Re-Think Health Podcast Series

Maria Palombini: Hello everyone and welcome to the IEEE SA’s ReThink Health podcast series. I’m your host, Maria Palombini, Director of Healthcare and Life Sciences Global Practice at the IEEE Standards Association. This podcast puts industry stakeholders from around the globe on the spot to answer an important question.

How can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security, protection, and sustainable equitable access to quality care for all individuals? This season five, the Rise in Demand for Telehealth Equity and Accessible Technologies, is presented in collaboration with the American Telemedicine Association, the ATA, which is a nonprofit organization completely focused on advancing telehealth, committed to ensuring that everyone has access to safe, affordable, and appropriate care.

So, we were participating at the ATA 2023 annual conference, which took place in San Antonio, Texas. And one of the big areas, and we saw a lot of sessions, was around challenges of closing the gap of inequity, despite the rise in telehealth systems, devices, and services.

So for those of you who are not familiar with our podcast series, you can learn more about it at the IEEE Rethink Health, um, website at ieeesa.io/healthpodcast. Or you can just scroll through the podcast channel on your podcast player.

Alright, so today we’re gonna get a little bit into an important issue that everyone seems to think they know about, but. Not necessarily. So we’re gonna talk about rural telehealth. So these are patients in rural communities who are prime candidates for telehealth services because they are in communities with limited access to healthcare facilities and providers.

And it’s also well known that less populated areas have less physicians and health facilities available. Plus, we know that patients living in rural communities are less likely to either own a smartphone or have robust access to the internet, broadband fiber, you name it. A peer research study showed in 2019 that 71% of rural residents reported owning a smartphone.

Compared to 83% of suburban and urban residents. So we are already seeing some, um, unbalance in those numbers. Now we all know that there’s going to be a rise in digital therapeutics in the form of mobile health apps and remote patient monitoring and therapeutic devices that require the use of smartphones.

So patients without this tool, a smartphone, are automatically excluded from this form of delivery of care. We need stronger cellular networks to further penetrate into these deep rural communities. And with that, I’m delighted today to have with me Dr. Patrick Fullerton, who is an emergency room physician and CEO of OPTAC, who presented an exciting session at the ATA annual conference, on reaching the unreachable patient, connecting past the wifi, and also he competed in the ATA Innovator Challenge.

Welcome, Dr. Fullerton.

Dr. Patrick J. Fullerton: Wow. Thanks, Maria. That’s a great introduction. Appreciate being here.

Maria Palombini: Awesome. I am so excited to get into this conversation. Um, but before we begin, I have to get this out of the way, a short disclaimer, IEEE nor ATA, endorse or financially support any of the products or services mentioned by or affiliated with our guest experts in this season five. Guests are invited to participate to offer opinions and perspectives, representative of their own knowledge and experience.

So now that we got that out of the way, we can get to the good stuff.

Dr. Patrick J. Fullerton: Sounds good.

Maria Palombini: Because we are in virtual land, we like to humanize the experience for our audience, right? ’cause they can’t see us and we’re not in front of them. So, uh, Dr. Fullerton, you are a highly regarded emergency medicine doctor, scientifically trained to deliver care to patients.

I also hear you’re an Ironman competitor. Wow, that’s amazing. Um, so my question to you is what drives your passion? Like, helps you find the time to enter into the technology world to deliver care via another channel in this form of telehealth?

Dr. Patrick J. Fullerton: Oh my gosh, that’s a, an interesting question. You know, all since the very beginning I’ve been a kind of a self-starter and, um, always pushing the limits of what, um, we can do both in technology and also physically.

So first start out my, in, in my life as physically seeing how far I could push myself as an athlete. And then that kind of, uh, when I got into my professional career, I was like, well, what else can we do? How else can we deliver care? And so that’s kinda really it. I started doing Ironman about, about 11 years ago.

Uh, I’m probably not that good at it, uh, ’cause I’m built like a football player. But, uh, I try because, uh, it’s a challenge to me to, to see how better I can do and compete with myself.

Maria Palombini: I will tell you, you’re probably way ahead of me and a lot of people I know in that Ironman competition for sure. But it’s, it’s really interesting.

Um, when I first started to read about, you know, OPTAC, I, I thought this was a really interesting statement considering that I am with a standards association, right? So it says, you know, it’s kind of like putting a stake in the ground saying that you’re setting the new standard, um, for remote communications, right. Supporting the future of global telehealth and remote assistance. Sure. So, yeah, I mean, I think that’s awesome, right? Like we all want that. We all want that. So how do, how do you guys see this mission supporting, bringing telehealth access to individuals who are in these deep rural areas and often the most challenged to reach, to give them these services?

Dr. Patrick J. Fullerton: Yeah, so, so originally we had to take a, a, you know, a step backwards and kind of look at, um, who actually created the technology because we were looking at this for over probably 15 years of how do we reach, uh, patients that are coming into the hospital. Um, and so what we did is we started looking at satellite communication systems first.

Not really the internet of things and the platforms we could deploy it on. And so literally that was the start of, of trying to find out who was doing it the best. And so then we came across a lot of satellite companies, uh, terminal companies that are, that, you know, connecting the satellites in space, in the GEO MEO LEO Orbits.

But I also wanted to make sure that we were not just using satellite, but we were using. Like low terrestrial, um, environment connectivity as well. And that’s the 4G/5G cellular networks. So really after a lot of research and development, uh, we stumbled across the Cometa company and Cometa actually started, um, doing this at Duke University.

And so their history was kind of, you know, kind of, you know, in R&D for a long time until Bill Gates came along. And he said, you know what? This is revolutionary. This is gonna revolutionize the way people communicate. And he specifically invested in Cometa because he wanted to improve the healthcare access in Africa.

Hmm. So when I heard that story, I was like, let me reach out. I literally cold called them on the phone. And then through different conversations that happened, uh, you know, we landed, uh, in with the, the director for SOCOM for Cometa, and that’s where we started. Um, so when you look at satellite terminal technology, that’s really where it started for us, is who was doing this the best and what was the revolutionary technology that was out there now that we can utilize off the shelf. And so what, what electronic steered antennas do is it removes the barrier to be stationary. They can do it mobilely and also also stationary. So it’s called, um, communications on the pause and communications on the move. And that flexibility really, um, lets us be deployed on multiple platforms, which is really, really cool.

Um, so hopefully that gives you, uh, you know, the past. And then, uh, I’ll talk a little bit about where we are now. So we contacted those guys and we said, Hey, look, can we, can we, we wanna do a pilot and, and we wanna do it with special forces. Um, are you guys interested? And they said, yeah, we’d love to do something like that.

Because originally it was started, you know, and invested because of remote access to healthcare in Africa that Bill Gates wanted to achieve. And so well, I said, well, that sounds good for the military and it sounds good for rural communities. So I’m on board. Um, so the, so our, our interest aligned, uh, per se, and that’s how we began.

Maria Palombini: That’s awesome. There’s so many projects I can think about that started from Bill Gates, you know, um, just, uh, even on the health side, right? He, he actually, you know, he’s with the Gates Foundation. They look at TB projects like trying to get non counterfeit TB medicine to rural areas. Yeah. I mean, they do, they really paved the way, uh, for some of these opportunities.

But it’s amazing. I think I always see Africa as the land of opportunity and for new innovation. So it’s a, it’s a, it’s a, it’s definitely a great place.

All right.

Dr. Patrick J. Fullerton: Agree.

Maria Palombini: So this is a great segue, uh, into the core of what we’re trying to talk about. So, one of the challenges, uh, with rural telehealth right, is the varying requirements amongst the US states for credentialing and licensing of telehealth providers.

We also see this in the world of decentralized clinical trials, right? Like investigators not being licensed in every state trying to recruit patients from different places. It becomes a chaotic regulatory situation, but the variability amongst these states leads to higher costs, right? And more consumption of time by, uh, providers trying to get licensed in these states.

So, you guys, OPTAC right, is offering remote telehealth services, right, with providers. So how do you kind of navigate this? It’s a crazy issue to navigate, but you have to navigate it. So how are you guys doing this?

Dr. Patrick J. Fullerton: Yeah, so what we did is, uh, we said at first, you know, everyone makes mistakes when we’re starting off, um, a company and a concept and an idea, right?

And so through our trial and error, we figured out, it’s gonna take a long time to build our own network. And so we have a small network now, but then we met a team called Amwell and uh, and we had a meeting with them yesterday and we said, Hey guys, do you guys wanna partner with us on this? And, uh, and so they’re like, yeah, you know, another, yeah.

So, so, so that was two yeses in the books. And, and we said, because we literally thought that, I was like, look, we got to, we have to form the legal infrastructure in all 50 states. We’ll have to form the legal infrastructure abroad. And how do we do that? How do we do that well? Like what’s the, what’s, what’s the biggest team we can get that we can scale this globally?

Um, so literally this, this is a recent development, um, at the ATA we stopped by the Amwell booth and said, Hey guys, we have a, we need behavioral health and we need also, um, full, full medical care with our trauma physicians and also critical care and prolonged field care, uh, you know, for our DOD vertical.

But we also need that for the hospital when we’re looking at transitional care clinics, how we get people into the system after they’ve been discharged, and also how we, how we reach out to the remote patient that, that can’t have access or, or geographically it’s just prohibited. Um, ’cause it’s far away or the cellular access isn’t great.

You know, we looked at all those problems that, that give us, um, issues trying to deliver care anywhere. And so we said alright, we’ll have our own team, but we need to partner with some bigger teams. And so that’s what we’re doing. We literally just acted like, you know, I hate to, I hate to bring up this, this, but you know, when in, you know, most of my team, uh, has either supported special forces or served in special forces in the, in the Army and also the Navy.

And actually we have one Air Force guy too. So, and Air Force as well. So we said, you know, alright guys, look, um, We’re force multipliers, right? This is what we’ve been trained to do all our careers, um, as military soldiers and officers, how do we force multiply us and that force multiplication of like, look, do it with people already doing in that state or that country and our new concept is bring as many teammates in as possible to impact the globe for global reach and remote access to healthcare. And that’s what, yeah, so that’s kind of, it’s the cool part about a building an ecosystem is, is no one’s a competitor to us. Really. We look at them as partners.

Maria Palombini: That’s, that’s really good, especially when you’re a startup. Like you said, when people say yes to you, especially one of the top 10 telehealth companies in North America, and they say yes to you, that’s like, that’s like, that’s like golden, right? That’s what you’re looking for. So kudos to you guys for that big time.

Maria Palombini: So, you know, in, in discussing in this, this season five, you know, with all of our, uh, guests, this question of trust keeps coming up, right? Um, so, you know, we know that if there’s a lack of patient trust, it can easily undermine the potential for telemedicine. Like, you know, to mitigate the issue we’re seeing with health disparities. Right?

Highlighting that trust in telemedicine needs to be, I guess, fostered or nurtured simultaneously. You know, I was reading a study, uh, by, um, an analysis of Mount Sinai’s de-identify Covid 19 database, which was published in the The Lancet Digital Health and it identified patients of color. Uh, so in this case would be black, Hispanic, native Americans, et cetera, were less likely to use telehealth services during the Covid pandemic and prefer to go to emergency rooms to address their ailments.

So the inferred correlation is this right? That the lack of relationship between the patient and the doctor further exasperated the lack of trust in the telehealth system. And this might not be just a person of color thing. This can be just the average patient-doctor relationship. So here’s my question to you.

How do you as a doctor with a network now of tele physicians attempt to bridge this gap in trust with patients?

Dr. Patrick J. Fullerton: So that’s a great question and, and I’ll answer it this way. So each state has a pot of money, um, that’s allocated for, for essentially emergency management and disaster preparedness. And so right now we have on the books a meeting with the state of Tennessee, we’re going to have a meeting with, uh, Kentucky, um, Texas as well. And after that, I think the domino’s gonna fall because the biggest question, uh, that you ask, it really has a, has a financial burden to the patient, right? And that financial burden gets mitigated with already state allocated funds to provide this network architecture in their state. So therefore, instead of asking from the patient to say, hey, look, here’s the new 4G/5G phone that you really need to have, and you need to have Chrome or Safari or Firefox on that phone, um, as a browser, um, that kinda creates a barrier to entry, right? Because I know my cell phones are expensive.

I mean, I, I. Yeah, I think I paid five or $600 for my cell phone. Um, some people can’t afford that. Right. And back in, when I first started out, you know, my dad was a truck driver. My dad still doesn’t have a, a smartphone. He has just a regular phone. Um, and he’s 80 years old, still driving a truck for living. God love him. Irish man will, will work till, till the day dies.

But, uh, but I see that as a barrier entry just in my own family. So how do we, how do we give them access to a network where it wouldn’t be, uh, there wouldn’t be any healthcare disparities because of lack of technology or asset access to technology in the communities.

And literally we start at the states. And we, and we provide that through an already allocated pot of money for Covid and also for disaster and preparedness. There’s still untouched monies in the each states for these things, and that’s what we do is we go from a top-down approach and help the, the states deliver that to their municipalities.

Maria Palombini: Okay. So that sort of addresses I think, an important question ’cause we often hear. You know, like people can’t afford 5G access and broadband and all this other stuff, right? And this is why they’re quote unquote disconnected to begin with. So I think this is a really interesting approach to try to, you know, work with government to sort of putting it, bringing it down to the people, essentially, like give it back to them in this form, right?

Dr. Patrick J. Fullerton: Sure, a hundred percent. And we did that. I can can give you an example where we did that before. Um, before I started OPTAC, I was the deputy Chief Medical Officer for the Great Plains area.

And if you know that area, you know that area of North Dakota, South Dakota, Iowa Nebraska is very, very remote and we’re, there were tons of challenges on the reservation that we were trying to fix. Uh, we had, we had tuberculosis outbreaks. We were just trying to make sure they were taking their medicine, things like that.

Um, there was, there was other issues that we were facing with, um, early disease progression with hypertension, diabetes, and heart disease. We would literally go mobile around to these communities, uh, to deliver healthcare because they had such a lack of access to come into the hospital reservation or to the reservation on the hospital where we actually went to them.

And so I remember, um, uh, this is not a plug for iPhone ’cause I’m an Android guy. But we dropped off, um, iPhones to, to patients’ houses where they didn’t have the technology. They didn’t have the money for an iPhone. But it was some technology that that was developed to watch them take the medicine, that we ensure that they take the medicine for tuberculosis to ensure that they were getting treatment.

So we actually gave them the technology. And I think sometimes in, in areas that are remote that have a lack of, um, access, whether it be from, from geography or from finances, uh, you know, we need to help provide that ’cause I believe, you know, as, as we, I can say this on, on say Patty’s Day, um, as a good Irish Catholic, we are, we are our brothers and sisters keepers and I, and I believe we owe it to, to humanity and to the globe to take care of others.

Maria Palombini: Absolutely. Well said. I think that’s really amazing. You know, just interesting on this case study though. Um, you know, I’ve heard a lot of case studies where foundations and coalitions go in and give technology to people in rural areas and just interested to know, because they said in some cases, some people like accepted it and trusted and some people didn’t.

They didn’t want it. They were like, this is gonna cause too many problems. Like, you know, you know, familial like things going on in their families or the multi-generation gap. Just interested to see more or less from your observation, like how did people respond to getting this technology and being able to use it and like, did you find that they were totally accepting towards it or at first they were like, hmm, not so sure I wanna use this.

Dr. Patrick J. Fullerton: Yeah, uh, it was not so sure I wanna use this. Um, really there’s a, there’s a huge educational piece that goes along with that, and that educational piece has to have, you know, the, the people they trust, uh, coming out to talk to them as well. So, so that was a key piece of, of what we did as well. And also, there was another initiative. There were, there were, um, you know, there were increased incidents of suicide on the reservations as well. So we said, how do we address that? Well, education was the key, you know, we had children, um, in high schools committing suicide in packs. Um, so how do you address that, right?

How do, how do you reach those kids? Well, you go out to them. And you go talk to them and you educate them why they shouldn’t do this, because, um, you know, this is not the right answer to, to solve problems. This is not the right statement you want to give, um, because of, of, you know, the problems that they were facing and, and they could be individual that can be selective, but, but really it starts with education. And the word doctor comes from a Latin word, docēre, it means to teach. And I think a lot of us forget that, that our responsibility is to teach as well. Whenever I, I’m teaching medical students or residents, I, I tell them, I was like, all right, you know, anybody can give a history of physical, right?

But, but physicians are trained to diagnose, but then they get stuck on the rest of the piece in a treatment plan. Treatment plans consist of three things. Um, diagnostic, therapeutic patient education. And I’ve been teaching that for 22 years. You know that patient education is really, really important and sometimes we need to lead with that rather than end with that.

Maria Palombini: Right. Good point. Yep. I think that’s important. I, I agree.

I think digital literacy and I think you’re more prone to trust something when you understand it versus just, you know, if you don’t understand it, you sort of like, I don’t know if I could trust this thing. Right. It’s just the unknown. Right. So, good point.

Very good point.

Dr. Patrick J. Fullerton: And Maria, digital Literacy. That is a great buzzword. Um, I love it, and I’m glad you said it first because I, I always forget that word. Um, but digital literacy is really, um, how we get folks to trust what we’re doing because you can’t see them face-to-face. Mm-hmm. And, and you can’t establish that face-to-face relationship we have done for years. But, um, but we still have to keep trying to improve digital literacy so there is trust um in the healthcare system.

Maria Palombini: Okay, so now we’re gonna go to one of our more well-known challenges throughout the entire healthcare system.

And that’s interoperability, right? So I mean, I attend conference after conference and I don’t care what area of the healthcare value chain, always hearing, there’s a challenge with interoperability. So you know what kind what happens here is that we know it’s a main issue. It’s an, you know, technologists, patients and physicians are feeling the impact of it.

You know, healthcare records are not interoperable. Now we’re layering in a new channel, right? Telehealth and saying, you know, Hey, we’re gonna throw something else at it that’s not going to integrate into the healthcare record. So I guess from, you know, your perspective, being in the thick of it on both sides now, right?

Telehealth, in-person patient, trying to teach future doctors. Like where do you think policy can maybe support, uh, the better the support, better the integration of telehealth systems into the overall, you know, patient health record?

Dr. Patrick J. Fullerton: Oh, gosh, that’s a great question, and I’ll tell you the reason why I, you know, you know, for the longest time everyone was siloed and sometimes still is.

And I’ll, I’ll tell you about a brief project that I, I did and I did it for the right reasons. Mm-hmm. Um, but it never got implemented because of the, of the silos that are, that are still, they, they still exist in healthcare, in healthcare systems.

And it was a PHI sharing platform. It was my senior project. Um, and I hate to drop the word, but when I was at Harvard, um, getting my healthcare master degree, no one cared about when I went to Daytona Beach Community College when I got outta the military. Mm-hmm. People, some how they like. You know, do, do not like that word.

Um, but I’m really proud of, of, of what I learned there. And, and when I was there, they, we got an opportunity to discuss, alright, do you wanna do another QI project quality initiative, or do you wanna build a company? Well, me being me, I said, I wanna build a company. And so I built a company that literally shared PHI between healthcare systems.

And, and the reason why I did that, because sitting in an ER, I have an EKG in front of me, right? I have to make a decision. You know, does this patient go to the cath lab or does this patient go to the I C U? And if I had that other E K G from another hospital system, I could compare the two. And if there was a change, it’s very easy.

I’m calling in the cath team. Calling the interventional cardiologist to put a stent in the, in this person’s heart. So that inter, that’s where it first started of, of, of my trying to be interoperable, um, and creating something to do that. And so that system actually was called the HAPIE, uh, corporation.

So Healthcare API Ecosystem. And we used an API that was used in, we made sure it was used in other healthcare systems, sharing information across systems for that inter and intra interoperability. Did I say that correctly? I think I said that wrong, but anyways, you guys can understand the point. But, you know, that was really important to me to be able to, to, to solve that problem.

And, and so as we develop, uh, the technology, we’re like, okay, well can we do it? You know, will we be, why are we gonna be allowed to do it, first of all? And, um, The answer was no. And this was back in 2018, 2017/2018. The answer was no. But I think now I think we’re finding that that interoperability that first really started in radiology.

Um, as we, as we progress through the different specialties in the healthcare systems, I think they’re finding that better patient care, um, is given on a population health standpoint. Um, now if you’re interoperable, So the pressures will be placed on, on state and local governments to become more interoperable.

Mm-hmm. Um, because I think the biggest fear was, was it’s gonna leak outside the system. Well, it’ll leak outside the system regardless if you’re interoperable or non interoperable. Mm-hmm. You know, just from ha having managed thousand physicians in my career, uh, at my last position as well, you know, where I was a healthcare executive, um, people are gonna leak, people are leak out their system.

Uh, and, and you, that’s be expected. Where the hard work comes in is the leaders of the healthcare systems have to understand and educate their teams that they’re on the team for the right reason. So even if they go outside the system, those patients are still still gonna come back. I. Right, so promote interoperability.

It’s not gonna help to leak out the system. If you don’t have a specialist you need in, in your system, then get that person and then you don’t have to worry about it. But interoperability is, is the way of the future, and I, and personally, I fully support it.

Maria Palombini: Absolutely. Um, I think, you know, uh, we just keep hearing about it and I just hope we start to really move the needle on it, but we’ll see.

I don’t know. So, Dr. Fulton, you’ve given me so many great thoughts, and definitely our audience appreciates all the insights. I think the, the case studies that you’ve talked about are really, really insightful, so I totally appreciated your comment that it’s sort of our human responsibility to take care of our fellow men.

I, I totally agree and appreciate your, your, your commitment to that.

Dr. Patrick J. Fullerton: And, and woman, by the way.

Maria Palombini: Oh, yes.

Dr. Patrick J. Fullerton: I, I was using as I, as I live in–

Maria Palombini: That’s a good point.

Dr. Patrick J. Fullerton: As I live in a family of women, you know, two little girls and a wife. I, I live in a family of women, so if I don’t do that, my wife will literally

Maria Palombini: Absolutely, uh, correct.

Dr. Patrick J. Fullerton: So yeah, she’s not cooking, she’s not cooking dinner and I have to do a lot more chores tonight if I don’t do that. Usually we share responsibilities, but, uh, she says you do cook a special dinner tonight for St. Patty’s Day, and I can kiss that goodbye if I don’t say, uh, women as well.

Maria Palombini: You could just leave me on that one. But, uh, so for all of you out there, if you had a noticed today is actually we’re recording this podcast, but today is actually St. Patrick’s Day, so it’s March 17th. So, um, you know, so we’re all talking about the, this very, very special quote unquote holiday we have here in the us. Uh, we are, we try to observe as best as we can, but, um, so, Dr. Fullerton before we, we end this exciting interview, I just wanna ask you, is there any kind of final thoughts you would like to share? I. You know, with this audience, we have a diverse audience of technologists and researchers and clinicians and regulatory people, or any other, you know, stakeholder who really wants to get into the process to make change and try to see, you know, specifically around, you know, developing technologies and services and opportunities for, you know, those who are, I would say most disconnected, right?

The ones in remote and, uh, deep rural areas.

Dr. Patrick J. Fullerton: Sure, sure. I think, I think the biggest thing I can say is, you know, let’s not reinvent the wheel. The wheel already rolls as it is now. And this global multi architecture of satellite and LT hybrid, um, solution that we’ve created with multiple technologies.

You know, let’s start thinking about how we can become, um, an ecosystem and deliver that care together rather than siloed and apart. And if you reach out to OPTAC we will show you how to do that ’cause we’re doing that currently with, with the DOD, we’re doing that currently with, um, the commercial market as well in healthcare, we’re doing that overseas, um, outside the United States. Um, so, and that, and that is on, you know, three different areas. You know, we provide the, the global multi-network architecture, but we will help anyone as far as the users support networks and the platforms we deploy on and all the IoT that we can plug into this.

We literally can build an ecosystem together and, and, stop competing really, because if, if we’re doing this together, um, I think a team is, is probably a better approach at solving these problems than individual companies. And so if you think about what, um, the Commonwealth did in Massachusetts, solving a lot of different problems with their ecosystem, we just took that, that concept, and we developed this global multi-network architecture, um, to support different users and support networks, platforms and IoT. So definitely reach out to us and, and if you don’t want to involve us, we’ll, we’ll help, we’ll help show you how.

Maria Palombini: Excellent. So for those of you who would like to learn more about OPTAC, you can visit www.OPTACx.com. Um, and, uh, Dr. Fullerton, thank you for joining me today.

This has been really, really exciting conversation.

Dr. Patrick J. Fullerton: Thank you, Maria, for having me. It’s been a pleasure. And this is, by the way, my first podcast.

Maria Palombini: You see now you’ve gone out to the global world and just tell them all the exciting things you’re doing. So thank you. You know, it’s not easy sometimes to come on these things and, uh, you know, roll with the punches.

And I think you’ve done, I think you’ve shared some really great insight and I, I think our listeners are gonna really enjoy it.

So for the rest of you out there, uh, you know, as I mentioned earlier, the season five is presented in collaboration with the American Telemedicine Association, um, and as I mentioned, their 2023 annual conference, um, just passed in March, uh, in San Antonio, and they’re already gearing up for 2024.

If you wanna learn about their activities and everything that’s going on at the ATA, you can visit www.americantelemed.org. For us here at the IEEE Healthcare Life Science Practice, a lot of the things that, uh, Dr. Fullerton talked about today are covered in many different initiatives and collaboration programs we do here.

Our goal is obviously looking at the opportunities for developing technical and data standards through collaboration, building consensus, and bringing solutions that are ultimately going to help all of the patients. When I say all, I mean all patients in every corner of the globe. Um, so if you’re interested in getting involved, you can bring your expertise.

You don’t have to be an engineer. You can be a clinician, you can be in research, could be a regulator. Um, your expertise will help us build, uh, uh, opportunities and solutions to help others. And you can learn more about all the great work of the healthcare life science practice at ieeesa.io/hls.

So I wanted the special thanks to you, the audience for listening in today. We invite you to share this podcast with your colleagues and networks to help to get this information out to those who want to make a difference or wanna learn about these great technologies and opportunities and overall, contribute to better healthcare for everyone.

We thank you for joining us

Until next time, stay safe and well.

Maria Palombini: Hello everyone and welcome to the IEEE SA’s Rethink Health podcast series. I’m your host, Maria Palombini, Director of the Healthcare and Life Sciences Global Practice here at the IEEE Standards Association. This podcast series puts industry stakeholders from around the globe on the spot to answer an important question– how can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security, protection, and sustainable equitable access to quality care for all individuals? We are delighted to bring you season five, the Rise in Demand for Telehealth, Equity and Accessible Technologies, which we are presenting in collaboration with the American Telemedicine Association (ATA). The ATA’s a nonprofit organization completely focused on advancing telehealth, committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it. Enabling the system to do more good for more people, and we all like that. You can learn more about the IEEE Rethink Health podcast series and tune into previous seasons on ieeesa.io/healthpodcast or just scroll through the Rethink Health podcast channel on your player.

We are hearing more and more that the global aging population is rapidly growing. According to the WHO, the World Health Organization, it is estimated that by the year of 2050 people, 65 and older globally will reach 1.5 billion.

Here’s another wow fact– in 2018, for the first time in history, persons aged 65 and over, outnumbered children under five years of age, globally. These numbers have significant implications. Who or what will be able to fill the gap in a way that provides quality support for their needs with dignity, privacy, insecurity.

One thing for sure is that the aging are the most diverse geographic demographic, socio and economic group to serve. And in no way, one aging adult represents all. And one of the more significant challenges with the aging is developing a range of remote or connected assistive technologies that can be equally accessible and feasible for all.

It’s not just a lack of infrastructure as the challenge, but again, we will see the issue of distrust rise again. In season five, we are bringing the technologists, the researchers, the clinicians, advocates, and a host of other stakeholders who will discuss the rise in demand and need for telehealth, along with the growing concerns of addressing the challenges prohibiting equitable access, especially for the most vulnerable.

Since this is a special season as the collaboration with the ATA, our guests will be a selection of speakers from the 2023 Annual conference, which is taking place on the fourth to the 6th of March in San Antonio, Texas. The IEEE SA will host a unique panel session entitled, Aging at Home, Bringing Feasible and Accessible Assistive and Digital Technologies.

And with me today, I am delighted that we have one of our panelists, Dr. Elizabeth White Baker here with me as a special guest. Welcome, Elizabeth.

Elizabeth White Baker: Thank you so much for having me.

Maria Palombini: Oh, I’m super excited about this interview. So before we begin, just a short disclaimer, IEEE, nor ATA, endorse or financially support, any of the products or services mentioned by or affiliated with our guest experts in this season five episodes. Guests are invited to participate to offer their opinions and perspectives, representative from their own knowledge and experience.

So we’re gonna go right into segment one, which humanizes the experience. Elizabeth, we’d like to just share a little bit about ourselves with our audience before we get to the core of what we’re really here to talk about.

So you have a highly esteemed educational background at MIT and VCU and you’re adept at understanding how information systems can work and not work. I mean, I look to you for always great answers ’cause you always have them. You are an advocate for driving inclusion in the technology engineering field.

And you know, inclusion means different things to different people. So my question to you is, what does it mean to you? What are you trying to inspire or call attention when teaching these future engineering stars? When it comes to inclusion? Why is this critical in the healthcare domain?

Elizabeth White Baker: Well, for me, when I’m training engineers, and when I’m talking even with healthcare practitioners who have to use the technology– what is important is inclusion includes everyone, differing types of engineers, differing types of patients to get different and better perspectives on the technology that we bring to healthcare.

So really humanizing what the tools that we want to use are and I have to remind people, particularly my engineers, that technology has to work with the healing process and not against it. And what do I mean by that? I, I mean, when we design technology, often we do it in a bubble that is different from what is on your lab bench or on your computer when you’re designing a device, and we have to remember that that device is gonna be on a patient or near someone who’s not well. And so, We want to make sure that everything that we design is with it, um, is with that patient and the caregiver in mind. It can’t be complicated for the caregiver and it can’t be complicated or, um, uneasy for the patient.

Otherwise, the technology that you introduce, Makes them less well, which is exactly what you don’t want. Um, and that’s why it’s critical in the healthcare domain. We need to ensure that we’re making the tools to help humans care for other humans as opposed to displacing humans or, um, thinking that we are, um, diagnosing, uh, robots.

You know, it’s, it’s people who aren’t well. So, uh, a quick story here. Um, you might have an elder that you’re taking care of at home and, um, you know, you may need your eyeglasses to be able to see the instructions of how to put this device on or how to make it work. And understanding that the caregiver might not be a 20 year old who can read, you know, eight point font is important, or that they may not understand the abbreviations that you’re using.

And these are very simple design and engineering decisions that can be made, that can make all the difference for the efficacy of the tool. So that’s what I think about inclusion, that everybody is not like you, and that in healthcare in particular, we’ve got to have engineers that are differing and we have to understand that the patients that we’re serving are differing.

Maria Palombini: Absolutely. So, you know, for our audience out there, you know, Elizabeth is an associate professor at, um, Virginia Commonwealth University, and she’s also the volunteer secretary of the IEEE’s Transforming the Telehealth Paradigm Industry Connections Program. And I’ll mention a little bit about that at the end of the interview.

But, her expertise is really critical because when we talk about inclusion, we know in telehealth in general, there’s this big cloud of this idea of inclusion or lack of inclusion, um, that we’re all trying to adjust. So let’s get to the core of what we’re here to talk about. Um, you know, inclusion is a huge issue or lack of inclusion, and we hear it from every angle in the healthcare sector as it relates to, you know, algorithmic, um, AI bias, algorithmic bias, or to lack of healthcare access.

Um, you name it, telehealth inequity. We hear it all the time. Um, but when it comes to the aging population, inclusion is just as a critical issue, right? So when we look at the future of technology engineering, Where do you think the field needs to start addressing this idea for inclusion for such a diverse population of aging adults?

And how can these principles, um, be embedded into either the design and development so that they can fundamentally assist the diverse needs of this aging group?

Elizabeth White Baker: Well, you’re absolutely right. It seems like an incredibly daunting process to try and take into account all of the diversity that you have to include, but with respect to boiling it down to the simplest, um, principles.

We really need technology engineering people like me who teach this and who train others. We need to address both the humans and the technology working together to maximize patient outcomes. And this is different than what we look at normally because normally, Tech uses is just between a user and a computer.

So the human computer interaction is just two dimensional. But in healthcare, you have the unique situation where typically you have three entities. You have the caregiver, and that can be the healthcare professional. It can be someone in the home, it can be both. The patient and the technology. So you have this triad that you have to consider because the patient themselves is likely not gonna be the only one.

They’re gonna have this caregiver involved, and we don’t look at that often enough. We don’t look at the fact that they are three different entities involved and all of them need to be. Considered when we’re designing new technologies and we have to account for all of them in the context that we’re in because ultimately we can design anything we want.

But if it doesn’t have utility, if, if it’s not useful and nobody adopts it, you’ve just wasted your money in design and, and we don’t wanna be engineers that design the things that only we like. We want to be engineers that design things that help people. Get better. And so I think that’s where we really need to start looking is that, um, context can be the same homes, hospitals, you know, where we get care can be generalized.

And this idea that there are three entities involved can be generalized. And if you go from there, you can improve the tools dramatically.

Maria Palombini: Absolutely important. Everybody forgets the caregiver when there is one actually ’cause now the older generation is outpacing the younger generation. So I think there’s gonna be more of them and less of them to care take care of them, unfortunately.

Elizabeth White Baker: Absolutely.

Maria Palombini: So this brings me to an interesting scenario. Um, You know, the other day, uh, you had mentioned it, uh, about, you know, Japan already, uh, being, uh, out there developing robotics to assist with the aging.

You know, Japan is probably at the forefront of having a larger aging population and kind of starting to try to address that. This issue because they don’t have enough younger generation to take care of these older generation. And then simultaneously, I ran into an article by, um, the M I T technology review article that mentioned that the National Government of Japan by 2018 alone, had spent well in excess of $300 million, funding, research and development for these kinds of, um, robotic devices to care for older people.

And they actually had one called Rob Bear, um, which was developed in 2015. Um, but it’s been since 2015. There’s all this money behind it, yet it’s not normalized in care facilities or private homes. So we have a problem. So the question is, is why is something like this not taking off? If this is the be the trailblazing model to follow, what do we need to rethink from a techno solution?

You know, when it comes to care, especially when we’re talking, this could be for emotional support care, healthcare, et cetera, for this aging population.

Elizabeth White Baker: I think that the key issue that we can start with is that often maximizing profit and maximizing health outcomes kind of work at cross purposes, and that is not always very helpful. We need to maximize both of these and not sacrifice one at the cost of the other. And, and so that’s the answer in my opinion as to why these are not taking off. Because what the current model that everyone’s trying to follow looks to do is replace the human caregiver completely rather than augment the human caregiver.

And what do I mean by that? Um, yes, there’s a demographic challenge and there’s no question, but if we can make the human caregivers more efficient and effective, we don’t have to use the technology to replace them, we can use the technology to broaden their reach. Uh, and make them more effective for both cost and efficiency reasons.

So what you have to understand is that a lot of technology makes things transactional, meaning I give you this, you give me that, and, and that reduces friction and makes things more efficient. In healthcare, you can’t really do that quite so well because healthcare isn’t transactional, it’s relational. I am here to help you get better.

I am here to have you trust me. It’s not sort of a one-off kind of thing that you can do with just technology. So I think we need to, this trail blazing model is important and we’re about 80% of the way there, but I think the 20% is working on how to make this technology more relational, meaning. How do we trust and believe, get the patient to believe, and the caregiver, I’ll add, that this technology is actually working to, to make my healthcare better, uh, in the most efficient way possible, in a way that I can trust. And, you know, it, it just behooves us in healthcare to think about both, uh, patient outcomes and um, uh, profit maximization. Both you, it can’t be one or the other.

And I think that’s where we’re really struggling.

Maria Palombini: Absolutely. I think, you know, obviously we all know there’s not gonna be a robot in every single aging person’s home or at every bedside in an assistive care facility. Um, I mean, maybe one day they’ll be commoditized that way, but it is something to think about.

Elizabeth White Baker: I also don’t think that you need that. And what I mean is, you know, even something that has less functionality than a robot, an Alexa, can go a long way in, um, helping say guide animals, which we already have, help people’s mobility around the house or to get, um, to get things. And so it’s just a design, uh, concern as well.

So I, I don’t think. We have to have everything all at once. Everything everywhere, all at once to quote the movie title. I, I think that we could roll it out such that we have great gains with maybe technology that, uh, doesn’t have to be quite. So “doing everything.”

Maria Palombini: Yep. Absolutely. Good point. Very good point.

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There is no cost to join. You will not only have the option to advance your objectives, but also you will contribute significantly to optimizing adoption of these technologies which will benefit the telehealth system for all stakeholders, visit ieeesa.io/telehealth-startup to join this growing community.

So, a little earlier we talked about inequity and lack of inclusion, obviously in the healthcare system. And this isn’t of course, being carried over into telehealth. Um, you know, some people have argued, well, the, the issue is that these marginalized populations. Um, don’t have access to adequate digital access infrastructure, um, so they can get access to digital health and telehealth services.

So would you agree or disagree that if we, the global tech community and obviously you, with a very un unbelievable understanding of technology engineering in this area, can fix this issue of lack of digital access and that we would solve the problem. Here’s your internet access and here we go. Or is this problem more. A little more complex and is it more a digital literacy and or health literacy problem?

Elizabeth White Baker: This is a really interesting question and I wish I had better news. Um, I don’t think it’s an access issue at all at this point, at least when you’re talking about first world countries. Um, if you look at OECD, information about technology adoption, particularly with respect to mobile phones. You have north of 95% adoption and that’s all you need to have access. So I think if we’re looking to blame it on that, we can’t anymore. I think the issue is more complex and it has to do with not at looking what tech can do in and of itself, but what it can do for the consumer.

And you know, do people know that they can use audio only phone calls for health? Do they know that a school, um, that a facilitator at a senior center can call to get services. Do the people at the senior center know that they can, uh, reach out and facilitate help? It, it becomes very, uh, complicated and I think also, um, in addition to a literacy or a health problem, I’ll talk about that in a second. Um, it, it really has to do, it’s more chaotic. It really has to do with market forces. And, you know, we had a lot of states that had tele access laws on the books long before Covid, and it wasn’t until it became profitable for them to offer telehealth services that they began to do so. Even though the policy was there supporting them, and I just know this from my state of Virginia. So I think blaming it on access is convenient. Blaming it on the user not being educated is convenient. But really it has to do with harnessing access, education, and policy. You know, the, the market forces all together to make, um, the digital divide, uh, shrink.

Maria Palombini: Absolutely. Um, you know, I think there’s a good point there about digital awareness. Um, I don’t know if I would call it digital literacy, but definitely the idea of digital awareness is really, really important, especially for the aging

Elizabeth White Baker: Well and community-based care. I mean, at this point, for instance, we saw a lot of the deployment of religious communities to help with covid, uh, vaccination.

We saw, um, a lot of social groups helping with healthcare, and I think particularly with the aging, that’s going to become even more important as, uh, we get upside, what I call upside down triangle with the aging being so many more than the, uh, than the younger generation in terms of numbers.

Maria Palombini: Absolutely. So with the aging, uh, our favorite elderly, uh, and aging by the way, for everybody out there can mean anything anywhere. We could say from the age 50 and older, 55 and older, 65 and older, we don’t have a standard there. No pun intended. Um, well, even

Elizabeth White Baker: That’s so funny because even the United States, when you look at, um, DHHS, the health and human Safety, they have aged, very aged, very young aged.

It’s amazing.

Maria Palombini: It’s like this amazing range. You are just aged. I don’t know if you anybody wants to be classified like that on their healthcare documents, but you know, it is a reality for all of us. So we know with this particular group, uh, you know, there’s a major issue of trust because a lot of things are changing, right?

Technology is changing how healthcare delivery is changing. So it is human nature that the less we understand something, the less likely we are to trust it. I mean, this is, I think, in every aspect, every generational gap. But this brings me to one of your areas of expertise and, uh, around cybersecurity, right?

The aging population is a highly vulnerable one. Um, and, you know, not understanding like this whole digital landscape. Um, therefore, how do you see cybersecurity being a major element of the design in these innovations to a population of users who may not even understand what it means to be cyber vulnerable and how to protect their digital and personal data when utilizing these technologies.

I mean, what responsibility do you think engineers may have in this role? And maybe perhaps, where do you think if, you know, policy has a role like this is like another sort of complex area as well.

Elizabeth White Baker: Well, the good news is I think we’ve already solved this problem in one area of society, and I think we can transfer it.

And so we already have very robust cybersecurity with respect to electronic commerce. We put our financial information online routinely, and it has, uh, robust standards to secure it. And I think that the good and a lot of people, this is not gonna surprise anyone, use e-commerce without understanding how it works.

And I know this just because of the people I teach, I ask questions and they have no idea, uh, about, uh, necessarily data transmission security or data storage, security or anything like that. They just know that they can trust when they put their credit card in that it’s not gonna be stolen, and they’ll get the goods that they have ordered. With respect to the aging population and cybersecurity, I think from the engineers have all the responsibility, in my opinion to make sure that the personally identifiable health information is protected. Now, fortunately, we have policies behind that. I think those policies most certainly need to be more sophisticated than they are, but they’re a good basis.

And so we can very easily secure health data transmission and we can fairly easily secure health data storage even if we decide to store it, uh, offsite in the cloud somewhere. We are starting to develop, um, standards of based on cybersecurity and compliance rules, um, through the FDA. So what I tell my engineers is design it as if it were your parents’ data at risk, because it is your parents’ data’s gonna be at risk, right?

Um, think about it, you know, think about what it is that you’re trying to protect here and in terms of policy, we need to get policies in place that force continued education because the risks are rapidly developing. Cybersecurity is, um, endlessly defensive. If you’re not on the offensive, almost you, you aren’t well defending.

And so we need to ensure that it’s not a set it and forget it type of project that cybersecurity with healthcare information is a program. It’s something you keep working at and you keep looking at, um, to protect your patients and their data. We can facilitate people trusting this. So the aging population, they won’t use what they don’t understand.

That’s probably true. Um, Well, it’s definitely true says the person who didn’t even use streaming television services until my kids kind of explained it to me a little better. Right, right. And so I think that if we use humans to translate trust in technology, again, this is where the caregiver can really come into play.

In this particular situation that we can really rapidly move adoption along because then the caregiver can trust that the technology is safe and the, it’s definitely in the provider’s best interest ’cause they could be highly sanctioned. So, um, all policy is important. Engineering is important, and then this idea of bringing the provider in, all three of those have to be addressed in terms of cybersecurity for it to be effective.

Maria Palombini: Absolutely all very, very important points. You mentioned, uh, something interesting, uh, I heard the term technical standard. So, which leads us to our next question. Um, you know, where do you see the role of technical standards development to truly address some of these issues with security and accessibility?

You know, for our audience who may not all be engineers or in the standards development land, um, can you explain why the development of a technical standard can make these challenges you know, seamlessly resolved, um, to the end user while still fostering innovation for the designer and the developer?

Elizabeth White Baker: Absolutely. I’m asked this question all the time, uh, particularly with respect to medical device design. And that is, you know, why standards make it harder to differentiate your product, right? And so we don’t want to adhere to standards because if we did, then someone could copy what we’re doing and then make our innovation worthless.

And I, I couldn’t disagree with that more. There’s certain things that we don’t need to compete on, and in fact, if you don’t, you’re gonna lose your ability to have your device adopted because it’s not interoperable with anything. So what I’m gonna tell you is that competition is healthy, but if you don’t have rules or standards, you’re not even gonna be able to play the game.

And so the idea that standards are available, actually create a basis upon which you can focus on innovating on the things that will give you economic advantage, sustainable competitive advantage, as opposed to trying to differentiate on things that are gonna make you in. How do you say un interoperable not not able to play well with others.

And in healthcare it’s too expensive. We can’t afford to have things that don’t work with other things. Like, it’s just, it’s, it’s not gonna work out. So, um, I believe that if we are able to, make the standards clear that then we can have our innovators focus on things that truly make devices innovative, and we can compete on that more effectively for better interoperability, and therefore, more interoperability means more people adopting your product in the long run.

Maria Palombini: Absolutely. Um, I think that’s really, really important. Uh, plug and play. Plug and play, right? We wanna make it easy. We wanna make it, uh, we want the information that we need to help ourselves, right, as patients. And, um, and that even as caregivers, right? Caregivers are managing patients’ data all day long.

Uh, so whatever we can make to help them help themselves is always, uh, really, really critical in the, in the scope of better healthcare, you know?

Elizabeth White Baker: Absolutely.

Maria Palombini: Elizabeth, you shared so many insightful points today. Um, you know, any final thoughts you would like to share with our, uh, diverse audience as it comes to any of the challenges, issues, you know, any kind of needs to gain wider adoption of remote assisted technologies?

You know, what can we do as a technologist, a researcher, a clinician, a patient advocate, or any other stakeholder in the process, you know, to contribute to a trusted and ethical system of sort of, you know, care, uh, for these, uh, aging population.

Elizabeth White Baker: My final thoughts really tie back to what I said in the earlier in the podcast, which is that it’s not strictly a technological problem, and we as engineers have to push beyond our comfort zone to ensure that we can embed trust in what we build patient trust and caregiver and physician trust in what we build. And if we do that, if we push out beyond and we develop things that push the envelope and people are able to trust them, we’ll revolutionize care and a story about this, um, comes from my own health experience.

Um, When I was pregnant with my oldest daughter, I suffered from a severe pregnancy complication that caused me to be hospitalized for 35 days prior to her birth. And I wasn’t hospitalized for any other reason other than I needed to be monitored 24/7. Now it was our first baby. It was my husband, uh, had to try and keep the home running and being with me at the hospital constantly worried and I, I think that that me being in the hospital made me less, well. It made me more afraid. It made me less comfortable with just understanding that this was something that we just had to get through. And I think about how if we had had the technologies for me to be monitored at home, it was basically two sensors and a belt that went into, um, a computer device that.

I could have been monitored in my own bed. I could have been at home. I could have been much calmer. I’m, they always wanted my blood pressure to go down. I’m sure my blood pressure would’ve been down. My husbands and the other people caring for me would’ve been a lot less concerned.

And when you talk about what we can do in terms of revolutionizing the environment of people getting better with remote assistive technologies. Uh, we just have to go for that vision. We have to, because it’s not just gonna be the technology, it’s gonna be every other piece of it. And so my vision is that your mom or your dad, or your T or your TIA can be at home and or be in an environment where they’re comfortable and be monitored.

And you can have people, um, just like we monitor networks remotely, monitor patients remotely, and then if there’s an emergency, someone can be called just like we do. And so I think that’s the vision of the future that I’m hoping that we see. And so for all of us, let’s just build more trust and push beyond what we’re comfortable with to make sure that what we develop falls into that category.

Maria Palombini: Yeah. Thank you for sharing that personal story. I think it, um, it resonates with many of us. Uh, everybody has some sort of personal sort of journey that inspires them. Um, but I think, um, you’ve given us so many exciting points and I, I think my favorite takeaway is, design like you’re designing for your mom and dad and your grandparents, and uh, you know, sometimes that kind of just personalizes, it brings it down to home. So, um, you know, thank you Elizabeth for joining me today and also for being such a great volunteer and the great work you do on the IEEE SA Transforming the Telehealth Paradigm Industry Connections program. You are just a tremendous, uh, insight to me anyway.

So I really enjoy having you part of the group.

Elizabeth White Baker: It’s a pleasure, Maria. Thank you so much.

Maria Palombini: And for all of you out there, if you would like to learn more about the telehealth program. It’s an open incubation program, and it’s really all these volunteers from all walks of disciplines designed to come together to look at solutions to major challenges, impeding, equitable, sustainable quality, and secure access to the telehealth system.

Um, you can learn more about it at ieeesa.io/telehealthic. And there’s links from obviously the Healthcare Life Science Practice website. Um, as I mentioned earlier, this season five is presented with the ATA. Um, and if you wanna learn more about their important education, uh, awareness and advocacy activities, their annual conferences, they do smaller conferences throughout the year, um, you can visit their website at www.americantelemed.org.

You know, a lot of the conversation and concepts we talked about today and throughout the entire season five, um, series is really, uh, addressed in many different activities here at the IEEE SA’s Healthcare and Life Science Practice, whether it’s in standards, incubation programs, conferences, podcasts.

We, we try to cover it all and really our mission of the practice is aligned with the, you know, the goal of this series is engaging multidisciplinary stakeholders and have them collaborate, build consensus, and share ideas, and bring awareness and develop solutions in an open, standardized means to support innovation that will enable us to really get to this, um, sustainable equitable access care for all. If you wanna learn more about the great projects going on here in the practice, um, visit ieeesa.io/hls. And a special thanks to you, the audience for joining us today. We invite you to share this podcast with your colleagues and networks to help to get this information out to who those want to make a difference and contribute to the overall better healthcare for all. Um, we thank you for joining us and keep doing the great work you’re doing to improve our healthcare system. Um, tune into the other episodes of Season five, featuring the experts and some of the speakers from ATA 2023 annual conference.

Until next time, stay safe and well.

Maria Palombini: Hello everyone, and welcome to the IEEE SA Rethink Health podcast series. I’m your host, Maria Palombini. I am the Director of Healthcare and Life Sciences Global Practice here at the IEEE SA.

This podcast puts industry stakeholders from around the globe on the spot to answer an important question, how can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security, protection, and sustainable, equitable access to quality care for all individuals?

We are delighted to bring you season five, the Rise in Demand for Telehealth, Equity, and Accessible Technologies and I’m delighted to say we’re presenting this in collaboration with the American Telemedicine Association, the ATA. The ATA is a nonprofit organization completely focused on advancing telehealth, committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it. Enabling the system to do more good for more people, and we all love that.

So you can learn more about the IEEE Rethink Health podcast series and tune into our four other seasons on ieeesa.io/healthpodcast. Or you can just scroll through the Rethink Health podcast channel.

So many of you out there might have heard this term are consumers of healthcare. The term was coined back in the 1930s, and in simple terms, the concept makes sense. We as patients are consumers of healthcare. are consumers of healthcare can mean different things to different people. However, the concept has been fueled by both a transformational mind shift in the idea of empowering patients to take control of their health data and the rise in demand for a retail shopping-like experience when it comes to healthcare services.

Many have argued that this concept of “consumers of healthcare” has been fueled by the growth of the use of telehealth services. No doubt we see a rise in the use in demand for telehealth, including the growth of RPMs (Remote Patient Monitoring services), RTM (Remote Therapeutic Monitoring devices). This concept of bringing hospitals to the home and more.

However, the rise does not reflect everyone. A late 2020 study published in the journal Population Health Management examines telehealth uses inequities during the pandemic. Essentially found what we already all know people in urban areas where doctors in care facilities are already in plentiful supply, were more likely to use telehealth solutions than those in rural areas.

And the same was true of people in wealthier versus less affluent locales and neighborhoods. So in season five, we are bringing technologists, researchers, clinicians, advocates, and a host of other stakeholders who will discuss this rise, demand, and need for telehealth, along with the growing concern to adjust the challenges prohibiting equitable access for especially the most vulnerable populations.

Since this is a special season as it is a collaboration with the ATA, our guests will be a selection of speakers from the 2023 annual conference, upcoming March 4th to the sixth, 2023 in San Antonio. And for those of you who are not familiar with the ATA, they always host a large annual conference every year.

So if you miss this year’s 2023 conference, You can definitely catch next year’s 2024. We’re going to hear from these experts on advancements of accessible technologies and infrastructure in progress and policy developments, as well as how much more is needed to have a more comprehensive approach to accessibility and equity in the telehealth system.

So before we get started, IEEE, nor the ATA, endorse or financially support any of the products or services mentioned by or affiliated with our guest experts in this season, five. Guests are invited to participate to offer opinions and perspectives representative of their own knowledge and experience.

So with that out of the way, now it’s my pleasure to welcome Dr. Joseph Kvedar, immediate past chair of the board of the ATA. He’s a professor at Harvard Medical School, and he’s also an editor of NPJ Digital Medicine. Dr. Kvedar, welcome to the Rethink Health Podcast.

Dr. Joseph Kvedar: Thanks so much for having me, Maria. I’m delighted to chat with you today.

Maria Palombini: I am so excited to get into this interview with you, so we’re gonna jump right into it. And you know, just because we’re audio only on podcasts, I like to humanize the experience for our audience, so, you have had a highly reputable career as a board-certified dermatologist, having completed your residency at Massachusetts General Hospital and are now currently a professor at Harvard Medical School. You are an early pioneer and continue to advocate for telehealth adoption. You’ve authored some interesting books, the Internet of Healthy Things and the New Mobile Age, How Technology Will Extend the Healthspan and Optimize the Lifespan.

You also do an interesting blog called C Health, which provides your insights and vision of connected health. So my question to you, as an early pioneer, can you share with us what drove your interest and passion for telehealth? What did you see in it at a time, let’s say 30 years ago, that others perhaps could not see?

Dr. Joseph Kvedar: Well, thanks for the question. It, it, it perhaps will sound a bit quaint, and you have to take yourself back, uh, listeners and, and then if you’re, If you’re a younger person, you have to imagine a world where the largest hard drive was 30 megabytes. The first digital cameras were one megapixel. It was a different world.

We didn’t think about moving things around. We were just starting to see something like the Netscape Navigator come in. So in that context, I was, uh, Assigned really as it turns out, by, by, uh, chance a project to look at this new technology called digital imaging. And would it be of diagnostic, uh, caliber in dermatology?

And it was really during a clinical trial in the early to mid-nineties of that tool that I had. Uh, it was like a light bulb went off one day, and I thought if you could separate. The mental, uh, intellectual activity of a provider from where the patient is. You could just open up all kinds of opportunities to change healthcare, access, quality, and efficiency, and I never really looked back.

Um, I had at the, in the beginning, I, I thought I was probably, this is the part that really answers your question. I, I thought I was among the last to have that, uh, Insight when, of course, I wasn’t among the last, maybe among the first, and so I thought, let’s get going and, and we sort of, I assembled a team and got some early funding from the hospital and started moving forward and, and sort of have pursued it since.

So the work’s not done, uh, as, as you point out, it’s, there’s still plenty to do, but we’ve, we’ve also come a long way in 30 years.

Maria Palombini: That’s, that’s, um, that’s awesome. And I think this really embodies the spirit when we say, how can we rethink the approach to health using these kinds of tools? But you started it a little bit earlier than the rest of us, so that’s what’s really exciting about it.

Okay, so, uh, I hear that you recently launched the ATA new podcast series, entitled Health Virtually Uncensored. So welcome to the world of podcasting. Um, maybe you could share with our audience, um, the mission of the series. Like what are the main points you would like to get out and hoping to use this medium, like to really emphasize or bring awareness to, uh, things of that nature?

Dr. Joseph Kvedar: Thanks again for that, uh, for that question. You know, audio, as, as you, you’ve talked about audio only already in this, in this interview, audio is such a special medium. I, there are lots of stats, and I don’t have all of them at my fingertips, but people will listen to a long-form podcast all the way through.

Uh, whereas if, you know you’re lucky on, on a, on a video, on Facebook or, or a. A tweet that you get, uh, 30 seconds of, of a viewer’s attention. So there’s something about the medium that’s very, very charming and, uh, intimate. Uh, you’re right next to someone’s ear. Um, and so with, with that in mind, I, I looked at our industry, and of course, it is ATA so we’re, we’re always, uh, bringing in people to talk about things that are on our minds at ata, whatever’s topical at the time, but there’s also.

The, the, the title is very deliberate and, and it’s, I think one of the things we’ve suffered from in, in our field over the years is people for whatever reason have tended to over, um, state a little bit their successes, whether that be through numbers of consults or revenue dollars or whatever their thing is.

So I wanted to bring in people that could really. And, and, essentially ask some hard questions too, like, what, what really needs to happen? Where are we really? What? And so we’ve done one episode, we have one coming out in, in a week or so. We’re gonna record a couple more at the annual conference. I have done podcasting before.

I, I love it as a tool and as a way to get the word out. So very excited to see it launch and, um, and move forward. And, the first one got a lot of, uh, attention. So we’re off to a good start.

Maria Palombini: That’s great. I agree. Way.

Dr. Joseph Kvedar: Uh, if I could, I just, um, the one thing that I realized after we launched, uh, I’m, I didn’t pick this up before, but if you wanna find it on Apple Podcast, your, your best to search either my last name, K V E D A R, or health.virtually.uncensored. It’s, it’s, uh, we probably have to change that, but it’s, if you just put in health or health, it won’t come up. So, and you can also find it on the ATA website. So we, we’d love for, have people, uh, rate, review, subscribe, et cetera. And, and thanks, for the plug.

Maria Palombini: Yes, absolutely. I think whenever we can get good information out to our listeners, I’m all, I’m all for it.

So, uh, definitely everybody, you podcast lovers, uh, please be sure to check it out. All right, so we’re gonna get to some good stuff. Why are we here? Right? What are we gonna talk about? It’s really important, so, yes. You know, uh, some have opined or argued that 90 to 95% of healthcare interactions by the year 2030 will be non-face-to-face.

This is pretty significant, but, uh, through our experience or your experience at the ATA in your research, you have written and advocated for making telehealth a permanent part of care delivery by creating a system of omnichannel care that includes both in-person and virtual care. So can you share with us how real this 90 to 95% number can be looking at some of the continued challenges, which I know you’ve written about as well, having with payers and disbursements, this confusion around policy and overall, not a very comprehensive rate of adoption from patients?

Dr. Joseph Kvedar: Yeah, that’s a great question. So, I guess I’d start by saying 90 to 95% seems quite aspirational to me. And, and I’ll quickly add that, I’m not sure why people aspire to numbers like that, right? Mm-hmm. The answer should be what is the right way for you as a patient to get your care in the moment? If it is the best way for you to get your care is through a chatbot.

Or through an urgent care facility If for a video visit you, you early referred earlier to remote patient monitoring, um, the point is you should have access to all those channels, and they should be, um, you should be using the one that best suits your need at the time. I, I don’t know why anyone would aspire to have 95% of our care delivered virtually.

Um, there, there are times when. Patients and or doctors really want to see you in person. There’s a reason why that’s special too. So it has to be balanced. Um, and I don’t know the right number. It’s interesting. I follow the Fair Telehealth tracker, um, which tracks the percentage of healthcare claims. Um, and it’s about 5% now of all claims or telehealth, just for quick comparison, before the pandemic about 0.2% were, were, so it’s, it’s been significant, it’s been consistent, uh, uh, for at least a year and a half.

Now that it’s about 5%, again, I don’t know if that’s right. That might be low, but 95% might be high. And either way, I think what we want to do is figure out. The best way to deliver care is, as we’ve said, telehealth is about access. It’s about efficiency, it’s about quality, and you as a patient have to be cared for in a high-quality way no matter what channel you use.

Maria Palombini: Absolutely. I think it’s really important. Uh, and I think it’s a good point. It’s like, what’s the best model that works for you, and what do you need to get? So totally, uh, an important point to get across. So, uh, getting, talking about access and obviously making sure people can have access to, to care. You know, we all know that there’s an inequity in the traditional healthcare system of care and delivery that has carried over naturally to the telehealth domain.

Many have argued that it’s. Simply because rural and marginalized populations don’t have adequate digital access infrastructure to use telehealth or digital health services. Would you agree or disagree that if the global community came together and just said, Hey, we’re gonna fix this issue of lack of digital access, would we really solve the problem, and would they, the patients utilize the telehealth system or maybe is the problem a bit larger and complex?

There is an issue of trust that seems to always fly under the radar, like trust, um, by marginalized populations in the healthcare system. I know this is a major area of interest to you in, in the work, in the research you have done. So maybe in your perspective, how can telehealth bring some trust into the healthcare system to mitigate this issue of inequity or fear of utilizing the technology and these services?

Dr. Joseph Kvedar: Well, well, Maria, let’s unpack that a little bit. There’s a lot in that and, and you sort of answered your own question in a way that, so, so the first, the first part is about, uh, extending broadband. Let’s pretend that we had a magic wand and we could put broadband in everywhere. Uh, you’re quite right that that is a step.

It’s necessary, but not sufficient. It’s not gonna solve the problem without it. It’s hard to solve the problem, but with it, the problem still may exist. Trust is part of it. Uh, digital literacy is part of it. Affordability is part of it. Um, and so the Ata I, I’m quite pleased with our, our CEO, Ann is a wonderful leader, and she pulled together, uh, over a year ago, a group on diversity, equity, and inclusion and telehealth to tackle this issue.

Because as much as people might say that telehealth and you, you cited a study earlier, um, Led to some inequities. We would argue that it could be a digital divide-crossing tool if employed in the right way because again, it extends access. And so many of those individuals we’re talking about could be urban, could be rural, doesn’t necessarily mean.

But having access, if you gave it to them in a way that was, uh, acceptable, uh, uh, would, would be I think an exciting thing. So that’s one thing we’re working on in terms of trust, you know, you’re quite right. I’ve, I’ve been thinking about this. I actually just published a blog on it, and I intend to talk about it at the annual meeting coming up in about a month that you referenced.

Uh, when I started out, I used to bristle at, at, uh, folks saying, um, Well, I guess this, this new technology that you’re talking about would be okay for a, for a patient who didn’t have access to a real doctor. Um, and I would get so annoyed at that because of course I was a believer from day one and an evangelist and trying to say, not only is it good for rural, it’s good for urban, it’s again, it’s another channel.

It’s not perfect, and it’s not the only channel, but it’s another channel. So, Um, that signaled to me early on, and I didn’t really articulate it this way, but it signaled to me that there was this sort of lack of trust that somehow, and it still exists, uh, there are many layers to it, but that somehow when you use a virtual channel to deliver a service like this, that, that there’s a, uh, an erosion of trust could be because.

You know, the old adage, no one knows you’re a dog on the internet, right? It could be because there’s an un sort of lack of familiarity on the internet. There’s a, there’s a randomness to it. Um, I often tell the story of a doctor who I was told by a friend, so I, I assume this is a true story since, but a doctor who took.

Uh, a video call with a patient with sitting on the beach with no shirt on, you know that individual, a man mm-hmm. Would never go to the office, I think with no shirt on. Right. Why, why do people feel like they can do that? So, I know I’ve been babbling a bit. There’s a lot to it. There’s a lot to uncover and trust, and again, it’s something that we’re gonna be focused on in 2023 at ATA.

So looking forward to unpacking and peeling back the onion and trying to fix it.

Maria Palombini: Hmm, absolutely. I think just overall anything trust in an internet or virtual environment, you just can’t help but have that complexity around it. Um, we see it in every, obviously, healthcare is naturally an area, but we see it in every other industry as well.

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Okay, so healthcare, consumerism. We as patients are consumers of healthcare, and there’s just been this theory of discussions, research papers more recently, and this idea of patients being empowered, uh, to take the driver’s seat of their health data and care, um, especially now that more and more they’re expected to pay out of pocket, um, for their services.

And a great deal of this is fueled by the convenience of the telehealth experience. We know where patients are, likening it to an online shopping experience. I mean, Giving your work, um, what is your perspective on this topic? Um, do you envision maybe a future with a full swing reversal where patients are completely in the driver’s seat, like complete medicine being, you know, patient-driven, um, and commanding that retail-like experience where they’re no longer waiting 30 minutes to see a doctor?

It’s like, I’m here, you service me now. Concepts, right? There’s like all this discussion, um, taking the full ownership of their healthcare, I mean, Where do you think telehealth kind of plays the, the best role in this mind shift?

Dr. Joseph Kvedar: Well, you know, this is another great, uh, thoughtful question I, I reminded of, of, uh, again, back, back in the day when I started, uh, doing this, uh, another trend that was, was happening early in, in my, in my career of, of, uh, telehealth was the trend of patients, um, looking things up on the internet.

And at the time, a lot of doctors kind of blanched at that. People would bring in printouts, To the doctor and the doctors would get very upset with him. Uh, we u at that time, we all sort of felt like, what, what’s between the patient and me? Is that big thick textbook on the shelf? My education, my, uh, use of a certain linguistic when I talk.

Uh, all of that sort of creates, um, a little bit of mystery around the role of being a doctor. Uh, and, and so some of that still exists. And I think it always will, like, you know, there are some professions, if you need an attorney, you need an attorney. I don’t, unless you’re trained as an attorney, it gets to a point where you, you need that expertise.

Unless you’re trained as a physician, at some point, you’re gonna need my judgment, and it’s citizen science that can only take us so far. But with that said, I think we are in an era, and increasingly where patients are in the driver’s seat. They’re voting with their feet on various types of health plans, whether it be virtual first or uh, et cetera, where they feel like if they need a certain service, they’re gonna get it.

And the other example I would give on this is all of these, uh, I would call ’em maybe carve-outs, but, but services like, uh, where you could get birth control filled on, on a, uh, website or you could get your, um, Uh, erectile dysfunction medicine on a website or there, there’s again, many of them, a lot in behavioral health.

And the idea behind those is simply pointing out that there’s a market need for, to make certain, what I call transactional services. You don’t need to get birth control filled. You, you don’t need a whole lot of relationship with a doctor. You just need to make sure it’s safe, and you get the prescription.

And, um, there are those snippets of care. If we as traditional healthcare providers were providing the service in a way that suited everyone, those companies wouldn’t be succeeding. So they’re meeting a market need, and I think we have to look at it that way and rethink how we deliver.

Our services. So again, long-winded answer, we’re, we’re in the middle of that journey. We’ll never get to the point where it’s totally like retail, I don’t think. Mm-hmm. But we are going towards a place where patients have much more control, and that’s a good thing.

Maria Palombini: Absolutely. And just for our audience, if you notice Dr. Kvedar said rethink. So it is an important part of our process in the healthcare system. There you go. Alright, so as you mentioned, and we talked about the annual ATA 2023 conference is upcoming in a couple of weeks, uh, from March 4th to the sixth, and obviously it’s gonna be in San Antonio. Um, and you also just mentioned a few moments ago that you’ll be presenting an important keynote on the value of building trust in the telehealth system.

But also the ATA is celebrating an important milestone. It’s 30th anniversary, which may shock some of our audience to know that telehealth has been around for more than 30 years. Um, so maybe you can share, um, your perspective on this important milestone. How much has changed? Obviously being an early pioneer and obviously seeing the evolution and really how much has been realized that was originally predicted versus what has really come to pass.

Dr. Joseph Kvedar: Yeah, again, love the question, and I’ll be, I, I promise you and your listeners that I won’t be, be too, sort of reminiscent of the good old days. Um, but one of the things I like to use as an analogy when this kind of question comes up is, and if you’ve seen the original film Blade Runner. Uh, there’s, there’s a lot of interest in that.

So that film was shot, I think in 1980 or so. Mm-hmm. And, and it allegedly took place in 2020. So, uh, at the time, that was 40 years in the future, we had things like flying cars that, that hasn’t come to be, but, but there was a scene where, uh, uh, the, the main character has a video conference, and what I find fascinating about that is, They got the video conference part, right?

But he went to a payphone to do it. Uh, there was no notion that you’d be carrying this thing around in your pocket that had a network, uh, video, uh, uh, storage, all of that rolled in, you know, photography, all that rolled into one tiny device. So those are some of the things that I think really have changed the world, the I, the iPhone and.

And the interface that Apple created, which of course was immediately adopted by Android, that sort of changed everything because it made it easy for people to interact with this tiny computer in their hand and do all these things. And we just don’t even think anymore about how important mobile is.

Search was a similar kind of advance, uh, just having browsers and being able to do work through browsers. Uh, having software in the cloud. I mean, there are so many examples, and I think in the last 10 years, wearables, uh, as well and, and the connectivity and the feedback that wearables give you. So that’s, that’s a little bit of a game-ish.

I’ll, I’ll give you that, but, but when I look back at the beginning and what’s funny about it was at the time, any, any point along the 30 years, what we, we thought we had. The right technology to do the job. And typically in healthcare, we’re always behind the technology. So, you know, in the beginning, we had these big, two, two companies were, were, uh, prominent VTEL and PictureTel, these big CRT displays with big, uh, codex underneath them, $70,000 a pop.

You had to run three ISDN lines. It was a nightmare. But we thought that was great and people did it. Uh, and again, 30 years fast forward and you’ve got it in the palm of your hand. You can connect anywhere wirelessly, and it’s different worlds. So all that said, it’s been remarkable, and yet as you and I have said, telehealth isn’t probably where we need it to be yet.

We still have a long ways to go to get it in that proper omnichannel world that we’ve talked about, and we look forward to, uh, those challenges and getting ’em right as time goes on.

Maria Palombini: Absolutely. I think it’s, uh, continuously evolving and emerging, uh, technology and domain. So, uh, I think we’re getting ready for this conference, right?

I’m gonna be there. I’m looking forward to it, but, uh, maybe from your side, you can share with our audience who may be coming, who may be thinking about coming. What are you, what are some of the technologies or issues or areas that you think are going to be covered at this series conference that maybe people, something new that maybe people should be like maybe keeping their eye on anything that maybe is caught your eye so far?

Well, I can’t necessarily speak to new technologies only because they show up on the exhibit floor usually, or, or in some of the research. Uh, we do have a very strong research track with posters and presentations, highly curated. Um, we have a lot going on on the exhibit floor in terms of. Uh, uh, supplier presentations and, and new things going on, trying to attract a lot of, uh, early-stage companies to show their wares as well.

And we have an innovators challenge, so there are a lot of ways, to get new stuff in. Um, but some of the themes, one of them is going to be, uh, this has been on our minds for two years, and it’s, or three, and it’s, uh, not going away, which is just extending. All of the regulatory environment is in the right direction to allow us to keep delivering this care.

Uh, we now have a window till the end of 2024 for most things, but because it’s an election year, we think we’re gonna really have only a year to try to get that, uh, extended further. So that will come up. Um, you know, this idea of omnichannel comes up, and that’s gonna be. Uh, a prominent one. We have an executive invited session for a whole day where people are gonna talk about, uh, you mentioned, we both mentioned, um, excuse me, equity, equity is a big focus of ATA So, so those are some of the themes. Again, it’s, uh, it’s a little bit like a com, uh, like a street, uh, uh, fair. There’s so much going on in a good way. So come learn. Meet people, um, in, in San Antonio is, is just a lovely place.

Maria Palombini: Absolutely, especially this time of year. Um, so, uh, you know, we’re coming through the close, and you know, Dr. Kvedar you have already given us so much insight. Um, perhaps you can share with us one final parting thought, um, and with our audience, share with them, you know, maybe something when it comes to the challenge, the issue. The need to gain wider adoption. You know, I think, um, these kinds of challenges take a village.

I don’t think no one person or one group can solve ’em. So, you know, what can we do as a technologist, a researcher, clinicians? Mm-hmm. Um, or any other, someone who’s committed to seeing the process, you know, become more trusted and ethical and equitable for all.

Dr. Joseph Kvedar: Sure. I thank you for the opportunity.

I, I mean, I, assume, that the IEEE audience is going to be people who are keen on innovative technologies, and my message to those folks usually is to simplify as much as possible, get, get as much feedback from end users in your, in your dev, um, development as possible. Unfortunately, when we have engineers devise.

Tools that other engineers, like, sometimes they don’t go as far in the marketplace as quickly as, as we might like, because people are, they’re, they’re, that’s, those people are really smart, and most of the folks they want to design for aren’t as smart as them. So just be really thoughtful about making things, uh, easy to use, intuitive, um, and exciting.

Uh, I think there’s a, you know, this technology nowadays, whether it be wearables or. Other, uh, apps, et cetera. The ones that are winning are ones that people just delight in using. And, uh, and I think we can make healthcare delightful in, in that way.

Maria Palombini: Absolutely. Um, so thank you, uh, Dr. Kvedar for joining me today. Um, this has been a really, really insightful conversation.

I wanna thank the ATA for collaborating with the IEEE Healthcare Life Science Practice to bring this special season five of Rethink Health, um, to you, our global audience. Um, you can learn more about Dr. Kvedar and his research, his blogs, they’re all available on, um, joekvedar.com and I’ll spell that for you all joekvedar.com. Just for all of you out there. Many of the concepts in our conversation today, um, are addressed in various activities throughout the IEEE Standards Association, healthcare, life science practice, and its, you know, standards and pre-standards, um, programs. The mission of the practice is to engage multidisciplinary stakeholders around the world, to have them openly collaborate, build consensus, and develop solutions in an open standardized means.

Um, we have activities such as wearables and medical IoT, interoperability, intelligence, and transforming telehealth paradigm industry connections programs, which are really addressing the many things around equity, accessibility, feasibility, privacy, security, interoperability by design, all these challenges we’re seeing, um, pervasive in our healthcare, uh, in our telehealth system.

If you wanna learn more about all of the activities, visit ieeesa.io/hls. So a special thanks to you, the audience. Uh, we invite you to share this podcast with your colleagues and networks to help get this information out, um, to those who want to make a difference and contribute to overall better healthcare.

We wanna thank you for joining and keeping doing the great work you are doing to improve our healthcare system. Be sure to tune in to our other episodes of season five, in which we’ll have some exciting speakers, um, from 2023 at the annual conference. Um, stay safe and well until next time.

Today is another day to dream big and bring new designs and ideas to life to support the growing need for telehealth services and technologies across the world.

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Maria Palombini
Hello everyone and welcome to the IEEE SA Rethink Health Podcast Series. I’m your host, Maria Palombini, Director of the IEEE SA Healthcare and Life Sciences Global Practice. This podcast takes industry stakeholders, technologists, researchers, clinicians, regulators, and more from around the globe to task. How can we rethink the approach to healthcare with the responsible use of new technologies and applications that can afford more security protection and sustainable equitable access to quality care for all individuals?

We are in season four of the podcast series. You can check out our previous seasons on ieeesa.io/healthpodcast.

As we all know the result of the recent pandemic, the term telehealth has become one of the most frequently used ones, and it does not appear to be going away soon. The reality is the way we see telehealth today will look very different tomorrow. It’s manifesting in many different forms. It’s more than what we commonly see as a doctor/patient exchange on an audio/video platform.

It continues to grow, especially with RPM devices, Remote Patient Monitoring devices. The telehealth experience has changed the patient’s expectations on healthcare services. They’re relating it more to a concierge level, online retail experience: convenient, appropriate, and personalized.

And then there’s this growing RPM space. There’s so many different forecasts when it comes to RPM. Anywhere from U.S. 150 billion dollars by 2028 to estimates that 40% of patients will utilize one or more of these types of devices at one given time. But here’s one thing for certain, regardless if we’re talking telehealth, mobilized health, RPMs, the future of delivering healthcare is not confined to a facility and it will need to be patient-centered.

So season four, of this podcast series, Telehealth’s Quantum Leap into Patient-centered Care, talks to the innovators. These are the winners of the IEEE SA Telehealth Virtual Pitch Competition, the industry leaders, clinicians, and other researchers who are at the forefront of driving innovations with solutions on accessibility, human factor design, flexibility, interoperability, security, inclusivity, and any other necessary ingredient to migrate telehealth care to a patient-centered care system.

So a short disclaimer before we begin, IEEE does not endorse or financially support any of the products or services discussed by our guests in this series.

It is my pleasure to welcome Sanna Gaspard, CEO of Rubitection, Inventor of the Rubitect Assessment System to our conversation.

Hi, Sanna, welcome to our podcast.

Sanna Gaspard
Thank you for the opportunity. Looking forward to talking to you today.

Maria Palombini
I’m excited to have Sanna here with us! Rubitection garnered the first place position in the entity category of the IEEE SA Rethink the RPM Machine Competition.

So Sanna, before we get to the core of your innovation, tell us a little bit about you. You’re CEO, you’re an inventor of this solution, what drives your passion in your work? How did you get here?

Sanna Gaspard
What really drives my passion in my work is being able to innovate to improve healthcare. I have a PhD in Biomedical Engineering with a specialization in Medical Device Development and Commercialization. I came to that after thinking about being a pre-med to become a doctor and realizing that wasn’t the best career for my personality and what I wanted to do. I decided I really wanted to still have an impact in healthcare, but maybe on developing the technology that doctors use. And so now I’m just passionate about getting the technology out there to help caregivers and patients.

Maria Palombini
I think it’s fascinating because I’ve interviewed physicians who are migrating over to IT and Technology Design because they felt like, well, this is really what I wanted to do.

So we often hear that starting a company in this space derives from some sort of personal experience. Somehow they may have been afflicted, a family member, or something they came across doing university research. Is there a personal story behind bringing this innovative RPM approach to wound care? What was the vision and impact you imagined that it could have for patients?

Sanna Gaspard
So the personal story was really driven more by my desire to want to improve healthcare as a career than personal experience with the condition. I came across a condition while I was in grad school. At the time I was looking for a project where I could develop technology to improve care, but I really wanted to focus on something that was a healthcare problem, that was very common, but being overlooked.

And so when I learned about bed sores and I went and researched it, I found that it was killing like 60,000 people every year, affecting 2 million people per year, but the assessment approach was really still something that was manual where technology could be used to improve that assessment to save lives.

And so that was really what drove me to do that, I wanted to make sure that I spent the time on my PhD doing something that I could translate out to improve care and really address a real healthcare problem.

Maria Palombini
Absolutely. So it’s interesting, we often hear you need thicker skin to survive in this world. And in this case, you just mentioned 60,000 people die from complications due to bedsores every year, people think, oh, it’s just a little condition, but it does take people’s lives. That’s one person every nine minutes, so it’s pretty significant and over 55% of nursing home residents die from bed sores within six weeks of onset of the wound.

We all may have elderly relatives living in nursing homes, this is something we all have to consider. So let’s get to the core of the interview of how this RPM innovation can start to really have an impact.

Can you share the types of research, maybe some modeling in the years that worked, that went into developing this product? What would you say in your research was the most interesting piece of information that came through in this R&D phase?

Sanna Gaspard
The most interesting piece of information I would say was twofold. One, how long the problem was outstanding. There’s comments back to Florence Nightingale and I think even possibly some references in Egyptian literature to these wounds and bed sores. But there was no real solution at the time. And that was partly being driven by legislation and policy partly because a lot of the costs for those wounds was being covered by the insurance companies and Medicare. But as they’re providing primary care and the patient develops a wound, they would still get additional payments for that care. So for me, that was a striking thing that was driving a lot of the lack of innovation in this space. There was a longstanding need.

The other thing that really caught my attention was the importance of correlating the technological platform to the clinical environment and how important that would be. So when I first learned about the issue, I went and researched all the different technical logical approaches you could use like ultrasound spectroscopy ,temperature and tried to match that against the user needs in that environment to see what would be the most appropriate. And I found that really was an interesting exercise in terms of like someone who’s interested in developing tech, you can’t just go and say, oh, I think this is a tech I want to use or the technological platform I want to use to solve this problem. You really have to cross check it around what the users need and how it would integrate into that environment around usability and ease of use. That was a lot of the early work I did that drove the direction of the technology in terms of development.

Maria Palombini
There are many different skin conditions from eczema to bed sores to wound care. How does the RAS system work to identify the abnormality? And at the same time, how can it indicate what exactly is the abnormality? Like it’s a diabetic ulcer, it’s a bed sore, it’s a wound, whatever it may be.

Sanna Gaspard
The Rubitect Assessment System, abbreviated RAS, is essentially a device that helps to assess the skin to identify chronic inflammation or conditions in a dermatology space or in the wound care and surgical space. So in a dermatology space, it could be used for things like rosacea, eczema, eventually, maybe things like skin cancer for early screening and in the wound care space, we’re looking at diabetic foot ulcers, pressure injuries and surgical wound monitoring.

It essentially includes a software system that you can monitor data on and a device that you place onto the skin to make measurements of the skin, to identify areas of inflammation. So you place a device on the skin. It makes a measurement predominantly using optics, and then you get an assessment following that measurement about low, medium, or high risk or gives you a diagnosis.

And you can then share with your primary care physician to get an updated care plan or to understand the next steps in the care plan. Our real goal with that system is to really support effective early assessment to prevent the progression of advanced wounds or to help patients in a dermatological space, either do early assessment to evaluate treatment effectiveness based on the prescriptive treatment that their doctors provided so that they can support care compliance and using the system, or get a new prescription if that product is not working. On the wound care side, it’s catching it early to prevent advanced wounds that can be deathly.

Maria Palombini
Very interesting. So we’re trying to get ahead of the game here.

Sanna Gaspard
We’re trying to get ahead of the game and empower people.

Maria Palombini
One of the key features that you presented in the competition is that the data collected is interoperable with medical health records, which for patients, that’s a great opportunity. How have you seen physicians and caregivers use the data collected about the patient to sort of alter their care, to make it better and how does the data collected actually integrate into their patient’s medical chart?

Sanna Gaspard
So right now, we’re still in R&D. So we haven’t fully launched the product, but when we launch it, we depend on having an EHR integration. From a remote patient care standpoint, the measurements they do at home to provide a risk assessment or to do care planning and management would be sent back to their primary care physician.

Where they would confirm the data, confirm the care plan, and then also be able to save that in the EHR. When using an acute care setting, it would just be an inherent part of the EHR as they’re using the system. The data’s then also stored in the EHR for later data analysis or reporting and documentation.

Maria Palombini
We mentioned nursing facilities and long assisted living facilities. So one of the population sets that this may benefit is naturally the aging population. However, when we think about the aging population, they’re not usually considered the most digital and or trusting of these types of technologies.

What has been your experience or in research, being able to reach this age demographic, to utilize the RAS system, to trust it, to want to use it? What are some of the lessons that you might have learned through this engagement?

Sanna Gaspard
I would say some of the lessons I’ve learned through this engagement oftentimes is that you have to go through a family member or you have to go through their adult child.

Oftentimes their adult child is the person providing care or the nurse is the person providing care. So the main part of targeting this population is going through their care provider or their primary care provider, or the person who’s managing that care. And then basically working with that person to either explain the importance of the problem or how the technology can really help support them in managing that care.

But oftentimes getting access directly to those potentially elderly patients can be difficult, because you really can’t necessarily go to them directly. You have to go find their care provider.

Maria Palombini
Trying to turn caregivers into advocates for the use of this technology in order to help this area of the population.

Sanna Gaspard
Yes, exactly. And finding those caregivers in either advocate groups or finding those consumer targets in a home setting can be difficult. You’d have to go through the primary physician or the primary care provider. Basically go that way.

Maria Palombini
When we think of the pool of patients, it’s more than just the aging, because we’re talking a wide swath of wound care issues, other issues, diabetics. How do you see your technology being patient-centered? And when we talk about patient-centered it could be a point of accessibility, inclusivity, feasibility, adaptability. Is there a population of patients that you can better serve with this technology that perhaps could not be reached or accessed or included before when it comes to RPM opportunities?

Sanna Gaspard
We’re working on a skin health assessment tool that has applications in dermatology, in wound care, and surgery. In all of those fields for patients who have chronic dermatological conditions like psoriasis or eczema and even skin cancer, oftentimes, they would have to come into the office to get an assessment, or they were sending pictures or using really crude technology to try to document their condition to eventually share that with the doctor when they went into the office. Also true for patients with wounds so that when the patient goes home, their family members and caregivers are told here’s the care plan to help prevent this person from getting a wound but then they only see the doctor once the wound develops. So that makes prevention and early detection really difficult.

So really in each of those market segments, we are providing an access to a level of care that wasn’t available before, unless you went into the doctor’s office. So now you can have in-home monitoring to monitor changes in the skin to catch things early, share that with your physician, get an updated care plan, then catch things at an earlier stage when they’re least costly and the easiest to treat.

Maria Palombini
That’s a fascinating point. Because as a caregiver, you call a doctor and how you articulate something is not going right in a medical way. So I think this is a fascinating area because that is one of the caregiver’s biggest concerns. Can I take care of this at home? Am I capable of doing this? How about if something goes wrong? You get all these questions, right?

Sanna Gaspard
Exactly. And then in talking to caregivers in the home setting, another thing that comes up is like, as you’re responsible for that care for your loved one, your parent, your grandmother, maybe even a disabled child or someone with a chronic health condition, you’re trying to do your best to manage the care and manage your life. And when they get something that’s preventable, like bed sore that can be really severe. There’s a lot of guilt and shame associated with that oftentimes because they feel responsible and we really want to just help empower caregivers to understand that without technology, it is really hard to do that early detection and then to empower them to feel like they have the tools to prevent some of the chronic complications of a bed sore so that they can feel confident in the care that they’re providing in managing that care.

Maria Palombini
Absolutely. That’s a great benefit for caregivers out there. For sure.

As a tech startup, would you think of any technical standards, policies, opportunities, or something in place that would’ve made the development of this product go faster, easier. And after going through this process, what areas have you identified would open the doors to innovation in the telehealth space? And in your opinion, what would be the best way to address it?

Sanna Gaspard
One is funding because you need funding to be able to develop the technology. And I think having technical organizations that can support technical founders in getting access to funding or providing funding as investors or grants would be already a great start.

And I think also from a medical standpoint, technical standards around EHR integration would also be really helpful in meeting that HIPAA requirement because there’s so many ways, it’s usually customizable to each person’s technology, but having really clear standards about how you have that healthcare integration with each EMR systems would go a long way. Because all of the EMRs are slightly different, how you communicate with them in their platforms. And so it makes tech development with EHR integration very cumbersome and expensive.

Maria Palombini
So it’s almost like a tech entrepreneur mentorship sort of way of helping tech engineers. One being able to understand how to source and get funding as needed as they’re developing the product. But also understanding what tech guidelines are out there that maybe no one knows about, because we tend to always uncover these things and even say, okay, they’re not existent, but maybe this is something else you can use.

So I agree. I think there could be some definite guidance from people in that role before, and probably can point you in a faster, easier way to get to the answers you’re looking for.

Sanna Gaspard
Yeah, I would agree with that.

Maria Palombini
You’ve given us some really interesting insights, especially when it comes to this whole area of therapeutic on the health side and the opportunity of supporting the caregiver for which we don’t see too often in a lot of RPM devices. What is something that you would like to share with our audience? It is a diverse group. We have technologists, we have people in the clinical field. We have researchers, regulators, policy people, whoever’s listening to this podcast. What would you like to share with them when it comes to really understanding developing technologies under the context of patient-centered care?

Sanna Gaspard
I think the most important thing is that it takes everybody. Technology can’t be created in a vacuum. As someone developing technology, I need access to healthcare providers. I need access to the caregivers and patients to understand what their needs are. In terms of the clinical providers, I need access to them to understand clinical integration and use cases and how to ensure that the device meets usability requirements and also clinical integration requirements. Policy makers usually end up driving things around pricing and large market drivers that affect adoption around reimbursement or medical policies for use or requirements for use in reporting that really end up driving clinical adoption. And also things around regulatory issues like the FDA. So it really takes everybody and there should be really more groups where that brings together a diverse group of stakeholders that technologists can access in one place. So like right now, if I wanna talk to a doctor, I have to go and find a doctor. Then I have to go and find the patient in a different location. And I have to go find the stakeholder from a policy standpoint in a different location. There’s not one place that you can go and get a holistic view of the problem to get the perspectives of each major stakeholder in one setting.

Maria Palombini
I can see that, but that’s also symptomatic unfortunately, of the healthcare system, right?

Sanna Gaspard
It doesn’t have to be fragmented. I mean, people have historical data of their images of their personal life and we can’t manage to get longitudinal data of our own health.

Maria Palombini
That’s a very good point. Sanna, thank you so much for joining me today and sharing all these exciting insights.

Sanna Gaspard
Thank you as well for the opportunity. I enjoyed talking to you, and if anybody wants to reach out, they can shout to me at [email protected].

Maria Palombini
Absolutely. If you guys wanna learn more about the Rubitection Assessment System and about Rubitection in general, you can visit rubitection.com. And you can learn all about Sanna as well and her advisory team and all the other information that’s on there.

Many of the concepts we talked about with Sanna today are addressed in various activities throughout the IEEE SA Healthcare & Life Science Practice. The mission of our practice is engaging multidisciplinary stakeholders and having them openly collaborate, build consensus, and develop solutions in an open, standardized means to support innovation that will enable privacy, security and equitable, sustainable access to quality care for all.

And these are activities such as WAMIII: Wearables and Medical IoT Interoperability Intelligence Incubator Program, and Transforming the Telehealth Paradigm Industry Connections Program. And there’s a whole host of others in Decentralized Clinical Trials, AI, Digital Therapeutics for Mental Healthcare. So if you’re interested in learning how you can get involved or think about instantiating an activity, you can visit our practice website at ieeesa.io/hls.

If you enjoyed this podcast, we ask you to share it with your peers, colleagues on your networks. This is the only way we can get these important discussions out into the domain is by helping us to get the word out. Be sure to use #IEEEHLS or tag us on Twitter @IEEESA or on LinkedIn, IEEE Standards Association.

I wanna do a special thank you to you, the audience for listening in. Continue to stay safe and well until next time.

Maria Palombini
Hello everyone and welcome to the IEEE SA Re-think Health Podcast Series. I’m your host, Maria Palombini, Director of the Healthcare and Life Sciences Global Practice here at the IEEE Standards Association. This podcast series takes industry stakeholders, the technologists, the researchers, clinicians, regulators, and more from around the globe to task, we ask them how can we rethink the approach to healthcare with responsible use of new technologies and applications that can afford more security, protection, and sustainable, equitable access to quality care for all individuals?

We are currently in season four, but you can check out our previous seasons on ieeesa.io/healthpodcast. So we all know as a result of the recent pandemic, the term “telehealth” is frequently used and it does not appear to be going away soon. The reality is that the way we see telehealth today will look very different tomorrow.

And it’s manifesting in many different forms. It’s more than what we commonly see or think as the doctor/patient exchange on some sort of audio or video platform. We look at innovations in RPM, remote patient monitoring. We look at how telehealth experience has changed even the patient’s expectation on healthcare services relating more to a concierge level, online retail experience, convenient, appropriate, and personalized.

And with this growing RPM space, there’s so many different forecasts when it comes to it anywhere from U.S. 150 billion by 2028 to an estimate of 40% of patients may be utilizing one or two of these devices at one time. But one thing is for certain, regardless if we are talking telehealth, mobilized health, or RPMs, the future of delivering healthcare is not confined to a facility. It will need to be patient-centered.

So season four of this podcast series, Telehealth’s Quantum Leap into Patient-centered Care, talks to the innovators, which are the winners of the IEEE SA Telehealth Virtual Pitch Competition, the industry leaders, the clinicians, and other researchers who are at the forefront of driving innovation with solutions on accessibility, human factor design, flexibility, security, inclusivity, and any other necessary ingredients to migrate telehealth care to a patient-centered care system.

A short disclaimer before we begin, IEEE does not endorse for financial support any of the products or services mentioned by or affiliated with our guest experts in this series. And now, it’s my pleasure to welcome Dr. Shayan Vayas, Senior Vice President and Medical Director of Clinical Operations at Teladoc Health.

Shayan was also a judge and advisor on the IEEE SA Rethink the Machine: Transforming RPM into a Patient-centered Care System Virtual Pitch Competition. And he’s also a participant in our Transforming the Telehealth Paradigm Industry Connections Program. Welcome Shayan.

Shayan Vyas
Thank you very much, Maria. It’s a pleasure to be here with you and IEEE listeners.

Maria Palombini
Before we get started to the core of the awesome work that’s going on at Teladoc, Shayan, you started with a successful career as a physician and you transitioned to virtual care and IT design. What was the catalyst for this change?

Shayan Vyas
Being a critical care physician, I’m at the frontline with the team, treating the sickest patients in the hospital. It’s the most vulnerable time for patients and families. This experience taught me a lot about obviously medicine and really the patient experience, but also mortality. As we think about how technology transects patients, physicians, and clinicians, it significantly helps them, but it also can overburden them.

Furthermore, clinical care or even just bedside medicine is a model of one to one. I deliver care, clinician or nurse delivers care one to one and that’s not scalable. Even during my early training, when I was doing missionary trips as a young clinician, I wasn’t well experienced and I was still learning the art of medicine.

I wasn’t typically seeing bread and butter illnesses. And at this time, I really started to begin valuing and using technology. Phones started having the capabilities of doing video visits pretty easily and it’s become part of our everyday life.

That moment when I used the device to be able to call my mentors and my coaches back home during these trips, I realized this could be a catalyst. This could be a transition of how one to one can be one to many; how others can be impacted if I’m in another world, another country delivering care, and I’m able to connect to specialists and mentors back home, how can this affect the patient?

Technology can redefine the world we live in. We’ve seen that with innovators like Steve Jobs, Bezos, think about that with healthcare. There’s gotta be a way where we can take IT design and virtual care and just redesign the world that we live in, in healthcare.

Maria Palombini
Absolutely. I remember we were having a meeting one day in our telehealth group, and you just said something in passing, but it caught my attention. And I remember you vividly saying that tides have turned. No longer is the patient’s health experience like beholden to the times when you go to a doctor’s office and you have to sit there for hours, waiting for them to let you in. Like a patient’s demands are changing. And they want that concierge level experience as they get with retail. So how do you see telehealth overall, trying to meet that changing need?

Shayan Vyas
Patients are patients, but in this context, let’s say the word consumers, right?

So patients/consumers, they’re bringing their everyday expectations from other industries into healthcare. They’re intersecting their experience when they shop online or they stream a movie or even buy an airline ticket into healthcare and other industries. That experience that they enjoy and have the flexibility of doing in entertainment or shopping or whatnot, they’re starting to expect that in everything that they do. When’s the last time the listener actually went to the airport to buy a ticket? When’s the last time the listeners actually went to a store and rented a movie? That haul has changed. Even more, if you’re outside of a very large city, like New York, I’m in now, when’s the last time you actually flagged down a cab or you drove to a restaurant to carry out? Those things, they’ve revolutionized the world we live in. They can be done on an app or a browser. And that same consumer experience is what folks are craving when it comes to healthcare.

Consumers/patients, they don’t wanna wait in waiting rooms anymore. They don’t wanna wait six weeks for their PCP to send them to a specialist. Telehealth is just the beginning of this transformation. It allows that one to many that I described earlier, but more importantly, it’s starting to meet the bend of what consumers are demanding. I think this transformation of healthcare is just getting started. The in person aspects of medical care or going to the doctor will be held for the very few life threatening procedural needs.

I really believe that the tide has changed in that healthcare historically was built around the doctor, my waiting room, my parking lot. You’re gonna go on my terms, it’s changed to the patients. Patients now can schedule visits, they can go and look up what medical school I went to and what my press community score is. They can now shop around and that power is obviously well deserved. Consumers should know where they’re walking into. They have the right to choose what movie they wanna see, they can see the reviews and what others have said about it. The same thing should be in healthcare.

The tides have changed.

Maria Palombini
Absolutely. I think we get caught up in everything and sometimes we don’t realize that because innovations are coming out so fast, we lose sight of some of these things.

So Teladoc is one of the top 10 telemedicine companies founded in 2002. There’s rankings all over on the internet, but it’s always in the top 10 and that’s 20 years ago. The world really wasn’t talking about telehealth, nowhere near at the level we do it today and it’s actually only the publicly listed telemedicine company. So obviously the pandemic catapulted, the use of telehealth out of necessity. However, Teladoc was already on its way.

Do you find that Teladoc’s success is founded on its principle, that it’s a patient-centered platform?

Shayan Vyas
Absolutely. 20 years ago when Teladoc started, our physicians were actually breaking the law. We were taken to court and we ended up counter suing my home state, the board of medicine there.

And we changed the way society and law looked at a physician and a patient relationship. We did that because it was all about the patient-center. We wanted patients to have access to healthcare 24/7 without having to leave their home. In my mind, that ruling and the fundamentals of our company changed the balance of the physician “owning” the individual patient.

And it allowed now the patient to really understand and own their journey when it comes to healthcare, their choices, their flexibility. This is a transformation in not only just the law, but medical economics, and the fundamentals for consumers, obviously that propelled us to be the first publicly traded company and really the largest virtual company in the world.

It’s all about the patient. We have to deliver high level quality care. That’s an expectation that is a basic need in healthcare. Patients deserve to get the highest quality of care, but changing the principle around and delivering a platform that the patient can control was fundamental.

Maria Palombini
I think often we see innovations coming out and it’s all about, oh, the next best shiny thing. And it can do this and that, but we lose sight that we’re still serving the critical need of the patient. And I think this is really interesting. So for all you out there, Telehealth Doc, this was just released publicly. They signed a partnership with Northwell Health. And for those of you outside the New York Metro area, Northwell Health represents, one of, I think, New York’s largest healthcare provider. And the goal is to better provide access to virtual care across its enterprise. So we definitely focused on the patient, but one of the things, when we think of telehealth services, we think it’s easy, right. You just plug into a platform, turn on the mobile device and let’s connect and, obviously have the doctor/patient experience.

What are the considerations for the workflow from a physician’s perspective that must be changed to accommodate this transition to virtual care?

Shayan Vyas
A comment on Northwell, they have one of the greatest CEOs in the healthcare world ever. Very great organization. Over 18,000 physicians. They’ve been practicing telehealth for a long time.

When it comes to accommodations to transition to virtual care, there are multiple consumers that are using the platform. There’s the health system. So the administrators from the health system need to have data. There are physicians and now nurses and all kinds of clinicians are working. So we’ll use the term clinicians and then there’s the patient. There’s the IT team.

And so all of these consumers need to be thought of. So when we first started out, as mentioned previously, we built a platform really around the patient, but now there’s multiple end users that need to be thought of. You gotta think about those that we just mentioned. And in terms of thinking about how to transition everything to virtual care, the bar to virtual video visits is very low.

There are many ways to do a virtual visit now. You can do it essentially for free now with any app, to connect with grandmother or to connect with colleagues around the world. That bar is now very low. Everyone has a video platform. The bar to scalability is very hard. The bar to interoperability within multiple EMRs.

I think Northwell has 22 hospitals, 830 facilities, the integration in and out of the firewalls and in all the data systems that they’re using, that’s the hard part. And then when you multiply it, we have over 600 health systems around the world that we work with.

That is really hard in terms of just the individual physician’s perspective to replicate the in person experience or has to make it much easier.

Physicians are wasting a lot of time today with stuff that is not really adding value to the patient, the care they’re delivering, or even the ROI that the health system is investing in. And so when we think about adding video conferencing, it’s not just that. You have got to amplify the ability for folks to be able to practice at the highest level of their license.

Maria Palombini
It’s very interesting that you mentioned that because I was talking with Dr. Keith Thompson, who’s also part of the Telehealth Program and he said almost the exact same thing from a clinician perspective. As doctors we’re getting in all this administrative action outside of actual care action, helping the patient because of all these changes in workflows. And he was saying that this is where it’s really important to understand what the doctor needs to focus on and what the patient needs to focus on. And then let the experts handle all that other stuff.

Shayan Vyas
Here’s the reality, right? As an intensivist, I have a different perspective than an ambulatory physician, but even as an intensivist, I spend maybe 10% of my time at the bedside. The other 90% is I’m a data clerk. I’m entering data into an accounting ledger. It’s not making patient care easier. It’s not making the care safer.

It’s really a billing machine. And when you talk to my ambulatory colleagues, they’re doing the same thing, right? They’re spending minutes. I think that the average family practice doctor spends eight minutes with a patient. And they spend 30 minutes just charting and documenting and clicking here and there. As a consumer, I would rather a clinician spend 30 minutes with me and then the eight minutes doing the charting that adds no value to the system, but is where all the money and the transaction occurs.

Maria Palombini
I’m sure patients would agree with you 100% on that point.

So as we move towards greater adoption or use of virtual care, more acceptance, how do hospitals best negotiate the balance of patients expectations for home care versus hospital facility care? They are significantly different, but we still have patients’ expectations when they’re not doing well. So how does that balance work out?

Shayan Vyas
Maria, this is a great question. So let’s take a step back. The origin of modern day telehealth started really with employers and health insurances. They wanted to figure out a financial way to lower the delivery of care. The emergency room versus a telehealth visit is significantly cheaper for everybody. Significantly easier if you can get your symptoms and your illness resolved that way. That’s really where it started. It was really around the payers. Regarding hospitals, they get paid for beds and heads. It’s a very common term. We’re in a fee for service world. And the best way to get paid is when you have a head inside a bed.

When you look at health systems like Northwell Health, Kaiser Permanente, Intermountain, they have moved out of this fee for service world where they no longer are getting paid based on every procedure they do. The fee for service industry itself has plagued healthcare. You go to a surgeon, they’re gonna operate on you because they get paid that way.

That’s the way the model was. There was no value incentive for a surgeon not to operate on you. And so as we move from this fee for service world and to this value based world, that’s where we start to move the needle. The financial incentives now to actually do what’s in the patient’s best interest, try to deliver on this expectation that consumers or patients have in home care versus hospital care.

That’s where we start to see the needle move as more and more health systems start to develop MA plans and they start to take financial risk. They’re starting to think about how they can move away from bricks and mortar care to virtual care. That’s easier for everybody, it’s cheaper for everybody. And that’s how it’s gonna happen.

I think health systems are gonna have a hard time to be honest, trying to deliver full based virtual care when they’re fee for service. It’s not the same. It’s dollars to pennies when you meet in person versus you see me in virtual, in that fee for service world, but in that value based world, as long as I deliver the care, no matter if it’d be virtual or in person, delivering that care is what it’s at.

Patients are expecting that virtual visit when they go to the doctor or they have a surgery and they wanna do that visit. It’s a standard that a patient expects. But again, there’s a balance of getting paid and when health systems and physicians are getting paid more in person than virtual visits, then that’s a challenge.

It’s hard to move the financial needle that way. But as health systems and CMS are starting to push really for this value based care will really exponentially propel telehealth and virtual care.

Maria Palombini
I think that’s a really important transition that I think the whole industry needs to better evaluate and keep an eye on. I often say, and I talk about this with many different volunteers here at IEEE SA about the future of telehealth looking very different than it does today. And as a physician, why is it important to embrace the migration towards virtual care? The idea of bringing healthcare outside of the facility to the home and can it really improve patient outcomes? Can it actually better serve patients across the board?

Shayan Vyas
Before virtual care or even telehealth or remote patient monitoring, the standard for any of us was to go into the doctor, the bricks and mortar doctor. What did we learn from that? We learned that those that had access got better care. The proof is here. Everyone knows about DNA and genetics and hereditary diseases. Today 60% of health outcomes are determined solely by one thing. Do you know what that one thing is? Zip code.

Maria Palombini
Interesting.

Shayan Vyas
Not your DNA, not how long your parents lived, not the cancers that are in your family, but zip code is the primary determiner of your health outcome.

That’s fundamentally flawed. For those that live in a poor area, rural area, those determinants, what we call social determinants of health, access to fresh groceries, clean food, all of those things, high education, good paying jobs. Those are all social determinants of health, but when it comes down to access and one’s health, it was zip code.

And so as we think about this migration of virtual care, no matter where you live in this country, no matter where you live in this world, you can get access to Mayo Clinic. You can get access to. Kaiser to Northwell to all of these health systems. And that’s changed the game when it comes to access.

As we think about this embrace migration towards virtual care, I think that patients are gonna get better outcomes. That’s just the start of it. So there’s factors out there like the digital divide, not every American has access to high broadband, but those are being addressed. When we think about 60% of one’s health is determined by just your zip code.

We can change all that with virtual care.

Maria Palombini
Wow. Just the zip code. It’s so astonishing to think about. And I think this leads to my next question on health equity. Especially as there are marginalized populations without access to healthcare for a whole myriad set of reasons, but telehealth technically should reach those who are the hardest to reach. So in your view, how can telehealth equitably reach the patients who are currently not included in the healthcare system? What do you see as some of the challenges that need to be addressed so that telehealth could be a viable platform to close this healthcare gap?

Shayan Vyas
I think this is the golden question that a lot of CEOs, health systems, and those in the ecosystem are trying to address. We mentioned one of those barriers is zip code, but also the digital divide. Almost two out of 10 Americans don’t have access to broadband. Telehealth equity needs to address that.

It’s one of the main reasons that we merged with Livongo almost two years ago. Livongo was the first publicly traded chronic disease management company. What made them very successful and continues to help us grow is that all of the devices within that are sent to the patient doesn’t matter if they have access to broadband or not.

Why? Because they’re cellularly enabled. There’s cellular chips in the device, right? So glucose is checked for diabetics. The glucometer is the device that actually checks the glucose. Those devices have cellular chips in them. So we are automatically connecting these patients no matter where they are cellularly.

As we think about those that don’t have access. You gotta design it. We’re talking to the future entrepreneurs, engineers of the world. You have got to think of the basic connecting blocks when it comes to patient care. And so that was an MVP. Livongo started to make sure that the devices were all suddenly connected.

When you think about the scale of what we do at Livongo, we are now able to predict what folks’ glucoses will be, or predict mental illness for patients. And so, that’s the full spectrum that needs to really be addressed when you think about a viable platform that can help close the healthcare gaps.

Maria Palombini
I think that’s really interesting and I think you started the segue to my final question. You’ve given us so many great insights and talking to you is always an educational experience.

Any final thoughts, Shayan, about what you would like to share with our audience as it comes to really developing virtual care technologies under this context of patient-centered care; maybe it’s a call to action or a call to think about innovation in a different way.

Shayan Vyas
First off, Maria, thank you. I appreciate the invitation. I hope so far that it’s been insightful for your listeners.

Here’s my call to action or innovation: spending in the United States’s Healthcare System doubles every 13 years. The healthcare industry today is over 3 trillion (U.S.) dollars. If we continue, we’re gonna destroy the economy. There will be no social security, no retirement, the investments that we’re trying to make in our infrastructure, in our children’s lives, that will all be robbed to pay for healthcare. And so we have got to jump on this. I’ve never been more excited about healthcare and innovation. I’m excited. I believe in Moore’s Law, that technology dramatically increases in power and decreases in cost and that’s what gives me hope.

As you and I continue to age and when we get sick one day, we would love that technology to be “Uber” easy, right? Travis Kalanick with Uber, Elon Musk, Jeff Bezos, and Steve jobs- they were able to transform the world we live in into just a new experience that 10 years ago, we wouldn’t have even experienced.

I remember my mom would tell me, don’t get into somebody’s house that you don’t know. We do that with Airbnb. My mom also told us not to get into a stranger’s car. Now we’re calling strangers to pick us up. And so if you think about how those transformative leaders really recreated the world we live in, I’d love for your listeners to stay curious.

Think about equity when it comes to all people and don’t accept the status quo. The way we do something today is not okay. Think about how you can transform the world. If you stay curious and you have that open mindset that you want to help everybody, not just the financially well off, and you really challenge what we do, why we do this today, don’t accept those things.

So I hope that’s motivation and I’m looking forward to watching IEEE help a lot of startups and entrepreneurs. And I appreciate the opportunity. Thank you, Maria.

Maria Palombini
Thanks, Shayan, this has been really great. It’s really interesting you mentioned aging. We just started an activity for telehealth around robotics to support the aging, healthy, and assisted living for the exact same reason. I think we are expecting our aging population to outpace our younger generations, for sure.

Again, special thanks to you, Shayan, for joining me today, it’s been an absolute insightful experience.

Shayan Vyas
Appreciate it. Thank you.

Maria Palombini
And for all of you out there, if you wanna learn more about Teladoc Health, you can visit teladoc.com

Many of the conversation concepts we had here today with Shayan are addressed in various activities throughout the Healthcare Life Science Practice. The mission of the practice is engaging multidisciplinary stakeholders and have them openly collaborate, build consensus, and develop solutions in an open standardized means to support these goals around innovation that will enable privacy, security, and equitable, sustainable access to quality care for all.

Programs such as Transforming the Telehealth Paradigm, WAMIII, which is Wearables and Medical IoT, Interoperability, and Intelligence, and a whole host of other things on Decentralized Clinical Trials and Digital Therapeutics for Mental Healthcare.

If you wanna learn more about these projects and all these different activities, you can visit our practice website at ieeesa.io/hls. If you enjoy this podcast, we ask you to share it with your peers, colleagues in your networks. This is really the way we get these important discussions out into the domain is by you helping us to get the word out. You can use #IEEEH LS or tag us on Twitter @IEEESA or on LinkedIn @IEEE Standards Association when sharing this podcast.

I wanna do a special thanks to you, the audience, for listening and continue to stay safe and well until next time.