Telemedicine – The New Arsenal for Healthcare

Nitika: Hi everyone and welcome to the Zinnov Podcast on Business Resilience. In today’s episode, we will be covering the healthcare sector and more specifically telemedicine. As we all know, the healthcare sector has been at the forefront of the COVID crisis, and healthcare workers have been on the frontline, striving to flatten the curve, every single day. But as the saying goes, not all heroes wear capes, and within the healthcare space, telehealth and telemedicine services have emerged as the silent hero that is making a difference every single day by helping people stay home and stay healthy.

In today’s episode, we have with us, Kali Durgampudi, Chief Technology & Innovation Officer at Greenway Health, someone who’s been doing his part in combating the COVID-19 crisis. Welcome Kali, it is an honor to have you here today.

Kali: Yeah, great to be here, and thank you for having me today.

Nitika: To kick start this discussion, I wanted to talk about telemedicine services in the pre-COVID, COVID, and the post-COVID era. How do you think that is going to play out across these three different timelines?

Kali: In the pre-COVID era, telemedicine has been a very difficult concept to get along. Even though there were a lot of entities and companies and push towards telemedicine services, not a lot of adoption has happened in the Pre-COVID era. As with any technology, a change either takes a slow pace, or it takes a revolution. In this case, the revolution has happened, which is the COVID. Now all of a sudden, in the COVID era, we are seeing anywhere from a 100% growth to 4,000% growth in telemedicine visits because that’s the only way most of the care can be done safely. So, telemedicine services have taken off in many ways, not only from a technology standpoint, from a behavioral standpoint, from a regulatory standpoint, and an adoption standpoint. I believe that telemedicine is here to stay from now onwards. In the post-COVID era, I think it will be as important if not more important, especially because of the burden that the physicians have taken during the COVID era. Also, the patients have now delayed a lot of visits and all of that will catch up to us in the post-COVID aspects of it. So, I think the telemedicine services will play a key role, going forward, and I think this is something that is probably here to stay forever.

Nitika: Thank you. The numbers that you stated are fairly remarkable in terms of the amount of increase. We know that now in the COVID era, telemedicine has been playing a critical role in filtering and ensuring that the system is not overwhelmed. Can you share a few anecdotes of how telemedicine is being used in the current crisis?

Kali: So, every provider practice now has either adopted or is in the process of adopting telemedicine, without which many businesses would go out of business from a non-healthcare standpoint. But from a healthcare point of view specifically, the care has to go on. There are only so many things that you can postpone and are elective. So, the care has to go on, and especially in the primary care pediatrics area, patients’ parents and patients want to go get the check-ups done, sometimes for COVID purposes and sometimes for non-COVID purposes. So, all non-COVID care cannot stop, but also the COVID care, cannot stop.

So, there are two particular areas where telemedicine services are useful – one in the triaging process of a COVID patient. So if you truly have symptoms – obviously a lot of people have set up chatbots and assessment pages where you can go through – but let’s say you do go through one of those assessments, and you’re either positive or relatively positive, then you need to see the physician, or at least remotely to begin with it so that the triaging process is done with Telemedicine. The second way in which telehealth is useful is cutting down doctor visits. However, let’s say that I had a skin doctor appointment, which is very tough to do via telemedicine obviously because the doctor had to look at my body physically for a skin rash. So, I had to visit a particular physician. But in other areas, like ENT, most of the visits are being done by telemedicine. Even when I visited the skin doctor, by the way, they offer services around dermatology and they’re doing all those now using telemedicine.

As I said, the telemedicine visits have exponentially increased, using Zoom, FaceTime, Teams, and so on. Technologies are limitless in terms of using telemedicine services.

Nitika: Great, very interesting. So, Kali, the promise of telemedicine has always been there but there have been inherent challenges, relating to providers’ adoption, patients’ adoption, as well as the fundamental regulatory challenges. How has that changed in this particular time?

Kali: Very important question. In the pre-COVID era, telemedicine visits were not paid at the same rate as a regular visit. Plus, there was another big issue here in the United States – physicians, could not practice across state lines easily. So, by relaxing those regulations now, here’s what has happened. One, telemedicine services are now being paid as the same visit type as a regular visit. This is phenomenal because now physicians can get paid for doing the work that they’ve always done. And secondly, if a particular city or a state is overwhelmed, you can get help using telemedicine. So, you don’t have to physically travel. For example, I live in Florida and if Florida got overwhelmed, a physician practicing from anywhere – be it Georgia, Seattle, and even India, or the Philippines can help me using telemedicine. Of course, they have to be credentialed correctly, but now this has taken away the borders from a technology and a regulatory standpoint. Now there are still some regulatory hurdles across countries, by the way, but at least, the state-level hurdles have been done away with. Now the second one is behavioral, even though telemedicine was always available, but people were hesitant to do it via telemedicine. They’d think, why do it through telemedicine when you can ride there within five minutes? But now, especially with the social distancing aspects of it, people will think about why to go to a hospital when you don’t have to, patient behavior is changing. Even physician behavior is changing because now they are realizing that telemedicine visits are as impactful as a regular visit. The technology is as good as seeing the patient in person. So, they’re able to adjust their schedules.

The other thing is scheduling. So, telemedicine services now allow the scheduling to not just be between eight to five, but maybe different shifts. So, there are dynamics here that are permanently altering views and because COVID situation is not here just for five days or so, but it’s been weeks and months, this behavior is here to stay.

Nitika: Got it. So, you made a very interesting point on how the regulatory aspects are different across the globe. How do you see the situation being different say in Europe versus the US? There are several studies, indicating that some countries or some continents lag in telemedicine due to legislation issues and lack of political direction. Do you see that changing and how is it any different at the moment?

Kali: I do see it changing. Some countries that have already established telemedicine rules and regulations have obviously relaxed and are doing better. Some countries who are not there anymore, have done it during the COVID crisis. If you take India as an example, they’ve issued some guidelines within a matter of days, which is unheard of from an India standpoint. There are CIOs who have already adopted the telemedicine services guidelines that have come out. So, I think the advanced countries who had rules and regulations are going to relax it while the other countries who are slightly lagging will quickly adopt it and because of the technology advancements that we have, I think it’s going to be very seamless and easy even for developing and underdeveloped countries. So, I think this is going to be one of those Game Changer type opportunities across the globe and I think I look forward to even crossing international boundaries and continental boundaries when it comes to these visits.

Nitika: So, you talk about technology and technology enabling access. What kind of technology shifts and changes have you seen and what are some of the technologies, apart from the collaboration technologies such as Zoom, WebEx, or even Teams that have started seeing the light of the current situation?

Kali: So, the actual technology to provide telemedicine is one aspect of it, but the technology surrounding it and supporting it another aspect of it. So obviously the technologies like Zoom, Teams, even custom-made software are there to be able to enable the visits. But the important point is that the visit will still be documented. The visit should still be entered into the systems. Just because I picked up the phone today and started talking on FaceTime to a new doctor that has started offering telemedicine, they still have to have an intake process, then the doctor has to have a documentation process that they have assessed me and cared for me. And then there’s the billing aspect of it based on telemedicine. So, the technology is quickly adapting to new ways of scheduling patients, new ways of in-taking patients, new ways of triaging patients, new ways of documenting on telemedicine visits. Now, in some cases, technology actually will make things easier, because it’s all digital. You’re not dealing with any ambient disturbances and noises aspects of it so if somebody wanted to record the telemedicine visit, and as long as it’s legal and regulatory approved, you can do that. And there are crystal clear voices that you can parse using natural language processing and apply artificial intelligence behind the scenes. So, I think with increasing number of telemedicine visits more technological advancements are going to happen because all the pieces will come together, and a complete ecosystem is going to come together. Further, artificial intelligence and natural language processing, etc. will add much more meaning to those visits.

Nitika: Thank you, Kali. I have one last question for you because I believe this will summarize what we have been discussing until now. In this whole episode, one clear thing is that we have to make our healthcare system more resilient. So, what do we do in the next decade, taking the learnings from the last few months?

Kali: In the immediate future, I think, we need to ensure that we adhere to the goodness that comes out of telemedicine services. And I think we will, because of all the pent-up demand with the elective services that have been canceled. If you look at the burden of physicians who are already on the frontlines, it is going to create a new level of demand in the post-COVID era. So, I think in the immediate future telemedicine is here to stay. And I think the next step, as we look towards the decade, is ensuring that the regulatory and the behavioral concepts stick. I do see that in the next decade or so, a majority of the visits could be converted into telemedicine visits. People are already experimenting with home healthcare devices where they can quickly stand on a scale and the scale is going to now communicate through the device to tell the physician whatever they need to know from weight to BMI. So, with the advent of telemedicine as well as home health care devices, it’s completely conceivable that physicals can happen from home. It’s completely conceivable that any type of visits that do not require any surgeries or are impacting physical body parts can happen virtually. So, I look forward to the days when the phones, and the devices and the home health devices are talking to the Cloud, and the physicians have access to the information that enables a quick telemedicine visit, without actually traveling. It is heart-warming to see this kind of resilience in the whole system. So, the whole ecosystem had that resilience, the agility, the heart, the soul, the depth, to be able to do this. So that’s the great outcome of this unfortunate tragedy.

Nitika: Absolutely. Thank you so much for your time, Kali. It was great to get your perspective and I think we can agree that telemedicine is no longer the silent hero of the healthcare economy. We look forward to seeing how telemedicine will play a key role in making healthcare truly accessible across the world. Thank you for your time and it was great having you.

Kali: Thank you for having me and I look forward to a bright future of telemedicine as well.