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Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

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Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

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Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

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1rem

 Continuing our focus on Burnout this month, we are featuring my conversation with Dr. Jonathan Wisen about speciality telemedicine and how it might help reduce increased telehealth burdens reported during the pandemic.

 Dr. Jonathan Wiesen, Founder and Chief Medical Officer of MediOrbis wrote, "Approximately 

 have at least one chronic disease, and 77% have at least two, hence the urgent need to enhance and support the adoption of telemedicine and digital monitoring among Medicaid and Medicare Advantage (MA) patients. The Center for Medicare and Medicaid Services (CMS) has slowly come around to this realization, and cloud-based telehealth-based remote monitoring programs for managing chronic diseases are now 

A helpful place to start for this particular discussion is to identify what exactly 'specialty telemedicine' is and

 Telemedicine, telehealth, general telemedicine, and specialty telemedicine mean different things to different people. In our company, when we refer to specialty telemedicine, we're describing a mode of telemedicine which is nuanced, which is specific to an area, and which requires a higher level of expertise. That might be specialty telemedicine, much as you think of clinical medical specialists like cardiology questions, nephrology consultations, and endocrine issues; or it may be a very specific area of focus, like chronic disease management, which is which is unique and requires a level of sophistication and expertise. So, general telemedicine has been around for a long time. It's a well-trodden path. But developing very specific and specialized areas of expertise is something that we've been working on many Orbis.

 One area in which specialty telemedicine may increase effectiveness is in chronic care management.

 One of one of the issues in medicine that we've been struggling with for years is the “silo effect”. Physicians, care providers, patients, and technology have all been working in their own individual areas and domains and there hasn't been good integration between them.

Specifically, weight loss programs have been around from time immemorial. I mean, I remember my grandmother, starting a weight loss program, when I was just a few years old. And that had nothing seemingly to do with some of the programs that we're seeing now. But it was very specific, and it wasn't with the recommendation of precision physician, it wasn't integrated into overall clinical care. And so, when you have a specialty telehealth program, led by physicians like we [MediOrbis] do, it improves patients—not just their particular program that they're involved in, but the overall clinical and medical picture, because it's integrated with care providers.

Digital health has been around for quite some time, and especially over the last few years, we've seen great growth in that area. But all too often we find that it's a path to nowhere, and you may get an alert or a notification that something is amiss, but there's no one to really help you manage that. And so, by integrating everything under the auspices of a physician, or a specialist who's trained and knowledgeable in the areas that you're working under, you're able to not just monitor clinical conditions and give recommendations, but actually manage them from a clinical medical standpoint.

 Telemedicine may present new obstacles for physicians, and specialty telemedicine—with its unique focuses—is no different.

 I think that in any area of telemedicine, you encounter obstacles. But the truth of the matter is that in clinical medicine you do as well.

I've been practicing clinical medicine now for 15 years, and I've been in resource-poor environments and resource-poor clinics. And I've also been in some of the top medical institutions in the world. And everywhere that you practice there are components of the care that you deliver that rely on your surroundings and others that you have to realize, “Okay, I don't have access to those particular components and therefore have to function independently of the area that I find myself in.”

Telemedicine is no different. There are some areas of telemedicine of clinical care that are much better with telemedicine. I find that sometimes you can establish a rapport more easily with telemedicine because you're sitting down, you're focused, there's nothing else bothering you. You can you also have to take a great history.

I’m a pulmonary specialist and patients come to me all the time with abnormal CT scans. You know, the first thing they do is they hand you a disc and then you look at it and sometimes I don't even get to hear their story. Whereas with telemedicine, you're forced to encounter the patient, to interact with the patient, create a connection with the patient, hear exactly what's going on, and then make your clinical decisions. There are certain limitations—I'm not standing next to you, I can't do a procedure if it's indicated, and it could be that there are certain diagnostic tests that I would like that I can offer as well. At the same time, I think that there are great benefits as well. And just like in clinical medicine, if you know what you have access to and know what you don't have access to, then you can practice appropriately for the environment that you find yourself in.

 For physicians looking to use telemedicine to treat patients with chronic conditions, Dr. Wisen says that there are three things you should be striving for in your telemedicine program.

 It's really, really important to put together a program that's intuitive, that's intelligent, and that's easy for patients. You know, I actually taught for four years in between undergrad and medical school and I learned from a great mentor that he said: “It's not important what I teach, it's important what the students learn.” And it's the same idea in medicine: what I say is irrelevant, what the patient does is important. If I prescribe a million medications, and they don't take a single one, I've accomplished nothing.

So, we designed a program, where it's engaging, where it's simple, where it can be accessed from any device at any time, where everything is presented with a nice user experience that the patients can easily access it, they can easily ask for help with just the click of a button. They can interact with staff very simply through technology modalities, or any means that they prefer some of the elderly patients prefer to call up call us on the phone, younger patients, we just want to send a text message and be done with it. Whatever your preferences, that's what we want to provide. And again, it's not really important, what I say it's important what the patient does. And we designed all of our chronic disease programs and our clinical programs in the specialty realm with that in mind.

That's really important for all patients to know that having digital health solutions is not sufficient, having just telemedicine is not sufficient, but having a health record that that can pull in all the information from the different components that can pull in all the information from your physicians, and that can present it in a manner that's simple and easy to access is crucial and integral.

So again, EHR, and we won't get into all of my feelings about EHRs in general, but an EHR is supposed to be an electronic modality for managing your care. And to the extent that it does that, it'll be useful and to the extent that it doesn't do that it will not be useful. And that's exactly how we designed ours as well.

Physicians Practice® spoke with Dr. Jonathan Wisen, Founder and Chief Medical Officer of MediOrbis, about specialty telemedicine for the treatment of chronic conditions and how these technologies can improve a practice's offerings and patient outcomes. 

Specialty telemedicine for independent practices

. In this podcast, we'll bring you some of the most interesting and influential guests in healthcare. If you have any ideas for podcast guests or topics, email us at 

Today's physician needs to be tech savvy, says Elson Lai, MD, an independent ophthalmologist out of Los Angeles. If not, they'll have a tougher time attracting patient

This is why Dr. Lai has made it a point to invest in his practice with up-to-date technology: Apple computers across the board, an iPad he uses to chart while seeing patients, a snazzy website that allows patients to schedule appointments, and more.

"Doctors are almost like a consumer [business] right now. [Patients] go online, they check Yelp, they check Google, Healthgrades. They do a lot of checks before they even go to the doctor to make sure they are going to the right person," says Lai.

Lai joined Ken ComÃ©e, a Silicon Valley venture capital veteran and the CEO of CareCloud, a cloud-based EHR and practice management systems vendor based in Miami, on this week's edition of the 

. The ophthalmologist's interest in technology is a rarity among doctors, especially in the independent world. The 

 that most practices haven't optimized themselves with technology beyond the EHR. Lai and ComÃ©e talked about why many doctors are hesitant to go beyond the EHR.

"I wouldn't say [doctors] are slower to adopt, as much as I would say they've been disappointed by the options they've had in the past. That's caused a little reticence, especially [with the] EHR, where the government's subsidizing the digitization of health records may have gotten a little ahead of itself. The technology was not ready," ComÃ©e s

ays, who adds the drive to value-based payment and the increasing consumerization of healthcare will turn the tide in terms of the usability of systems and physician adoption.

Lai added that age has a lot to do with it: "You're seeing a wave of the older generation doctors because they are on their way out. There's the newer wave of doctors coming in and adopting these new technologies because whether they like it or not, they have to do it."

The two also touched upon how they view the effectiveness of current health IT systems, as both a doctor and a health IT executive. The Tech Survey also found 75 percent of practices would give the health IT industry a failing grade for not providing physicians with systems they like to use. Both were far more lenient with their grades and analysis.

Click above to listen to the entire podcast.

An independent physician and a health IT executive join the podcast to talk about the current landscape of technology in medicine. 

A Doc, Health IT Exec Discuss Tech's Standing in Healthcare

Don't be mistaken - Dr. Robert Wachter, MD doesn't want to go back to the world of paper-based health records.

Indeed, Wachter, the Chair of the Department of Medicine at the University of California at San Francisco School of Medicine and Bestselling Author of the Book, "

," says that health IT has done more good than harm as it relates to patient safety.

"When you look at some of the problems with [EHRs], it's easy to get romantic about the old days [and think], 'Wouldn't it be wonderful if we went back to paper?' No it wouldn’t. There were hundreds and hundreds of errors related to the doctor's handwriting, or forgetting the patient was allergic to medicine, or information that came out of an X-Ray that wasn't transmitted to the primary-care physician," he says.

But Wachter is adamant that there is a lot of room for improvement with current EHR systems. In this episode of the 

Dr. Robert Wachter wrote the book on the failings of health IT and the effect these systems have on patient safety. He joined us for the Pearls podcast.

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