Is digital healthcare better than the doctor's office?

[MUSIC] During this pandemic, the number of Americans seeing a doctor over a digital connection has nearly a Drupal's. Remote sensors have changed medical technology too. We've moved beyond stairsteps and heart monitoring, even to mental health monitoring from home. Now the onus is on the industry to figure out how to make this experience even better after COVID-19. [MUSIC] All shifts we made in 2020 29 may matter more than the one that happened in health care. Telehealth saw a spike like few others and modern tech history. Usage by US broadband households jumped from 15% to 41% between q2 of 2019 and q2 of 2020 according to park associates. A jump like that would have taken years on a pre- pandemic trajectory. I think for certain situations, it makes a heck of a lot of sense. I think it just depends on what my question is or my problem. [MUSIC] Alongside the telehealth trend, consumer health devices have been moving from elective to more essential. Apple Watch 6 can read cardiac rhythms and blood oxygen levels. The Amaan Heart guide measures blood pressure the same way a clinic does. Amazon's Halo band tracks body mass and monitors your voice for health trends. And Abbott's freestyle Libra is now used to monitor blood glucose for people who don't have diabetes. Lightning Bolt trends was one of the biggest health tech headlines of the year. Tella Doc, a telehealth platform thought livongo which, among other things can integrate home health device signals to indicate when you might need a visit with a doctor. All of this can jump a lot of stubborn health hurdles. Like making doctor's visits accessible for people who otherwise can't afford the time off of work. My wait was about 10 minutes, which is longer than I like to wait, but much shorter than a visit to the For people who live in rural areas, a trend that grew in 2020 And telehealth visits are less of an event, encouraging patients to do quick check-ins on small issues before they become big problems. I would be much more ready to just hop on a telehealth call to sort of talk it through, right? There are often things that we run across or that we feel That we might brush off and say, I should get that checked out. Right. It's a really easy way to sort of talk through and get things checked out. [MUSIC] Of course, Tele-health is the right tech at a time when we remain focused on controlling exposure to others.>> They were able to answer my questions. Quickly and confidently without me having to take the risk right now of going into a medical facility. And while lacking the three dimensions of an in-person consultation, tele-health can convey the correct. Context of a patient's lifestyle that might be absent in a clinical environment. But don't start putting all those doctor's offices up for rent just yet. Patients and providers don't relish fussing with new technology. I'm in the software business so I understand what a good user interface could be. It was a little sketchy getting it set up and then waiting for the doctor to appear. Everyone knows how to use the door to a doctor's office. But the same can't necessarily be said for Telehealth visits. Doctors aren't convinced that a simple video call can convey the same diagnostic new arm. As an in person visit, and all of those health tech devices, they run the risk of adding too much information potentially creating false alarms for providers and worrying for patients. [MUSIC] Finally, does this modern health tech revolution go too far toward making the patient a consumer potentially distorting the doctor patient relationship? The question isn't whether we pursue tele-health and at-home health devices that can inform it. But whether these gadgets and services are additive to excellent affordable healthcare and not a shiny distraction for me [MUSIC] To bring this all together. Talk about what challenges and opportunities face us in the coming years and telemedicine. We brought together a panel of three thought leaders. I'd love to welcome Dr. Yulin Wong. He is the head of r&d at teladoc. He has a deep history in creating telemedicine products. Thinking about how telemedicine can change the future of medicine for both patients and for doctors. I'm really excited to have him here, Dr. Wong. What a year. What do you think that we've learned in this year of COVID, now behind us, that has changed the future of telemedicine? Well Lindsay, first of all, thanks for having me here. And 2020 has certainly been quite a year and there's been many things which have changed but to your specific question, which has certainly changed is telemedicine and virtual care has been thrust into front and centre in healthcare, I think prior to COVID. Telemedicine was actually gaining momentum nicely in terms of its growth rate in terms of physicians and the medical community at large. their willingness to use it and it was growing at a 20 to 30% annualized clip, and then when COVID hit. The growth rate of telemedicine went up tenfold. almost overnight. It was just mind boggling that really put everybody systems to test teladoc did well through that transition to 10 x improvement, actually growth rate. And I think that what we've learned. Is that telemedicine is a very valid and effective and safe way to deliver health care. And what brought it to the forefront was, everybody's afraid to getting COVID rightfully so whether you're a patient or provider, and telemedicine solves that problem. And you can't get sick through a virtual type. Console. So it seems like going into this year, the telemedicine industry had been very much focusing on fulfilling the needs of people who might not have access to doctors on a daily basis or might not be able to leave their home very easily. I guess my question is, do we Were we in the right position? What hadn't we thought of as an industry? What the telemedicine industry? I'm guessing hadn't thought of some of the things we would need to address in the past year. What did we learn? Well, we've learned that telemedicine which came from places like giving access to people in rural areas. Are giving access to people who are for whatever reason, it's hard for them to access a brick and mortar type of setting. Or actually giving access to care to a patient who needs it immediately like in a case of a stroke or something like that. We've learned that those aren't the only places to apply telemedicine and that you can apply it more systemically through the entire healthcare delivery system. As opposed to those specific types of use cases. You can actually apply telemedicine wherever you can actually deliver care effectively via a virtual interaction and some people claim that that's, Half or so of all of healthcare delivery, so it's going to be systemically changing how healthcare is delivered just in general. It's probably hard to know yet because we're still in this. Bit of a mess, how much of it? How much of acceptance of telemedicine for the patient? Do you think will stick after this is over? Do you think that people have learned what they are capable of doing remotely and will take that with them into the future? I think so, I think that if you start on the patient side or the member side, quite honestly, members in general have embraced telemedicine more rapidly than the provider or the clinician side and and why have People embraced it so easily because it's more convenient. It gives people I mean, think about banking, you know, we don't have to drive into the bank anymore. We can just do your banking from our computer at home. Same with telemedicine, you can now get your health care from a home there are time You certainly need to go into the hospital if you got to get a CT scan or an MRI scan or, Or you need to get some lab work done or surgery those things obviously you do need to go in for but for lots of things you don't. The doctor side and provider side has taken a little bit longer and I think doctors some have embraced it quite quickly and immediately but some a large segment Had not and one of the key reasons why they had not one is it was just the way they have historically worked. But the other big thing has been reimbursement and reimbursement. In other words a doctor, if I see a patient in my office I get paid if I see him virtually I don't. Now that's changed through COVID where COVID where the government and, and all of the private payers have followed suit. So that if a doctor see the patient virtually they get paid as well. And that's actually change the adaption rate amongst physicians tremendously. I don't remember the exact numbers but there's lots to reports out now would say Things like you know, 75% of physicians want to continue promoting and pushing telemedicine, even post COVID. Medicine has typically. Quickly lagged a little bit behind other industries in terms of innovation for very good reasons. Because this is where safety matters probably the most, this and transportation probably. There's a lot of regulation. But there's also now this huge opportunity for innovation based on what we've learned in the last year. What do you think is coming? What isn't that in the future three to five years out that I might not be thinking about, but that's going to change the world for patients and maybe for doctors. Well, so thank you for the question. It's something I think about all the time as my job. I think that You know, when you have the entire interaction digitized, okay, now you have a computer between the provider and the patient who technically can know everything that's going on. So that right there is a very, very powerful statement in terms of capabilities. And so one of the things we're working a lot on is to figure out how to use the latest technologies in machine learning, in analytics in order to make the computer Enhance the knowledge base of the providers and clinicians as much as possible in order to help take care of the patients. So for example, in some cases, maybe the computer can actually Do an algorithm which helps the patient take care of themselves first without even passing on to a provider, thereby reducing the shortage issue. So for example on a diabetic person who might be nudged by a machine learning algorithm in order to help take better care of their chronic disease But then that machine learning algorithm also might know when it's appropriate to pass on the diet medication on to a coach on to a primary care doctor on to an endocrinologist on to a specialist in the local health system where they ultimately have to go into But these are all things that we can do with technology, which are gonna improve the access to care. They're gonna make it, easier for the patients to navigate the system and allow us to be more effective with the resources we have. And as you've already pointed out, we have a shortage of them. That's that's great. And, I personally am very much looking forward to a more seamless predictive system. Thank you so much for your time. This has been really fun. It's been my pleasure. And once again, thanks for having me on Lindsey. Our next guest comes to us with a healthy dose of skepticism about what telemedicine can and can't do for us. I'd like to welcome Wendy Dean MD. She is the CEO and co founder of moral injury of healthcare. And she has a really interesting perspective on telemedicine and and both its promises and its pitfalls. Dr. Dean We talked a little bit as we were prepping for this about what we've learned in the past year from the pandemic and telemedicine's role in the pandemic, and also how it's impacted families. Many of us, myself included, find ourselves Being a healthcare provider and a school teacher and a worker all at the same time from the same place. What have you been thinking about, about what we've learned from this big telemedicine experiment over the last year? So, there are a lot of things that come up in in what we've learned. The first is that telemedicine definitely has a place But I also am very concerned that as with many other of the innovations that we've had in healthcare, we're really focused on what the good parts of it are. And we forget about what the unintended consequences might be and in this case, one of the big unintended consequences Is the burden that may get put on care caregivers at home. So pushing all of the work that we can on to health care workers and they're still overwhelmed. We're reaching out into the community to look for caregivers there. So, wives, mothers, daughters, sons Are going to get pulled into healthcare while they're still trying to do the educator role and the worker role and all of those other roles that they didn't expect that they would have either. What's an example in the telemedicine situation? Let's walk through a real life scenario. You're setting up a doctor's call for your child. And presumably the doctor needs some information, what is the role that the person at home ends up playing in that? [LAUGH] How does that end up impacting us? Right? So you have to play multiple roles. So you have to play IT support in getting all of the Bluetooth Maybe you've got a bluetooth pulse oximeter to tell the oxygen tension. And so you have to make sure that's connected. And then you have to get your child to sit still and have it in the correct position. And then maybe you have to take their blood pressure and you have to make sure that you do it correctly. So you have to learn how to take a blood pressure and how to be, you, in effect, a medical assistant so that you're getting the correct information, that provider and also that you're getting it transmitted because that we've learned over the course of the last 10 months has been much more difficult than we expected. Even people who are relatively savvy, including myself, [LAUGH] I mean, I'm on these calls a lot. And when I went to connect to an appointment for my son, [BLANK_AUDIO] Didn't work. I couldn't get connected. And so, you know, I think we're under estimating the challenge of some of these technologies, and particularly in the situation where the person who's making the call is vulnerable and ill and not functioning at 100%. That multiplies those challenges, and the difficulties of using the technology most effectively. Is there anything that we've learned in this past year, that surprises you about people's About the challenges people are facing. And I think that there probably are people out there who would respond to this and say, Well, we've learned how to use computers. And we'll learn because we have to how to do this and it'll be easier in a couple of years. Is there any place where you can see the infrastructure sort of breaking down because of the load that's been misplaced? I don't think that we have well, so there are a couple of places. I don't think that we are seeing what the real burden is if we truly push to fully telemedicine, you know, to really implementing this to the level that I think folks would like, and the, the reason for that is that, we're still trying to get back to business as usual. Right. So we're seeing it as a temporary fix. We're acknowledging that. Tele medical care is better than no care at this point. But the goal is still to get back to business as usual, bringing people back into brick and mortar. And so I think that we're not really seeing the the long term consequences of telehealth care, which is doing this diagnoses because we're not getting accurate information. Does that mold that we thought by telemedicine looked okay? Is that actually a melanoma when we finally get the person in and the coloring is right and the detail is is sufficient. So we're not seeing that we're not seeing the challenges with getting the accurate data. Yet because again, we're not seeing the long term consequences and maybe that blood pressure has been elevated for six or eight months, but their technique wasn't as good as we thought. So,I think for sure in the pandemic when we're doing everything we can to keep people isolated, telemedicine has been great. But I worry that if we rely on it as much as we think we can, we may not be acknowledging some of the drawbacks. If you look about three to five years out, given your vast experience with patients and with this system, realistically speaking. What do you think will be with telemedicine in three to five years? Is there something on the horizon that I haven't thought of yet, industry hasn't thought of yet? And what's your prognosis? So what I hope we've done in that time is to have identified who are the patients who are appropriate To use telemedicine, what are the conditions that we can probably say safely are easily treated by telemedicine? and that we've that we've deployed it as extensively as we can. Because I do think that patients deserve the convenience of telemedicine when it's appropriate. And I think, in those situations, physicians will feel comfortable treating patients in a certain circumscribed situations. So I really hope that we do. Roll it out. But that we're careful how we do it.>> Thank you so much for your wisdom. It's been a really interesting conversation and I really appreciate your perspective. Thank you very much Dr. Dain and stay healthy. Our third guest is here to help us see how How all of these industry changes will affect the patient. I am here with Dr. Han Lee, who is the CMO of Healthline media. What does that mean Dr. Lee, what do you do at Healthline media which is a sister site have seen it? Well, thanks for having me, Lindsay. So a chief medical officer is actually kind of a new title than a lot of medical organizations have. And I as other medical officers, what we do is make sure that all of the work that a medical organization like my mind, does is medically accurate and has medical integrity for Healthline media as America's largest consumer health care content organization in America. What we do is create medically accurate, credible information for consumers. And we do that as a medical team. I do that as the chief medical officer by making sure that we provide medically accurate information and expertise in house as well as externally with our partnerships. Making sure that all the physicians and clinicians that we work with are credible, informed, licensed, credentialed people. So you must encounter questions from and conversations with lots of patients who are gobbling up all of this information that you're helping to provide. What have you heard? From patients coming out of this past year of COVID lockdown dealing with their doctors using largely telemedicine, what have they come across during this what is like kind of a big experiment in using telemedicine in a way we didn't quite anticipate using it. Well, we heard uniformly across the board that everyone was afraid of going into the hospital to see their doctors or going into the clinics to see their doctors. And there was also a very big concern that perhaps we were sacrificing our own healthcare because of this fear of going into the hospitals in the clinic. And so everyone was scrambling both from the patient, but also the provider side to be able to still provide great medical access and medical care for patients. Luckily, telemedicine was available to provide care, But telemedicine is a very broad term that can apply to a lot of different things. It could be as sophisticated as a video call like what we've go going on right now or it could be as simple as just a phone call. And there was a lot of confusion initially in the beginning about what is telemedicine? Do I personally have access to it and how can access it? Does my doctor provide telemedicine and what can I get out of that care? Yeah, maybe I can talk about my medication and medication management but can I really get other care like I would in person when I see my doctor? So we've had a lot of those questions, and we've worked really hard to help provide that clarity for people. So I'm type one diabetic. I do a lot of measuring of myself. As a result of that. I'm constantly measuring my blood sugar most. Most importantly, and all of that information is very important for my doctors to have. There's also a lot of labor that goes into transmitting all of that information to doctors. Do you think that the past year has helped us make some Progress on getting patient information to doctors in a digestible way that doesn't put a ton of burden [LAUGH] on either the doctor or the patient. Well, the unfortunate thing is that I would love to say yes, but I don't think that that's actually been the case when it comes to the data. That you're talking about the systems in place for data capture have been lacking for years. We started working on it years ago with the Obama administration trying to work on integrated systems so that there could be much better record sharing. but for years we haven't been able to really build out an integrated system so that there could be data sharing between medical systems or even with within a medical system telemedicine has completely exploded since the covid pandemic and has allowed for better video and audio Communications, but that hasn't necessarily solved the problem of the data sharing. Unfortunately, clinical physicians are still sharing information through CD ROMs and paper records that are still being faxed to this day. And telemedicine in itself has not solved that problem. Yeah. So what have we learned in the past year that we can take with us to make this experience? Probably not in a replacement for the doctor's office but supplemental to the doctor's office? Is there anything that you think we can take away that will help solve that problem? Well, I love that you say that because I think that People have been talking about telemedicine as much as is very much in the vein of this is the new thing and this is going to suddenly replace inpatient clinical care and that's simply not going to be the case it will very much be a supplement to it because there are certain things and certain care that you have to provide to a patient as a physician that will never be able to be Accommodated by telemedicine. But I think what we've learned in the last nine to 11 months, is that the adoption was much better than we anticipated it would be. I've been in conversations with healthcare systems and in my own work as a physician for decades about telemedicine and there was always this question of, Is this something that patients will adopt? Will patients want it, particularly older populations? Will they be interested in a technology based option that they have to figure out either on their phones or their computers? But you know, like they say, this mother's Necessity is the mother of invention. And because we had to do it, a bunch of people said, you know, we're just gonna do it. And what we saw was that a lot of people just figured it out. And my own mother who's in her late 70s figured it out and got on telemedicine most people got on telemedicine pretty quickly and adoption became a huge ramp up for not only patients, but also their providers, and it's been great to see now The other thing that we learned from this experience like anytime you have a technology that is adopted very quickly is that there are a lot of pitfalls that you have to be aware of and be able to plan for. We think about telemedicine as this great video call that can enable great personal conversations. And that's true for certain health care conditions for mental health. It works great for a lot of primary care visits. It works great if I had a patient who wanted to talk to me about cold and cough symptoms or allergy symptoms or even dermatologic conditions and they wanna show me the rash that works great. But in no way should a telemedicine visit be used for a cardiology visit. If someone's having acute chest pain that might be suggestive of a heart attack, or they're having respiratory problems that could be an asthma attack or even neurologic symptoms. These are not conditions that I would ever have my patients delay care for because they're waiting for a tele visit. So that's another key lesson that we need to learn is how do we educate and inform an arm our patients with the information so that they know when to seek out care via telemedicine Versus when to brave the visit into the office or the hospital despite COVID. Do you think that there has been any aha moment in the past year that or idea that will come to fruition in the next three to five years that will help take what we've learned now and turn it into some future experience that we haven't Have you? Well, so in my clinical practice and in my work in technology since then, what I've come to see often is that documentation of that patient provider visit is one of the biggest struggles and barriers to adoption. For most electronic health records, the question is always been during the patient encounter, there's so much information to capture document retain, for not only medical legal purposes but for billing purposes to one of my aha moments that I hope comes to fruition is that this video visit that we have. Can be recorded as a document of the visit. And so it actually could remove the burden from both the patient and the doctor to document the conversation. And then any transcript that comes out of it could be used to create that medical record for the doctor and the patient and to enable billing And that would actually remove a lot of burdens, desktop medicine burdens off of the physician. Now, as I say that I suspect that a lot of patients and physicians may have an automatic visceral response like I don't want my visit to be recorded. That sounds terrible. We don't necessarily love the idea that visits is recorded. But for medical reasons, it might be great to have that record because, you want the physician to be able to recall what you said. I think a lot of patients get frustrated with they feel that, Maybe the communication between patient and provider was not clear wasn't easy to retain and recall. The Video Visit may really help with all of that for patient both the patient and the provider. That's a really interesting idea and I do think it helps so much. And I wanna thank you for this time and it was fast, really valuable. Thanks for talking with us. I really enjoyed it. Thank you so much for having me. Thank you so much for joining us for this engaging conversation about the future of telemedicine and we hope you have a healthy 2021. [BLANK_AUDIO]