Tech Beyond Telehealth

Tech Beyond Telehealth

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- [Announcer] You're watching Baptist Health Resource Live, where our respected experts bring you timely and practical health and wellness information to improve your family's way of life. We're healthcare that cares. This is resource live. - When the world's shut down 18 months ago, it brought about the rise of telemedicine and being able to see your doctor from the comfort of your own home. But now nearly two years later, we've just begun to push the envelope on care using health technologies from wearables like Apple Watches and Fitbits that can measure activity level and much more the sensors and devices that allow your body's blood pressure, heart rate, sleep patterns, oxygen levels, and even your weight or menstrual cycle to be monitored remotely through Smart Home programs. All of these can provide a continuous care experience that balances clinical support along with the potential for self-management.

Hi everyone. I'm Dr. Jonathan Fialkow, Chief Population Health Officer for Baptist Health South Florida come to you live from the Baptist Health Newsroom. Here to talk about these rapidly evolving smart technologies and ways to care for patients at home, our experts from the Baptist Health family. I'd like to welcome Danny Elfenbein. Dan is the Director of Consumer and Digital Health Solutions at Baptist Health South Florida.

Great to have you with us, Danny. - Thanks, happy to be here. - Melanie Rodriguez, Melanie is the Manager of Urgent Care Express, Care On Demand and the Infusion Centers of Baptist Health. Thanks for being here, Melanie. - Thank you for having me, great to be here. And Dr. Ian Del Conde.

Ian's the Associate Chief of Cardiology and Director of Vascular Medicine and the Medical Director of the Hypertension Program at the Miami Cardiac & Vascular Institute. Happy to have you with us, Ian. - Thank you. - Before we dive in today's subjects, I wanna remind all of viewers to send in your questions and comments throughout the segment.

We're here for you and happy to answer the questions you may have. And let's get started with you. We know the COVID-19 pandemic drastically changed our lives, but we're able to stay healthy without having to leave the comfort of our home now with doctor visits and monitors and what. Let's talk a little bit about that. How can we as doctors monitor patients at home using the current technologies and why has that become so important in the COVID environment? - So COVID-19 really catalyzed and accelerated changes that had already begun to happen many years prior, but during COVID-19 we had the absolute necessity to empower patients to monitor themselves at home and to establish ways with which doctors could take care of these patients without the need of that physical condition or that physical interaction. And what we learned is that there are many conditions, especially those chronic diseases that are relatively stable.

They can't be successfully managed remotely. And this can range from a virtual visit, which would be not too different to what we're doing now to more sophisticated technology such as remote patient monitoring and another things I'm sure are we're gonna be talking about today. - So the COVID 19 pandemic at the early stages when we were really struggling to figure out where healthcare was going to be able to be delivered, we had a big concern regarding the use of personal protection equipment, right? Masks and gowns and whatnot.

And one of the things I know we would only say is the best personal protection equipment is a virtual visit. (laughs) You're not in contact, you're not having to go to a doctor's office, not having to go to the emergency room. So I think that also really catalyzed things.

Would you agree? - Absolutely. And we saw it, we had a tremendous surge of patients seeing us, but this time it was remotely. - So Melanie, the smart technology is rapidly evolving. It's hard to keep up with it. There's so much movement in this space. If a provider, if doctors or providers wish to use healthcare technologies, we think that they are a solution for everything.

And we do wanna review together what are the great purposes and uses of the technology, but where may a challenge occur... Can you tell us a little bit about where in your space you're seeing the use of the technology in the virtual capacity is really making a difference? - Yeah, definitely. So although telemedicine is a new to some, it's very exciting. There are a few challenges.

So first of all, you need to think about what tech you're using. So if we're talking about like a telemedicine platform, it needs to be easily accessible to the patient. It needs to be user-friendly. It also has to be safe and secure. So any information that is discussed over that platform or typed into that platform, we have to make sure that it's safe and secure just like your information that you would give to your doctor's office.

So fortunately Baptists Cares On Demand platform is all compliant with all of those necessary things. Some conditions we cannot fully treat over telemedicine, but we can still use our telemedicine as more of like a triaging tool. So sometimes we'll get on telemedicine and we'll just talk things out with the patient. We'll hear about what symptoms they're experiencing, their past medical history. And this may be something that they do need to go to a different care site to fully diagnose and get a treatment started. For example, back pain we can treat over telemedicine, but some back pain is different.

So we listen for those key words that may say that there may be something more serious going on. And then if that comes up, we can discuss with the patient our concerns and that I think maybe it's best that you go possibly to an emergency department or an urgent care center to get further testing for diagnosis. Some good cases that we see on tele medicine, rashes, urinary tract infections, cold and flu symptoms, pink-eye allergies, things of that nature can easily be diagnosed with a thorough history and reviewing past medical history with the patient. - So, Ian mentioned some of the medical diseases that we can take care of virtually that would have otherwise been an office and even monitoring disease states. You're alluded to Care On Demand. Can you go into that a little bit, that kind of virtual urgent care methodology of what Care On Demand is? - Yeah, definitely.

So if we're talking more of acute or episodic care, that way easily be taking care of over our Care On Demand app. So for example, if you wake up with a sore throat, you can get on our cares demand application, and we can get you set up with a TA, nurse practitioner or a physician, and they can talk things out with you. They can actually also use what we call a home health kits that's for purchase. And we can actually look inside your throats. We can look inside your ears for a more thorough physical exam. - So there's the way to schedule visits and have an appointment with a doctor or a care team provider.

Then there's the, I don't know what to do and that's where, again, the opportunity to download the Care On Demand app and have somebody on the side handling that question exists as well. - Definitely. - It's like we take care of patients who have been on vacation and they woke up with a rash. And so they'll just get on the app and they'll have a diagnosis within 15 minutes. - It's fascinating. And we had none of this many years ago,

and again, being catalyzed with COVID. Danny, let's go to another use case if you will, of the technology, which is that of the Smart Homes. I've seen you in your work and your team's work where home builders are offering now healthcare tech to homeowners when they purchase new homes or condos or apartments. Tell us a little bit about this and tell some way Baptist is involved in participating in some of these Smart Home capabilities. - Thanks, Jonathan.

So it's interesting when we say Smart Home, just like everything else in healthcare, we have to be clear, right? What we're talking about Smart Homes, there's a couple of different layers. There's the everyday device, which my Apple Watch your Fitbit and Alexa and smart scales that people just have because it's part of their everyday life. And then there's a second layer, which we're starting to see grow, which is consumer purchase health devices. And so all of these devices have some connectivity. And then there's a third layer that we might talk about later, which is (indistinct) monitoring. So when you say Smart Home, Jonathan, I think from a healthcare perspective, we're really looking at connected health.

How are you connected to your health outside the four walls of the health system? And one of the ways that we're doing that is we've brought to light the Baptist Health Digital Health Kit powered by TytoCare. And we realized consumer adoption of anything health-related is typically slow. So we wanted to put it where the consumers are. And we kind of put together a little campaign. Health care is included, partnered with a builder here in the corral area, across South Florida CC homes.

And when you purchase a home in Darale at one of their developments, as well as in another part of South Florida, you actually get this device included. So I don't wanna say think of the (indistinct) because that was a little bit more futuristic, but this is a modern day per se kit, where you have the ability to hold in your hand this device, that's a size of a nest thermostat and allows you to look into your ear, look into your throat, listen to your heart and your lungs and transmit that exam directly to a Baptist provider via Baptist Healthcare Care On Demand. So you think about that now, a consumer buys a home and in that home is this medical device. And what we're doing is skipping the decision point for that consumer, because they're not likely to go buy these devices yet. We're still too early in digital health, but if we get it to them, we can help that adopts to improve a little bit more. - I appreciate that.

And do you see an evolution towards the houses themselves monitoring one's blood pressure, heart rate and alert, just sensors within the walls? I mean, quite frankly, the technology is there. We're not there to be able to do something with it, but do you see that as an evolution of where we're going with Smart Homes? - Yeah, I think to say that the house is doing, is a little bit self guide however beacons placed in your house or beacons placed in your your Google device, your Alexa device will essentially read what you're wearing, read what you're using, and we'll be able to transmit that out to your medical provider. - So to that end, turn it over to Ian.

We see the rapid technological advances, things that we are using routinely that a few years ago would have been Saifai as Danny mentioned, where do you see the future of technology is going? And also if you could speak a little bit about the other side, which is it's one thing for a consumer or a person to have something that technologically monitor something, but what's the other part of that, which is how you get that to someone who can do something with it, a value. Lots of unpacking that question, but I know you can handle it. - I think it's an incredibly exciting time to live in because we're seeing literally the early parts of a new era of medicine and how we do things.

And the same way that perhaps maybe in the 1950s, people could have not fathom going to an ATM or doing online banking without the personal relationship with their banker. I mean, who nowadays has a personal banker that they see on a regular basis? I think the same thing is gonna happen in medicine. And as we start saying, I think COVID-19 really accelerated that change. There are many different layers in which this is gonna happen, I think. Some people will have these remote monitoring systems to stay healthy.

Healthy people, they use these to stay healthy. And I think that to your point, absolutely, there'll be cloud-based systems plugged in to healthcare systems such as Baptist and have multiple sensors at home that monitor your vital signs to speak or to give an example like your blood pressure and other things. But then you have patients with established chronic conditions and there you can go from relatively simple things that we're gonna be measuring to very advanced remote patient monitoring systems for much more complex diseases. This is the beginning.

- Talk about that a little bit again, 'cause we've been working towards piloting and now rolling out some of these remote patient monitoring for some cardiovascular conditions. Give a little bit of how impactful it has been to you as a provider, as a physician and as an expert where have you seen the real benefits to you being able to deliver care and then speak a little bit to the patient experience? - All right. So I think that I'd started off by saying the current healthcare system has not been conducive to taking good care of certain patients with chronic conditions.

And I think that many cardiovascular patients fall into that category. There are a number of different parameters that need to be monitored carefully and treatment changes are made based on those parameters. For example, blood pressure. Blood pressure is something that you monitor constantly, and sometimes you need to make frequent changes.

You don't see a doctor every six months with blood pressure control, especially if your blood pressure is not well controlled. So we established a program about to say remote patient monitoring system to take care of patients with hypertension, which allowed us to look at these patient's blood pressures almost real-time and make very quick changes and numerous iterations that would've not been possible if we had relied in the old system where patients need to make an appointment and come to the office. So I like to think about these changes as an air traffic controller, just sitting in front of a monitor monitoring 10,000 patients and we identify quickly who's doing well, who isn't, who needs attention? You call you make the changes you reassess the impact of the treatment decisions. And to your other question, as providers, as doctors, what do we do with this flurry information that is to us? We're just learning.

There's a lot of noise, a lot of signal also, and we're trying to filter and determine what's the best way to handle all this data coming to us. And it's very exciting because I think we're gonna learn a tremendous amount of information about all these chronic disease. - So for the patients in the hypertension situation that get treated quicker, minimal visits to the doctor's office, wind up on less medications because we're able to, as you say, someone's angry and the blood pressure's up, we don't necessarily react and add medications immediately.

So lots of beneficial outcomes. And I appreciate that evaluation. Melanie, Danny mentioned and you've mentioned the TytoCare as an example, go through that a little bit what actually is involved in that, but what are the tools that patients can use when they wanna access their providers or provide information? What are the more common ones that we're seeing? - Yeah, definitely. So Dr. Del Conde and Danny both mentioned the remote patient monitoring on. So Dr. Del Conde talks about how we can use that

for chronic conditions such as high blood pressure, but we even see it for more acute conditions such as COVID-19. We were keeping people out of the hospital by actually monitoring their oxygen level, blood pressure and temperature while they're in the comfort of their own home. And then nurses can check in on them on a regular basis.

With the Tyto home kits, they're very cool. We love seeing patients when they have the Tyto home kits, so they can actually look inside the ear with what's called an otoscope. We can listen to the heart with a stethoscope, and it also has a tongue depressor, so we can get a more thorough exam of the tonsils in the back of the throat.

And it has a thermometer as well. So when we combine the Tyto home digital health kit, along with the virtual care visits. It creates such a streamlined visit that it makes a diagnosis in a physical exam, super easy. Our providers do feel confident in their diagnosis and of their assessment of the patients.

So I think kind of with those two together, it provides such a great experience for the patient and for the provider. - Dan, I'm sorry. If someone has the kit at home and they arrange for let's say a Care On Demand visit, does the person walk them through how to use it, or when they get the kit, do they need training or again, pretty simple, just do this, do this. What's the experience like? - I can actually speak to that as someone who's used it many times. It is fairly intuitive and the beauty of some of this technology, and you might be used to it from the technology you're buying for your house.

It comes as a self guided tutorial, right? We've eliminated that (indistinct) have a person to teach how to do things. Now this is a little bit different. Most of us have never known that if it pull apart our ear we can get a better view of the inside of our ear canal.

But when you have a video telling you how to do that, I hate to say this, but DIY Healthcare is this new area that we're not necessarily saying it's good for everything, but when it comes to safely assessing your ear, your throat, your lungs and so on with this device, it's pretty impressive. 'Cause it is learned on your own. - No, I don't think anyone's against the do it yourself healthcare, as long as it's accurate and it doesn't create problems, which is what I want you to talk about right now, Danny. So the idea of you push a button and you get healthcare, it's great. I mean, do you see it evolving that this will be for just pretty much most conditions people have, but to that end, what's the downside I can tell you and Ian can speak to this where getting all day night EKG strips from people's Apple Watches, which is great when you have your cardiologist's cell phone or email and you can follow them, but how do we scale and all this information that's gonna be coming in? - Dr. Del Conde mentioned getting information and a lot of the noise, that's part of that information.

So there's a lot of layers to that. I think the first and the most important thing is we're talking about behavior change, right? And a huge aspect of becoming healthier is behavior change, the behavior change we're seeing now is that patients who weren't reporting or self-reporting information patients that weren't adherent or compliant, We always say, oh, well, if you're not compliant, you're not gonna improve. Technology's gonna allow for them to actually be more compliant by choice because they chose to be a part of our program or they believe that they need to be a part of the program, so it's gonna create a lot of data.

I think what we're gonna have to see is how that data effectively gets to the right place, make sure that it alerts at the right time and place. If you're under a program with your cardiologists, we don't want your data going anywhere. It needs to go to your cardiology team and the care team, whether it's a pharmacist, whether it's the practitioner, the physician who can be there if needed and route you to the care you need or give you the guidance that you need, whether it's a medication change or an appointment or so on. But I think what we will start seeing is that as consumers become more empowered, we'll see behavior change. As physicians see that behavior change, we're gonna find a ways to filter through that noise, make sure that you and Dr. Conde aren't getting messages

at midnight, at two in the morning all the time from all these different apps and data is gonna be in the middle there to really help filter bucket and send this out to different places. One thing just to be clear on this isn't like using your Google account, that you can log in to anything at the app perverse and just do whatever you want, change your information. This is healthcare. So it's gonna take some time for a good reason for both our patients, our physicians, and the data to find that right kind of parallel to beyond in order to make us all healthier.

- Yeah, so to follow up on that, people who otherwise would not have access to a healthcare provider, whether they can't leave work or they can't leave the loved one or have to stay at home with their kids will not have access healthcare providers who wanna be involved in a patient's care more than just when they're in front of them for an office visit will not have access to how they're doing to move things forward. So as we're elaborating on those, not just concepts, we're really doing these things. Melanie, where do you see the person benefiting the most? In your space, when you're talking about urgent care and Care on Demand, these other resources are the majority of your visits really sick people or people who have something but they just don't know what to do about it. Speak a little bit about where you think this will have the biggest impact for people to be able to have connectivity with virtual visits. - Yeah, definitely.

So fortunately for Baptist, we were already established in the telemedicine world before COVID started. So when COVID affected our nation, we already had our providers and we were ready to treat our community. So when most of our community was stuck at home, we were able to see them talk to the patient and see, is this something that they really need to leave their house for, come to our urgent cares, come to our ER and wait and see a provider in person, or is this something that we can kind of talk about or diagnose over virtual platform? And then we can just write the prescription for them and they can go pick up their prescription. So most of the time for our acute care visits on Care On Demand we are able to make a diagnosis and establish a treatment plan right there over the virtual platform.

Something I wanted to kind of mention it's very exciting for us is our telemedicine side along with our express care urgent care side, we've kind of collaborated with the support of our medical director, Dr. Michigan and we have created something that that's more of a virtual to in-person type of care. So that means that we can see a patient over the video platform. For example, maybe you have a urinary tract infection and we can talk about it.

I can place the order for a lab order. And then the patient will drive to our express care clinics, arrive, get sent right in to leave the urine specimen. And then they leave and go back home. Then the provider will assess those results and then call the patient back when we get the test results back.

So it allows for more accuracy to making those treatment plans and allows us to send out tests for further treatment. We've done this a lot also with COVID testing. So I'm able to see a patient over the video platform. If I suspect that you may have COVID, you don't have to stand in line. You don't have to sit in the waiting room. You don't have to sign in again.

I ordered that lab. You arrive at the clinic, you get the test and you go home so there's no waiting. Our patients I've had such a great experience with this new service that we're able to start.

- Well, this is great information guys, and really great dialogue. Now let's take a couple of questions from the viewers. Ian, we'll start off with you. The question is, is wearable healthcare technology like an Apple Watch, a reliable source to keep times on my health.

- Right. So many people are purchasing Apple Watches. They have the ability to monitor amongst other things for example, on an EKG electrical activity of the heart. If you're a healthy person at low risk of having real disease, I think this is fine. They're useful people like them.

They have reasonable algorithms to sort out normal from abnormal. If you're a someone with established disease, they can be helpful in monitoring what is already known to be a diagnosis. What is problematic is those people who don't have a formal diagnosis may have disease, Apple Watch is not the way to monitor these people.

You still need medical grade diagnostics. - The sensors that are out there, the Fitbits, the Apple Watches, things are in development are really exciting, but still from a reliability standpoint, we still look for something a little bit more sophisticated. Appreciate that. I'm gonna go through one more question to answer in an interest of time. I'm gonna ask each of you to answer it.

To Melanie, what's your experience or in your experiences and Danny, what you're seeing in as an expert in this industry. The question is, what about the older generation that's maybe not so tech savvy. Is this technology user-friendly for them? So Melanie, speak with them, start with your experiences as what you're seeing. - Yeah, definitely. That's an excellent question, but I can say pretty confidently that we see patients of all ages.

So if you have access to a desktop computer, a laptop computer, a cell phone, or even a tablet like an iPad or any type of tablet like that, and you can access the internet, we can see you and we can have a telemedicine visit with you. No problems. - And Ian, is that what you're seeing with your telemedicine visits and speak a little bit to the remote patient monitoring expert experience as well. - So obviously we started in our practice with a broad universe of people. And as we started using these devices for home monitoring, we did see that there was a small proportion of patients who simply don't do well.

Interestingly age is not always the strongest predictor, but yeah so some people are more early adopters than others, but by and large, I would say that I've been surprised. I think that older people adopt the technology pretty well. It's user-friendly. - And that will be part of the support we wanna provide. Danny, what are the thoughts on this and the industry? - Yeah, I think to close it, if we look at it this way, it took most of America eight to 10 years to switch from regular TV to streaming TV. What we saw in 18 months was most of America about 70% of all physician visits, which is mostly people age 50 and up.

We're not talking about the young millennials here. 70% of those visits happened via some sort of virtual or digital technology. So the way I always tell people is if you can FaceTime your grandchild or your child, you can have a video visit with your doctor, some of the technology like devices might require some hand-holding, but all of that will come in time just like how we changed the remote controls on the aging population over the years. It will be easier, it will take a little bit of time, but it's gonna happen a lot faster than we can imagine.

- Well, this is great comments folks. And I think we unpacked quite a bit here. Remember that the Care On Demand app and utilization is there and it's well received by those of who use it and with a promo code of Care 19, you'll have some benefits in that.

So Care 19 would be a promo code. If you use Care On Demand for your physician visits certainly ask if virtual visits are available. Very often they are though keep in mind, not for every kind of medical condition we're still evolving into where these visits are appropriate, but we're all really excited about the rapid evolution in this space and hearing from our experts such as we did today. To the viewers again, remember you can connect with us on our social media channels.

That's Facebook, Instagram, LinkedIn, Twitter, and check out the resource blog for the latest news at that's, I'm sorry. You'll find the link there to all episodes of the Baptist Health talk podcast as well.

On behalf of everyone at Baptist Health, we ask you to please stay safe and say yes to the COVID-19 vaccine. - [Announcer] Find additional valuable health and wellness information on our resource club at and be sure to interact with us on our social media channels for live and upcoming events. Resource Live is brought to you by Baptist Health South Florida Healthcare that Cares.

2021-10-04 09:48

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