Telemedicine Can Benefit Patients & Physicians Alike

Geeta Nayyar, M.D., MBA: The other thing is, people are not just searching online for the answers. They are searching for doctors online, right? Telemedicine, virtual visits.

Janae Sharp: Or they’re searching their Facebook mom groups.

Geeta Nayyar, M.D., MBA: Exactly.

Janae Sharp: I found my doctor in my Facebook mom group.

Geeta Nayyar, M.D., MBA: That’s right.

Janae Sharp: You get terrible medical advice, but you can find a good doctor.

Geeta Nayyar, M.D., MBA: So where do virtual visits fit into this? Your work at Geneia is all about this. So talk to us about that, Heather.

Heather Staples Lavoie: Well, we talk about this all the time at Geneia, and we have 10,000 people turning age 65 every day and will do so for another 15-plus years. So these are baby boomers who have different expectations about how they want to age in their home. We don’t have enough caregivers to care for that population, and certainly not with the rate of chronic disease that we have in our population. We have over 100 million prediabetics, and we have to find new and creative ways of treating and caring for this population. There aren’t enough physicians or any other clinicians to help support the population. So we do support people in the home through remote patient monitoring. We’ve allowed — we’ve really supported people to stay independent.

We have patients who we care for who are 100 years old but have been able to maintain a strong lifestyle in their home. We’ve also been able to understand and provide contextual information about that patient, in terms of humidity levels and pollution levels and other information about that patient that might be exacerbating their situation. We also have been able to even go in and course-correct where we’ve seen their blood oxygen level might be low, and breathing exercises have been able to get people off of supplemental oxygen.

So there are simple things that you can do by capturing more biometric information. But when you’re capturing that volume of data, you really need more sophisticated systems. That’s where AI [artificial intelligence] plays a great role because it’s perfectly positioned to help support mining through volumes of data in that way, because physicians can’t manage all of the alerts that might come through managing populations in that way and being notified. So you need a way to quiet down noise that might be false-positives and really only alert when there are real situations that present for a physician, and/or other clinicians, other nurses or other caregivers can then be monitoring patients in the home. So it’s a perfect application and is necessary for the population that’s aging.

Geeta Nayyar, M.D., MBA: Regarding telemedicine, for me as a rheumatologist — we’re pretty rare, we deal with rare stuff — I remember early on in my career getting a call from this primary care physician somewhere in rural America who said, “There’s a newborn here that has this rash; I’m terrified it’s lupus. Will you help me?” And I didn’t know who they were, and they didn’t know who I was. This was before the smartphone. I just said, “Describe it, describe it to me and I can give you a sense for what to do.” And now, zooming ahead, even if that doctor had texted me a picture, it would have gone a long way.

So I would love to hear from you, Rasu, on this because in telemedicine, clearly the technology is there, that’s not the issue, right? It’s the reimbursement, it’s regulation. So where does it fit into the future for physician burnout because it seems like such an asset?

Rasu Shrestha, M.D., MBA: It is an asset. What’s interesting about telemedicine in general, as you rightly pointed out, is that it’s actually been around for a while. There are multiple iterations of telemedicine — there are multiple add-ons in terms of capabilities and services. But it’s really interesting. A lot of folks today are talking about telemedicine. There are a lot of businesses proliferating around telemedicine, leveraging the cloud and the power of these technological capabilities.

I think the reason for that transformation happening right now is that there’s starting to be more of a reimbursement movement toward telemedicine, to a point where I say that telemedicine is an overnight success story that was 30 years in the making. Everyone’s now talking about telemedicine — it’s great, but reimbursement is a big factor.

And we’re going to see more of this happening in 2019. The CMS [Centers for Medicare & Medicaid Services] is talking more about this as well, and I’m really bullish about the fact that with additional reimbursement around telemedicine, what we’re going to be able to do is to leverage these technological capabilities of not just having synchronous and asynchronous communication capabilities between clinicians across multiple care teams and patients who are in remote locations, but also capitalizing on the power of video. Capitalize on the power of voice. Capitalize on the power of these devices that allow for you to monitor things remotely and allow for us collectively to then look at the care that we’re providing to our patients in a much more longitudinal manner.

It really has to be about the care continuum because then it starts the conversation about how we humanize care and not just focus in on that one episode of care.

Janae Sharp: I really like telemedicine. I had a friend who was a nurse, and then she fell and hurt her back. And she couldn’t do her job anymore. She really couldn’t do it. So she was able to pivot into helping people on the phone and doing telemedicine. And she still had that same level of pay, she still had the same job.

So telemedicine, in a way, allows us to give physicians and nurses, other caregivers, more options. If you have a career and you’re super unhappy, maybe you could take time with the telemedicine crew. We need to rethink the way that we’re giving physicians options. This isn’t just a way for patients to get it. I love not having to go to the doctor, I love that. But I also think it’s great to be able to connect with a doctor who’s happier in their job as a virtual M.D.

Geeta Nayyar, M.D., MBA: Sure. I think all of these are excellent points. And one of the things that Rasu mentioned was the womb to tomb. Janae, I know you just had a baby, right?

Janae Sharp: Yes, he’s here, but not on camera.

Geeta Nayyar, M.D., MBA: For the first few months, you’re at the doctor all the time, right?

Janae Sharp: Yes, and it’s horrible. This is the last thing I want to do, bringing my 2-week-old to the doctor to check out this rash, just in case. That’s exactly what I wanted to do today, as opposed to sleep. I really wanted to just pack it all up and go.

Rasu Shrestha, M.D., MBA: Absolutely. And you know the advent of telemedicine and the fact that it’s actually taking off is driven in large part by convenience, right?

Janae Sharp: Yes.

Rasu Shrestha, M.D., MBA: We have these technological capabilities today. We’re taking selfies of each other and immediately Instagramming it and texting it out to our buddies. Well, what about the medical selfie? This is happening today, right? We’re taking a picture of our rash and we’re uploading it to a service. And in the cloud is an AI algorithm that’s really analyzing that rash and then feeding back to me whether I should be worried about it, the acuity of that rash.

And it’s the same thing with cardiac murmurs, and we’re all really in awe of the announcements that companies like Apple and others are making. Samsung is working actively toward this as well. Simple devices that consumers now have can measure rhythms that could really predict if you have a serious problem, if you’re going to die from a heart attack, if you’re going to have an arrhythmia that’s going to kill you right there. And it’s been uploaded to the cloud, and there are these algorithms that are recognizing these patterns and aiding the clinicians.

So I’m bullish about technology. I think it’s important for us to make sure that technology plays a role in physicians being better in the task that they signed up for in the first place.

Geeta Nayyar, M.D., MBA: I don’t actually think it’s the technology, though. I think it’s the consumer. Why? The consumer is saying, “Why can’t healthcare be convenient? Why is healthcare not convenient?”

Janae Sharp: Right. And people will pay for that.

Geeta Nayyar, M.D., MBA: Like who?

Janae Sharp: I would probably pay a lot of money for a nap as a new mom — a lot of money. So if being able to reach my physician and take care of my infant is easier, I’ll pay money for that because it matters to me.

Heather Staples Lavoie: Sure. And a lot of Americans are in rural areas, and so they don’t have access to specialized physicians. I see this in my own community. I’m in the northern part of our state, and there’s just no access to child psychiatrists, subspecialties, and so telemedicine really gives access in areas where people can’t drive the distance and may not be able to get in. And so it really does provide for care that’s really needed in the community.

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