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NYITCOM Careers in Medicine & Clinical Practice Reflections


Presenter: Terri Seppala, President & CEO of Telehealth Associates Inc.

Location: New York Institute of Technology College of Osteopathic Medicine

Old Westbury, New York

Date: 01-17-2020


Terri Seppala:

Well, hi, everybody. You can hear me back there? Good. I hope you all turn out to be as good a physician as Dr. Todd Cohen is, because he has been in our lives for several years managing this condition with John. And to me, he is the most empathetic, and compassionate, and scientifically-oriented, and innovative physician that I've really ever come to know. And like he said, I was at Medtronic for many years, and my responsibility was to educate physicians, which I’ll tell you a little bit more about, but I can't thank you enough Dr. Cohen ... and Jill for everything that you've done for us. Thank you.

So, I'm going to take you on a journey about telehealth today. And I'm joined by Todd Stack, who is the senior director of Henry Schein Medpod. He is going to show you some equipment, that we brought today, that we've had a lot of success with. And it's very cool. I'm actually just watching with John now all of the Star Wars, the whole Star Wars series. And we just got Disney+. So Disney+ allows you to start with Episode One and move all the way through to Episode Eight. And it gets you ready for Episode Nine, which is filmed actually in the Jordanian desert, the red desert, that Dr. Cohen and Jill, and John and I visited last year. And he showed you some pictures of that amazing Petra.

But we felt like we needed to get through that whole series, and we have a life. John and I have a life because of all of this innovation that Dr. Cohen has done. But anyway, let me ... The reason I brought up Star Wars is because I look at this MobileDoc that you're gonna see from Todd, and it just reminds me of C-3PO and R2-D2, and this is what our life is like now. We didn't know that back when we were looking at the first Star Wars movies. But telemedicine? It's here. And whether you know it or not, and whether you're familiar with the terms of telemedicine and telehealth and virtual care, you ... every one of you will be a telehealth provider in your medical practice, in some way, in the future.

And I'm trying to make this go forward but I don't know how to ... how that works here. So, thank you. So ... Oh, good. So I can just use this now? Thank you. So, in the year 2000 ... You may not even have been born then, I'm not sure. But in the year 2000, 20 years ago, if an organization did not embrace using hardware and software applications to manage all aspects of their business, they went out of business. Now, today ... 20 years later, you, me, your patients, we're all using digital solutions for all varieties of things to manage our life. Banking, retail, and including healthcare. Healthcare is no different.

The technology of telehealth has really advanced so much in the last couple of decades. And let's consider, consider some of the things that have been happening during the times that you were growing up. So engineering. Engineering has made sophisticated medical devices that are compact, that are portable, that can go into the patient's residence, such as fitness trackers, medication dispensers, alerts, reminders. Wireless technology has enabled blood pressure cuffs, and pulse ox, and scales, and thermometers to be put into the patient's home, where patients are able to transmit readings from those devices to a clinical dashboard in the cloud, where remote clinicians are monitoring the readings and can escalate to a doctor.

Video has made it possible for you to do e-consults, and you can do it with compassion. A patient can see you and you can do it using devices. You can do it using biometric devices, when you're on video, and you're going to see some of that with Todd. Software algorithms, and artificial intelligence, and data warehousing allows you to review, analyze, and make decisions, diagnostic decisions. As well as creating care plans for thousands of patients at once who have the same condition.

The research in telemedicine is also varied and very wide. And it is particularly significant in the areas of managing individuals with chronic disease and managing behavioral health issues. Now, Dr. Cohen asked me to talk a little bit about my path to telehealth. Sorry. And so let me just give you a very brief ... It's not brief, really, but it's a little description of what my career has been like.

I've been in the healthcare industry for a long time and in particular in the area of healthcare IT. I started out at 3M. And at 3M, I was in charge of sales and marketing for programmable hearing aids. So that's where I start. Sort of got my first introduction to how can a patient be monitored with a device in their ear and help them have a better quality of life? And when I moved to Oracle, I helped healthcare organizations. I was the vice president for North and South America for Oracle services. And I helped healthcare businesses implement large system applications for their practices.

John and I moved to Long Island to work for Computer Associates. They're out on Exit 58 on the Long Island Expressway. And I did much of the same things as I did at Oracle. There, I was the senior vice president for Global Services. And then I went back to Minnesota. Some of you may have known what happened with Computer Associates at that time. Some time ago, the executives all went to jail. So I decided, "I don't really want to be here anymore. I think I just ... I'll go back to Minnesota." And we'll learn about cardiac rhythm. That's how I met Dr. Cohen. And I was responsible for ... I was the vice president in charge of global education for the cardiac rhythm, the cardiac device area.

And in my life there, at Medtronic, I actually built a fleet of trucks that contained an electrophysiology lab, so that I could bring education to the doctors, where they were in the hospital or in their practice, and they would walk out of the hospital and they would go into the truck, and they would learn how to implant devices. We had robots that they could practice on, and we actually had live pigs. And we took very good care of those pigs. So it was an okay thing.

But that was my first experience of really bringing education into the home or into the place where my customers were. And in this case, we're going to talk about how we are bringing services, telehealth-enabled services, to the patient and honoring their need to control their time and flexibility over their schedule. And that kind of thing. At American TeleCare, then, after I was done with Medtronic, I worked with Mayo Clinic to help them develop a telehealth-enabled program for their nurses, for the actual employees of Mayo, because those nurses were incredibly expensive in the Mayo medical plan. And so we had some success putting them on a telehealth program and being able to monitor many of their chronic illnesses on a continuous basis.

And then, also, I worked with the Veterans Administration who, by the way, is the largest consumer of telemedicine programs in the country. And with the VA, we started a early stage renal disease program monitoring vets for their vital signs, and so forth, that had that kind of a problem. And so along the way, I chaired the board of directors of HealthPartners, which is an HMO in the Midwest, very large staff model HMO. And the rest of these folks are, today, my clients and partners.

So in 2005, after American TeleCare, I decided to start my own business in New York. I didn't want to be in Minnesota anymore. We were ready to come to New York. We had a great house and good friends here. So I started Telehealth Associates in 2005. And during that time now, since my business has started, we helped write for UnitedHealthcare, a telehealth innovation plan for tele-mental health. And we also got a grant from New York State, the Department of Health, to evaluate telemedicine equipment, which is how I met Todd in Henry Schein, and we decided to use Henry Schein Medpod's equipment in this grant, to develop a telehealth-enabled Urgent Care program for developmentally disabled people here in New York. So that was a very successful opportunity for us, and so it's been quite a journey.

And about Telehealth Associates, just very quickly. We've been in business over 15 years, we have 10000 patient days of telehealth experience. We work with providers to integrate telemedicine into their practice, and everybody is looking to do that now, in large part because Medicare and Medicaid are reimbursing for telemedicine more than they ever have. And so we work with clinics, and hospitals, and home health agencies, and school nurses, and prison clinics, skilled nursing ... Do I say skilled nursing facilities? Anyway, we have a wide variety of clients. And part of why we can be so successful is from this grant that we had with Henry Schein.

We were able to generate some amazing, remarkable outcomes. 86 percent of avoidable ER visits, 50 percent faster access to care, 98 percent patient and provider satisfaction, 25 percent reduction in medical spend for inpatient behavioral problems. So there's a lot of research and a lot of outcomes to justify your getting into telehealth.

So what is it, exactly? So, this is my definition. It's the flow of data between the patient and provider. And let's stop on that a minute because data comes in so many different ways. It comes from texts, from emails, from John's loop recorder, from cameras, from mobile devices, from your television. I mean, it comes from everywhere. And it's delivered synchronously, which means real-time. And asynchronously, which is store-and-forward. You store the data and you forward it later.

And what it does is it enables the provider to create an envelope of care for the patient. When I talk about an envelope of care, I'm talking about, really, a holistic approach. I'm not just talking about ... You see advertisements for Teladoc on TV, and some of these insurance companies are saying, "Oh, yeah. You can have access to a physician." Telemedicine, telehealth, virtual care, I use those terms interchangeably, it's so much more than just a video consult. And you can take this data that's coming from all different sources, relevant data, and send it to specialists. You can send it to social workers, to nutritionists, to mobile labs, all for the purpose of creating multiple high-quality encounters for the individual, to stabilize, maintain, and improve their health.

Now, as I mentioned, telehealth is no longer an innovative fad. I mean, it's necessary for physicians to meet people's ... your patient's demands. And your demands. You want control over your time, you want flexibility, and they do too. We want privacy and we want access to care for the right provider ... at the right time.

Salesforce, which is a customer relationship management application, recently reported that 60 percent of millennials support the use of telehealth to eliminate in-person health visits. And look, with the continued addition of coverage from Medicare for telehealth services ... We follow the money, doctors follow the money, just like everybody else. It's causing an explosion in the interest and the adoption of telehealth.

In addition, all 50 states have Medicaid coverage for telemedicine in some way. And commercial payers are reimbursing for telemedicine at the same rate as an in-clinic visit for the same type of visit. A lot of opportunity now for you to take this seriously.

So now let's look at one model of how telehealth can deliver the ability to collect data, to observe the patient, to analyze that data, do a diagnosis, and do the treatment. I'm going to show you a model that's in the cloud under the umbrella of a single platform. And this is what Henry Schein uses to deliver their telehealth products, because they are really also a software platform for doing this. So let's start with patient facing. This is a browser-based system that allows for live tele-video and data streams, for synchronous and asynchronous data collection. You can see that they can collect data from the telephone. Interactive voice response is one of those modalities where an individual will take a survey and answer questions and that data gets sent to a dashboard. Virtual video visits or live tele-video streams, that have both voice and audio, that gets transmitted.

Virtual video visits with diagnostic devices. What Todd is going to show you is a device that allows the doctor to remotely control the diagnostic tools. It's capable of mobile ultrasound, it's capable of mobile labs, for real-time face-to-face virtual diagnostic assessments in the home. In the home. Then there's biometric data which is remote patient monitoring. This is leaving behind biometric devices like blood pressure cuffs, and pulse ox, and scales, and thermometers so that the patient can take a reading and digitally transmit that reading to a dashboard in the cloud where there is a remote clinician who is monitoring the readings and escalating symptoms before they exacerbate ... to a physician, or an NP, or somebody else who can deal with that escalation.

Now, there's a physician facing part of this. And the physician facing part is observing the patient, because we know how important that is. Once you've collected the data, you need to see the patient. And then also, to be able to use the clinical dashboard to analyze, diagnose, and treat. And that clinical dashboard takes all the information and it helps develop trends, and reports, and other kinds of care plans that will help you make the best decision.

And finally, there's a practice facing element to this, where data is integrated into the EMR, the electronic medical record, of the providers choosing. And this is all connected in one platform. Now, I will say that telemedicine vendors today, many of them ... most of them don't have a common platform like this. Henry Schein and Medpod do, and so that's why we use their product ... with various solutions. So let's go to Todd and have him show you, take you on a little journey down [crosstalk 00:21:24] R2-D2.

Todd Stack:

Hello, good morning. Thank you for the opportunity to present Medpod. So as Terri said ... I think you started with Star Wars, so I'll just mention that we refer to this as M2-D2 because that's ... I don't know if you saw me open it up, but it literally weighs 30 pounds, it folds down into this travel case, it can go on the trunk of a car, it can go on an airline overhead. And we actually have signed a deal with Uber Health to help deliver health services, so this is an exciting time to be involved in healthcare and technology. I think the other point that I would make is, if I asked 10 people the definition of telemedicine, I'll get 12 different answers of what it means and they're all valid explanations.

If you go back to the beginning of telemedicine, and NASA, and stuff that's gone on in a hospital, and Telestroke, and Tele-ICU, all fantastic stuff, stuff that happened in the cardiac side well before it had happened anywhere else. Fantastic. The technology is finally here now on the ambulatory side to really change how and where care is delivered. Terri mentioned a New York State Department of Health program that we were fortunate enough to participate in. We had eight of these units, actually the previous generation of this, and 14 nurses take care of approximately 2100 IBD patients, so these are complex medical cases in a group home.

Unfortunately, 100 percent of the time, these folks, if they need care after hours on weekends, wind up in an ambulance to the hospital and get admitted 50 percent of the time at a cost of greater than 14000 dollars. We reduce the incidence of them ever leaving the group home by 86 percent. That's off the chart. So again, as Terri mentioned, one of the unique things ... Medpod is not a product. It's a platform, so it's software. So if you want to do just video visits, you can have video interactions with your patients and keep them in your own ecosystem, rather than putting them out to some third-party services that are going to provide the same level of service.

There's translation services built in across the platform. So a person trained in medical terminology, that speaks that patient's language, comes up live on the screen, interacts between you, or the on-site caregiver, and the patient. A great tool. That's fantastic. If you don't use it, you don't pay for it, versus a physical translation services.

From there, again, you can move into diagnostic devices. This is just one of the configurations. This is the MobileDoc version. So literally, wheel it in, set it up. I'm not setting up 20 pieces of equipment. I unfold it, I log in, and I'm done. There's nothing for the remote provider to install. So if I'm on the other side of the equation, and I want to have an encounter ... If my laptop would wake up. I merely need a browser, and then what would happen would be the same thing that happens in the physical world. So you'd have a lower-level provider interacting with the patient, capturing the vitals, seeing who's available to see that patient, and then reach out to the higher-level provider remotely.

That higher-level provider could be anywhere, as long as they have an internet connection, as long as they're licensed in the state where the patient is. By the way, I think we're up to 19 states that have across state licensure compact now, so that's a great thing. That remote provider can turn these devices on/off, capture audio, video, clinical data, annotate the images, and have a full interaction that's on par with a physical visit, and billable ... in many cases. Some qualifiers there. And more importantly, since we're a platform, we're also agnostic to the EHR. So nobody's re-keying all the data that's being captured. The data is going to be captured locally as part of the encounter, wherever that encounter might be, and then the records are going to flow directly into that patient's record, for that physician, under that practice.

So, again, I'm going to just simulate a few things here. So what would happen, there's a Bluetooth scale, and a Bluetooth ... Actually, a ultrasonic stadiometer. So I just go like this and it bounces off the floor, and it captures my height and weight. For the purpose of demonstration, I'm just going to plug that in. So that will be transmitted automatically on this side, it goes to this side automatically on the local side. And when I'm the doc ... I'm sorry, I'm not logged in because of the guest WiFi. But as the remote physician, that data that appears here, appears live on my browser with that patient. And then I can obviously ... I'm interacting with the on-site caregiver, which could be a low-level provider. It does not have to be a nurse. It can be a tele-presenter, a new position that we can march towards hopefully getting certification for. So it's really a person that's trained to deploy and utilize the devices and interact with the patients, and hopefully have a great rapport with the higher-level providers.

But again, the neat thing is that the remote provider is in control of the session just like they were in the room with the patient. And again, that includes ... So if I'm the remote provider, I can turn the stethoscope on remotely. So I'm going to be instructing the on-site caregiver where to position the stethoscope. As you can see, there's a waveform ... I don't know if everyone can see that because the screen is a little small, but you can make that any size you want. And then again, the neat thing is the remote provider is in control of the session. They can change the frequency of the stethoscope remotely based upon the type of exam they want to do. This puts that provider in complete control of an encounter with a patient as if they were in the room. Similarly ... Sorry.

The remote provider can turn on the JEDMED multi-scope. Not sure if you've seen one of these. Great tool. So it's got a camera, and a display, and interchangeable lenses. So I can survey the situation, what's going on in this environment where this patient is. I can do a complete body exam and then I have a wide variety of lenses. So I can additional exams including a dermoscope lens that's off the chart, as it relates to how accurate it is. And again, that provider, on the other side, is turning it on, instructing the on-site presenter where to position the camera. Can capture video or still images, and then annotate those images live, that appears on this side, to interact with the patient. And then whatever we capture goes to the patient record.

So exciting stuff. I think one of the most important things to note is that part of this requires thinking a little bit differently. A lot of medicine, good, bad or indifferent, is built on transactional fee for service. It's gotten us to where we're at, and there's a lot of changes and different models out there with ACOs and other incentives. I would say from a legal, and regulatory, and reimbursement perspective, things have never looked brighter. Things are changing fairly rapidly and that's a great thing for all of you.

But also think differently. Don't just think that medicine can only be performed in a physician office, in an urgent care, in a hospital. You could bring this anywhere, literally. It really depends on the qualifications of the person that's interacting with the patient, as well as your qualifications and your desire to be able to use this equipment. This is only going to get smaller, faster, cheaper, lighter. As Terri mentioned, part of the platform also includes remote patient monitoring. So we can have monitoring for chronic patients in the home. Part of the neat idea of the model is you have chronic patients, they have an episode, you see what's going on instead of having them come to you. You could deploy a low-level with a MobileDoc directly to them. And that really changes, again, how and where care is delivered.

Terri Seppala:

Great. Thank you, Todd. That was excellent. Very cool. I want to tell you that patients love this. We brought this device, MobileDoc, into ... We did 300 visits, brought that into their home, and they were crazy for it. They love seeing themselves, they love seeing the doctor. And the evaluation that we did on this grant was done by a third-party researcher. They actually moved the needle. The patients moved the needle on feeling more accountable for their health. And they started out at a low level of non-engagement, and they moved to being more excited about taking care of themselves and being more compliant in coming to the doctor. So, it's great for the patient and I'm sure you have now a mental image of how this could be great for you. How it could expand your footprint and extend your reach with patients.

So now I just want to show you a quick video, it's two minutes, of a television clip from News 12, on our use of this equipment. It happened a couple years ago. The version of MobileDoc that you'll see is the precursor of this new model, but I think you'll find it interesting.

News 12 Anchorman:

It's billed as the first of its kind on the island. New technology that reinvents the way doctors treat patients. News 12 Long Island's health reporter Shari Einhorn shows us in a story you'll see only on 12.

Shari Einhorn:

Yes, it looks like carry-on luggage but I'm not jumping on a plane today. What I am doing though, is getting a first look at how this little bag is changing the way doctors make modern day house calls.

Jack Tawil:

This is the equivalent of a doctor's visit pretty much anywhere.

Speaker 1:


Jack Tawil:

I think it's transformational for the healthcare industry.

Dr. James Powell:

Hey, it's Dr. Powell. How are you today?

Shari Einhorn:

Dr. James Powell is the doctor. He's sitting here in his office in Central Islip.

Dr. James Powell:

So we're going to take a look at Peter today.

Shari Einhorn:

Peter Faulk is the patient, and he's here at home in Hauppauge.

Peter Faulk:

It's cool. I like it.

Shari Einhorn:

It's called MobileDoc, an example of what's being called telemedicine.

Jack Tawil:

We were looking to figure out how do you actually take a whole medical office and put it into a bag, and literally being able to bring it anywhere.

Shari Einhorn:

And he means anywhere.

Dr. James Powell:

I was in the parking lot, using the WiFi, doing sessions, I'm behind the pilot, I was at a conference in Orlando. The accessibility is unbelievable.


And doctor, what would you like to do first?

Shari Einhorn:

A registered nurse acts as the doctor's remote hands, doing what he'd be doing if the patient was in his office. Back at his desk, the doctor sees and hears everything.

Dr. James Powell:

You got a nice, regular rhythm.

Shari Einhorn:

Patient Peter Faulk is wheelchair-bound with cerebral palsy, and says he likes the convenience of a modern day house call.

Peter Faulk:

Having the thing come here, and checking you out, and doctor seeing you on the screen, I like that.

Shari Einhorn:

On the Health Beat, I'm Shari Einhorn. News 12 Long Island.

News 12 Anchorman:

The Medpod MobileDoc took about a decade to come to fruition and was officially launched last month.

Terri Seppala:

Yeah. It's great, right? This is why I say we're all telehealth providers. I mean, we have all the elements of success now, with telemedicine, to move forward in our practices. So just a couple more things about the promise of telehealth for you. It's the right care, at the right time, with the right provider, in the right place. And there are three different kinds of care that I just want to talk with you about.

The first is Virtual Care. And Virtual Care is like virtual reality in the gaming industry. I mean, it's real. The effects are real. You can see that when you bring that MobileDoc into the home, you can do a diagnostic assessment in the same way or as good as you can do in the clinic, with the exception of not being able to smell or touch the patient. And as Todd mentioned, the tele-presenter, who in our video was the nurse, is the eyes and ears of the doctor in the home. So he or she can address some of those issues.

The other thing is that we are not confined to geography, distance, time. There are no physical barriers to getting access to care. And there's no temporal barriers to getting a scheduled appointment with the doctor that you want to see. And now just imagine in New York City, on a snowy day, you have an emergency. You need to go to the emergency room. The ambulance can't get to you and you can't get to the emergency room. But you can pick up your phone or your tablet and have an e-consult with a doctor. Likewise, if you're upstate New York and you're having a panic attack, and the psychiatrist is 100 miles away, you can pick up your phone or your tablet and have an e-consult right then and there.

The second area is Augmented Care. Telemedicine enables Augmented Care. This is remote monitoring, of leaving behind these devices of blood pressure cuffs and other kinds of biometric devices that will take vital signs, and they can be digitally transmitted to a clinician who is looking at a dashboard remotely. Similar to John, when he talked about having his loop recorder on his night table ... It's like having Dr. Cohen sitting on your night table. And you can imagine how comforting that is for a patient. Having my cardiologist in my house 24/7. Well, you're going to get better! You are going to get better. That's the promise of telehealth.

And finally Extended Care. And I just want to make mention, the emergency room is one of the best concepts that we have in medicine today. Why is that? Because you have an interdisciplinary team of specialists that are delivering care at the right time with the right provider at the time that you really need it. And telemedicine allows you to virtualize the emergency room process. It can bring all of the specialists that are needed without the problems of sitting for six hours in the emergency room and waiting to be treated, or having to schedule all these different specialists at a time that you need them.

So, just a couple more thoughts about use cases. No matter what specialty you're going into, telemedicine has a role to play. So for example, with Primary Care, you can offer alternative visits to your patients rather than in the clinic. And telemedicine is becoming a way of attracting new patients as well. Behavioral Care. I mentioned this as particularly helpful in areas where behavioral health specialists are scarce. Urgent Care is ... keeping the patient in your practice after hours and on the weekends. Doctors can be paid for telemedicine visits from their home office on the weekends. And so you don't have to send patients out to the emergency room or to Urgent Care on the weekends or after hours. You can handle them in your practice. Acute Care really requires some very specific expertise and immediate access to expertise. And when virtual care is available, there's significant research that shows clinical outcome improvement for stroke, for MI, for trauma, for OB.

Transitional Care is supporting the individual when they move from the hospital into a step-down facility or into the home. And there's a lot of research, again, showing that if you give a patient a remote monitoring kit before they leave the hospital, you can shorten their length of stay. Chronic Care, like diabetes, heart failure. Can you imagine the multiple high-quality encounters that can happen if you equip these individuals with remote patient monitoring and access to tele-video and access to MobileDoc? And finally, Specialty Care. When a patient is not able to get this kind of care in your clinic, they can have access to virtual examinations and consultations using telemedicine.

So, how will telehealth change your practice life? Now, Dr. Cohen said, "Don't show this slide because," he said, "these students are very serious and they don't like cartoons." All right, I'm doing it anyway because I think they're just great! And data shows that almost one third of physicians are burnt out, and many of them report that more control over scheduling and increases in work-life balance would increase their work satisfaction. One third of physicians are burned out. Well, telehealth technology can extend your reach, expand your footprint, and also fit easily into your existing workflow. That's what we see when we work with our physician groups.

This says, "I opened another location with a telemedicine cart." Extending your reach, expanding your footprint. This says, "Adding virtual visits to my schedule was easy for me and my staff." And you heard in the video, this is the 21st century house call. And I told you that patients feel so comforted when they know the nurse is monitoring blood pressure.

Todd Stack:

Sorry, can we switch?

Terri Seppala:

Yes, yeah.

Todd Stack:

One comment. Yeah, is that on? So what Terri is talking about, in this case I opened another location with a telemedicine card. So I had the good fortune, or of misfortune to call on some of the largest surgeon care operators in the country. And one of them that had over 200 locations was spending 10 million dollars a year on per diems. They had enough docs but they were in the wrong place at the wrong time. So they had doc's playing Parcheesi in location A, and the head of ton of patients in location B. Doing this, they could have the docs that were idle see those patients in other locations and save part of that money. Having remote patient monitoring is an enormous benefit from a financial perspective, for you as a physician, because CMS finally woke up and has proper reimbursement in place for that.

And then on the virtual care side, there's other companies out there that have an entire business, with lots and lots of money, and are public companies that do nothing but virtual visits. And that's fantastic, but what you're doing, in many cases, you're pushing your patients outside of your ecosystem. So if you could keep them in your own ecosystem and then treat them these other ways, I think it makes great sense from a business model perspective. So I would just add, as young physicians and students, to look at the business side of medicine and say, "How can this change how I practice medicine as I go forward in my career?"

Terri Seppala:

Absolutely. Some of you, I bet, are going to become virtualists. Just like hospitalists. You are going to do nothing but virtual care, just like hospitals serve only patients in the hospital.

Improving the quality of life for your patients and yourself. I want to just make note that virtual care gives back to your patients, really, control. Control of their time and the thing that they value the most. And honestly, it also is particularly helpful for people who feel isolated, and need to connect and to feel good through tele-video. And also those who are embarrassed in a small ... This says, "It's such a small town. I can't be seen being treated for addiction." So it provides privacy for the individual and it allows you to achieve more. It allows you to provide more encounters, more opportunities for value-based care, which is where reimbursement is going for quality measures and better outcomes. It allows the patient more choices and it gives you more flexibility.

Okay. So in conclusion, there are three things I want to summarize. Number one, telehealth is not just medical FaceTime. I hope you understand that from what we've just talked about. It's multiple modalities delivering, importing, exporting data. It's creating a holistic envelope of care, enabling high quality, multiple encounters. And it ends up with a more educated and engaged patient, caregiver, provider. But there is a danger of data overload. And that's the other thing. I'm talking with physicians that I work with, their challenge is there's so much data, how do you choose the data to pay attention to? Are you collecting the most relevant data to make a decision? Are you ordering too much data? Are you ordering the right data?

And finally, and this is what I want to end with because, most importantly ... is the nuances of care that are human and compassionate. It's like I was watching Dr. Cohen and John here, and imagining that they were in a clinical visit. And telemedicine allows you to collect a lot of data ahead of your scheduled doctor's visit, so that when the patient actually does come to your clinic, to see you, you have already all this data that you can use during the meeting, during the appointment. And you can practice at the top of your license. You can spend time talking with the patient about important things.

So many of these scheduled appointments that you have, you need more than 15 minutes to deal with the patient. And this allows you to take the time to ask the questions that Dr. Cohen was asking. "What happens when you drink?" Or, "How has your life changed as a result of your heart condition?" Or ... He didn't ask. "How do you feel about your grandson who is being raised in a way you may not agree with? And what kind of emotional or physical reaction do you have to that?" So that's the beauty of what we have here. And if you want to learn more, there are some certification programs that are available to support successful telehealth projects and tele-presenters.

So thank you.

Dr. Todd Cohen:

Well, that was great. Well, thank you very much. I want to ... I'm going to ask you a question or two. Then I'm going to let people take a little break and then we'll go into informal questions. And we'll deal with people who are interested in innovation, research, whatever you want to talk about. We'll be here for a little bit more. So the first question I have for you, Terri, is ... These are medical students, they're first and second year. What do they need to know? And how can they be ahead of the curve when they graduate NYIT, come and go out, so they can get a job and be prepared for the world when they come out and be able to do this telemedicine? And is there any kind of certification that we could provide them, so when they come out here, they have a certificate, and they could put that on their resume and they have this experience?

Terri Seppala:

Yeah. I will say that other medical schools ... I'm not familiar with NYIT, but other medical schools are designing curricula to incorporate telemedicine into the practice. And there are organizations that are out there that would be happy to help create a curriculum and I think that's really important because this is becoming so prevalent. And the other thing I would suggest is go out and see what it looks like from a provider point of view. Long Island Select Healthcare, located in Central Islip, is offering telemedicine visits. And they're doing it in this envelope of care, a holistic approach, where it's remote patient monitoring, and video visits, and MobileDoc. Visit with them, learn how they think about it and how they're ... what the provider side is. Watch a telemedicine visit being done from the provider side. Go to a patient's home and be happy to help out with any ...

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