Healthcare Conversations: Taking a Look at Telehealth

About this episode:

In this special episode of UB Insider, Utah Business’ Pat Parkinson talks to industry experts about the benefits and limitations of telehealth, especially for people who have limited mobility, live in rural areas or otherwise might have a hard time getting into the doctor. Subscribe or download this episode via iTunes and Stitcher.


Pat Parkinson: Hey, greetings everyone. Thank you for being with me today. I’m very excited to be podcasting today from the future of healthcare conference. I’m podcasting today for Utah Business magazine. I’m in Salt Lake City, Utah at the beautiful Grand America Hotel looking out the window here at the beautiful Wasatch Range. And I’m joined by two very interesting guests, and we’re going to be talking about a very timely topic. You don’t get much more timely than virtual medicine and solutions.

These two gentlemen just spoke on a panel called “Virtual Medicine and Solutions”. I’m joined here today by Nate Gladwell and John Larsen. And Nate and John come to us, they’re with the University of Utah. They’re with telehealth and telemedicine at University of Utah Health Care. Now that’s right, you guys are University of Utah right? You’re associated with the U, or no?

John Larsen: Yeah. That’s where we work.

Pat Parkinson: Cool, cool. It’s great to have you guys here. Welcome Nate and John. They were just kind of briefing me a little bit on the panel that they just participated in. Fascinating stuff for both the tech and non-tech minded, I think. You know, Nate, you just kind of set it up really well, man.

You gave me a good idea of the different audiences and some of the different demographics that you guys work on. Why don’t you… Actually, we need to start at the beginning with this one. Because even where you all work is a little bit hard to figure out, right? Telehealth and telemedicine. I think we know what that prefix means, if you will, but tell me what tele means as it relates to healthcare industry if you would, Nate.

Nate Gladwell: Absolutely, a great place to start. So when we think about telehealth, telemedicine, virtual care, there’s a lot of ways to say it. I think the challenge for your average consumer of healthcare is really to think of it as, all we’re doing is providing expert medical care, high quality care, high standards of care that we provide at the University of Utah in a way that utilizes technology that’s all around us, right? Our laptops, our iPhones, very simple technology by and large. Maximizing and utilizing that technology in a way to provide care to patients wherever they are by our world class specialists with just some simple technology in between. So call it telehealth, call it telemedicine. The more important part is we’re talking about high quality medicine.

Pat Parkinson: I can appreciate what you’re saying about kind of the need to really keep it simple, probably for it to be effective. How do you keep it simple when you’re kind of dealing with technology and healthcare and these super weighty topics, you know?

Nate Gladwell: Yeah. It’s one of those things that we’ve seen really transition over time. You know, telemedicine has been around for 30 plus years. It looks like a soundstage that we’re in now. You know, wires and monitors all over the place. But really what we’ve seen in the transition, with the advent of the internet, with simple software solutions, we’ve really been able to see a transition from very high complexity interactions to what, you know, what grandmas and grandchildren do today on their iPhones and other devices through very simple video conferencing solutions that are easy.

Pat Parkinson: John, what kind of stuff can you accomplish in healthcare using technology?

John Larsen: That’s the tricky part, right? And I think Nate gave me the statistic a while ago, that 80% of encounters like visits with the doctor, the doctor doesn’t even need to touch you. You’re just talking. You’re following up on a condition. It’s just communication. That’s where we talk about it being simple, is really complexity doesn’t really matter.

Now there’s a rub in that there are sometimes little things that a doctor does that we don’t have the technology to do, like feel your pulse or your fever. So, I say we don’t have the technology. We do, but it’s, that’s the transformative space. That’s getting those things to the consumer or to the person in their home, right?

Pat Parkinson: So communication is a big part of that, obviously, especially when you say that 80% stat.

John Larsen: Yeah. You know, I think most of healthcare is communication – your doctor asking you questions and you answering them. So in that case, that’s the simplicity we’re talking about. And unfortunately the wires and what not can be intimidating so people don’t use what otherwise they could.

Pat Parkinson: I’d like to hear more about that. You can speak to it. Nate can speak to it as well. People are relatively quite informed these days about technology. Everybody uses social media, and many people use the internet and the access to that has obviously improved greatly, and the user friendliness of that, if you will, has improved greatly. Do you think you could be a little bit more specific about some the technology, the platforms that we’re using or the types that we’re using?

John Larsen: Sure. I think you’re right that people are used to using things like Skype or FaceTime to talk to grandma in Florida. And they’ve adopted that technology or talking on the phone or texting. But when it comes to going and talking to your doctor, we sometimes just don’t wrap our heads around that, right? Or the doctors don’t.

The idea that we could do a follow up visit using the same technology. Now the devil is always in the details. We have HIPPA and privacy laws and making sure that we are following Federal regulations. So it’s not as simple as just plugging in Skype. But from a technological perspective, that’s basically what it is.

Nate Gladwell: Yeah. But to build on that a little bit, I think the interesting thing that we’re seeing in really all spaces of consumerism, be that movies, be that how you consume maps, as simple as maps nowadays. I mean, when was the last time you physically opened or unfolded a map? Unless you’re a Boy Scout, right now, in the mountains, probably it’s been a long time.

So people are very used to interacting with the world around them with a device in between. And so I think as more and more people sort of grow up in that digital environment, interacting with your medical care should be just as easy and just as available. The challenge is to keep it just as high quality. So that’s what we’re focused on.

Pat Parkinson: So that’s a very interesting point, obviously. That asks for many other questions, what you just said. It’s limited in what you can do as far as the services you can provide in healthcare? Or do you guys not really look at it that way? Do you kind of stay pretty open minded about that?

Nate Gladwell: Right. For our teams, our minds are as wide open as they possibly can be. I think the culture of healthcare is really one of the biggest opportunities to change. Which is, you know, if you’re a patient, you’re used to just taking a half day off, going in to see your doctor. Your doctor is used to you coming in to see them, having, if you sort of imagine them having a whole toolshed behind them of devices and technology and labs and imaging to be able to treat your condition whatever is presented to them. Where I think…

Where we need to go is, all of that is great and fine and wonderful, but there’s a whole opportunity here, I think with very simple technology, to be able to interact much more effectively, efficiently and have improving outcomes while actually decreasing costs. Which I think is what everyone is striving for in healthcare. And I think if we just apply some simple technology…

I’m a nurse by background. I’m not a technologist by background. So seeing it through sort of the lens of just the humanism of it, if you’re a grandma potentially and you have a hard time getting around, why not, you know, you just saw your kids, your grandkids on Skype. Why not use that same simple technology to see your doctor if it’s HIPPA compliant and secure and those things?

Pat Parkinson: Is it a lot easier… And this is, I’m sure you’ll have a good answer to this. Is it a lot easier to convince that grandma to call her grandson on Skype than it is to call her doctor?

Nate Gladwell: Well I think the simple answer to that is probably yes.

Pat Parkinson: But it’s not that the latter or the former is a huge barrier to entry. That’s what you guys are trying to convince people to do.

Nate Gladwell: Yeah. I would agree with you that it’s very difficult to have that conversation with a patient if they’re for 30, 40 plus years they’ve developed a relationship with their physician. They like to go in. They like that hands on approach and we don’t want to diminish that. But what I think we’re saying is, those of us who grew up with a Redbox right next to McDonalds and now streaming onto your TV right at your house, your favorite movie. The demand for services delivered in a convenient environment is only going to increase.

Pat Parkinson: Absolutely. And I’m going to shift to John with a question here, but you’re absolutely right. One, there’s already a lot of people in the workforce, and we’re kind of talking about business here today. There’s already a lot of younger people, I’m thinking about the millennials and stuff, where it’s more normal for them probably to consider calling their doctor on Skype than it is for them to go to the office. It’s more preferred. They’ve already embraced that.

Nate Gladwell: Correct.

Pat Parkinson: And that’s just going to become the norm, I would think, in the future. So that’s very interesting. Hey John, I’m wondering man, could you, he actually gave a pretty good example, but I’m wondering if you could break it down maybe even further and kind of give us an example, like almost an anecdote of where, how this communication happens. The Skype example was good. I’d love to hear you like, maybe talk about a tool or something that people are familiar with.

John Larsen: Sure. We have two big programs at the U that utilize telemedicine. One is our telestroke program. The other is our teleburn program. So the University of Utah is, of course, a magnet hospital. You know, it has a high level of care. It’s the regional burn center for people all over, you know, in Wyoming and Montana and Idaho. So you can imagine that oftentimes burns can be pretty complicated. You look at the…

The skin might look a little bit red, but even for an emergency doctor, it’s a little spooky because they don’t know what’s going on. They’ve dealt with some burns in med school, but that’s not their specialty. So what we’re able to do is take these remote emergency rooms and in a matter of minutes have them hooked up with our burn center. And have doctors who are very familiar be able to use cameras, interact with the patient and be able to make the call of whether or not they should be transported down here or whether they can stay where they are and be treated by doctors who it’s a little bit out of their realm of expertise. Same thing with strokes.

Pat Parkinson: So this would happen when the person is at a healthcare facility?

John Larsen: Sure.

Pat Parkinson: However, a similar thing could play out if the person is at their home?

John Larsen: Potentially.

Pat Parkinson: We’re not quite there yet for like the burn example.

John Larsen: These things are starting to hit the marketplace. They’re early in their adoptive phase. Where rather than running to Urgent Care, you can get an app on your iPhone, these things are there right now, and swipe your credit card, pay your $50 and suddenly you’re talking to a doctor.

Pat Parkinson: That’s awesome.

John Larsen: But we’re still working on the connectivity, getting the whole ecosystem of the healthcare connected up that way.

Pat Parkinson: That’s great. I don’t want to put you on the spot, but this is really interesting stuff, obviously. What’s the coolest thing on the horizon, John? What’s something that I or that the audience, we don’t know that it’s going on, but it’s going on?

John Larsen: There’s a lot of fascinating stuff. We have a technology team that’s investigating this all the time. There’s billions of dollars in the United States and billions and billions more outside of the United States investigating all these devices. Things that we can just put on top of you in sort of a Star Trek environment, you know, where we can pull data that might have gone to labs for weeks and now we can get it fairly instantaneously. So it’s really almost overwhelming.

Because one of the things that Nate and I do is evaluate all of this stuff and see which ones are actually sticky enough to get in front of the doctors. So virtually everything that you can imagine in terms of being able to measure healthcare. And things where we used to have to stick needles in people to get, we can do those on the surface right now and they’re really fascinating.

Pat Parkinson: Is it all good? And you can speak to this too. Is it all good? And I mean that from like a, maybe from an ethics standpoint or maybe even from a science fiction standpoint. I mean, and I’m asking this to you guys. The general public might have a different view of this. Some conspiracy nut might have a different view of this. But you guys, the experts, is it all good? The potential?

Nate Gladwell: I think the easy answer is maybe. In my opinion, there’s a lot of opportunity for improvement in the way that healthcare is delivered.

Pat Parkinson: And we could be healthier and have a higher quality of life as a result of what you guys are talking about? In the future, I mean.

Nate Gladwell: Yeah. I mean, we could all avoid McDonalds too. Yeah. I think the important thing is, where we come from is the University of Utah Health Care, our focus really is on value, right? High quality, high service at the lowest possible cost. That’s our main mission as an institution. We really replicate that in the telehealth space is, if it makes a consumer feel like they’re interacting with their healthcare environment and it makes them happy? That’s high value right?

If it actually improves their outcome, so as a diabetic, if their care is actually better because now they can interact with their physician using some technology as opposed to going to see their doctor once every three months. If it improves their outcomes and decreases their potential cost of care, that’s high value. I mean, that’s really what we’re laser focused on. We don’t want to just throw technology in front of patients or in front of doctors just because it looks cool. We want to put technology in the sphere of medicine so that we improve value.

Pat Parkinson: And you don’t worry about… I don’t want to say don’t worry, but, you’re not alluding too much to some kind of Doctor Frankenstein situation that could happen. Like this technology gets away from us or something. And again, I know I’m being kind of hyperbole here, but just like… I’m sure these discussions obviously take place a lot in your field. How far do we go?

John Larsen: One of the things that makes our job more complicated is just what you’re talking about, the legal and regulatory environment. Sometimes things are slow to adopt because the technology is disruptive and people are a little nervous about it. To your question about is it dangerous, I would say not really. Not any more than anything else. There are doctors who can do malpractice or practice medicine in a damaging way no matter what you give them, right? And this is just another tool in their tool kit.

Pat Parkinson: Very cool. I don’t want to get off on a tangent. I hope this doesn’t get us off on a tangent, I don’t think it will, but we haven’t kind of spoken to it directly. We’ve talked about Skype, and really Skype is a social media tool, obviously. And I just wonder if social media in general, you guys have been in this field for a while, thinking you were probably in this field, probably in healthcare before social media was invented. How often do you talk about the potential of social media as it relates to social networks like Facebook or Twitter or LinkedIn or things like that? Does that have a big role in the future? Is that going to go away? Do you guys kind of have any predictions about that?

Nate Gladwell: I think there’s lots of opportunity from the social media perspective. I think, I mean there’s actually a social media forum today. I can’t think of the name of it now, but where physicians have actually created a social media environment.

Pat Parkinson: That doesn’t surprise me. They have their own network.

Nate Gladwell: It’s their own app. It’s their own platform where, you know, a radiologist from Tampa can say, look at this weird x-ray. And shoot it out there to the social web and say, does anyone have any advice for me? And radiologists all around the country can say, oh, I’ve seen that before. That’s X, Y, Z.

So I think social media has a big place. That’s always sort of in the background though. Our focus is really on the consumer. So there’s a lot of messy policies and protocols and procedures behind the scenes. What we want to do in telehealth is pull all of that complexity inside the system. And then for the consumer it’s really smooth and clean and convenient and easy. So that’s where, we’re laser focused on that consumer end. All the process of delivery on the backend is challenging.

Pat Parkinson: You can’t get muddled down in that though, so to speak. It’s very interesting stuff here. I wonder, why don’t you tell me a little bit here, we have a few minutes left, what do… I want to kind of want to ask you guys… How do I want to put this question here? I kind of want to ask you guys… I’ve been asking people all day to kind of part the podcast by leaving some helpful advice. But in speaking to you guys, I don’t know if maybe advice is as poignant or compelling as what the future holds. And I wonder if we’ve already kind of beaten that in this discussion. I don’t know if people would rather hear you sum up here by saying the three big trends you see in the near future, or if they’d rather have you tell them something about maybe why they should perhaps come around to telemedicine a little more.

Nate Gladwell: Yeah. Let me take a first stab and John can go. Maybe we can play off each other a little bit. One of my big soap boxes in the world of telehealth and all of this future technology is that you’ve got to be grounded at the end of the day to what you’re trying to accomplish. So our grounding, our sort of third rail always is the relationship between our providers and our patients. If we’re not laser focused on that, all this technology just sort of becomes a fog of either missed opportunity or wasted monies. And so, what I really like to tell people, and I do often is: At the University we’ve been doing telemedicine for 15 or more years. This is not new. This is not…

Pat Parkinson: Using a computer. Using digital.

Nate Gladwell: Digital. So just because you see it on, you know, the latest science magazine doesn’t mean it’s new. At the University we’ve been doing this for a long time. Our telestroke program is now partnering with 26 facilities throughout the Intermountain West to deliver high quality healthcare. So we’re just sort of building on that inertia that we’ve built over time to say, how do we take it to this next level to you, the consumer who’s right down the street from us? How do we interact with you in a meaningful way using technology? That’s our next step and maybe John I’ll turn it to you from there.

John Larsen: Yeah. I think, you know, there’s really a triangle. There’s the physician, there’s the patient, there’s the technology. When people talk about telemedicine they always get focused in on the technology. That seems sexy. It seems interesting. But it’s the easiest part. You ask about advice? Well sometimes I think we’re in a waiting game because the patient doesn’t know that it’s even a possibility from the doctor’s perspective. And the doctor doesn’t understand, necessarily, that the patient wants it. So it might be as simple as, sometimes we’re trying to break through that log jam of trying to do the cultural adaption of it as opposed to the technological or regulatory.

Pat Parkinson: So well said and so interesting.

John Larsen: So maybe it’s just letting your doctor know that you’re interested.

Pat Parkinson: That’s often the case in these complex matters. People sometimes just get in the way, for lack of a better description.

John Larsen: They get used to doing things the traditional way. Telemedicine is not as disruptive as people think it is. It’s just something a little new.

Pat Parkinson: Disruptive in a good way. Potentially.

Nate Gladwell: The last thing I would say looking forward into the future is, you know, the FitBit phenomenon, the Jawbone era that we sort of all live in. Everyone is interested in collecting data that we just produce as humans. Our steps, you know, our calorie intake, our calorie output. All of those things that are just generated from our body.

What I envision here in the next 10 years is, if you’re interested, I guess we ought to start there to John’s point, if the patient’s even interested. But as consumer, you wake up in the morning and on your device is sort of your health dashboard. Which says, you know, you got so many hours of sleep, you exerted so many steps yesterday, based on an algorithm you’ve already developed a step goal for today. You know what your heart rate was throughout the night. You know what your blood sugar average was over the last 24, 48 hours so that today you can know, gosh I’ve really got to cut down on my sugars today so that I can sort of stay healthy.

That’s what I envision. Is all these devices that are beginning to show up to wear, the wearable sensors are powerful today. But we haven’t even started thinking about collecting that data one, so that it’s meaningful for the consumer and two, so it’s meaningful for your healthcare provider team.

Pat Parkinson: Very, very interesting stuff here. Guys, we’re getting down here to the end. I’d like to just maybe go to you, Nate, to close. I feel like you guys have just really given us some great information. You haven’t really promoted yourself at all. Not even promote, but just kind of talked about what you guys do in detail.

I wonder if you’d like to close, one question that I have that you could maybe transition from or maybe piggyback off is, I think I’m a little bit unclear. I kind of heard you mention more the consumer at the end of our conversation. I’d love to hear who you really serve, maybe in the context of you being at this conference today. This Utah Business conference where there are a lot of business owners. And then if you just want to tell us a little bit more about your organization. It might be kind of a cool way to close here today.

Nate Gladwell: Yeah, you bet. I’m happy to. So again, University of Utah Health Care, our telehealth team is really invested in disrupting the way that medicine is delivered. We have a long track record of success, as I mentioned, 15 plus years in this industry. What I think we’re really focused in on today is, as a healthcare industry we really see the challenge in the cost.

The economics of healthcare are brutal for businesses, for consumers and for governments. What I’m very passionate about is in the United States of America we have one of the most phenomenal healthcare systems in the world. Some of our outcomes are a little bit behind. What I think we have a real opportunity to do is cut through some of the regulatory issues, cut through old stereotypes and cultural issues and with a little simple technology and adapting more technology over time, what we can do as a health system is really impact, number one, that cost of care. So decreasing the burden of healthcare on everybody.

Two, improve the way everyone accesses their care. Whether you’re a stroke survivor and thriver, and you’re setting up your follow up appointment with your physician, let’s do that in your home. Let’s do that where it’s more convenient for you. Or you’re a diabetic and you’ve got reams of data on your blood sugars that, you know, unbeknownst to most, your healthcare team doesn’t really look at very often. Let’s put that data in a meaningful way in front of you, the consumer, and we as your care team to make better decisions about our daily activities.

Pat Parkinson: And when you use the word consumer, it seems that could apply to an employer or an individual. From your perspective I mean.

Nate Gladwell: Absolutely. So employers are really the focus of our conference today.

Pat Parkinson: They’re your customers. But they’re not exclusively your customers though.

Nate Gladwell: But they’re definitely an important customer given that a lot of employers are either self-insured or moving that direction. They are the actual payers of healthcare. So when their members, their employees go in to access healthcare, it’s oftentimes the employer that’s paying that bill. So from an employer’s perspective, we are very conscious of the burden of healthcare to them. And what we would like to do is develop innovative solutions most often in partnership with employers. But develop innovative solutions that we can then take to employers to say, you know that million dollar spend that you had last year on your employees? With some simple technology and some innovative new work flows, we can cut that spend in half. Let’s do it together.

Pat Parkinson: That’s awesome. It seems the benefits maybe could even be compounded by the healthcare reform environment that we live in today. I mean, obviously technology is a funny thing. It’s always there. It’s always evolving. But society changes and technology is kind of still there to soak up the slack. I’m sure it’s an innovative solution that has been pretty handy in this uncertain healthcare environment.

Nate Gladwell: Yeah. I think the last thing I would say along those lines is we look at Kodak decades ago that failed to see the value of digital imaging. I think healthcare, I don’t think we’re beyond the pale. I don’t think our industry is really going anywhere anytime soon. But I think we have a real opportunity to learn from the mistakes of Kodak and say, there is some real cool technology. It’s getting much easier. How do we as a culture in the healthcare sector, how do we as a culture adapt this technology into the way we do business to just help the people we’re trying to serve, which is our patients?

Pat Parkinson: John, you all have mentioned the stroke, the telestroke center a couple times. I’m not sure what the proper name is there, but I’ll throw you one more question here. I appreciate you guys taking so much time to speak with me. This has been one of the longer podcasts today. It has just been really interesting, obviously. Is there one ailment, or kind of one discipline whether it be neuro or whatever that you guys are just really knocking it out of the park on? That’s really relevant? Or is that kind of too broad?

John Larsen: We’re actually, we have a big initiative this year to get devices to consumers that they can use to manage particularly chronic conditions. Chronic heart failure, diabetes, COPD, or just a bunch of these things that people live with long term so that we can get alerts to doctors if your condition gets out of tolerance. Rather than rely on you calling EMS five days later, we can do intervention right away. So that’s an exciting point that we’re doing a lot of research in right now.

Pat Parkinson: That’s very exciting. Gentlemen, I know how busy you guys are. You’re obviously extremely intelligent guys, and I really appreciate you sitting down here and chatting with me a little bit about this today.

John Larsen: We appreciate it.

Pat Parkinson: Yeah. Let me tell you one more time who these guys are, for the audience. We were joined today by Nate Gladwell and John Larsen. I’m hoping my information is accurate here. Nate Gladwell is the director of telehealth and telemedicine at University of Utah Health Care. And John Larsen works closely with Nate. My notes are telling me that he is a project manager at telehealth and telemedicine at University of Utah Health Care. Is that correct?

John Larsen: That’s right.

Pat Parkinson: Guys, thanks so much for joining me. I think the audience has really probably enjoyed this podcast today.

Nate Gladwell: Great.

John Larsen: Thanks for the time.