- [Narrator] The region's premier medical information program, "Call the Doctor."

- So much changed when the COVID-19 pandemic hit two years ago, and people were forced to stay put.

That includes medical professionals who had to find innovative ways to treat their patients from home.

Telehealth became a popular option.

Seeing a doctor through a computer screen, or a phone line, instead of in person.

We take a closer look at some of the lessons learned, what worked and what didn't.

Maybe, more importantly, what comes next?

The future of telehealth now on "Call the Doctor."

And hello, we're so glad you have joined us for this episode of "Call the Doctor."

I'm Julie Sidoni.

I'm the News Director here at WVIA.

And I'll be your moderator this season.

The episode you're about to see is about telehealth.

Talk about a word we didn't use a whole lot a few years ago.

Today, as you heard in the piece, two years after the world practically shut down because of COVID-19, telehealth is a staple of some healthcare models.

And it doesn't look like that's going away anytime soon.

So we've asked a few of the regions' medical experts to help take us through the future of telehealth.

Tell us a little bit about what they've been seeing these past few years, which I'm very happy to introduce you to two of those experts tonight.

Dr Dempsey, we'll start with you.

Thank you both for being here.

Tell us just a little bit about yourself, who you are, what you do.

- Sure.

So my name's Marla Dempsey.

I practice outpatient family medicine in Scranton, PA with the Commonwealth Health Network.

So what that means is I see every age from newborns through elderly patients, all in the office setting.

And spend a lot of time doing just some primary care, basically.

- Okay, and Dr Matthew.

- I'm Aswathi Mathew, I'm an Internal Medicine Board Certified Physician currently working with Lehigh Valley Health Network at East Stroudsburg Practice.

- In East Stroudsburg?

- [Aswathi] Correct.

- So, and you also work in the office type setting?

- Yes, in outpatient setting.

- So, I mean, we said earlier in the piece, was telehealth a word I even knew a couple years ago?

I'm not, I'm sure it existed, but I think the whole world just became, you know, interested in it when COVID hit.

So the first question I have really talks about the different types of telehealth, the different types of services.

Because I think we all know, I mean by now, we know Zoom and we know Google Meet and we've all had to do meetings online.

What kind of services and what types are there in each of your organizations?

- Sure, so in my practice, how we utilize telehealth mostly is through video chats or phone calls if people don't have access to video services.

And mostly for the same kind of things that we would see a patient in person for.

So if they're sick, if they have a cold symptom, that was kind of how we initially started to use it a ton during COVID.

But now we use it for routine follow-ups for diabetes and high blood pressure, anxiety, depression, all of those kind of things.

So usually just with a video chat.

Sometimes our nurses will also call patients after they've gotten outta the hospital.

That's another way that we use telehealth to kind of close the gap between hospital and office setting.

- Not necessarily a video, but could also be a phone chat?

- A phone call, yeah.

Yeah, just to check in to see how they're doing post hospital.

- Okay, Dr Mathew.

- So at Lehigh Valley Health Network, an outpatient setting like Doctor was saying, we do the video visits and the phone visits.

But we have something called a baby cam, which is like monitoring your baby in the neonatal intensive care unit from home.

So parents can watch the babies at home.

That's one type of service, that's one type of telehealth.

Other one be like a transition care team where like the patient is contacted after the patient gets discharged from the hospital.

Maybe one to two days to close the gap between the hospital discharge and seeing a doctor in the office.

- That's interesting you both used the term close the gap.

So there obviously had been a gap there during COVID, in particular, with the amount of people who could get to you.

- Yes.

- Yes, for sure.

- All right, actually access was what we were gonna talk about next here.

Tell me a little bit about who you were able to see and treat that you might not have gotten to before.

We'll start with you this time, Dr Mathew.

- So I would say that, you know, the elderly population, like the bed-bound patients that were not able to come to the office.

We were able to, you know, follow up with them and see how they were doing.

Patients like out of state or if they are not near to us, if they needed to follow up with us, we were able to do that through the televisits.

Those were some of the examples I would say.

- And did that happen before COVID or was this all a kind of something new that bubbled up when people couldn't get to you?

- I believe this was happening even before COVID.

But telehealth, you know, became a thing after COVID.

So we were able to address this.

And I believe that, you know, addressing that now in the future too, the telehealth will exist to address this population.

- And baby cam, I mean, I'm interested in that.

That was also something that was brought on by the pandemic?

- So from the, I'm not very sure about that, but from the Lehigh Valley Health Network, I think it was there.

Yeah.

- I just think that's kind of interesting.

So okay, that's what I kinda wanted to get at was, did telehealth exist, that you know of, before COVID?

Is this something that you ever did three years ago?

- So me, myself, no.

I think it did exist in a small subset of people.

Like there were different online companies, where insurance companies would pay where you could call and talk to a doctor who wasn't your doctor.

But I don't think for primary care it really existed to any major degree where you could call and get your own doctor, and actually talk to somebody who knows you.

I think that's one of the big advantages of telehealth with a doctor who knows you.

As opposed to going to like an urgent care or something like that, where it's someone who you don't know.

- That's interesting, kind of an urgent care online.

You could find a doctor, you just didn't really know who that person was?

- Right, yeah.

So I think people would use that for like a UTI or something simple where they just wanted an antibiotic or something quick and easy, but not for routine kind of primary care.

- Right.

And you said you were still in residency, right?

- I was doing residency was like, I think one and a half years into my residency when we saw the COVID hit.

So yeah, it was complete shock to us 'cause we are used to seeing patients, you know, do a physical exam, talking to them.

So it was an adjustment for us have the televisits, the phone visits.

But I think it has its own limitations, but I think it has a lot of benefits as well.

- I actually didn't consider until what you said right now, someone being in med school or in the residency during COVID 'cause all of what you have studied, I don't wanna say, and a lot of it was obsolete then if you had to treat a patient online.

- Yes, yes.

- Yeah, so we were used to like listening to their hearts, their lungs, you know, feeling their abdomen to see what's going on.

But now we have to like kind of take a step back and then reassess everything from that perspective, yeah.

- What were you gonna say, Dr Dempsey?

- Yeah, for sure.

I think the one thing that I've found with telehealth is I'm surprised how much a physical exam, in a lot of instances, is not that important.

You know, we think of it when we're learning and it's so drilled into us that you have to have this really great physical exam skills.

And sometimes you certainly do for certain things, there's no question, you need an in-person exam.

But there is a lot of medicine you can do without actually touching the patient, which is pretty cool.

- Is it a little bit that you have to trust the patient more?

If you don't have eyes on them, are you asking different questions to get them to tell you what's wrong?

I mean, did your approach have to change?

- For sure, yeah, for sure.

I think especially if you do have a video visit, I think you can get that idea of does a person look sick versus not sick?

That's something that I've always kind of felt you get kind of quickly by seeing them.

But if you're just talking to them on the phone, you definitely need to get a lot more in detailed history from them to figure out what's going on.

- Yeah, and like for example, if their legs are swollen, I would ask them, "Oh, can you show the camera and let me see your legs."

Or if there's a rash, I would ask them to show me the rash through the camera.

And if there's something that I'm worried about, I would make them come to the office so I can take a closer look at that.

- So in some cases you had them do a visit anyway?

- Yes, based on how much I think like they need to come into the office.

- Did you do just as much video as you did over the phone?

Was it typically mostly video?

- No, there's a limitation to video, especially with the elderly population, 'cause they're not very good with technology, some of them.

So in that case, and I had some video visits that need to be changed to phone visits like that.

But otherwise, I think I prefer video visit more than phone visits.

At least we can see the patient and you feel not as connection as when you do an in-person visit, but at least you can see the patient.

See if they're smiling or they're worried.

You can see their facial expression.

So I prefer more video visit.

And I do more video visit compared to phone visits.

- There's obvious advantages for the patient, not having to leave their home if they're not feeling well, as you suggested their post-op, or whatever the case may be.

But are there advantages from your standpoint?

- Certainly, yeah.

You know, I think a lot of times doctors get kind of caught treating things just via a message without actually getting to talk to the person, if they can't come into the office for whatever reason.

So I think the advantage for us is we get to actually talk to the patient, hear the whole history, and not just treat based on what other people are telling us.

So that's definitely helpful.

I think it definitely allows you to have a better idea of what's going on with the patient when you can talk to them, rather than just get a message about what they have going on.

- So through an online portal or some other type thing.

- Sure.

Just them talking to your nurse rather than actually getting to talk to you.

- What about you?

Did you see an advantage?

- And sometimes- Sometimes that some patients wouldn't show up because it's hard for them.

They do not wanna come to the, you know, the office.

So you, that continuity of care is kind of, you lose that continuity of care.

But now that you have video visits and phone visits available, so patient has that option.

Like, okay, if I don't want to go in, I can at least talk to my doctor through a video visit.

And then I can, you know, tell them my concerns.

So we have that continuity of care more.

I have noticed that we have more follow-ups and more continuative care since we have started the televisits.

- More follow-ups?

- More, yeah, continuity of care.

So it's like I can follow up more, like a 90-year-old, I don't expect them to come to my office like every four months or every three months.

So if I see them in the office once, then I ask them to come to, you know, do a video visit three months or four months later.

- [Julie] Oh.

- Rather than always making them come to the office.

- So you can track them.

I mean, you track them- - More closely.

- A little bit better, a little more closely?

Yeah.

- [Aswathi] Correct, yeah.

- What about, I mean, since we just talked about advantages, there are, obviously, some disadvantages.

What might those be from both your perspective and the patient's perspective?

- Yeah, so definitely like I said, certain things cannot be done via telehealth, right?

So if somebody has chest pain or even abdominal pain, that's a tough one to do without examining the patient.

And you're missing out on kind of a little bit of the personal aspect of getting to see them in person and them getting to talk to you and feel connected to you.

So that's definitely one of the disadvantages, I would say.

- There's a chance you, you talked about the physical part of it, which I think is interesting.

It's the first thing you come in and you do blood pressure, and they check your lungs, and the whole thing.

- [Marla] Sure.

- You can really do a solid visit without those types of things you're saying?

- You can, I mean, a lot of patients for blood pressure have a home cuff, so they'll give me their stats when we do a telehealth visit.

They'll tell me what their blood pressure was that day.

If they don't have access to that, then definitely, yeah, you're missing out on that.

Or their sugar numbers if they're diabetic, and those kind of things, so yeah.

- I mean, it depends on the type of problems that they're having.

So if it's just a preventative care or a follow-up visit, then easily, we can do it through televisit.

But if it's something they're having a chest pain, they're having shortness of breath, it can be multiple things.

So we need to assist them in the office.

So it depends on, we schedule based on what their, you know, issues are.

- You're pointing out what I was going to say next.

And that is that we're pointing out that telehealth exists and it's wonderful for everyone out there.

But let's go over some of the, perhaps, symptoms or the things that people might have that really need to be taken care of immediately.

What are, you mentioned a few just now, which is what got me thinking about this.

If people are exhibiting XYZ symptoms, what is telehealth not gonna be able to do?

- Yeah, so for sure telehealth can't do blood work.

It can't do an EKG.

It can't do imaging of any of type.

So obviously emergency type symptoms like chest pain, or shortness of breath, or severe abdominal pain, severe headache, those kind of things need to have vital signs assessed, need to be seen in person and had some additional work up done that can't just be over the phone.

So most of the emergency type things where you would say I'm maybe on the verge of going to the ER, that would definitely be something that wouldn't be appropriate for telehealth.

- [Julie] Go ahead and be seen in person.

- Yeah.

- Yeah, for example, shortness of breath.

It could be a cardiac cause, it can be something related to your lungs, or it could be your anxiety.

It could be a wide variety of things, right?

So if they come to the office, we can do an EKG right away.

We can listen to their lungs.

If there's anxiety, we can do a questionnaire to see if there's underlying anxiety present.

So, you know, we can do all those things in just one visit rather than televisit, we are not able to do any of that.

So those are the limitations.

Or rash, or something like that.

I know it could be, that sometimes it's better to see in person than over a video visit.

- I'm interested in what technical upgrades may have had to happen, not just in your respective organizations, but all across the medical community.

Suddenly, this thing is in our laps and you have all of these patients who need to be seen.

To the best that you can talk about this, what kind of technical upgrades have you seen either personally, or that you've seen in other hospitals that made all of this possible?

- Yeah so, for sure, when COVID first started in our organization, we were kind of scrambling to figure out how we were gonna do this.

- [Julie] Everyone was.

- Everybody was, right?

So, we were using our phones, our own personal cell phones to do like FaceTime and those kind of things, or just the office phone to call people and some free online apps that were kind of available to all doctors during COVID.

But since then, we've really adapted to now where it's integrated into our electronic health system.

So, the system that we use that has the patient's email and their cell phone, they either get texted a link or emailed a link to the video and that's integrated right into our system.

So, it's all HIPAA compliant and secure and all of those things now, that it wasn't when it first started.

- What a big job that must have been.

- [Marla] Yeah.

- What about from your perspective, Dr Mathew?

- So I think one important thing would be the interpretation.

Like we have like interpreter services built into the televisit.

So we have like somebody they're Spanish speaking.

We have somebody available in that telehealth platform that's able to, you know, help us during the visit.

- Tell me a little bit more about that.

I'm interested in that because we have such a, there's a diverse population here.

A lot of different languages are spoken.

I know some hospitals have language services, you know, that they can call, but how did that work with telemedicine?

There was always someone available?

- Yeah, there's like a number that you can dial.

It's like a mutual call and then we just, the interpreter will join the call and then we just do the call together.

- I never even considered that, yeah.

- [Aswathi] Yeah.

- There was so much you had to think about so quickly.

What about hesitation?

And I don't just mean from the older population, I suppose, there might be some people in the older population who really weren't sure how to work the computer, whatever the case may be.

But I would bet the hesitation went a little further than that.

Talk about the things that you saw in telehealth that maybe you weren't sure were really gonna work.

- Yeah, for sure.

So I think, in the beginning, like everyone, you hear, well, I'm just gonna tell to my doctor on the phone.

And people don't think they're getting maybe their money's worth or whatever you wanna say, they're worth out of the visit.

So there was definitely some hesitation at first, what is this?

What do you mean, you're just gonna call me?

But I think the more that people experienced it and got to see what it was really like, I think then there was little, I get little hesitation now.

Actually I get people calling, asking to do telehealth visits 'cause they don't have to leave work and all that other stuff.

So now I think there's very little hesitation.

But in the beginning, just 'cause it was new and unknown, there certainly was some.

- And you say now you have just as many telehealth patients as you do normal, or I shouldn't say normal, that's in-person patients, yeah.

- Yeah, for sure.

My day now is mixed.

You know, I don't have like a specific telehealth day.

I'll have like at 10:00, I have a telehealth.

At 10:30, I have an in-person.

So I just kind of bounce back and forth between my office and exam rooms.

- Hmm.

All right, well with you, what about the hesitation question?

Did you see this?

- Yeah, some patients prefer to be seen in office, like they like to talk to their doctor, come and see you and then, you know, go from there.

So even elderly people, they like to come to the office.

So when we switched from televisit to in person, they all wanted to come to the office to say hi to us or you know, to see us in person.

So that's about it.

- What about trends?

So at the beginning, March 2020, everyone was telehealth.

Have you seen certain trends where people have gone back and forth?

Are they mostly in person now again?

Again, what have you seen as the virus has sort of, you know, grown and come back down again?

- Yeah, we are doing more of in person right now.

I would say like 80% in person versus 20% televisits.

- So you're still mostly in person now?

- In person, correct, yes.

- Yeah, same for me.

I would say maybe 90% in person right now.

But back in January when it did kind of surge again, we were probably more like 50/50 telehealth again.

'Cause when people get kind of less comfortable coming to the office, they're worried they're gonna catch COVID by coming- - [Julie] Yeah.

- Then they kind of would request to do telehealth visits.

- Is there something to worry about when it comes to insurance?

Do you have insurance issues or what can you tell people who may wonder whether their insurance is going to pick up or cover that doctor visit that wasn't actually in person?

- Sure.

You know, we always tell people, make sure you check with your plan 'cause everybody's different.

But Medicare, which is the biggest insurer and, you know, with most insurers follow suit with Medicare, is covering telehealth through the end of 2023.

So that's already been kind of approved.

So they cover, you know, the same thing that they would cover in person, it's covered through insurance.

The copays would be the same.

During COVID, actually, the copays were waived for telehealth.

So it was actually more cost effective for people to do telehealth then to come in person.

So I think it's gonna continue.

I have not had a lot of patients tell me that they get bills for doing a telehealth visit outside of the ordinary.

I have not had many people complain about that.

- And did you notice any issues?

- Yeah, same thing.

No, no issues with the insurance.

- I never really thought about it until more recently.

And I wondered if people who had gone to the telehealth method had had to kind of redo how they did everything.

- [Marla] Mm-hm, yeah.

- You know, I guess everybody had to redo everything over these two years.

- [Marla] For sure.

- So I would like to talk a little bit about what you see in the future.

So, you know, I'm not gonna say we're gonna get over the virus, but it's gonna come and go possibly as it has the last couple of years.

What do you each expect telehealth will do?

- I think telehealth is not gonna replace our current practice of medicine, but it's just a continuation of how we are gonna practice medicine.

So if for patients who need, you know, there's that option available and it's widely available.

Every organization, every hospital system, every outpatients offices, they have this service available.

So it's just an extension of our current practice.

It will never replace our current practice.

- And maybe that's what people wanna hear more than anything else, that it's not like we're gonna all go to online medicine.

- For sure.

Yeah, for sure.

I agree that it's here to stay and I think there will be a place for it, but will never be the end all be all.

There will always be an in-person office where you can go to.

I think we'll see it expand into different areas, probably like pediatrics.

I think there's a big market for that.

There's some devices now where you can like look in kids' ears electronically and different things like that to check for ear infections.

So I think- - Really?

- That market will probably expand.

- I was just gonna ask that, why pediatrics and not adult medicine?

- Yeah, I think for the same reason, convenience, right?

So 'cause kids are busy, parents are busy.

Getting them to come into the pediatrician's office sometimes is difficult.

So it's easy to treat certain things over the phone if you can.

- Yeah, for like heart failure patients, they can monitor the volume status, their blood pressures from home.

Somebody else can monitor that from somewhere else and tell the patient how to adjust their medications.

So these are all different types of telehealth that we will use more in the future.

- What about any lessons learned?

I mean, anecdotally of course, but any lessons learned in these last couple of years, either personally or something that you have seen in your work, how things have changed with medicine?

Or how that is going to continue?

Things that people should expect as we go through this pandemic?

- I think we have to adapt to what's coming.

Like it was just a sudden change for me in residency.

Like it was one day everything was normal then a few days later we were like doing televisits.

And also, it was just adapting to the new changes.

Be open to everything, that's the main lesson that I have learned.

- Yeah, absolutely.

And I would say another thing that I've learned from telehealth is it's an interesting to get to see people in their own homes.

So sometimes seeing their environment, I think, is different from when they come to my environment.

I get to see them in their own environment.

Sometimes people are a little more comfortable in their own environment.

So you get to see a little more of who they really are.

And that can be helpful for caring for them as well.

- I never thought about that either.

There's probably a certain amount of anxiety that people, some people, would get coming into a doctor's office, especially if they think they're about to get some bad news.

- [Marla] Sure.

- So what, do you look for certain things in a person's home that might cue you or clue you into something that's happening?

- For sure, for chronic diseases, you know, you can kind of get an idea of what their setup is like or can they be active?

What kind of foods do they have around them when they're talking to you?

Those kind of things.

But I do find that people are more relaxed and may be more open to tell you the truth when they're in their own environment rather than coming into yours.

- Huh, that's interesting.

- Mm-hm.

- So with our last few minutes here, I'm just curious, kind of an open-ended question here, what you think you would like people to know most about telehealth or about how medicine is continually changing?

I know it's a big question with no real- - Yeah.

- You know, no real answer there.

I'm just curious about your observations.

- Sure.

- I think more advances are happening in telehealth.

We have very secure technologies right now.

Patient information is protected.

You know, more research is happening into the telehealth to make sure that, you know, we address all the patient concerns.

We have the continuity of care with all the patients, regardless if they're bed-bound status or if they're disabled.

So we are able to reach to a wide range of people through telehealth.

And I think this will continue to do so.

- And I agree.

I think just to have, what I would say to my patients is, it's an option.

It's not something you have to do or you ever, you know, would feel required to do.

But it's just one more thing in our toolbox in how to help care for you.

So if it's more convenient for you, or it's something that you feel like it helps, then I think we should continue to offer it to our patients.

- So, I mean, I don't wanna say, I don't wanna speak for all the medical community, but it sounds like it happened rather accidentally.

- [Aswathi] Yes.

- [Marla] Sure.

- But it looks as though it has some real application.

- Yeah, and I think most people would agree that both doctors and patients think it's an advantageous thing for medicine going forward.

- For all ages.

- Yes.

- Yeah, for sure.

- All right.

Any last minute thoughts?

I really appreciate you both joining us.

- Absolutely.

- It was a pleasure.

- Thanks for having us.

- Really great to hear your thoughts on this.

This is a topic that has interested me for a while because I am not of the older generation and I still had some hesitation as to how this could possibly be a real doctor's appointment.

But over the course of a couple years, you know- - [Marla] You got used to it.

- Yeah, you get used to it.

Advances are made.

And so I was curious about where this was going in the future.

So we'd like to thank you both for joining us.

It was great having you.

And that's gonna do it for this episode of "Call the Doctor."

If, by chance, you have missed a portion of the show, you can catch it on Replay.

That schedule is available online at wvia.org.

And you could also watch it online at that website, or find it at the WVIA mobile app for download.

I'm Julie Sidoni, thank you so much for watching.

And from all of us here at WVIA, we'll see you next time.

(relaxing music)