Telemedicine in a Time of Coronavirus: What a Recent Study on Telehealth Can Teach Us

We talk with the authors of a groundbreaking telehealth study in Michigan– Eric Frederick, Executive Director of Connected Nation Michigan, and Chris McGovern, Director of Research, Connected Nation. It's a timely topic now as many of us are sequestered and local, state, and federal officials look at ways to slow the spread of coronavirus. 

Learn what each of us can do to leverage this resource, the concerns people have about the technology, and the biggest barrier to universal telehealth in the U.S.

Transcript

spk_0:   0:07
this is connected Nation, a podcast focused on all things broadband, from closing the digital divide to improving your Internet speeds. We talk technology topics that impact all of us, our families and our communities. On today's podcast, we talked with the authors of a groundbreaking telehealth study. They share what we each conduce to leverage this resource, the concerns people have about it and the biggest barrier to universal telehealth in the United States. I'm Jessica Denson, and this is connected Nation. I'm joined today by Eric Frederick, the executive director of Connected Nation Michigan, and Chris McGovern, director of research development for Connected Nation. Eric and Chris recently authored a groundbreaking study looking at telehealth. This is a timely topic right now, as many of us are sequestered and the local, state and federal officials are looking at ways to slow the spread of Corona virus. Welcome, guys.

spk_2:   1:04
Hey there. How's it going?

spk_1:   1:06
We're gonna be good.

spk_0:   1:07
Yeah. Great. Thank you for joining us. Um, I take it you both are sequestered as well in your homes.

spk_1:   1:13
Yes, it's Ah, it's definitely a challenge. I'm used to tell it working, but not with two elementary age Children. Also in the house who are trying Thio do their schoolwork at the same time. So it's a challenge for sure.

spk_0:   1:28
You were telling me earlier, Eric, that ah, one of your kids is ah online interacting with his friends, is that correct?

spk_1:   1:36
Yeah, The, uh, one of the only ways that they can they can play together is a video gaming. So thank heavens for, ah, decent Internet connection to connect all of those devices.

spk_0:   1:48
And, Chris, how are you holding up?

spk_2:   1:51
Oh, we're doing pretty well here. My wife and I are both Ah, we're both teleworkers. So we're kind of accustomed working from home. And ah, it's really just been an issue of trying to help out where we can faras parents and other family folks who are, uh, who are quarantined. We're, uh, sequestered.

spk_0:   2:18
Yeah, all of us, I think, are dealing with that in some way. I'm ah, Kris and Eric are both up in Michigan, and I am in Louisville, Kentucky, and currently I have a cat that's trying to take over the mic. So I think together we can get through this if we just dollar patient. Um, a lot of people are feeling the stress and the strain of being sequestered and doing would quote unquote social distancing. Um, and some of the recommendations that were hearing from ah federal agencies and stated and seizes toe look to telehealth. So this study you guys did it's pretty timely. It just came out a couple of weeks ago. Eric, if you could If you could just give us a quick rundown of what, uh what you guys looked at the basics of this study and why it even was a thing that we decided to do.

spk_1:   3:08
Yeah, so, yeah, I'll give a quick overview of what Telehealth is, and then I'll talk about the kind of the three parts of the study, and then I'll let Chris talk about the, um, some of the recommendations in the findings that that came out of it so mean telehealth is a big umbrella. I mean, it's it literally is just the use of technology to provide access to medical care or education or training or medical supervision. So it's a really, really big umbrella topic. Um, sometimes it can get taking. Your folks get too specific when talking about telehealth, but it really is just just the blanket use of technology to provide access to health care and medical information and training. And so what we wanted to do in this study was really better understand the barriers to telehealth in rural parts of Michigan. Um, there's there's been studies done about the barriers of telehealth. But we wanted to look at us specifically in Michigan, and because connected nation is a a broadband organization, that is, that is what we do. We're looking at it through that lens, so we're not looking at it through the lens of a health care provider. Um, we're looking at it through the lens of connectivity and the use of broadband to improve quality of life. And, of course, tell health is one way to do that. So the three parts of this study Ah, we first looked at state tele health policy ecosystems and how progressive or restrictive state tele health policy environments are, um, and we combined that information with health outcomes at the county level, particularly for counties who have low access to primary care physicians. So what? What we want to do establish was that in states with restrictive telehealth policies of a state level um, they're rural counties often have low performance when it comes to health outcomes. So we wanted to establish that there's a there's a connection there. The second part of the study was focused on five counties in Michigan and we did a random digit. I'll survey of residents in those five counties. Two pick their brains about telehealth. Have they used it in the past? Um, what did they use it for? What are their issues with telehealth, or what? With one of their, you know, what are their hesitations with using telehealth technology to access medical care? What types of connections do they have a home, you know, if they have a connection s So we wanted to get the perceptions of Tele help from the patient patient side of the equation. Ah, The third bucket of this, then, is the opposite of that. We wanted to know what the barriers to telehealth were among health care providers. So we did focus groups and interviews with health care providers in those same five counties to better understand what their issues are with implementing telehealth visit. Other state policy restrictions are their reimbursement restrictions are their actual technical issues or connectivity issues with implementing telehealth. So those were the three major studies that were part of this broader, um, examination of telehealth in Michigan. So I'll turn it over to Chris to talk about some of what? You know what the outcome's were in, um, the recommendations and data points that came out of those three areas.

spk_2:   6:29
Yeah. We, um we looked at those three aspect really as, um, three parts of the whole. And there is a There's a national element. There is the demand side as faras the households go. And then there's the supply size Faras what? Ah, and what the health care providers are are saying. And so, um, you know, we ended up really well with some with some interesting insights from looking at all three of those. Um, you know, one of the things that, um, that we saw was that Ah, about 1/3 of the folks that we that we interviewed as far as our our residential surveys, um, you know, about 1/3 of them said that they were interacting with their health care providers in some way or other. You know, whether it was through videoconferencing, or, um, you know, maybe, ah, getting information or or talking with their health care providers through social, social media, through texting through through the through their websites. So about one in three people, huh? You know, adults said that they were that they were doing that And the ones who were, uh, who said that they had used those kind of tools. They really had good things to say about it. About those interactions. Yeah, they the majority felt that, uh, doing that the safe from time, um, it was it was more convenient. There were good, good things to say about the health care providers who are on the other side of the of that equation. And they the majority felt good about how comfortable and and how how they were treated by the health care providers. You knows, it was an overall positive experience for these users. Um, and there were amongst those who had it, used it. There were a lot of folks who said that they were interest like they really wanted to use it, but they had it for some reason, other, whether they didn't have the connectivity, whether their providers didn't offer it. You know, some some kind of thing prevented them from from using it. But, you know, they, the ones who were using it, liked it and the ones who weren't using it. Ah, lot of wanted to.

spk_0:   9:24
So, um, based on those surveys, were you getting a sense of the knowledge people had with about telehealth that they understood that it was even offering, um, or was there some lack of understanding of how to leverage it?

spk_2:   9:43
Well, we found that a lot of people love people are familiar with the concept of telehealth or telemedicine, but it is That is such a broad area that not everyone really had a grip on all of the different facets of it. You know, they they knew that. Yeah, they might see a new story about remote monitoring of blood pressure or, um, or blood sugar. You know, those kind of things, but they didn't always know that. Um, things like that are a bit more maybe mundane, but are very, very useful. Are available. Things like being able to ah, talk with a doctor through a videoconference. You getting a diagnosis online? Um, if there's an established relationship being with the physician, you know getting prescriptions filled that way remotely. So yeah, there. The news can really focus on a lot of the more cutting edge stories. But for a lot of people, what they want is to be able to see their doctor without needing to take a day off from work without getting baby sitters for their kids without with all without all those hassles. And there are a lot of telehealth tools that are able to do that for him.

spk_0:   11:26
Fantastic. And obviously, we're in unusual times right now that when this study came out, we were not in, uh, Eric explain a little bit about why activation Michigan partnered with AARP. Why was this important to that organization to take a deeper dive into telehealth?

spk_1:   11:44
Yeah. I mean, obviously, AARP is a is an extremely large organization, and their members are elderly residents across the entire country. Um, and they're particularly interested in this topic because they see an issue with a disparity among their members, particularly those between urban and rural areas. You know, those in rural areas there disparity is lack of broadband infrastructure and access to it. So there they definitely advocate for telehealth. Um, and this this topic in particular because they need to ensure that their membership all have access, um, to to broadband. Do you know how to use it? Um, and can access, um, this type of technology, no matter where they live. So Air P has been a great partner of connected nation Michigan for ah, a long time. So it was exciting for them to come on board for this this project in particular. And, you know, as we look at these rural communities, I think one of the most and in these these very interesting times that we find ourselves in now, Um, one of the most poignant stats that I think comes out of this study is that 40% of the people that participated in this survey and there were 2000 people across these five very rural counties, which is a is a high Ah, hi. Participation rate of 40% of the people that we called didn't have a home internet connection. So right there 40% of the people in these rural places don't even have the option to participate in telehealth because they don't have a connection at home. Now they could go to AA hot spot. They could go to a library that could go to McDonald's or wherever it happens to be to get access to access their their information online. They might have. They might have a cell phone, a smartphone to participate. But that could be limiting, especially for some of the more advanced applications of telehealth. If you're just check checking a patient porter roller checking your test results a smartphone, it will work. But if you're doing remote monitoring or two way video conferencing, a smartphone might not be the best option to do it. So we're already 40% of the population is already at a disadvantage to participate in telehealth because they don't have that home connection. And if they were, if there were going someplace to get that conductivity now during a global pandemic, we're all of a sudden shutting down those gathering places. So we're they're even Maur disconnected now because they don't even have the option to go to a library or McDonald's unless those places are relieving their WiFi on at night and making sure their parking lots are connected. Which is not an ideal situation for telehealth,

spk_2:   14:28
right? I mean, you don't. Ah, And also, you know, you don't want to be sitting in the middle of McDonald's, uh, telling your doctor about about this weird lump that you found the other two Ami are there There? There are things that are best addressed from home.

spk_0:   14:47
Definitely some things that you do not want to say in public. I completely understand that. Which brings me to the point that in your study, one of the concerns was data security. And, um, was that a little surprising that that was a big concern for people when it came to this or ah, Did it kind of follow suit with what you were hearing from, Ah, the people that you surveyed in the data that you were gathering?

spk_2:   15:12
Well, I would say that it was Ah, it makes sense because, like we said, the types of things that ah would be covered through Tele Health Service's are, you know, they're private matters. They Ah. And so we have learned over the last few years and with data breaches and, um, all sorts of information scares, you know, we've We've learned how sensitive our information is once it goes out on nine. And so when that information is about your private information? Um, yeah. Then, yeah, it gets really scary the prospect of somebody getting that information and and ah, being able to manipulate it

spk_0:   16:07
as part of the study. You guys also included, um, provider's health care providers and did some pretty in depth, um, meetings and discussions with those that would actually handle telehealth. Ah, what were some of the things that they were saying that are needed to increase their expand? Telehealth or ah, some of the challenges and and the positive things that were happening for them, including protecting our data.

spk_2:   16:36
Well, the health care providers were at, and they gave it a lot of good information. And, um, yeah, I was I I have tremendous. I was I was surprised at how impressive the telehealth networks were in these rural areas, you know? So there's so much news about ah, rural hospitals. Closing were the challenges of getting health care in rural areas. And what we heard from these providers was that you know, for that very reason they have been really growing and focusing on their telehealth presence in the fact that so many so many people are unable to you see a doctor or you get into a a hospital The fact that they have such challenges getting health care in rural areas. That was really the impetus for a lot of these providers to to really start and expand their telehealth presence. Um, in terms of ah, in terms of challenges, you know, one of the you know that well, the two biggest issues that we kept hearing, first of all, was ah challenges with the interoperability of the systems. So and the maybe a hospital would have one tool like a cart to toe help diagnose or treat patients who may be having a stroke. Ah, they may have a separate cart with a separate system to facilitate, you know, uh, cardiac care. But a lot of times the challenge was that these two systems don't communicate and they come from different providers. They are connected with different networks in with the doctors that that see patients through one tool will be different from those that see them through another tool. So yeah, they the networks don't mesh. And so what you end up with is ah lot of different tools, none of which, um communicate well with each other, so that's a challenge. Ah, the 2nd 1 Ah, the second biggest challenge that we saw has to do with reimbursement rates, particularly through through Medicaid. Um, but also with Thio Ah, lesser extent with private insurance. You know, the fact that there are Ah, and there are doctors get paid differently when they see somebody through Ah, telehealth service versus seeing them in their office. And so, uh, obviously these these healthcare providers are top notch. They they want to take care of the patients to the best of their ability, but at the same time, they need to pay their their bills as well. And so, um, you know, if if there is ah, if there is not uh, yeah, if if they can't get enough, um, for seeing somebody on on mine, then it creates an incentive to bring more people into the office into really ending up in emergency rooms or, ah, walk in clinics. And so it creates a disincentive to expand and focus on telehealth.

spk_0:   20:45
Gotcha. One of the things we saw this week from the White House was, um, lifting some regulations on Medicare too. Provide funding and reimbursement. Four telehealth. That's I take it that some of that's in response to what you're talking about. The idea that there may not be reimbursement or understanding of if your if your insurance will pay for that or not, Um, air. Can you talk? Can you discuss a little bit about, um and Chris? You touched on it briefly about reimbursement for doctors and the cost of that in this study there is there are a couple of stats that show some major savings. Ah, through using tell health. And this is on the everyday, everyday common world, not the not the current when we're in with Corona virus and having to deal with that. But even just from daily life, the normal daily life for Americans, we could see some major savings according to the study. Is that correct?

spk_1:   21:44
Yeah, that's right. So, I mean, when we look at estimating the cost of, you know, driving to a primary care physician for a normal 15 minute type, check up with a general practitioner, um, or or a physical or whatever, You know, whatever. Whatever happens to be that ails you. Um, you know, and we look at the rate of responded to our survey that said that they have participated in such activities with telehealth. We were looking at a savings of an annual savings of about $4.7 million just in these five rural counties in Michigan. Um, it again, that's just for a general normal 15 minutes, General practitioner type type visit. Um, And then you can add on top of that, an extra $1,000,000 or so, um, in savings from what otherwise would have been lost productivity in time travel Thio travel to the practitioner waiting, you know, waiting in the waiting room and then travel back home. Um, so you're looking at 5.7 million in total savings across these five counties alone, based on those who participated in our survey and there use of telehealth. So I mean, the savings just explode exponentially when you think about, you know, spreading. Um, you know, having more people participating telehealth who are able thio even just for simple visits like a general practitioner of is that doesn't count. You know, specialists and all of the other things that we go to the go to the doctor for, um So those savings will be astronomical if we could get to a point where you know we have incentives for doctors to participate in telehealth um you know, via reimbursement or the making sure that they have access to you. Ah, the latest and greatest technology to implement telehealth because it's not telehealth can be. There's kind of 22 buckets. There's the patient Focus. Tell the health where you're actually remotely connecting with somebody in a different geographic location. But there's also the just telehealth that exists on the provider side. Like Chris was talking about the different, um, carts and computers that they take to the different rooms to do different functions. Um, I mean, that's all internal Thio. The health care system and the patient might not might still have to go physically to a location to receive those service is, but it's still telehealth, Um, and so there's, you know, we're talking mostly about that remote access. Um, but there's also ways that health care providers can can save costs and time, um, by implementing telehealth systems within their own buildings. Already, when patient that when a patient doesn't have to come in for an actual visit, s O I think there's by reforming some of the policies at a state level on a federal level. Thio ensure that health care systems are being reimbursed equally for telehealth applications. And I think I think as a nation we would generally see cost savings and at times and time and productivity savings from being able to access the technology.

spk_2:   24:53
Yeah, Eric and tow piggyback off of that And there we've heard a lot about, you know, telehealth as as being some kind of panacea. Our catch All that's going to, um, from some circles. Ah, a lot of times it's people who are selling the service is. But, um, you hear about telehealth as being a catch? All that's going to, ah, you know, fix the the Cove in 19 epidemic And you know, the the fact that they're always going to be service is that have to be done in person, and it's going to ah, to really I mean, there you can't ah do, Ah, something's ah remotely. But at the same time, the ability for for people to to be seen remotely when possible for the service is that, ah that they that they can do remotely that's going to relieve the pressure on healthcare systems as they as they do focus on those issues that require an in person presence.

spk_0:   26:21
So well, since you brought up Cove in 19 what are some things that we can really apply from this study, Or at least some lessons? Um, to this time to this unique time period. It's on everybody's minds, obviously, because no one is not everyone is impacted in some way. So what are some of the things that myself for the average person can take away from this, um, that we can really apply to what's happening now?

spk_1:   26:52
Yeah, I'll take the first shot of that. I mean, one would be exploring what telehealth options might be available to you from your existing insurance company, Um, or your primary care physician. Um, you know, sometimes those those entities will give us information will give us flyers will get things in the mail. And until we really need it, we kind of ignore it. Um, I know in my own house, for example, um, there is a magnet on our refrigerator from our insurance company that we got at some point in time. Um, says blue cross blue shield. Um, you know, you can you can use your insurance for telehealth visits or, you know, Doctor, um, patient doctor consultations over your smartphone. Um, so I would say start number one. Start exploring what options might already be available to you. Um, if you have, ah, smartphone or, ah, good Internet connection at home. Um, as you, as we all self quarantine in our homes. Um, but you need to access medical care before you go to the emergency room. Think about what options might be available to you. Um um that you that you could get a get a cold diagnosed via tele health or or any other type of type of activity. There's there's there might be something already available to you through your insurance company or, um, through your primary care physician.

spk_2:   28:21
I would agree with that, Eric. And just to, um, to jump on that same track, there are a lot of There's a lot of information out there now, um, about about teleworking. I know. Connected nations Web site has a list of resource. Is that talks about, um, you know, different options and different, different things that providers air offering now And you in order to or one of the big benefit that I would see. I'm no epidemiologist Say that Ah, do not come to me for healthcare recommendations. But, um, you know, when you when you use a telehealth type service that that prevents you from needing to go out in public to going going to the doctor's office potentially, ah, spreading you know, the Corona virus, it's flu season. It potentially prevent you from getting the flu. Yeah, there are so many things that, um, that it's possible to kit nowadays. Um, and bye bye. Using the telehealth options, you are reducing wth ee Ah, the risk of potential spreading, potentially spreading those viruses and taking some of the pressure off of health care workers who are you're really working diligently now. Take taking care of the people who are at the highest risk.

spk_0:   30:09
That's a really great point there at the front lines. And the less that we the more that we can do to not expose them to additional issues, the better off they'll be. I'm sure, um, on just moving forward and just a couple more questions for you both. What do we not yet know about tell health or what is it that are the outlying questions that we still need to answer, Um, in the study or our broader as as a country,

spk_1:   30:42
you know, I think it comes down to the current activity of all of our residents. I mean, that's that's I think that's one of the biggest barriers to universal use of telehealth is that not everyone has an equal connection at home. Um, and not just a connection for consuming content, which is what has been the focus of broadband connectivity deployment to date, where we really focus on knew, how fast can we download things? But if we're talking about truly implementing telehealth, and that extends also to tell a work and distance learning and education through situations like this, the we also have to make sure that we can also distribute and send content at an equal rate. So we need to ensure that every American has has a connection that can that allows them to bring in content to their home, but also send content like a to a high definition video chat with the doctor who could diagnose a rash, be a your smartphone or or Webcam? Um, it is absolutely critical we need We need to make sure that those connections air there. I think that's one of the biggest barriers and still unknowns of how do we get there so that we can have an implement universal telehealth in situations like this, or just everyday when whenever we get back to normal, whatever that is, um, is that we need to ensure that every American has the connections that allow us to participate in these activities. So for me, that's that's one of the biggest challenges of question marks. Moving forward is, is how do we get to that point?

spk_0:   32:17
Chris, would you like to add to that?

spk_2:   32:19
I just heard on the flip socks. I think I think Eric covered. Ah, you know very well the one of the biggest issues on the consumer side. A SZ far as a health care providers, um, you know, getting support for for expanding and, uh, you know, promoting their telehealth service is it could be a really big deal. And these, uh, these providers have spent millions on getting their internal network set up and optimized and in from getting set up and being able to use these Tele Health Service's or offer them. But these air small Ah, lot of these are small groups. And so, uh, they don't have a dedicated person who is, uh, able to follow. Just tell health ah, studies or tell health research or find, you know, federal funds Thio to expand their tell health service things that things that could help support them. And so that really, um, and that would be of benefit to the health care providers that meets the ones with whom we spoke. Um, and they also have the connectivity issues as well. Like Eric said, you know, they you know, the consumers have it at the lack of service at home and then these health care networks. I said they they've dedicated a lot of resource is to optimizing their, um, their service within their facilities. But then, if they can't send information or receive information from other facilities because the network between the two places isn't it up to par, then it really doesn't help them much. So, um yeah, improving connectivity both for the households and for the health care providers is a big deal.

spk_0:   34:32
Yes, connectivity is one of the ah, the biggest issues that we're seeing right now, not just on the tele health level, but with Tele work kids being schooled at home Now, uh, connectivity, obviously, for our nonprofit is important on all levels. And we're really seeing the ramifications of that. Now, I think, um, just to wrap this up, guys, what do you think is are the next steps. What? What will happen now, is there Are there some new things to look at? Um, what do you both envision as, Ah, what's next? After doing this, this deep dive study that you did?

spk_1:   35:12
Yeah. So we actually received support from the Michigan Health Endowment Fund for a phase two, if you will, of this telehealth project. So the first phase was this study and better understanding What the what? The barriers are on all sides, um, in the implications and the next step. Apart from addressing policy at a state and federal level, the next step for us is to actually go into these five counties that we studied and implement what we're calling a tele health intervention, if you will. And the idea is provide boots on the ground education, empowerment capacity building an awareness around this issue in these five counties toe hopefully improve the use of telehealth. So we'll be going to these five counties and holding telehealth public forums once we're allowed to gather again in public places. Um, well, we'll be bringing together, um, healthcare providers and patients and all this all the organizations that support or touch health care. So senior centers and libraries in K 12 and other entities to really talk about this topic and get things moving will also be providing webinars to folks in these counties on what Telehealth is dispelling some of the myths providing training on information literacy and digital literacy so that we again we can overcome these barriers that we identified during the study. And then we'll cap it off with a second forum after we've done all these this boots on the ground type work and support for patients and providers. Um uh, hopefully next year, um, and then we'll finish it up. Finally, with another survey of residents, these five counties that weaken benchmark ourselves between when we did this original study and then after the intervention took place and see what what changes have been made in the use of telehealth. So I'm excited to really get boots on the ground in these in these five communities and start affecting change in the telehealth ecosystem there.

spk_0:   37:16
All right, I want to think our guest, Eric Frederick and Chris McGovern, who authored this groundbreaking study looking at telehealth specifically in rural areas. I'm excited to see what you guys do next. I'd love to visit with you again. Thank you guys both.

spk_1:   37:32
Yeah. Thank you. No, thank you. It's good. Good talk about it.

spk_0:   37:36
You can follow connected nation Michigan on Facebook and on Twitter at Connect Michigan. You can also find the entire tell Health study at connected nation dot org's Backslash Michigan. Thanks for listening to connect a nation. I'm Jessica Denson. If you like our show and want to know more about us, check us out on connected nation dot org's. Please leave us a review on iTunes. Join us next week when we talk about digital inclusion and look at what specifically each of us can do for those who are on the wrong side of the digital divide during this difficult time