February 26, 2021

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February 26, 2021: Telehealth has become a household word. The numbers in 2020 were staggering. What trends should we expect in 2021? What is the new normal?  Dr. Joseph Kvedar, Harvard Professor, Senior Advisor, Virtual Care at Mass General Brigham and Chair of the Board for the American Telemedicine Association discusses the technology around televisits, consults and remote patient monitoring. With the use of artificial intelligence and symptom checkers, a patient can start their telehealth journey working with software and then get triaged to the appropriate clinician. That’s pretty cool. Clinician adoption used to be a big barrier to telehealth. Have we gotten through it? Will the next generation of med school students get different training? What is the legislative agenda for the ATA coming into the Biden administration? And how can we tighten security and privacy? 

Key Points:

  • Telehealth has become a household word [00:06:10] 
  • ATA is not in favor of national licensure [00:24:20] 
  • The nice thing about the technology track is there’s so much money chasing it right now that there’s just innovation upon innovation [00:32:42] 
  • Our patients and consumers care deeply about their privacy, especially when it has to do with medical information [00:33:25] 
  • We should be providing people with the most seamless workflows that we can to ensure that they’re productive and happy with their work [00:39:30] 
  • American Telemedicine Association
  • Mass General Brigham
  • Harvard T.H. Chan School of Public Health

Telehealth – Where It Works and Where It Doesn’t with ATA Chairman Joseph Kvedar, MD

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Telehealth – Where It Works and Where It Doesn’t with ATA Chairman Joseph Kvedar, MD

Episode 370: Transcript – February 26, 2021

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. 

[00:00:17]Today Dr. Joseph Kvedar the chairman of the board for the American Telehealth Asociation joins us. He’s a Harvard professor, digital health advisor to Partners Healthcare. And we have a wide ranging [00:00:30] discussion on telemedicine where it’s going, where it’s been through COVID and what we can expect into the future.

[00:00:36]I want to take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on on social media. You can follow me personally Bill J Russell on LinkedIn. I engage almost every day in a conversation with the community around some health IT topic. You can also follow the show at This Week in Health IT on LinkedIn. You can follow us on Twitter Bill [00:01:00] Russell H I T. You can follow the show this week in health HIT on Twitter as well We’ve got a lot of different things going on Each one of those channels has different content That’s coming out through it We don’t do the same thing across all of our channels We don’t blanket posts We don’t just schedule a whole bunch of stuff and it goes out there. We’re actually pretty active in trying to really take a conversation. You know, in a direction that’s appropriate for those specific channels. So we spend a lot of time on this. We [00:01:30] really want to engage with you guys through this. We are trying to build a, more broad community. So invite your friends in, to follow us as well. We want to make this a dynamic, conversation between us so that we can move and advance healthcare forward.

[00:01:45]Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to [00:02:00] [email protected]

[00:02:01] Just a quick note, before we get to our show, we launched a new podcast Today in Health IT. We look at one story every weekday morning and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts. Apple, Google, Spotify, Stitcher, Overcast. You name it, we’re out there. You can also go to todayinhealthit.com. And now onto today’s show. All right today, we’re joined by Dr. Joseph Kvedar the American [00:02:30] telehealth association President Harvard professor, Digital Health Advisor for Partners Healthcare. Good morning, Dr. Kvedar. Welcome to the show.

[00:02:36] Joseph Charles Kvedar MD: [00:02:36] Great to be with you, Bill. Good to see you today. 

[00:02:39] Bill Russell: [00:02:39] This should be a fun topic. We did a COVID series for about three months and every CIO or health system leader that came on just started sharing staggering statistics between, you know, the months of I guess really March and May, the numbers were just unbelievable. So I’m looking forward to having the conversation [00:03:00] about, you know, where we’ve been and where we’re going. And now we have a new administration too, you know, what, what is potentially, you know, what are the things we’re taking before them to, to move this forward?

[00:03:12] But let’s step back a little bit and let’s start with the ATA. So what’s the purpose of the ATA and what is your work look like as the president? 

[00:03:22]Joseph Charles Kvedar MD: [00:03:22] Well the ATA is I think it’s 27 or eight years old now. So it was it’s really an [00:03:30] organization that’s grown and changed as a tele-health marketplace has grown and changed.

[00:03:34] But our fundamental purpose is to be the sole advocacy group for the industry that moves the industry forward. So we represent provider groups. We represent suppliers to the industry and of course health plans and payers, as they are interested in making sure that we implement telehealth in a way that suits them as [00:04:00] well.

[00:04:00] So it’s really a combination of those forces and we we speak with common voice for all of them. 

[00:04:07] Bill Russell: [00:04:07] Yeah. And you were the  president back in 05. Contrast 05 to being the president in 2020. 

[00:04:17] Joseph Charles Kvedar MD: [00:04:17] Well, one thing I should just say, I mean, that’s a minor detail, but we changed. We just changed our bylaws. So the role which has always been the case, but we formalized that now it’s the chairman of the board. Okay. [00:04:30] Back when the association was formed was in an era when academic associations had a president and then an executive director who ran things. Over the years that executive director role and almost every association became the CEO.

[00:04:48] And when you have a president and CEO on the same slate, people get very confused. So it’s a chairman of the board role. So in 2005, and I think really [00:05:00] the world wasn’t that much different until earlier in 2020, but in 2005 it was about a formative industry. There were a few organizations forward-thinking entrepreneurs trying to make a supplier chain.

[00:05:20] And there were a couple standouts, but for the most part, it was all startups, pilots proof of concept work was hard to get clinicians to [00:05:30] frankly, pay attention. Clinicians saw this either as a you know, at worst as a bad thing, but most of the time it was a curiosity or a, yeah, I’ll get to that someday.

[00:05:41] And I was asked to come back in, there were a couple of people on the board who had to resign their positions because of changes in professional Commitments that there are new companies, wouldn’t allow them to have a leadership role at ATA. So they asked [00:06:00] me to parachute in about a little over a year ago and I thought, why not?

[00:06:04] Right. I’ve done this one. So it’ll be kind of like, and then all of a sudden, of course things changed. So now the difference is we’re in implementation mode all around the world. Telehealth has become a household word. People know what it means. Patients have all, almost all experienced it. Clinicians have done something. Some have dived in headfirst. Some are dipping a toe in the water, but we’ve all done something. [00:06:30] And health plans are of course now forced to pay for it, at least during the public health emergency. So it’s a real thing. And it’s, we’re learning what it means to be an implementation mode versus proof of concept or a or experimentation mode.

[00:06:46] Bill Russell: [00:06:46] So let’s put this, put some parameters on this when we talk tele-health it’s broad category. And just so we can sort of level set with with the listeners. Televisits, consults, remote patient [00:07:00] monitoring. Are there other categories that fall into telehealth.

[00:07:04] Joseph Charles Kvedar MD: [00:07:04] A useful way to look at it is a two by two grid. So a one dimension of that two by two grid is whether you’re a clinician dealing directly with a patient or with another clinician. And so if it’s directly with a patient, it’s a visit. If it’s with another clinician, it’s a consult. And the other side of the two by two grid is asynchronous versus [00:07:30] real time.

[00:07:31] So real time with a patient would be a virtual visit. Asynchronous with a patient would be an easy visit, et cetera. We use that grid a lot and then sort of over the last couple of years, people have added sort of a category underneath for remote monitoring. It’s doesn’t quite fit. So to answer your question with that, with that sort of conceptual background asynchronous very, very [00:08:00] important in the industry.

[00:08:01] There’s now at least a dozen or so companies all the way from HIMSS and Rowe and Murex and and others that are. forming these specialty niche, telehealth companies, where you, as the patient submits something about you, and then someone gets back to you as more, more like a chat or an email or a text than a real-time conversation.

[00:08:30] [00:08:30] And that’s very efficient and it’s for the right kind of problem sets very efficient for the patient as well. Another dimension that I think it’s important to point out in that follows on from that asynchronous is use of artificial intelligence, symptom checkers, things like that, so that you can, as a patient, start your journey working with software and then get triaged to a human being after a few things have been worked out in the context of [00:09:00] that software environment, right.

[00:09:06] Monitoring. That’s an important thing, I guess. And then of course, as you said, virtual consults, virtual visits. The one thing I’ll say, and sort of finishing off this thought is up until a year ago, they were all, I think, more or less equal contenders for people’s attention. Because of the way [00:09:30] telehealth unfolded during the pandemic and the public health emergency.

[00:09:34] If you were to do a word cloud now virtual visit would be 90% of it and everything else will be these little words around the edge. And I think that’s a bit of an anomaly and, but it is what it is right now. 

[00:09:47] Bill Russell: [00:09:47] Yeah. And it is amazing as the pandemic unfolded you know, I neighbors, my parents just having conversations and it really did become part of the common vernacular

[00:09:59] Joseph Charles Kvedar MD: [00:09:59] I [00:10:00] know  

[00:10:02] Bill Russell: [00:10:02] So I’ve had it sort of measuring, you know, Hey, how do you feel about this?

[00:10:05] And it’s interesting. My dad’s like I want every, everything to start with it. And my mom’s like, I want the doctor to see me. I’m afraid if they don’t see me, they’re gonna miss something. And so the, and I imagined, I mean, I’m just talking about the consumer side. On the physician side, the thing’s probably all over the board as well. I would imagine in terms of how they’ve experienced the last nine months or so. 

[00:10:30] [00:10:30] Joseph Charles Kvedar MD: [00:10:30] Yeah. Well, you know what the pandemic did for the  field is both that, like everything else is that there’s two sides to the coin. So on the one hand, I mentioned a minute ago, telehealth is a household word now. We can’t underemphasize how important that is for moving the field forward. When you don’t have to spend the first 10 minutes explaining something, but you can get right to the point. Very powerful. With that said because we went into lockdown [00:11:00] mode. We did everything that way, or as much as we could and we shoe horned some things that probably should be done in the office into a tele-health environment.

[00:11:08] And I think the other thing that maybe we’ll see how this plays out, but maybe an unfortunate consequences people now have in their minds merged telehealth and pandemic. So you know, when the pandemic goes away, does that mean telehealth goes away? And of course, many, many of us both on the provider [00:11:30] and the consumer side believe that it won’t, but maybe we’ll come back to that.

[00:11:34] But so those are some challenges, I think for doctors. Yeah we need to be proactive and I don’t see enough of this going on, unfortunately, but we need to be proactive in articulating what use cases are appropriate. And if you need to touch the patient to get your work done well, they got to come in the office.

[00:11:57] Right. It’s that simple. Whereas on the patient’s [00:12:00] side, I think we just a lot of times, and do we need to sell it a little better? So your mom is an interesting example, but I have a guess that if a physician she trusted said to her. Actually I am confident that I can do what I need to do to get you well, using this tool, she might feel a little bit better.

[00:12:24] Bill Russell: [00:12:24] Yeah. I mean, the physician really is one of the major drivers. Yeah. I do want to get into what it’s going [00:12:30] to take to maintain the momentum. Because momentum was huge early and then it sort of receded a little bit in some areas. Yeah, obviously in, in behavioral health, it’s still strong, but for good reason, it goes back to what you were just saying. I mean, it’s you know, tI guess a physical visit would help in some cases for behavioral health, but in a majority of cases, it’s just a one-on-one dialogue, right? 

[00:12:58] Joseph Charles Kvedar MD: [00:12:58] Yeah. For the most [00:13:00] part the physical exam is talking to the patient and behavioral. So that works. I mean, I think psychiatrists are supposed to do a complete exam when they first meet you. They’re supposed to be ruling out medical causes for whatever your behavioral symptoms are so maybe in the very beginning, there’s a need for in-person interaction. But I think most of it, not these days, they’re saying 90% is quite doable  online. 

[00:13:27] Bill Russell: [00:13:27] Wwhich is fantastic. What we [00:13:30] were going to come back to that in a minute. Let’s talk about the numbers and trends that you’re seeing. I mean again, we interviewed people. I actually I’ll go back to. You go back to 20. 2020 JP Morgan conference and Kaiser presents, and they have a number of telehealth visits, which is, you know, because they have a unique model. It is staggering.

[00:13:53] It’s one of those things you look at and you say, wow, if every health system would do that. Because they’re, their [00:14:00] incentives are almost perfectly aligned to say telehealth makes sense. Right. So they did that. And then you had this thing happened in the pandemic where we took down the walls, the barriers, the regulatory barriers, we created financial incentives to do it. The technology was already for the most part. There were some fits and starts on. So everything sort of came into alignment and we saw this initial huge spike. And now we’re seeing it come back down, but level off at a [00:14:30] higher rate than it was before those are the numbers I’m saying, are you, what kind of things are you seeing? What kind of do you have any statistics that you generally talk about?

[00:14:41] Joseph Charles Kvedar MD: [00:14:41] Yes. I think at a global level, most providers that I talked to are doing between 15 to 25% of their ambulatory activity by telehealth these days. It’s going to vary by a little bit by state [00:15:00] depending on how overwhelmed their inpatient environment is. It’s going to be again, there’s a, in the background of the thing is the fact that we’re still in a public health emergency payers have to pay for everything you can use Skype, you can use FaceTime.

[00:15:15] All those regulatory relaxations are still in place. And so in Massachusetts, we just had, for instance another request from the governor’s office to do more [00:15:30] telehealth because we’re getting a second spike. It’s not clear where it’s going but there’s worry that if we don’t be more thoughtful that we’ll get to this point again, where the hospital’s clogged and we have to shut down elective surgeries and so forth.

[00:15:46] So that variable will play into it somewhat, but I think there’s another side of it where now that patients have experienced and there’s this magic triad of [00:16:00] quality access and convenience. And when you hit that, everyone’s like, people are like, why couldn’t we do this before? Why do I have to come in the, I mean, for me, I’m a dermatologist, so things like follow up visits for acne or stable psoriasis, or what have you.

[00:16:18] Whereas if you have, if you have a history of skin cancer and a new changing lesion, you’ve probably got to come in the office. So, but it’s sorting those things out. And when you hit that [00:16:30] and sometimes there’s travel involved, I had one interesting telling story, a woman whose home is probably 50 miles South of Boston.

[00:16:42] The patient, her son is a special needs. I think he’s 20 years old, but special needs takes an army of people to get them out of the house. And she has three other kids. So the fact that we were able to take care of him without her doing all that she was almost in tears. And so you get those things, [00:17:00] which the reason I mentioned that story is because it’s hard for you to believe that we’ll go back to a scenario where.

[00:17:06] It’s a curiosity again, there will be some, whether it’s 10%, 20%, 25%, that is still to be worked out. And it also depends on the reimbursement environment and the regulatory environment. 

[00:17:20] Bill Russell: [00:17:20] Yeah. And we’ll get backto that. Let’s talk a little bit about dermatology. I mean, that’s your area of practice technology that’s [00:17:30] required. I would assume it’s something like this, a visit that we’re doing, but the camera has to be a fairly good quality for you to do that. That visit. Have you had instances where you started the visit via telehealth and had to change it, or has it been a pretty high level that you’ve been able to complete the visit?

[00:17:51] Joseph Charles Kvedar MD: [00:17:51] Well in dermatology, I think it’s pretty uniform that people will get still images first. So it turns out that [00:18:00] smartphone cameras today are quite capable. They have been for a decade or so quite capable of capturing high enough resolution images that can be of diagnostic quality when the person has given some guidance on how to take an image and focus.

[00:18:15] And so actually for what we do. Now, I don’t know how long we’ll get to continue this, but we have patients submit images of our patient portal. And then we do a telephone call because it’s, the image is what it’s all [00:18:30] about for us. And the conversation about how we’re going to make a diagnosis and formulate a care plan can be done by audio only. 

[00:18:39] Bill Russell: [00:18:39] You know, it’s interesting sometimes the plain old telephone gets lost in the, in the shuffle here. But that’s still a, do you have a statistics? It’s still a significant number amount of? 

[00:18:53] Joseph Charles Kvedar MD: [00:18:53] It varies. I think when we were at the height of our [00:19:00] telehealth probably first part of May, first part of June that time we were doing 60,000 telehealth visits a week at our system. And I think 60% of those were audio only.

[00:19:12] Bill Russell: [00:19:12] Yeah. That’s interesting. So the numbers are coming back. Why do you think the numbers are coming back and what are we going to do? What can we do tostem the tide a little bit? 

[00:19:22] Joseph Charles Kvedar MD: [00:19:22] Well the tide, again, it should settle out where it makes sense. So that’s the first thing is the reason they’re coming back is [00:19:30] because we threw everything at telehealth and it’s not designed to do everything. We were locked out. We said, you Bill, you can’t leave your house unless you’re. You need to come into the ER for something dangerous. And as you know, a lot of people avoided coming in for heart attacks and strokes and things like that. So that’s a bad scenario. We write that’s nothing to measure our success against. Just for the record.

[00:19:55] And sure everything got done via telehealth. And of course it came back because as soon as we could [00:20:00] see you in the office, there, there’s a probably. 10 or 15% of interactions that we shouldn’t have been doing by telehealth. We stretched to do it. And so right away, you’re going to back off some the stemming the tide part is we call it at AKA, We call it cementing the gains. And for us, that’s really about some policy work. We’re particularly interested in, and this is a [00:20:30] little bit arcane, so I’ll cover it fairly quickly unless you want to. Go into more detail, but Medicare operates under a law. So it’s not a regulatory re it’s not their discretion.

[00:20:43] It’s a law that says that if you are a Medicare recipient to get telehealth, you have to be in the health profession shortage area, which is a very narrow geographically defined set of essentially where there are not enough doctors. [00:21:00] The doctor has to be at a physical clinic and you have to go to a clinic to get your telehealth service. So it’s a very 1990s view of telehealth, but it’s the law. It’s being ignored now because the law got thrown out during the public health emergency. But unless we change that law, we will have a very strong, downward draft on enthusiasm around telehealth, because as you know, as Medicare goes, so goes the rest of the payer community.

[00:21:28] So that’s one really [00:21:30] important one we’re working on. And then we’re doing advocacy now and I think CA about half of the state’s ATS Relatively small scrappy organization. We do a lot with limited resources but we’re working with about half the States on some various state level.

[00:21:46] We just did for instance, a very nice, had a very nice success in Massachusetts where a bill was passed that ensures that behavioral health will be paid [00:22:00] at parody. And for at least two years, chronic illness management and primary care will be paid at parody. So those are good steps in the right direction.

[00:22:10] Where does 

[00:22:10] Bill Russell: [00:22:10] that just out of curiosity, where does that money come from? Does it come from the state budget? 

[00:22:15] Joseph Charles Kvedar MD: [00:22:15] Well, for Medicaid it comes as, you know, it’s a mixed program, but the law says that payers have to pay us so they it’s premium dollars. Largely. 

[00:22:26] Bill Russell: [00:22:26] Interesting. I was going to ask you, and I will just ask you about the [00:22:30] legislative agenda going into the Biden administration. At this point we have a lot of things that have been eased or changed because of the public health emergency. I assume that ATA has a pretty robust agenda right now that’s being discussed on the Hill. So what are some of those things? 

[00:22:52] Joseph Charles Kvedar MD: [00:22:52] Well, I mentioned our main one, which is this originating site law, we’re trying desperately, whenever [00:23:00] legislation comes into the path of our legislators. We try to make sure that gets entered in by one or more of our advocate, representatives of senators, as you know, the path that legislation takes these days is complicated at best. That always has been, but it’s because of the. Divisions in the country, it’s even more complicated.

[00:23:23] So we’ll see how that goes, but that’s any normal. We use a lot of resources to try to get that done. Then there’s a couple [00:23:30] of other things, federally qualified health centers. We feel need to have more latitude with how they use telehealth. That’s a big gap there. A couple of other things in that same federal agenda and at the state level it’s Medicaid.

[00:23:46] And then the biggest conundrum of all is private pairs because there’s so many of them and they have so much discretion. So are there ways that we can do repeat what we did in [00:24:00] Massachusetts and create legal structures that require payers to pay for the activity? So that’s one part of our legislative agenda.

[00:24:10] The second is around Licensure. And although ATA is, pardon me, ATA does not have, we’re not in favor of national licensure. I personally am not either. We do believe that [00:24:30] some, either regional compacts or ways for For organization for States that are, that are have similar. Like for instance, I have patients who come to see me in Boston from Hampshire. If I want to do a follow-up with them, I should be able to do it from their home. Right. I shouldn’t have to go through hoops to do that. So that’s the licensure side. And the third big area is which we don’t [00:25:00] have a particular strong position in, but it’s Is the technology and the privacy security. Now we have a strong position in that we’re very pro patient privacy and security, but we think that it’s unlikely that HIPAA will get attention.

[00:25:18] And the nice thing about what’s happened during the pandemic is that many of the video platforms that went into the thing without a HIPAA compliance solution created one. [00:25:30] So for instance where I work mass general Brigham. We’re Epic customer we’ve integrated zoom into our platform. And zoom now has a HIPAA compliant, medical vertical and then that’s a backup.

[00:25:46] If people want to use Doximity dialer, they can. And so we have. Two solutions that are HIPAA compliant which going into the pandemic, I don’t think we’re so a lot of that’s going on in the industry. [00:26:00] And I think that’s sort of solving itself. 

[00:26:04] Bill Russell: [00:26:04] Help me to understand. I joke that some of the show is just the education of Bill Russell here.

[00:26:10] Right? And so the licensure. Has come up several times. And for those who aren’t aware of this, essentially, the States have licensure it’s at the state level, it’s not at the federal level. Therefore you could potentially see a patient in Boston, but not be able to [00:26:30] see them via telehealth and  from New Hampshire, unless there’s compacts and there are compacts and a lot of States participate in those compacts.

[00:26:37] So it’s not like it’s. It’s not nascent. I mean it’s been, it has some good progress around it. But still there are cases where you know, you have a major hospital that’s right on a river and across the river, it’s a different state and they can’t see somebody who’s just on the other side of the river. But I’ve heard, I have now talked to several doctors. I respect who say no, it [00:27:00] should stay at the state level. That makes perfect sense. How helped me to understand why that makes sense? 

[00:27:08] Joseph Charles Kvedar MD: [00:27:08] Well, let’s see, we could take the high road first and then we’ll go take the low road. So the high road is that the function of the state medical board is to make sure people like me are not crooks and are not either doing awful things with our patients either medically or sexually assaulting them or all kinds of awful things.

[00:27:29] And [00:27:30] once you get to be, as you know, a profession professional people come to you and they put their lives in your hands. And so there’s got to be a self policing organization that handles that. 

[00:27:44] Bill Russell: [00:27:44] So oversight’s the high road? 

[00:27:47] Joseph Charles Kvedar MD: [00:27:47] Exactly. It’s a quality assurance program at the state level. And by the way it’s not always effective. And we’ve all heard stories about a doctor who got kicked out of state aid to come [00:28:00] up five States away with privileges there too. So just imagine. With no offense to our friends at the federal government. Imagine if that were administrated at the national level, right. It just, it’s so hard. Hard for me to believe that they could have any control over quality doing that.

[00:28:21] The low road is trade protectionism and it, you know, medical practice it is a [00:28:30] geographic as a business is a geographically based mindset. You have one cardiologist per whatever, 50,000 or a hundred thousand people. And if there are two, that means that they have to split. However many heart problems are up.

[00:28:44] And so imagine the fear that, and I work at a place where we have a pretty good brand mass general Brigham, Harvard people get afraid that we’ll somehow, and it’s, I think it’s misplaced, but they’d get afraid that we’ll somehow come in and steal all their patients [00:29:00] by tele-health. And so that’s the. I would say low road, part of why state medical boards continue to exist as they’re protecting at a geographic level an industry.

[00:29:14] Bill Russell: [00:29:14] Yeah. Yeah. And we saw in Southern California where I was, we saw that. There’s a ton of people driving out of orange County, going up to LA for cancer treatment at, I mean, any number of great cancer facilities. Cause if you have cancer, you’re going to go to the best you [00:29:30] can possibly go to. Now that’s changed.

[00:29:31] Because people realized there was a lot of traffic going up the 405 to those places. So places like City of Hope will come down and some others into the orange County market, I want to go through it. Yeah. A handful of areas. And just ask you about the progress that has been made. Let’s just say over that over the course of the pandemic, and I’m going to break, I wanna break this down into probably five areas, technology, security, privacy clinician education patient adoption and alignment of incentives.

[00:29:58] So let’s start with technology. [00:30:00] And you touched on this a little bit. We brought in a lot of new players in, by easing the restrictions. Where, how has the technology progressed over the last year?

[00:30:14] Joseph Charles Kvedar MD: [00:30:14] Well, let’s see. Let me try to be up 

[00:30:18] Bill Russell: [00:30:18] Or was it already there? 

[00:30:19] Joseph Charles Kvedar MD: [00:30:19] No, no, it’s definitely not there. It’s still the reason, one of the reasons I would say, remember I went and I said 60% of our visits were audio only [00:30:30] is because it was hard for those patients to get on the video. It’s still too hard, even though you and I quickly dialed up on Zoom today, and god knows it’s easier than it was a year ago. It’s still hard. 

[00:30:43] Now there are interesting work around. So I think, I believe it’s, Doximity, there’s, there’s a couple of solutions where I can text. Linked to a patient and they can click on that link in the video call launches and they don’t have to do anything. [00:31:00] We need more, whether it’s QR codes, we need more things that make it just easy for people.

[00:31:06] Two steps is probably too many, right. For a lot of people and they get frustrated. And then we just say, okay, I’ll call you. And as you, and I sort of said earlier, telephones work, they work all the time for the most part. So that’s really been the Holy grail of video since I started in the early nineties was make it as easy as a telephone.

[00:31:26] We still have to do that. And this reliable as a telephone, [00:31:30] because sometimes a video called drops to due to bandwidth or what have you. So it’s better. It’s but it still has a ways to go. I think, integration into the provider workflow. Again we have this wonderful and I think we, the guys on our team did a fabulous job.

[00:31:49] Because a patient can request and launch a call through our patient portal and the doctor does it right in the context of the medical records. So he, she can look at [00:32:00] the medical record, have a video call with a patient. People joke that they’re more, they’re interacting more with the patients via their telehealth calls because they’re not going back and forth between screen and patient all the time.

[00:32:12] So that integration has to be. And now we have a lot of resources and we could do that. If you’re a practice of two or three doctors, it may be harder. And so making that easy for them integrating things. Yeah. It’s like devices, whether it’s a title care or a home blood [00:32:30] pressure cuff or a home pulse-ox or what have you, there’s still a long ways to go on that. So there’s always problems to fix. We’re better than we were, but we have, we still have a ways to go. 

[00:32:42] Bill Russell: [00:32:42] I think the nice thing about the technology track is there’s so much money chasing it right now that there’s just innovation upon innovation. 

[00:32:50] Joseph Charles Kvedar MD: [00:32:50] So much. 

[00:32:52] Bill Russell: [00:32:52] Let’s talk about security and privacy. I’m curious as what you’re going to say about progress in this [00:33:00] area. As much as it is people have almost just put it on the back burner and said you know what we’ll deal with that later. It felt like early in the pandemic. That’s what we were saying. I don’t know if that’s still the case.

[00:33:13] Joseph Charles Kvedar MD: [00:33:13] No, I think it’s better. I alluded to the fact that most of these players, that if they saw enough business in their future, they invested in a secure system. Let’s face it our patients and consumers care [00:33:30] deeply about their privacy, especially when it has to do with medical. information, I’m sure you’re aware from your own travels in the industry, that people will often feel more comfortable sharing financial information than health information.

[00:33:44] So we owe it to consumers and patients to have the top level of security we can. Of course, that doesn’t mean we’ll never get hacked. Healthcare organizations get hacked every day, but. We try to do our best for them. And [00:34:00] so I think the industry knows that and feels like in order to move forward, they have to continue to improve  this area.

[00:34:08] Yes, again, we went into lockdown and mid-March and because it was almost like that the government said it’s okay. You Skype use FaceTime, which Skype is pretty secure. I’m sure you know that as an it person, but. My point is now we’re at a point where people are generally using more secure solutions and I [00:34:30] think that’s a good thing.

[00:34:31] Bill Russell: [00:34:31] Yeah. You know, it’s I talked to a CIO early on. He didn’t come on the air and say this, but he was talking about the story of, he goes, you know, I was battling with these physicians all of 2019. And one of my incentives was to get people on telehealth and and they were just looking at me like, yeah, we’re not gonna do it. We’re not gonna do it. We’re not going. You get you get to 2020. And you know, they’re, they’re busting down a store saying, you know, get it tomorrow. Yeah. [00:35:00] And he went on to say, to make the story funnier. He went on to say that they were quoted in the local newspaper for talking about the, you know, just extolling the virtues of telehealth to the community.

[00:35:17] But clinician adoption has been one of the barriers. So is it I have we gotten through that barrier and will we see this next generation of kids coming out, get different kinds of training in med [00:35:30] school? 

[00:35:31] Joseph Charles Kvedar MD: [00:35:31] Yes. No, we haven’t gotten over that barrier. And again, a lot of it is just plain and simple ease of use. One example I share is in my practice when we went back to in-person office visits in June, we were asked to add an additional half day, whatever your commitment was. I do, I’m currently a day and a half in the office. But whatever your [00:36:00] commitment was, you were asked to add an additional half day.

[00:36:02] Some of our clinicians full-time do six half days a week. And so they were asked to do seven all of a sudden to make sure we got enough telehealth visits in and, you know, over the long run, that’s not really sustainable. It contributes to burnout and et cetera. So I think making it easy for clinicians to participate, finding.

[00:36:28] Compensation [00:36:30] models at work now. Yes, again, in our system, it’s easy for a clinician for the most part to do telehealth now in the context of Epic. But it could always be easier and the workflow could always be better. So I think that’s one barrier. I think I mentioned this earlier, but this idea that.

[00:36:54] Not everything works for Tello. Yes, I’m sure I mentioned it. So we [00:37:00] need to roll up our sleeves as providers and thinks through the use cases. We can’t expect that to just settle out. We need to provide guides as clinicians. We owe it to our patients and our colleagues in the pear industry to come forward and say, these are the right things for tele.

[00:37:19] These things should be in the office. So those are two big things about clinician adoption. I think the last one which we touched on, but [00:37:30] just to make sure we give it, its due is, is consistent reimbursement. And that’s still, it is still a challenge. 

[00:37:38] Bill Russell: [00:37:38] I would think in the area of clinician burnout, I’ve often thought this, that, you know, one of the challenges I have and just managing my daily schedule is I go from recording a podcast to you know, handling a sales call to doing accounting and all those transitions take energy. They [00:38:00] take focus, they take. And so when you transitioned from, Oh, I’m seeing a patient, Oh, I’ve got to go sit in front of the computer for 20 minutes and dictate a note.

[00:38:07] Oh, and then I’ve got to go do telehealth. I understand that we block out hours and those kinds of things, we all do block scheduling to try to manage this. But when the health system isn’t adapting the operational practices to address this, that seems to me to be one of the, one of the more I don’t know, biggest [00:38:30] barriers and probably contributors to burnout.

[00:38:33] Joseph Charles Kvedar MD: [00:38:33] No, I agree. It’s fascinating to think back a year ago and burnout was on everyone’s lips. We had special sessions and this and that and programs, which have continued, but again, the solution to the pandemic was add on tele. So every clinician is doing a little bit more with, as you said, [00:39:00] different modality get into the future where I don’t, I’m  a fan of scheduling. So I mentioned, I do my telehealth sessions on a Tuesday afternoon, I’m a fan of that, as opposed to I saw you in the office. And then I went into my room and did a telehealth visit. I think that any efficient and difficult at best, but other people may feel like that’s the way they want to run it.

[00:39:28] And then I, again, I [00:39:30] think we should be providing people with the most seamless workflows that we can to ensure that they’re productive and happy with their work. 

[00:39:43] Bill Russell: [00:39:43] Fantastic. Well, Dr. Kvedar thank you for taking the time to join us today really appreciate the work that you’re doing and you know, anything we can do to keep getting the word out love to love to suport you in that.

[00:39:56] Joseph Charles Kvedar MD: [00:39:56] Thanks so much Bill for having me. It’s been a pleasure.

[00:39:59][00:40:00] Bill Russell: [00:39:59] What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. [00:40:30] Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.

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