Telemedicine - The New House Call
The, doctor, will see you now, but, in a different way telemedicine. Uses, technology, to diagnose, and treat illness remotely, for. The aging, it can provide 24-hour, care without, a hospital, stay and improve, quality of life through, more accessible, treatment options, joining. Us to discuss the latest innovations. In telemedicine are, the interim vice chancellor. Of UC Davis health dr.. Tom Nesbitt and Heather, young the, Dean of UC, Davis School of Nursing next. On studio Sacramento. At. Five star bank we create thoughtful solutions to help the Capital Region, thrive from, economic, development and education to. Public health and safety issues. That are vitally important to Sacramento's, prosperity, we're, proud to be part of the conversation, and hope you'll join in. This. Studio Sacramento. Episode, is supported, by UC, Davis health where, doctors nurses researchers. And staff share a passion, for advancing, health learn, more about their latest medical innovations, at health UC, Davis edu. Dr.. Nesbit what is changing, in society that, is leading, to this drive for innovation, in delivering, care remotely. Well. I think there is a number of things we're sort of in a perfect. Storm right now where we have, an. Aging, population. We. Have a population. That. Is. Using. More healthcare and as. People, are getting, older, and, staying. Alive older, and wanting to be active, older, they happen, to live with more chronic diseases so we have a number, of people that have chronic diseases, and, luckily. They are living longer but the, fact that they have these chronic diseases. Requires. Them to be more engaged with the healthcare system and. We. Also at, the same time are, experiencing. Particularly in some areas of the country and in this state, caregiver. Shortages, so we have to think about new. And innovative ways, of, caring for people with, crime. Disease and acute diseases and so that's driving, us to look at new models of care and technology. Has a lot to offer in that area so new technology. Enabled models of care are really becoming. Quite. Popular and, being used more frequently. But. Dr. young we. All prized. The. Personal. Attention and the touch, for, instance nurses, and so, we've, liked being in in, facilities. To. A certain extent because we know that a. Call, button away as a nurse, how. Does telemedicine. Replace. Well. I wouldn't think of it as replacing, anything, Scott it's really about using, enabling, technology. In conjunction. With the human side of things and in, fact most people want, to age in their own homes and they, prefer not to ever go to a clinical, setting if they possibly, can and with, a workforce, that's moving more and more into homes with, the ability to bring nurses. Into homes and other health care providers, as well coupled. With technology. I think we can in some ways craft, a different way of delivering, care and. In. Crafting. That different way how, is that transforming. The. Profession. Of Nursing, well, nurses are developing. New ways of thinking about their practice, it used to be that about, 80% of our graduates, went into hospitals, to practice, and now, just in the short period of less than 10 years it's down to 60% and so, we're really moving more and more into community, settings there's, more opportunities. For nurses to think about how to provide, person-centered. Care and, at, the time when people really, want it and need it because, health happens, everywhere, and it's, about having the right person at the right time in the right place and usually. It's where the consumer, wants to be the most I really. Like that term, persons, and centered, care yeah these. Innovations. That, are happening. How. Is it that medicine. Is being, transformed. We're. Really looking at the individual. And how, to improve their outcomes, as as opposed, to more, of sort of percent, an assembly, line approach. Yes. I think that's true and I think that these models, of care really.
Can. Encourage. That kind of thinking. In. The past. What, we've done is we've. We. Move the patient, to the expertise, now. We're thinking about ways of moving the expertise, to, where the patient is, so. That's more that's, more patient, or person focused. We. You. Know have tended, to. Look. At the way we deliver healthcare, it's, really been provider, sort, of centric, and. We've. Also really. Focused. All of our care on the professional, caregiver, with. With. Not a lot of communication what, do you mean by that well. We've. We've tended, to all, the care has been delivered by professional. Caregivers, and we know that, there's a huge, amount of care that's actually, delivered, by family members and informal, caregivers, and so, we have to figure out ways to bring them into the process and, technology. Can help us safely bring them into the process of, you. Know have, Thembi the, the the hands, at home. When. We're engaging a patient at home when we're monitoring, somebody, at home when were engaging, with a somebody. At home through video conferencing, we can have somebody who's who's, there with that with the patient and and, then, be the hands, of the caregiver, the. Professional, caregiver and. Having. Engaging. Those. Non-professional. Caregivers, as, part, of the, quote, unquote treatment, team. Actually. Enhances. The, health, outcomes, for the individual, in question as, opposed, to just moving them inside to a hospital. Well. It does, because we're able to provide care on a round-the-clock. Kind, of basis, and. I, think that because. In. The, past there's, not been good communication. Between those caregivers and the professional, care team a lot, of things have gotten missed, and. We've we tended, to, assume. That. What. We hear and see and measure in an office, setting in a very artificial, setting is what. The reality is for that patient, when, they're outside of that setting, when, in reality when, you're in the doctor's office your blood pressure may be higher your heart rate may be higher you you, know all, those things may be quite, a bit different than when you're in your home in your normal setting and if we can engage, patients, in that setting, measure, those kinds, of. Parameters. In, their home we can treat them on a round-the-clock, basis. And then, family caregivers, can also give us more information. On. A round-the-clock, basis, about what's really going on that medications. Making, making, my mother tired or she. Doesn't seem to be finding her words as well when she's on that medication particularly. At night we. May not get that information if, we, didn't weren't, able to engage the. Patient. And their and their family. Caregivers in their homes dr.. Nesbitt raises, a really interesting point about engagement. Yes, I can speak from personal experience. In terms of taking, care of a loved one of my own that. There, doesn't seem a, feel, totally at a loss sometimes. And. There doesn't seem to be a lot, of support, and training out there, what. UC Davis doing in order, to provide more tools, for those of us who are actively, involved in the loved ones care well you're bringing up an issue Scott that so, many families, are facing in the country now and it's an invisible problem to, a large extent, we're, really excited that a DC Davis we've recently founded the family caregiving Institute, and the, focus of that institute is twofold, one is to support family caregivers, with the knowledge and supports, that they need to be able to do, what they're being asked to do in some cases volunteering. To do and facing. Challenges, day to day and the, second part of it is to work to, develop a better understanding, on the part of health care providers nurses, and doctors and, others. About, what a family caregivers, really need how, can we do a better job of including, you how, can we provide you with the information you, need in the time that you need it we've. Been partnering with AARP.
Which Is one of the largest consumer, organizations. In the country to. Develop videos for example and some, of these videos are, resources. That help with, instruction. For family caregivers around things like wound care you, know how do I could persuade my mom to take a medication, when she doesn't want to take one he's told me those kinds, of issues because, they're very important, questions, and they're they're very practical they're. The kinds of things that people face every day and we're hoping to increase, the availability of that type of information you. Know you. Open a really interesting door, because, one, of the things that I think all of us deal with when we're dealing with a loved one is. You. Never quite know, does. Something, rise to the level of do I need to take her in yeah, or, is this something that can be handled a different way do. I disturb, the, physician, or the nurse. On, call at, that time and. Technology. Being, a bridge it. Sounds. Like it could be such, a stress reliever not, only to the patient, for those that are around them absolutely. And it's about having the conversation together. Where. The family caregiver is with the person who's getting the care with, the healthcare providers, and talking about what should I worry about when. Should I call you and how can I get in touch with you easily, that, may not be an office appointment, but maybe there's a way to text, or a way to get conversations. Going or send data I mean, it's wonderful for nurses, and physicians to get information, that's real-time, data about how things are going and, the. Technology, enables us to do some of that what. Are some of the most exciting. Innovations. In technology that. Are, now. Being moved. Out into the, community. That, you think are going to have an impact on improving. Lifestyle. And quality. Of health well. I think there's they. Fit, into several. Categories, so there are. Technologies. That monitor, things like heart, rate blood pressure, something. We call pulse oximetry, how well your Bloods being oxygenated. We. Can obviously, measure glucose. People's. Weight and people's activity, so, we can all, that information. Can, be passively. Sent, to. A care team if people are you know using those monitors, wearing, those kinds of monitors, there. Is now because, of the how, computers. Are now and how you know with skyping, and things like that but also with. Even. Your television, set, there's. Going to it's going to be easier, and easier to, do. Two-way interactive videoconferencing from. The home in with. Really high quality so. Being. Able to videoconference. With your care team with, nutritionists. With your nurse with. Your your physician. Will, be easier, to do from your home there's. Also some. Other, technology. Out there around you, mentioned medication. And how do you get, someone to take a medication. There, are medication. Adherence. Systems. That range all the way from what, does that mean medication, adherence well so making, sure that somebody takes their medication, so, the third thing yeah. They're, reminders. Where you you. Know you have the pier the pills laid out by, the week by the day of the week and when you open that up and empty that or, you open the bottle there's, a message, sent that says you did take your your, realization, yes so they have those they. Also there's, some. New technology, out there that. Actually is a chip that goes inside, the pill and there's. A something. You wear that. When that when the pill gets into your stomach, that, little digestible. Harmless, chip dissolves. And fires off a signal that says that you actually that you actually swallowed, the pill but. There's there are several kinds of systems that are out there that that, tell you whether whether, someone's, taken them their medication, then. There are. Technologies. Around rehabilitation. So. The. Gaming, systems, that are out there are. Are very good at measuring motion. Accurately, that's how they know if you hit the tennis, ball right or you. Know hit the baseball right, in the video game you're playing that can also be, repurposed. And we've done that with, a team, to, repurpose, that so it accurately, measures your rehabilitation, motion. So if you're trying to rehabilitate, your shoulder, it knows that you're moot you're doing the movement exactly, right and then we can connect with your physical, therapy, team to, measure this do do to patients, find that approach more fun than, traditional, therapy well so far we tested on a number of people and they do and, the the other thing about it is that again they don't have to go to a physical therapist, and watch them or even.
Worse When, you prescribe, home physical, therapy, and, you. They the, the the doctor, says well, have you been doing your physical therapy, and you I think so I think I've been doing it right they can say yeah, it looks like you've been doing it perfectly, and, so they can make decisions in. That way, there. Is one, piece. Of this that's that's critical, though and the critical, piece of this is to get the information from. Those monitors, from the rehabilitation. To integrate, that into the electronic, health record and that is a bigger challenge than a lot of people realize why, well. Because the. The. Information. That's coming from devices. Has. To be. Configured. In a way that. Can go through a gateway. And into, the electronic, health record but not just as raw data so, that the. Data that comes off a, heart. Rate monitor or, a blood pressure monitor needs, to be needs, to be converted, into actionable, information for, a care team and then arrive, in the patient's records so when the, care team is seeing the patient they can quickly. Look at a graph or something and see what's going on that's, a challenge, that that we've taken on actually through one a Heather's grants, and. And have, some experience, with that and really were one of the first places in the country to integrate, that kind of information. You. Know there's a lot of talk about wearables, now this, watch, right here is one that, you, know monitors, my heart rate and you, know how many steps I take and all that sort of all, that sort of thing will, there be a, greater. Movement to, integrate. And merge. Healthcare. Related technology. And more, consumer, related technology, future very much so and yes for so long the developments, been happening in two different parts and bringing, it together and using it as meaningful, data and interpreting, it in a meaningful way is where, we really need to head so, for someone who's got a chronic condition like diabetes which, takes a lot of adjustment. In your lifestyle. Your, activity, level your food your sleep those kinds of issues being, able to bring real-time data in so, that your healthcare provider can see it and see, how it's affecting, your blood sugar and whether you're getting better or not having. That all come together is so helpful, both for the person who's got diabetes as well as for the healthcare provider who gets real live data about, what's happening, so, I can see it really making a big difference in, being able to for each of us to set our own goals for our health and monitor. Our own progress and, do, it in partnership with the healthcare system what's. Most exciting to, the nurses, going through your program today about, this, explosion, in technology. Well. The fact that it's, becoming ubiquitous most. People are walking around with at least, cellphone and oftentimes wearables. As well and the, idea of being able to actually harness that and use that to improve health is very exciting. And because, it takes it out of something that's owned by the people in white coats in a clinical setting and it, means that each of us in our own way can own our own health and use. The information we gather to set our own goals to work with the, conditions, that we're grappling with and to, improve health I think there's a tremendous opportunity there. And for, older adults the, thought of being able to stay in our own homes to. Be able to get the care we need and to coordinate it and to, get the right supports, at the right time is a big motivator. Well. In. The recent. Documentary. Called. Forever, Young. One, of the things that that was talked about was how. Aging, itself, is, changing. And like many things the baby boomers. Have. You, know said, we're going to do it differently than, in the past. How is. Graceful. Aging, or healthy. Aging. Changing. Well. I think healthy. Aging is is, changing, one of the reasons, that's changing, is because the period of time between. When, someone, retires and, dies. Is. Thankfully. You. Know increasing, and so there's, a big chunk of people's lives, that. They. Are they're. Not going, to work every day they're, there they, have, to find other things to do with their time and because. They're living longer they. Are you. Know, living. With one. Or more chronic diseases, a lot of older. Adults are living with one or more chronic disease, but they. Don't want to be defined by that disease they, don't want their life to be defined, by that disease they they, want, to acknowledge they, have that disease but they they don't want to live in the world of the sick because. They're older and I. Think that therefore they, want to try and minimize the impact of that disease on their lives and be, able to stay in their homes be able to be active be able to travel be able to do those thing and so I think that's. One of the reasons why people are beginning to embrace these, technologies.
Where. They can you. Know measure their their, blood sugar their their blood pressure their you, know anything, that's going on with them communicate, with their care team make, a change. On the fly with, their medication. And then. See how things go over the next 24 hours without having to wait for three weeks for the doctor's appointment, can I travel should. I should i cancel my trip all, those kinds of things and I think this is this. Is really where it's going to impact, people in their in their daily lives, it sounds, liberating. Actually, you know that, we're no longer tied to. You. Know our our physical location, because. Our. Caregiver. Physician. Nurse, other. Health, professional, can be, accessed, anywhere at any time yeah. And healthy, aging so, much more than just the physical body and the disease it's. About who we are in our world our society our connection, with people our. Mental health our feeling, of well-being and, so, I think that's another exciting, part of we're healthy aging is going is looking. At people as whole people and in, the context. Of their families, and communities let's. Talk a little bit more, about. That how. Does how does that. Piece. Of it the more of the more kind, of quality, of life. Aspects. Of the. Health care equation, factor in to. How it is that health. Care is. Adapting. To, not only the aging population but, but just people in general so. When you think about health one of the biggest predictors, of living. Long and well is connection. With others so. Connection, with families and friends neighbors people who are important, to you and in. The past we wouldn't have thought of that as being part of a prescription for health because. The focus was more on medications. And on treatments, but, now as you think more globally about, health, being that state of well-being, technology. Can help in ways of connecting people so for example those are very isolated, in their homes can, have connections, through through, different types of technologies, where. They're in real time and we can be checking in with each other and have relationships, that. Transcend, our physical space and, that's.
One Really important, way of engaging people. It. Sounds like, with. All this technology and, the. Ability for people to stay not. Only in their homes but in their neighborhoods and communities, that. It's going to transform. Sort. Of the physical. Aspect, of how healthcare is delivered. 20. Years from now, well well hospitals. Look. The same be, the same as they are today with. All of this deluge, in technology. Well. That's. That's a great, question, that we don't know yet but we assume, that there will be. More. Emphasis on care. Outside of institutions. Shorter. Lengths of stay one thing we haven't talked about is this, also these technologies, might mean that, you. Can go home from the hospital early. We where we have some programs at UC Davis where we're able to get people home. And then videoconference. With them in their home after, surgery for instance and you. Know, hopefully. That will allow people to leave the hospital earlier, and therefore. If we're, shortening lengths of stay. We. Can decrease. The number of beds. Hospitals. You know will you, know they'll always need, to be I, see. Use and, emergency. Rooms and they'll have to be, operating. Rooms and and people, will have to stay in the hospital for some time but we're hoping to decrease. That time that people are in hospitals, and and. Make the transition, of care more, smooth from, the, care team that's, in the hospital continues. To see you but they continue, to see you in your home, let's. Go even further out. Projecting. Out you. Know, in. The, next, 20. Years or so. How. Do you think that. We, as individuals. Will. Be affected, by all this innovation what will we be doing differently as we. Monitor, our health and try and enjoy, a higher level of wellness, using. This technology. Well. I think. One. Of the things that, we, we, haven't talked about that that gets. To part of your your question is how much. Privacy. Are people willing to give up interest. To, to, you. Know, do. You want your, your, care team to know that your when. You're taking your pill what your weight is every day what you ate you. Know when. You cheated on your diet and those kinds of things so I, think it really depends. A lot on how. Much of that people. Are willing to give up when, they're sick when people aren't sick they're probably not willing to give up much privacy. When they are sick of it means being in a nursing home or staying, at home people are willing to give that up and so. I think it will change, our. Relationship. With our healthcare teams, and the healthcare teams need. To change as well too, to be, in a you, know provide. Care in a model like this where that is more. Patient. And person centric. And. If. You were to name just one. Technology. That. You, think is going to be exciting, and transforming, just, its name what is it I would, say communication, technology. Technology. That really brings information, to the point, of action, so. The ways that we can integrate information. And use it in. In meaningful ways all, right well. Thank you both, good. Luck and much success in your work thank you and looking for all of that training for caregivers, and everything. And that's, our show thanks. To our guests and thanks to you for watching studio Sacramento I'm. Scott Syphax. See you next time right here, on kvie. At. Five star bank we create thoughtful solutions to help the Capital Region, thrive from, economic, development and education the. Public health and safety issues. That are vitally important to Sacramento's, prosperity, we're, proud to be part of the conversation, and, hope you'll join in. This. Studio Sacramento, episode, is supported, by UC, Davis health where, doctors nurses researchers. And staff share a passion, for advancing, health learn, more about their latest medical innovations, at health UC, Davis edu. All. Episodes, of studio sacramento along, with, other kvie programs, are. Available to, watch online at.