis and treatment as well as prevention of many parental headaches and frustrations.

Interested in more information about Cook Children's School-Based Virtual Health program?

Click here to find out more about the program and how your school might become involved. If you would like to donate to this program, click here and type in "telemedicine" when prompted.

Electronic medical records, retail medicine, urgent care and freestanding ERs are just a few examples of recent topics that have divided the medical community. The current debate that I find myself in the middle of: telemedicine.

And it’s not that physicians are all Luddites who wish for the days of paper charts. Many of the concerned doctors are tech-savvy, customer friendly and progressive. Their concerns are very valid and come from a position of care. However, I do believe that some of the concerns reflect an incomplete understanding of what telemedicine is and what it could do for their patients.

Here are 5 half-truths about telemedicine

1. It’s not a good as an in-person visit.

This is true. Period. If we all had the choice to have 100 percent of the information possible before making decision we would like to have it but, even in medicine, we make decisions based on the best available evidence all the time. We even make choices to forgo gathering more information in certain cases. Not every patient with abdominal pain gets labs and an abdominal CT. Is it possible that, with certain complaints, we could gather enough information with a virtual consultation to diagnose and treat without an in-person physical exam?

2. I want to protect my patients from bad medicine.

First off, it’s not all bad. Just like any innovation, there will be many providers more concerned about profit than providing quality care. Perhaps they are more liberal with antibiotics or giving in to patient demands despite it not being the best medicine. The reason this is a half-truth is because you can’t protect your patients from participating. If a patient wants access to telemedicine, they will be able to find it and this will only become increasingly more the case as restrictions continue to fall in state after state. Physicians will not be able to keep you patients from using it, forever.

3. Telemedicine is only for “telemedicine companies.”

No, in fact there are many vendors out there that will allow you (for a pretty nominal price) to start to provide telemedicine for patients. Taking care of your own patients in a new and different way can be a great driver for patient satisfaction and practice engagement. Yes, there are vendors out there that all they do is telemedicine but why let them take care of your patients when you could do it as well.

4. My schedule is already full. Why would I do this?

Surveys increasingly show that patients are using telemedicine, are interested in using telemedicine or would consider the option of telemedicine an important part of their decision to select a practice. All that to say, if your schedule is full now, it’s probably because you were doing things that patients like. If what patients want change, will you?

5. I’ll wait until I can get paid.

With higher deductibles, patients are looking for more cost effective ways to receive care. Many are more than willing to pay cash for a visit. I’ve seen costs anywhere from $30-60. Overhead for providing the service is so low that you can sustain and even be profitable at this price point. Secondarily, if there is any increased draw to your practice, the benefit will certainly outweigh the cost.

Telemedicine is evolving quickly and will likely become a greater part of our days in the coming years. How will you respond? I encourage you to ask questions and learn from those who are providing care in this way to see what might work for you.