Journal is dr. Joseph kvedar, the president elect of the American Telemedicine Association. Dr. Kvedar, thank you for being with us. Tell us the mission of your association and the members you serve. Guest i am delighted to be on with you this morning for such an important topic at such an important time. The ata was formed almost i think 27 years ago, and really the mission is to both educate and advocate, really, for a new model of care delivery, which is enabled by communications technologies. Im sure we will talk about what that means. The members are from a variety of sectors. Folkse a robust group of who supply technologies and services to the industry. We have a number of quite a few Health Care Provider organizations like my own Partners Health care, mass general at womens in boston. Some of the health plans and folks at the payment industry as well. Thatis largely the groups encumber our membership. Kvedar, joining us this morning to talk about telemedicine, telehealth, use of the association. Explosionever seen an and interest in your field like you are now. Quite extraordinary from many perspectives. Yes, it is our time to show the world what we can do, and the concepts themselves really are not new. My predecessors at the mass general in the late 1960s were some of the first to do this work out of necessity. Using a microwave link to connect the hospital with a clinic at the Logan Airport at that time. And coining the term telemedicine in the late 1960s. Of course, it was largely a curiosity for many, many years, or something that we studied. We studied how it could impact care delivery, we started how it could impact the financial aspects of care. Obviously well, maybe not obviously, but there is an enormous opportunity to extend access with this approach to this kind of care. That is not new, but it is more apparent because everybody set everybody has to stay at home. Host perhaps one of the most obvious methods of telemedicine are like we are doing this morning, speaking by video, perhaps telephone, with your doctor, with your health care professional. What are some of the areas that term telemedical evidence integrally with the pandemic under particularly with the pandemic underway, what has it moved into . The ability to deliver care when the patient and the doctor are not in the room at the same time that can be a video. It could certainly be a telephone call. Pandemic, all of our telephone calls were done as part of routine care and not thought of as extra service. During the pandemic, we are doing phone calls as visits. The exchange of information, the way i like to the analogy i like to use is an email versus a phone call. You and i are talking real time. We are both tied up in time. We are separated in space, but there is some value in that. There is also valuable there is also value if we were going to change us Just Exchange messages through text or email. We do not do text or email for the patience because it is not secure, but we do Exchange Messages over patient portals and other secure platforms, and that is part of telehealth for sure. I am a dermatologist, so you could send me an image of a skin lesion. I have a couple patients later this morning that i will do visits that way with. I look at the image and i respond. And then there is this two other things i would mention. One is the idea you have monitoring chronic illness patients with sensors, things like Blood Pressure cuffs, weight scales, in some cases activity trackers, that are all internet, backhe to the electronic record so that the doctor and the patient have a constant history of the persons how the persons illness is responding to treatment. That can be extreme the powerful. And then there really are a fourth segment of which is more upandcoming, things like chat bots, which i dont really like the term because it sounds very foreign. But these automated chats you can get into with software, and it turns out with screening for a coronavirus for instance, it to anery minimal algorithmic series of questions that you might ask anyone driven by software. Starting by you having interaction with software, something that looks like a chat, and then if you have certain answer if you answer certain questions certain way, you could get triaged to a human being quickly. Ngs like that sorry Artificial Intelligence falls under the same rubric. We maybe will not talk about that today. That is pretty cutting edge come up with the idea of using Artificial Intelligence to guide Health Care Delivery could be part of telehealth. Host i have seen that chat but in health insurance. They say they actually sent out a link where you could engage too, as Program Online you said, scan for coronavirus patients. Our guest is dr. Joseph kvedar, a harvard professor at the medical school there, the president elect, the American Telemedicine Association. We welcome your calls, your comments, especially if you are interacting with your medical professional, your doctor this way during the pandemic. Line for theis the eastern and central time zones. Mountain and pacific, it is 2027488001. And for medical professionals, that line is 2027488002. Another thing i have noticed, dr. Kvedar, is my own medical practice, my medical professional is regularly sending out now chats online, zoom chats with professionals, other doctors in that practice talking about not just the pandemic but other things revolving around until health, safety, and things like that that we certainly did not see before from a practice like that. And wewell, it is true, talked a little bit earlier about telemedicine being very clinical and very specific to delivery. Health care but the term telehealth was coined probably around 25 years ago when people realized the same technologies could have other uses in health delivery, such as education, such as other ways of using the same tools. Telehealth is a broader term ist we pretty much now it the term that we use. And indeed, we can use these p t video platforms for these sorts of things. The other revelation we find and it is really not a video platform that we use, but through our electronic record, we have the opportunity for specialists to guide our primary care providers at our organization as they it is what we call teletriage for short. The primary care provider could put in, say, an image or a data point and a certain image history about the patient, and a specialist will answer that usually within 24 hours, guiding them about where they need to get the care, and of course before the pandemic, it was largely a triage do you need to come in the office or not . Now we have broadened that quite toward tools that deliver care. That use of technology has been extraordinary for us. We have been able to avoid about 25,000 specialist visits because of that triage function, and those patients are cared for right in the context of their own primary care provider, which is of course the more convenient for them. The quality of care is high, so everyone wins on that sort of use of the tool. For could you see a role telemedicine in a broader national triage in terms of determining testing or who needs priority in testing for either the coronavirus or the antibody test, the immunity test . Guest absolutely. You could see that. One of the things that has happened since the cares act was passed and you asked a bit earlier about the atas position one of our threads is advocacy, and person who is very involved in these efforts. We were very happy with what came out in the cures act cares act. Among those things was the idea that state licensing laws are being relaxed. Many states are now saying it is ok if a doctor from a state next to you is caring for one of your patients because we are in dire times. Of easter think of a more national if you start to think of a more National Network being available and as i stressed, we talked earlier about screening for the virus being algorithmic. In many cases we havent implemented. We simply have questions a Health Care Provider can ask you over phone or video and if your , we can are not severe pretty much do the screening over the phone. We can guide you to whether you need to get tested or not. That is easily done over telehealth. For those who test positive but dont get very sick, they can be followed at home by the team by the same toolset. Most of the followup is largely asking questions about your health which is very beneficial to this tool. You mentioned Mental Health and i want to put a plug in for Mental Health because even before the pandemic it was by far the biggest user of these services. If you think about the physical exam and a mentalhealth encounter, talking to the patient and seeing the patient, then you can do that very well over video capabilities. Almostfore the pandemic, half of Health Care Professionals were using telehealth in some way for their practice and to and thank goodness for that because there is so much stress, so much need for Mental Health services in this time. Host lets go to calls. We will hear first from gordon in washington. Caller good morning. You so much for your show because most of the time you are not biased. Doctor is ifor the believe you already answered it and that is i do not own a computer and i was wondering if i am going to be getting the same adequate information from my phone. That is one question. Host do you have another one . Go ahead. Is,er my other comment when you are asked questions that start with if, should, would, could, is there any positive attitude that can help in the epidemic taking place . Guest lets go over both of those. Question one, an important leadin to talk about talking about what is required to do highquality health care. Before we had these tools, whether they be telephone, exchange of information by the internet, we brought people into offices because it was the most efficient and easy way to get to the most patients during unit of time during a unit of time. Way back when, by hospital was founded at a time when people who had needs were cared for at their homes and doctors visited you in your home. Nowadays the most efficient way has been to come to the office. During that time when you visit your doctor, he or she is getting all kinds of information from you that it enables the doctor to make a diagnosis, apply some judgment and then help you with a care plan. The answer to your question about the telephone is if you know your clinician and have a Good Relationship and your clinician knows about your care, and most of what he or she needs to do to help you is about asking and answering questions, you are in good shape as your telephone will do a fine job with that. If her instance you need to send a picture, that is going to be harder without a computer. It all depends. We want to deliver the best possible care to his many people as we can. We want to keep people safe in their homes. We dont want to deliver terrible quality care. In terms of the second question, i like where you are going with that and i would say a theme we have seen not just in health care, but i see it on the news practically every night about how people are rising to this occasion to be kinder and better to others. We are trying to do that in Health Care Delivery. We are bringing hundreds of thousands of doctors onto this platform. A lot of them were skeptics and now they are turning into advocates. A lot of patients are saying i , inot sure i am comfortable would rather visit my doctor but i have to stay in hort i have to stay indoors. I think both would rather come in but they are being respectful of the fact that they need to be cared for and will provide highquality care to them. Is we are getting to try out something new and different in terms of care delivery. We feel good about how it is going and we are quite confident that when this craziness is over and we get back to some level of normalcy, Health Care Delivery will not be this unidimensional thing. You can come to the office or get care by telephone or video, etc. , virusirtual visits spurs explosive growth of long lagging telemedicine. We go to rebecca in ohio. Go ahead. You are on the air. Thisr i was wondering, telemedicine, a lot of people dont have computers or smartphones but the ones that do, who pays for it . Does the Insurance Company reimburse the doctors for talking to the patient like they do when you go to the office . Thank you for the answer. Guest great question and thank you for bringing it up. Everyone needs to make a living and businesses only function if there is revenue to support the cost of running the business. Every practicing physician is a small business, so in that context, one of the other things that the recent legislation we are championing provided was reimbursement restriction so that now for the time of the pandemic anyway, the government is paying for telephone, information exchange, video at the same level they would pay us if you came to the office. Private payers are variably doing that and it is a statebystate checkerboard. That is the beauty and the downside of being in the u. S. The states have a lot of power. Massachusetts, we have to be paid at the same rate we would if you came into the office. Happens after the dust settles . We are very keen to make sure that patients who have a good experience tell their health plans or if they are employed, tell their benefits people that we dont want to go back to this onedimensional way of delivering care. It is need it at home, very convenient and highquality. If you are a medicare recipient, talk to your congressman and let them know you had a good experience and you think it should continue. Host on twitter we are cspanw j. Privacyon asks how does figure into this . How do i know there is no one else in the room when i am talking to my doc . Guest it is a really important question. What i start by saying is that we in health care, i think i can say this with confidence, we in Health Care Care more about your privacy than any other service that you consume. As you probably know, we are required by law to keep your Information Private in a way that almost no other industry is and we take it. Very seriously. Health care is and we take it very seriously. Some would say it is even more private than your financial information. We have electronic records and they are on systems that are very buttoned down from a privacy perspective. All the documentation of your visit with your doctor, whether it be by video, phone or over the portal will be documented the same way as if you were in the office, and a secure electronic record. The video calls themselves, by and large those platforms are very secure and the chance of having a video call or telephone l hacked our infant small infinitesimally small. News has been a lot of about certain video calls, particularly Alcoholics Anonymous and narcotics anonymous meetings being what bombed by people who are mean. I think those links are posted to public sites. As much as i would call that behavior deplorable, i would not call it hacking if the link was public. If you are having an exchange with your doctor as our colleagues from washington journal sent me a link this morning, private links sent privately, it is a different kind of level of security. It is a longwinded answer but an important one to know about how much we care about your privacy and that we feel very strongly that these platforms minimize the risk of a hack. Host we will go to new mexico next and say hello to rick. Caller hello. My question is, have there been any studies done projecting the impact of telemedicine on the supply of physicians and if so, do the study show positive or negative results . Do the studies show positive or negative results . Guest that is a good question. There has been literature on this but i must confess i am not up to date on the most recent literature but i can say anecdotally, as i have studied almost 30 years in my career, and looked at these, it really depends the answer to your question is a fine one because for instance, if they if i as a dermatologist in reviewing history, i talked earlier about this feature we have for a primary doctor can send me a short history and a couple pictures of something they are concerned about in their patient. If i am doing those, that is pretty efficient. I can do a number of those, maybe eight or 10 an hour depending on how complex they are. In the office if i see more or for more than four or five patients in an hour, i am eroding the quality of care. So it is almost doubling the efficiency. The answer is complicated because if we are able to call out those interactions that we can be more efficient with, we should be able to deliver more care with the same workforce. One thing i would say and i wrote about this in a book i published a couple years ago called the new mobile age which is a book about Health Technology and aging, one of the things that is important to mention in this context is we few healthcareo providers to care for the amount of illness that is coming through the system. Are shows up in ways that disturbing to all of us. A shows up in your life as long wait to see a doctor, a long wait in a waiting room. It is very rushed. In your doctors life, it shows up as being frustrated at the end of a long day and still not feeling that they got their work done and having to go home and do notes in the evening on the electronic chart. It is simply because we have so much chronic illness in our system and we have not been able to effectively train more doctors and nurses. I will say it again, all of that is dependent on if the only way we deliver care is you come to ecb in the office, see me in the office. Failure that heart we see, we have our home care nurses monitoring 100 patients per nurse with Heart Failure because they are sending vital signs and it is management by exception and when the patient needs care, they get the care because we can see their data. We canre various ways use the tools to be more efficient to ask and extend our workforce. I would say it is very early in that journey. Most of the Time Healthcare providers are thinking onetoone in a big leap we have made in the last few week is we have gone to onetoone in the office to onetoone over video. In the future, we will have to do one to many of those kinds of interactions. Here is a color from ohio. Is i am a first time caller. I watch cspan every morning but. His topic came up i have an appointment today with my heart doctor. This kind of crazy how come on like this. Toave all of the equipment give my doctor. The little gadget that you put your two fingers on. My doctor does not want me to come to cincinnati because of the virus. He said im going to talk to you on the phone. I think it is fantastic. Datall be able to see your host he will be able to see your data . I will talk with him and he will take my temperature and my Blood Pressure and whatever it is and i will be done with it. He does not want me to drive 30 miles the way it is right now. Host that is great news. Thanks for calling with your experience. Examplet is a perfect in terms of highquality care that is delivered to the patient. I hope when this all settles you either call your representative or your senator and just tell them that you want to have this Service Available to you so you do not have to drive every time. It is going to be your doctors judgment. Maybe your doctor does want to see you maybe every other time, you will do it this way. We will see how it all goes. I would say that getting our patient voice out there is important as this goes forward. Host a question for you on underserved digital areas and places that do not have the best internet Service Available. Provincetown texted this fear has he won approached elon musk about a satellite system for small rural hospitals in remote underserved areas . Guest i dont know the answer to that. Works,e way musk anything is possible. Gone onknow if that has or if that conversation has happened. Host through the expansion of the use of telemedicine, a lot is on a robust internet system nationwide, correct . Guest it is true. These days, as i alluded to earlier, we are bringing on thousands of doctors and corresponding patients to these interactions. Sometimes the infrastructure does get burdened for sure during those times. We need better infrastructure. We certainly need better broadband nationwide, no question there. Places where broadband is lacking and we need it. Host lets hear from thomas calling from michigan. In morning. Good morning. Caller my concern about telemedicine is the Healthcare Providers required to use a unique video chatting tool that they develop. I live in Royal Oak Michigan and beaumont is our hospital and they have their own video chatting tool which does not work very well. I dont understand why these Healthcare Providers do not just or somele duo or skype other video chatting tool that people already know. Ands end to end encrypted video compliant and hipaa compliant. I dont understand why they dont do that. Healthcare providers are not Computer Science developers. Host ok thomas, lets hear from the doctor. Guest thank you for bringing that up. It is a wonderful comment. To start, during the time of the pandemic because of the doislation that had a lot to with this, there is a relaxation of the types of platforms that can be used. They include skype, facetime, zoom, and google. What i have been advising patients to do when they call their Doctors Office or go to their doctors website to find out what services might be available via telehealth is to ask if the Doctors Office can please use the platform you are comfortable with. They may say no. In your case, what you are saying probably preceded the pandemic. Are a lot of reasons that we as clinicians like to have these tools integrated. It is much easier for me if i can watch the video call from my electronic record while i have your record in front of me. It is more efficient for care delivery. Doctors do not like to go to multiple screens at once. We do feel that there is better security if we do it within the context of the electronic record. That is the ideal for us. You are right, it is a little bit of pioneering, a little bit of early days and sometimes they dont work as well. I hear you when you say doctors are not computer scientists. I completely identify with that. During these times, i would say two things. To have them use the platform you are used to. Maybe they will. And after we get back to some level of normalcy, make noise with your elected representative that you want to keep those restrictions lifted because it is easier for the patient. Jean ints hear from yorktown virginia. Yes, i would just hope that the doctors as they see you conference that they dont take on more workload in the office. , i am anollowup advocate of checking in and video chat. Everything is ok, i blood work, i have my copy, we go over that and everything is good and saves me the time of having to go in and allows that freedom of doctors to deal with more difficult situations. Lthcare provided healthcare for all would be good for that as well. What are your thoughts on natural aromatherapy or herbalist approaches to coronavirus such as steaming for clearing the lungs and herbs and essential oils for the clearing and building of support and immune system. What are your thoughts . Host a little off the topic but if the doctor would like to respond to one or both. Ofst thank you for thinking providers not taking on more work. The way this is happening right now is very much in tune with your wish because people are not taking on more work. There are only so many hours in a day that we have. There are not as many people coming into the office by far right now. Thank you for that. In terms of the aromatherapy and oils, i do not have a comment on that. Epidemiologist or an Infectious Disease expert. I hesitate to comment on that. I would say that everyone should be incredibly careful about introducing anything into their environment if they have symptoms, if they have tested positive. This is a virus we are learning about every day. In general, i would be concerned, but i do not have a specific comment. Host how do you see telemedicine changing or improving the collection of Health Records from individuals . Guest that is a great question. There is a lot underway. Aroundthe pandemic empowering consumers and patients to get more access to Higher Quality information. Most folks are aware that on your iphone you can get a download of your medical records. It is hard to decipher, but you can get it. There are various companies, one that i was on the board of called be wellconnected health is a great example of a company that is aggregating information enabling you as a consumer to be in the driver seat of moving your healthcare forward because you have access to more information and information is knowledge and power. I dont know that telehealth is the driver, but certainly what we would call Digital Health meaning that everything is now digitized is a very important driver to more consumerization and getting patients and consumers more in the driver seat for their records and knowledge about their health. Host we will go to our medical professionals line next. In west virginia, hello. Caller thank you for taking my call. I am a retired physicians assistant who works in a Government Organization providing healthcare and i worked in hepatology. We did telehealth with treating hepatitis c and it went very well. We were able to have points where patients came in and had their lap work done lab work and someone could talk to them about their treatment. It does require a lot of support. At the site where they came, we did not do it in their home, but the site they came to, we obviously had pharmacists available to help and nurses and other providers. It works beautifully and people did not have to drive four hours to come in and see us. The other thing i wanted to mention is you are talking about e consults. We got 1000 consults per month. Three of us reviewed those. One of the most frustrating things that i am not sure from your care providers understand is if you put a consult in with very little information, it takes a whole lot of time to either answerand questions or cannot answer questions. Sometimes they are not well thought out. Sometimes they are more of a triage which takes more of our time and delays people getting in to see you. Those, theye use were great. I did consults all the time for people who lived in another state that had liver disease. Getas a great way to initial work done that by the time it came to the clinic, you really could get more accomplished at the clinic visit. Host thanks for sharing your experience. Thank you for not only sharing your experience, but for all of the hard work over your career and the physicians assistants is an incredibly powerful role in getting better. We are doing better and better with that profession. I think both of your comments are quite thoughtful and valid and i appreciate them. I will address the e consults one because i am a provider of those services as well. There is always tension between primary care and the specialist because they are both busy people and they both want to get things done. Yes, we sometimes get not enough information from our pcps and in our case, we can spend a lot of time pulling from this file and that file hoping to gather as a package it all up for us. Hey would say, i am busy it tends to work. There are times when there is little bit of tension. Overall, it is an incredibly useful and most of the time very efficient way. From debraore call in columbia, missouri. Yes, i have a question. Dold telemedicine be used to a nationwide test study of covid where the doctors prescribe a test and have it delivered through the mail and analyzed by . Big Research Team guest thank you for that. To be honest, i am not sure that is the most efficient way to get that done because having publice tested as a health initiative, should that be something that we will actively decide as a good idea, it probably does not need a telehealth visit to move that forward. When i was a kid, we all went in and got our vaccinations and we lined up in school. Something that feels more regimented like that. I love it that people are calling with questions about the utilization. There are more ways to utilize this wonderful toolset. I know we are getting short on time, it has to be high quality. You have to feel cared for. Your doctor may want you to come in because maybe there is a piece of information that you cannot get by telehealth. That is them being highquality providers. Most of the time for people i have a relationship with, we can care for them just wait very effectively. When the dust settles and we are back to a normal way of life, make noise about this if you had a good experience like some of the callers. Let your representatives and your health plan no that you dont want to go back. Know. Host the American Telemedicine Association and he is their president. Congratulations on your election to that position, by the way. Guest thank you so much. Host thanks for being with us this morning. Trump leadsresident the White House CoronavirusTask Force Briefing this afternoon scheduled for 5 00 eastern. You can watch it here on cspan. Washington journal prime time, a special evening addition of the washington journal on the federal response to the coronavirus pandemic. s with the university of washington on the importance of metrics and data and checking and slowing the spread of the coronavirus. Washington republican congressman on the Coronavirus Response in his district. Join the conversation tonight at 8 00 p. M. Eastern on cspan. Television has changed cspan began 41 years ago. Our mission continues. To provide an unfiltered view of government. We have brought your primary election coverage. Now the federal response to the coronavirus. You can watch all of cspans Public Affairs programming on television, online, or listen on our free radio app and be part of the National Conversation through the daily Washington Journal Program or through our social media feed. Cspan, created by private industry. Televisionable company as a Public Service and brought to you by your television provider. New York Governor Andrew Cuomo says more than 700 new yorkers died over the past 24 hours. Hospitalizations are declining in the state. Here is a look at todays update reading from albany. Gov. Cuomo good afternoon. Thank you very much for being here