1 00:00:11,440 --> 00:00:13,640 Welcome to the Clinical Center Grand Rounds, 2 00:00:13,640 --> 00:00:17,440 a weekly series of educational lectures for physicians and 3 00:00:17,440 --> 00:00:20,080 health care professionals broadcast from the Clinical 4 00:00:20,080 --> 00:00:23,040 Center at the National Institutes of Health in 5 00:00:23,040 --> 00:00:24,840 Bethesda, MD. 6 00:00:24,840 --> 00:00:28,400 The NIH Clinical Center is the world's largest hospital totally 7 00:00:28,400 --> 00:00:32,080 dedicated to investigational research and leads the global 8 00:00:32,080 --> 00:00:35,040 effort in training today's investigators and discovering 9 00:00:35,040 --> 00:00:37,200 tomorrow's cures. 10 00:00:37,200 --> 00:00:46,360 Learn more by visiting us online at http://clinicalcenter.nih.gov 11 00:00:46,360 --> 00:00:49,120 >>OUR SPEAKER TODAY IS 12 00:00:49,120 --> 00:00:50,120 DR. PANEEZ KHOURY. 13 00:00:50,120 --> 00:00:54,320 A SENIOR CLINICIAN AND EXPERT ON 14 00:00:54,320 --> 00:00:58,360 DISORDERS AT THE NATIONAL 15 00:00:58,360 --> 00:00:59,880 INSTITUTE OF ALLERGY AND 16 00:00:59,880 --> 00:01:02,480 INFECTIOUS DISEASES. 17 00:01:02,480 --> 00:01:04,560 DR. KHOURY EARNED HER MEDICAL 18 00:01:04,560 --> 00:01:05,840 DEGREE FROM THE ILLINOIS OF 19 00:01:05,840 --> 00:01:08,840 CHICAGO AND COMPLETED AN 20 00:01:08,840 --> 00:01:11,920 INTERNAL MEDICINE RESIDENCY AT 21 00:01:11,920 --> 00:01:15,840 THE OHIO STATE UNIVERSITY. 22 00:01:15,840 --> 00:01:18,600 SHE HOLDS A MASTERS OF HEALTH 23 00:01:18,600 --> 00:01:19,800 SCIENCES FROM DUKE UNIVERSITY 24 00:01:19,800 --> 00:01:22,040 SCHOOL OF MEDICINE AND BOARD 25 00:01:22,040 --> 00:01:24,400 CERTIFIED IN BOTH INTERNAL 26 00:01:24,400 --> 00:01:29,600 MEDICINE AND ALLERGY IMMUNOLOGY. 27 00:01:29,600 --> 00:01:30,400 DR. KHOURY TRANSITIONED TO 28 00:01:30,400 --> 00:01:34,040 BECOME A STAFF CLINICIAN AND IS 29 00:01:34,040 --> 00:01:35,560 CURRENTLY A SENIOR CLINICIAN FOR 30 00:01:35,560 --> 00:01:37,800 THE LABORATORY OF ALLERGIC 31 00:01:37,800 --> 00:01:40,520 DISEASES AND HEAD OF THE 32 00:01:40,520 --> 00:01:43,120 CLINICAL RESEARCH UNIT IN THE 33 00:01:43,120 --> 00:01:46,000 LABORATORY OF PARASITIC 34 00:01:46,000 --> 00:01:46,880 DISEASES. 35 00:01:46,880 --> 00:01:50,560 AS HEAD SHE PERFORMS RESEARCH IN 36 00:01:50,560 --> 00:01:56,880 CONDITIONS INCLUDING HYPER -- 37 00:01:56,880 --> 00:02:01,640 SYNDROMES, GRANULAR -- 38 00:02:01,640 --> 00:02:03,960 GASTROINTESTINAL DISORDERS AND 39 00:02:03,960 --> 00:02:05,800 DEVELOPMENT OF PATIENT CENTER 40 00:02:05,800 --> 00:02:08,480 OUTCOME AND QUALITY OF LIFE FOR 41 00:02:08,480 --> 00:02:10,400 PATIENTS WITH THESE DISORDERS. 42 00:02:10,400 --> 00:02:11,960 DR. KHOURY HAS BEEN THE PROGRAM 43 00:02:11,960 --> 00:02:16,040 DIRECTOR FOR THE PROGRAM SINCE 44 00:02:16,040 --> 00:02:18,600 2019 WHERE SHE HAS DESIGNED THE 45 00:02:18,600 --> 00:02:19,640 CURRICULUM AND PROGRAMS FOR 46 00:02:19,640 --> 00:02:21,680 FELLOWS IN TRAINING. 47 00:02:21,680 --> 00:02:23,360 DR. KHOURY IS INVESTED IN 48 00:02:23,360 --> 00:02:25,680 BLENDING HEALTH EQUITY JUSTICE 49 00:02:25,680 --> 00:02:28,120 AND INCORPORATING PRACTICAL 50 00:02:28,120 --> 00:02:32,960 SOLUTIONS INTO HER CURRICULUM 51 00:02:32,960 --> 00:02:35,560 AND SHE IS PASSIONATE ABOUT THE 52 00:02:35,560 --> 00:02:37,200 INNOVATION EDUCATION 53 00:02:37,200 --> 00:02:38,800 INCORPORATING ADULT LEARNING 54 00:02:38,800 --> 00:02:41,400 THEORY AS WELL AS CREATIVE 55 00:02:41,400 --> 00:02:43,000 SOLUTIONS TO NEEDS FOR TRAINING 56 00:02:43,000 --> 00:02:44,960 DURING A PANDEMIC. 57 00:02:44,960 --> 00:02:46,760 WHETHER IT BE TRAINING IN 58 00:02:46,760 --> 00:02:49,080 TELEHEALTH OR INCORPORATING 59 00:02:49,080 --> 00:02:51,840 STIMULATION AND FRAMEWORKS FROM 60 00:02:51,840 --> 00:02:54,520 TEACHING ABOUT AUGMENTED 61 00:02:54,520 --> 00:02:56,200 INTELLIGENCE INTO THE PROGRAMS. 62 00:02:56,200 --> 00:03:00,320 DR. KHOURY SERVES AS THE CHAIR 63 00:03:00,320 --> 00:03:04,080 AND IS A MEMBER OF THE NIH STAFF 64 00:03:04,080 --> 00:03:06,520 CLINICIAN COUNCIL. 65 00:03:06,520 --> 00:03:08,560 HER EXTERNAL ACTIVITIES INCLUDE 66 00:03:08,560 --> 00:03:11,160 INVOLVEMENT IN MANY ASPECTS OF 67 00:03:11,160 --> 00:03:14,160 THE AMERICANA ACADEMY OF ASTHMA, 68 00:03:14,160 --> 00:03:16,800 AND IMMUNOLOGY INCLUDING THEIR 69 00:03:16,800 --> 00:03:19,680 LEADERSHIP INSTITUTE. 70 00:03:19,680 --> 00:03:21,600 SHE SERVES ON THE BOARD AND IS 71 00:03:21,600 --> 00:03:24,120 THEIR SOCIAL MEDIA CHAIR. 72 00:03:24,120 --> 00:03:26,920 THE TITLE OF DR. KHOURY'S 73 00:03:26,920 --> 00:03:28,440 PRESENTATION IS LEVERAGING 74 00:03:28,440 --> 00:03:30,680 TELEHEALTH FOR OPTIMAL TEAM 75 00:03:30,680 --> 00:03:32,280 BASED CARE CLINICAL RESEARCH AND 76 00:03:32,280 --> 00:03:33,880 EDUCATION. 77 00:03:33,880 --> 00:03:36,720 PLEASE JOIN ME IN WELCOMING 78 00:03:36,720 --> 00:03:38,520 TODAY'S SPEAKER DR. PANEEZ 79 00:03:38,520 --> 00:03:40,040 KHOURY. 80 00:03:40,040 --> 00:03:41,720 >>THANK YOU VERY MUCH FOR 81 00:03:41,720 --> 00:03:42,560 THAT NICE INTRODUCTION 82 00:03:42,560 --> 00:03:47,280 THANK YOU FOR INVITING ME 83 00:03:47,280 --> 00:03:47,760 DR. BURKLOW. 84 00:03:47,760 --> 00:03:51,520 I HAVE NO DISCLOSURES TO REPORT. 85 00:03:51,520 --> 00:03:53,520 AND SO OUR LEARNING AND 86 00:03:53,520 --> 00:03:54,960 STRATEGIC OBJECTIVES TODAY ARE 87 00:03:54,960 --> 00:03:57,200 TO UNDERSTAND TELEHEALTH USE IN 88 00:03:57,200 --> 00:04:00,520 THE GENERAL HEALTH CARE CONTEXT. 89 00:04:00,520 --> 00:04:03,280 TO INCORPORATE TEAM BASED CARE. 90 00:04:03,280 --> 00:04:05,920 AND TO LEVERAGE TELEHEALTH USE 91 00:04:05,920 --> 00:04:07,600 IN MEDICAL EDUCATION. 92 00:04:07,600 --> 00:04:09,320 SO ULTIMATELY WHAT I WANT YOU TO 93 00:04:09,320 --> 00:04:11,080 LEAVE HERE WITH TODAY IS A 94 00:04:11,080 --> 00:04:12,600 BETTER UNDERSTANDING OF HOW TO 95 00:04:12,600 --> 00:04:14,360 LEVERAGE TELEHEALTH IN YOUR 96 00:04:14,360 --> 00:04:16,640 PRACTICES AS WELL AS HOW FACULTY 97 00:04:16,640 --> 00:04:19,440 AND LEARNERS CAN INTERACT BETTER 98 00:04:19,440 --> 00:04:22,680 IN THE TELEHEALTH ENCOUNTER AS 99 00:04:22,680 --> 00:04:24,720 WELL AS WHAT COMPARES SEES ARE 100 00:04:24,720 --> 00:04:28,760 REQUIRED BY * BOTH FACULTY 101 00:04:28,760 --> 00:04:30,840 RECEPTORS AS WELL AS LEARNERS TO 102 00:04:30,840 --> 00:04:32,440 BE ABLE TO USE THIS TECHNOLOGY 103 00:04:32,440 --> 00:04:34,840 APPROPRIATELY. 104 00:04:34,840 --> 00:04:39,800 SO THIS GRAPH DEMONSTRATES THE 105 00:04:39,800 --> 00:04:44,760 CLAIMS FROM JUNE OF 2020 -- 106 00:04:44,760 --> 00:04:46,440 MARCH TO JUNE OF 2020. 107 00:04:46,440 --> 00:04:48,920 AND THIS DEMONSTRATES THE 108 00:04:48,920 --> 00:04:51,880 POSITIVITY OF TELEHEALTH USE 109 00:04:51,880 --> 00:04:54,560 BEFORE THE PANDEMIC AND THEN THE 110 00:04:54,560 --> 00:04:57,080 INCREASE IN TELEHEALTH USAGE. 111 00:04:57,080 --> 00:04:58,600 ONE OF THE THINGS THAT THE 112 00:04:58,600 --> 00:05:00,440 PANDEMIC TAUGHT US IS THERE IS 113 00:05:00,440 --> 00:05:02,600 SOME DANGER IN TYING ALL HEALTH 114 00:05:02,600 --> 00:05:05,560 CARE TO BRICK AND MORTAR 115 00:05:05,560 --> 00:05:06,080 ENTITIES. 116 00:05:06,080 --> 00:05:08,640 WE ALL REALIZED THAT OUR 117 00:05:08,640 --> 00:05:10,640 PATIENTS WHO ARE ON CLINICAL 118 00:05:10,640 --> 00:05:12,560 TRIALS OR WHO HAD OTHER MEDICAL 119 00:05:12,560 --> 00:05:14,440 PROBLEMS NEEDED SOME CARE BUT 120 00:05:14,440 --> 00:05:15,640 COULD NOT PHYSICALLY TRAVEL TO 121 00:05:15,640 --> 00:05:16,640 THE NIH. 122 00:05:16,640 --> 00:05:19,040 AND TO THIS DAY THERE ARE 123 00:05:19,040 --> 00:05:21,000 PATIENTS OF OURS WHO HAVE 124 00:05:21,000 --> 00:05:22,280 RECEIVED LESS CARE THAN THEY 125 00:05:22,280 --> 00:05:24,240 OUGHT TO HAVE DURING THE 126 00:05:24,240 --> 00:05:24,480 PANDEMIC. 127 00:05:24,480 --> 00:05:27,000 FOR EXAMPLE, I SAW A PATIENT OF 128 00:05:27,000 --> 00:05:28,880 MINE LONG TIME PATIENT WHO HAD 129 00:05:28,880 --> 00:05:32,640 NOT HAD THEIR USUAL SKIN CARE 130 00:05:32,640 --> 00:05:35,960 CHECKS AND THEN TWO YEARS LATER 131 00:05:35,960 --> 00:05:39,040 DEVELOPED MORE ADVANCED SKIN 132 00:05:39,040 --> 00:05:41,240 CANCERS THAT REQUIRED SURGERY TO 133 00:05:41,240 --> 00:05:41,720 REMOVE. 134 00:05:41,720 --> 00:05:43,800 ALL OF US HAVE THESE STORIES OF 135 00:05:43,800 --> 00:05:44,840 DELAYED CARE AND SOME OF THE 136 00:05:44,840 --> 00:05:46,720 WAYS THAT WE HAVE TO PERHAPS 137 00:05:46,720 --> 00:05:48,560 THINK ABOUT INCORPORATING 138 00:05:48,560 --> 00:05:52,080 TELEHEALTH INTO OUR PRACTICES. 139 00:05:52,080 --> 00:05:53,920 SO ALTHOUGH TELEHEALTH REALLY 140 00:05:53,920 --> 00:05:55,800 TOOK OFF IN THE BEGINNING THERE 141 00:05:55,800 --> 00:05:58,920 IS A LOT OF HESITANCY AND SOME 142 00:05:58,920 --> 00:06:01,320 OF THAT HAS DROPPED OFF BECAUSE 143 00:06:01,320 --> 00:06:02,920 WE LIKE TO SEE OUR PATIENTS IN 144 00:06:02,920 --> 00:06:06,320 THE CLINIC AND OVER-ALL IN THE 145 00:06:06,320 --> 00:06:08,560 COUNTRY THE TELEHEALTH USAGE HAS 146 00:06:08,560 --> 00:06:10,880 DECLINED SINCE THE PEAK OF THE 147 00:06:10,880 --> 00:06:12,640 PANDEMIC BUT WE'RE STILL IN THE 148 00:06:12,640 --> 00:06:15,520 PANDEMIC AND SO PEOPLE ARE STILL 149 00:06:15,520 --> 00:06:16,840 USING THIS TECHNOLOGY. 150 00:06:16,840 --> 00:06:19,800 WHAT YOU CAN SEE HERE BY 151 00:06:19,800 --> 00:06:25,560 APRIL 2021 OVER-ALL TELEHEALTH 152 00:06:25,560 --> 00:06:27,520 -- DECLINED. 153 00:06:27,520 --> 00:06:29,640 THIS VARIES DEPENDING ON THE 154 00:06:29,640 --> 00:06:31,560 REGION OF THE COUNTRY AS WELL AS 155 00:06:31,560 --> 00:06:33,400 THE PARTICULAR PATIENT TYPES. 156 00:06:33,400 --> 00:06:36,680 AND SOME ENTITIES ARE USING MORE 157 00:06:36,680 --> 00:06:38,240 TELEHEALTH THAN OTHERS. 158 00:06:38,240 --> 00:06:39,800 TELL COUNSELING AND MENTAL 159 00:06:39,800 --> 00:06:42,520 HEALTH SERVICES UTILIZED THIS 160 00:06:42,520 --> 00:06:45,160 TYPE OF TECHNOLOGY. 161 00:06:45,160 --> 00:06:46,640 ONE OF THE THINGS THAT IS 162 00:06:46,640 --> 00:06:47,760 IMPORTANT TO REALIZE IS THAT 163 00:06:47,760 --> 00:06:49,760 IT'S NOT JUST THE CLINICAL 164 00:06:49,760 --> 00:06:50,640 ENCOUNTER. 165 00:06:50,640 --> 00:06:53,840 THERE ARE MANY OTHER WAYS TO IN 166 00:06:53,840 --> 00:06:55,600 CORPORATE TELEHEALTH INTO OUR 167 00:06:55,600 --> 00:06:55,800 CARE. 168 00:06:55,800 --> 00:07:01,480 FOR EXAMPLE, THE VIRTUAL AND 169 00:07:01,480 --> 00:07:06,840 DIGITAL KAREN ABLED OFFICES -- * 170 00:07:06,840 --> 00:07:08,800 MOBILE HEALTH APPLICATIONS 171 00:07:08,800 --> 00:07:13,680 BECAME POPULAR AND U TO -- AND E 172 00:07:13,680 --> 00:07:21,000 TO UNDERSTAND HOW TO USE THESE. 173 00:07:21,000 --> 00:07:23,880 AND I THINK THERE IS A 174 00:07:23,880 --> 00:07:26,840 CONTEMPORARY EXAMPLE -- THE FDA 175 00:07:26,840 --> 00:07:33,120 REVISED THE EUA TO AUTHORIZE 176 00:07:33,120 --> 00:07:34,840 PHARMACISTS TO PRESCRIBE THIS 177 00:07:34,840 --> 00:07:36,640 TYPE OF THERAPY WITH 178 00:07:36,640 --> 00:07:37,200 LIMITATIONS. 179 00:07:37,200 --> 00:07:39,080 THIS EXAMPLES DEMONSTRATE WHAT 180 00:07:39,080 --> 00:07:40,640 THE REACH OF TELEHEALTH CAN BE 181 00:07:40,640 --> 00:07:42,480 AND THAT WE NEED TO BE AWARE OF 182 00:07:42,480 --> 00:07:45,520 HOW TO USE THEM. 183 00:07:45,520 --> 00:07:49,400 SO MOVING TO THE COVID-19 184 00:07:49,400 --> 00:07:51,440 PANDEMIC AND TELEHEALTH USAGE AT 185 00:07:51,440 --> 00:07:52,640 THE NIH. 186 00:07:52,640 --> 00:07:54,680 COVID-19 WAS A HUGE DISRUPT FOR 187 00:07:54,680 --> 00:07:56,920 AND I THINK WE ALL ARE AWARE OF 188 00:07:56,920 --> 00:07:57,560 THAT. 189 00:07:57,560 --> 00:08:01,200 THERE WAS A POSITIVITY OF 190 00:08:01,200 --> 00:08:02,040 INFLATABLE POOLS. 191 00:08:02,040 --> 00:08:04,000 BROADBAND ACCESS WAS A PROBLEM 192 00:08:04,000 --> 00:08:06,160 AS ALL STUDENTS WENT TO VIRTUAL 193 00:08:06,160 --> 00:08:09,400 LEARNING AND WE WERE ALL IN THE 194 00:08:09,400 --> 00:08:12,640 SAME ZOOM ON OUR WiFiS. 195 00:08:12,640 --> 00:08:15,560 TALKING ABOUT THAT SORT OF 196 00:08:15,560 --> 00:08:16,440 DISRUPTION BUT ABOUT THE 197 00:08:16,440 --> 00:08:18,480 TECHNOLOGY AND THE PROCESS 198 00:08:18,480 --> 00:08:19,680 DISRUPTION AND THAT HAPPENED 199 00:08:19,680 --> 00:08:23,720 QUICKLY AT NIH. 200 00:08:23,720 --> 00:08:27,280 SO ON MARCH 13,2020 THE 201 00:08:27,280 --> 00:08:28,960 CORONAVIRUS WAS DECLARED AN 202 00:08:28,960 --> 00:08:33,960 EMERGENCY. 203 00:08:33,960 --> 00:08:37,240 AND IT WAS QUITE REMARKABLE. 204 00:08:37,240 --> 00:08:41,320 ABOUT ONE MONTH LATER THE FIRST 205 00:08:41,320 --> 00:08:44,160 TELL HEALTH VISIT OCCURRED. 206 00:08:44,160 --> 00:08:46,520 HOW WE DO THINGS AT THE NIH THAT 207 00:08:46,520 --> 00:08:48,320 WAS A QUICK PROCESS. 208 00:08:48,320 --> 00:08:50,360 AS YOU CAN SEE ON THE GRAPH WE 209 00:08:50,360 --> 00:08:51,640 DO CONTINUE TO USE IT. 210 00:08:51,640 --> 00:08:54,320 IT'S NOT NEARLY AS HIGH AS AT 211 00:08:54,320 --> 00:08:58,040 THE PEAK AS MORE AND MORE 212 00:08:58,040 --> 00:08:59,560 PATIENTS COME IN. 213 00:08:59,560 --> 00:09:03,120 BUT CLEARLY THERE IS A BENEFIT 214 00:09:03,120 --> 00:09:10,800 FOR PATIENTS. 215 00:09:10,800 --> 00:09:19,680 THIS IS NOT A POLICY TALK. 216 00:09:19,680 --> 00:09:22,280 BUT I WANT TO POINT OUT THAT 217 00:09:22,280 --> 00:09:25,720 THERE IS A MASK POLICY THAT 218 00:09:25,720 --> 00:09:26,560 APPLIES. 219 00:09:26,560 --> 00:09:27,920 THIS WAS DEVELOPED QUICKLY 220 00:09:27,920 --> 00:09:29,920 DURING THE PANDEMIC AND IT DOES 221 00:09:29,920 --> 00:09:31,880 HIGHLIGHT AND HAS BEEN REVISED 222 00:09:31,880 --> 00:09:33,840 TO INCORPORATE SOME OF THE * 223 00:09:33,840 --> 00:09:36,960 WAYS THAT WE DO THINGS AT THE 224 00:09:36,960 --> 00:09:37,360 NIH. 225 00:09:37,360 --> 00:09:38,960 THERE ARE SOME THINGS THAT ARE 226 00:09:38,960 --> 00:09:41,240 DIFFERENT THAN THE WAY PEOPLE 227 00:09:41,240 --> 00:09:42,720 PRACTICE TELEHEALTH IN OTHER 228 00:09:42,720 --> 00:09:43,200 PLACES. 229 00:09:43,200 --> 00:09:45,560 FOR EXAMPLE, OUR STATE LICENSES 230 00:09:45,560 --> 00:09:47,480 NO MATTER WHAT STATE THEY ARE 231 00:09:47,480 --> 00:09:49,200 APPLY FOR THE USE OF TELEHEALTH 232 00:09:49,200 --> 00:09:50,560 WHICH IS A BIG DEAL. 233 00:09:50,560 --> 00:09:52,440 MANY PLACES ARE NOT ABLE TO DO 234 00:09:52,440 --> 00:09:54,560 THAT AND THE BUYERS HAVE TO 235 00:09:54,560 --> 00:09:57,600 OBTAIN LICENSES IN OTHER PLACES. 236 00:09:57,600 --> 00:09:58,920 THE LEGAL REQUIREMENTS DON'T 237 00:09:58,920 --> 00:10:00,880 ALLOW US TO DO CARE FOR 238 00:10:00,880 --> 00:10:04,080 INTERNATIONAL PATIENTS AND THAT 239 00:10:04,080 --> 00:10:06,360 DID POSE SOME DIFFICULTIES AND 240 00:10:06,360 --> 00:10:08,200 WE HAD TO FIND WAYS TO REACH 241 00:10:08,200 --> 00:10:11,640 THEM AND DO CHECK-INS. 242 00:10:11,640 --> 00:10:14,040 AND I THINK IT'S WORTH 243 00:10:14,040 --> 00:10:15,520 MENTIONING BECAUSE OUR TRAINEES 244 00:10:15,520 --> 00:10:19,840 THAT ARE USING TELEHEALTH ALSO 245 00:10:19,840 --> 00:10:21,280 AFFILIATE SO IT'S NOT JUST AT 246 00:10:21,280 --> 00:10:23,000 THE NIH THAT IT'S WORTH 247 00:10:23,000 --> 00:10:24,040 UNDERSTANDING THE LOCAL CON 248 00:10:24,040 --> 00:10:24,960 TAXES. 249 00:10:24,960 --> 00:10:27,240 HOW TO DO CODING AND DOCUMENTING 250 00:10:27,240 --> 00:10:28,800 WHERE YOU ARE GETTING TRAINING 251 00:10:28,800 --> 00:10:31,600 OUTSIDE OF NIH. 252 00:10:31,600 --> 00:10:33,360 OneNoteABLE EXAMPLE IS THAT 253 00:10:33,360 --> 00:10:35,160 AT NIH WE'RE NOT REQUIRED TO DO 254 00:10:35,160 --> 00:10:39,000 A TELEHEALTH CONSENT VERBALLY OR 255 00:10:39,000 --> 00:10:40,480 IN THE DOCUMENTATION BUT IT IS 256 00:10:40,480 --> 00:10:41,600 BEST PRACTICE AND SOMETHING THAT 257 00:10:41,600 --> 00:10:43,520 PEOPLE DO OUTSIDE OF THE NIH SO 258 00:10:43,520 --> 00:10:45,480 IT MAY NOT BE A BAD IDEA FOR YOU 259 00:10:45,480 --> 00:10:47,600 TO THINK ABOUT HOW YOU CAN TAKE 260 00:10:47,600 --> 00:10:49,760 CONSENT AND WHAT YOU MIGHT DO IN 261 00:10:49,760 --> 00:10:50,600 YOUR RESEARCH TEAMS. 262 00:10:50,600 --> 00:10:52,240 ONE EXAMPLE IS DEMONSTRATED 263 00:10:52,240 --> 00:10:52,680 HERE. 264 00:10:52,680 --> 00:10:55,520 SO YOU SAY THIS THIS 265 00:10:55,520 --> 00:10:59,960 ENCOUNTER USES A SEVERE VIDEO 266 00:10:59,960 --> 00:11:02,280 NETWORK BETWEEN NIH AND THE 267 00:11:02,280 --> 00:11:04,280 PATIENT'S PERSONAL DEVICE. 268 00:11:04,280 --> 00:11:06,360 THIS ENCOUNTER IS DEEMED 269 00:11:06,360 --> 00:11:09,120 APPROPRIATE FOR VIRTUAL CARE AS 270 00:11:09,120 --> 00:11:12,440 DEFINED IN THE PROTOCOL TO WHICH 271 00:11:12,440 --> 00:11:17,240 THE PATIENT IS CONSENTED AND THE 272 00:11:17,240 --> 00:11:21,080 PATIENT HAS GIFT IN CONSENT TO 273 00:11:21,080 --> 00:11:22,680 PARTICIPATE IN A TELEHEALTH 274 00:11:22,680 --> 00:11:23,400 VISIT TODAY. 275 00:11:23,400 --> 00:11:27,440 IF YOU'RE WATCHING LIVE IF YOU 276 00:11:27,440 --> 00:11:32,160 WILL OBLIGE ME AND NAVIGATE TO 277 00:11:32,160 --> 00:11:34,400 MENTEE.com AND ENTER THIS 278 00:11:34,400 --> 00:11:39,240 NUMBER. 279 00:11:39,240 --> 00:11:49,400 99854209. 280 00:11:56,080 --> 00:11:58,120 PUT A FEW THOUGHTS OR WORDS 281 00:11:58,120 --> 00:11:59,600 ABOUT SOME OF THE BARRIERS OR 282 00:11:59,600 --> 00:12:01,640 DIFFICULTIES YOU'VE EXPERIENCED 283 00:12:01,640 --> 00:12:03,640 USING TELEHEALTH AND YOU CAN DO 284 00:12:03,640 --> 00:12:05,480 THIS WHETHER YOU'RE A PROVIDER 285 00:12:05,480 --> 00:12:07,680 OF TELEHEALTH SERVICES OR A 286 00:12:07,680 --> 00:12:09,520 PATIENT WHO HAS UTILIZED 287 00:12:09,520 --> 00:12:14,160 TELEHEALTH OR A TRAINEE WHO HAS 288 00:12:14,160 --> 00:12:15,920 BEEN PRECEPT IN THAT FORMAT AND 289 00:12:15,920 --> 00:12:17,320 I'M GOING TO SHOW SOME OF THE 290 00:12:17,320 --> 00:12:26,400 RESULTS OF OUR FINDINGS. 291 00:12:26,400 --> 00:12:28,120 AS WE SEE THERE ARE A LOT OF 292 00:12:28,120 --> 00:12:32,760 COMMENTS ABOUT THAT INDIVIDUAL 293 00:12:32,760 --> 00:12:35,520 -- BAD VIDEO QUALITY. 294 00:12:35,520 --> 00:12:39,760 DIFFICULTY WITH PHYSICAL EXAM 295 00:12:39,760 --> 00:12:40,600 FINDINGS. 296 00:12:40,600 --> 00:12:42,600 WE'LL TALK ABOUT THAT. 297 00:12:42,600 --> 00:12:44,240 NO PHYSICAL TOUCH. 298 00:12:44,240 --> 00:12:47,760 PEOPLE DO COMMENT ON THE LACK OF 299 00:12:47,760 --> 00:12:49,680 CONNECTION. 300 00:12:49,680 --> 00:12:51,360 AND TRYING TO LOOK FOR 301 00:12:51,360 --> 00:12:54,040 AVAILABILITY. 302 00:12:54,040 --> 00:12:55,440 OBVIOUSLY YOU SHOULD BE MORE 303 00:12:55,440 --> 00:12:56,760 AVAILABLE AND WE'LL TALK ABOUT 304 00:12:56,760 --> 00:12:57,360 THAT. 305 00:12:57,360 --> 00:13:00,720 AND THEN OBVIOUSLY THE 306 00:13:00,720 --> 00:13:02,240 CONNECTIVITY ISSUES, PROBLEMS 307 00:13:02,240 --> 00:13:04,840 RELATED TO EQUITY. 308 00:13:04,840 --> 00:13:07,480 SO I'LL LET ME POP-UP A LITTLE 309 00:13:07,480 --> 00:13:09,040 BIT LONGER BUT THEY ARE GOING TO 310 00:13:09,040 --> 00:13:11,120 GET SMALLER AND SMALLER. 311 00:13:11,120 --> 00:13:13,880 AND WE MIGHT NOT BE ABLE TO READ 312 00:13:13,880 --> 00:13:14,080 THEM. 313 00:13:14,080 --> 00:13:19,440 THANK YOU FOREI FOR -- -- ENTERG 314 00:13:19,440 --> 00:13:26,760 THESE. 315 00:13:26,760 --> 00:13:30,520 SO WHY THE TELEHEALTH HESITANCY. 316 00:13:30,520 --> 00:13:32,880 QUITE A BIT OF CLINICIAN 317 00:13:32,880 --> 00:13:34,240 DISCOMFORT WITH THE TECHNOLOGY 318 00:13:34,240 --> 00:13:35,400 AND TROUBLESHOOTING. 319 00:13:35,400 --> 00:13:37,080 WHAT HAPPENS WHEN THINGS GO 320 00:13:37,080 --> 00:13:37,960 WRONG. 321 00:13:37,960 --> 00:13:40,240 PEOPLE WORRY ABOUT HOW 322 00:13:40,240 --> 00:13:43,200 TELEHEALTH HIT RACE SEE FOR THE 323 00:13:43,200 --> 00:13:44,200 PATIENTS * THEMSELVES. 324 00:13:44,200 --> 00:13:46,480 ARE PATIENTS ABLE TO ENGAGE IN 325 00:13:46,480 --> 00:13:50,240 THE FORMAT. 326 00:13:50,240 --> 00:13:51,680 IDENTITY THREAT. 327 00:13:51,680 --> 00:13:53,320 YOU'RE NOT SEEING THE PATIENT IN 328 00:13:53,320 --> 00:13:54,360 FRONT OF YOU. 329 00:13:54,360 --> 00:13:57,240 YOU CANNOT HAVE THAT TOUCH 330 00:13:57,240 --> 00:13:59,160 ASPECT AND CERTAINLY THERE IS 331 00:13:59,160 --> 00:14:02,120 ALSO SOME CONCERNS ABOUT QUALITY 332 00:14:02,120 --> 00:14:05,240 FROM THE PROVIDER PERSPECTIVE. 333 00:14:05,240 --> 00:14:08,200 ARE THEY PROVIDING BAD MEDICINE? 334 00:14:08,200 --> 00:14:10,400 COULD THERE BE HEALTH OF RISK 335 00:14:10,400 --> 00:14:13,240 FOR DISCOMFORT. 336 00:14:13,240 --> 00:14:16,880 RISK FOR A MISDIAGNOSISES AND 337 00:14:16,880 --> 00:14:18,960 DISCOMFORT IN THAT PROCESS. 338 00:14:18,960 --> 00:14:20,760 FROM THE RESEARCH PERSPECTIVE A 339 00:14:20,760 --> 00:14:23,000 LOT OF PEOPLE HAVE COMMENTED ON 340 00:14:23,000 --> 00:14:25,840 THE ABILITY TO OBTAIN THE SAME 341 00:14:25,840 --> 00:14:28,720 SAMPLES AND DATA THAT THEY WOULD 342 00:14:28,720 --> 00:14:30,320 IF A PATIENT WAS IN PERSON AND 343 00:14:30,320 --> 00:14:32,720 THOSE ARE THINGS THAT NEED TO BE 344 00:14:32,720 --> 00:14:36,120 MITIGATED AND ALSO A LACK OF 345 00:14:36,120 --> 00:14:38,240 KNOWLEDGE ON HOW TO MITIGATE 346 00:14:38,240 --> 00:14:39,760 THEM INTO TEAMWORK FLOWS. 347 00:14:39,760 --> 00:14:42,440 IT'S OBVIOUS THAT CLINICIANS USE 348 00:14:42,440 --> 00:14:45,400 MANY FORMS OF OBSERVATION TO 349 00:14:45,400 --> 00:14:49,240 ASSESS A PATIENT'S CONDITION. 350 00:14:49,240 --> 00:14:51,360 AND EVEN OTHER CARE 351 00:14:51,360 --> 00:14:52,440 PROFESSIONALS PARTICIPATING IN 352 00:14:52,440 --> 00:14:52,960 THE CARE. 353 00:14:52,960 --> 00:14:55,680 SO NURSES AND OTHER SPECIALISTS 354 00:14:55,680 --> 00:14:57,360 MIGHT OBSERVE DIFFERENT THINGS 355 00:14:57,360 --> 00:15:01,920 DURING A NORMAL IN PERSON 356 00:15:01,920 --> 00:15:04,120 ENCOUNTER THAN DURING A VIDEO 357 00:15:04,120 --> 00:15:04,320 VISIT. 358 00:15:04,320 --> 00:15:06,520 IF YOU REALLY PAY ATTENTION 359 00:15:06,520 --> 00:15:09,000 THERE ARE SOME WAYS THAT VIDEO 360 00:15:09,000 --> 00:15:10,560 ENABLED VISITS OFFER THE 361 00:15:10,560 --> 00:15:16,960 OPPORTUNITY TO SEE PATIENTS IN 362 00:15:16,960 --> 00:15:21,040 THEIR ENVIRONMENT. 363 00:15:21,040 --> 00:15:22,920 SOMETIMES PATIENTS COME TO THE 364 00:15:22,920 --> 00:15:25,160 CLINIC AND DON'T PHYSICALLY HAVE 365 00:15:25,160 --> 00:15:26,160 THEIR MEDICATIONS. 366 00:15:26,160 --> 00:15:28,360 SO THERE ARE SOME OPPORTUNITIES 367 00:15:28,360 --> 00:15:30,080 AND WE'LL TALK ABOUT SOME OF THE 368 00:15:30,080 --> 00:15:31,600 ADDITIONAL OPPORTUNITIES IN THE 369 00:15:31,600 --> 00:15:32,920 NEXT FEW SLIDES. 370 00:15:32,920 --> 00:15:35,480 BEFORE WE DO THAT IT'S IMPORTANT 371 00:15:35,480 --> 00:15:38,520 THAT WE COMPARE AND CONTRAST AND 372 00:15:38,520 --> 00:15:41,320 IMAGINE SOME OF THE PARALLELS OF 373 00:15:41,320 --> 00:15:45,280 IN PERSON ENVIRONMENT TO THE IN 374 00:15:45,280 --> 00:15:46,800 PERSON ENVIRONMENT. 375 00:15:46,800 --> 00:15:52,080 THE NURSING STAFF OFTEN 376 00:15:52,080 --> 00:15:54,480 INTERVIEWS THE PATIENT AND SOME 377 00:15:54,480 --> 00:15:58,280 CONVERSATION OCCURS. 378 00:15:58,280 --> 00:16:00,400 WHEN THE PATIENT IS IN THE 379 00:16:00,400 --> 00:16:03,320 CLINIC MEDICATION RECONCILIATION 380 00:16:03,320 --> 00:16:06,760 OCCURS BEFORE THE VISIT. 381 00:16:06,760 --> 00:16:09,720 BUT IN THE TELEHEALTH VISIT 382 00:16:09,720 --> 00:16:11,480 SOMETIMES ONLY THE PHYSICIAN OR 383 00:16:11,480 --> 00:16:13,720 THE CLINICIAN IS IN THE VISIT. 384 00:16:13,720 --> 00:16:16,280 THEY HAVE TO BE THE ONES TO 385 00:16:16,280 --> 00:16:17,960 VERIFY THE MEDICATIONS DURING 386 00:16:17,960 --> 00:16:19,400 THAT VISIT AND ALSO DOCUMENT 387 00:16:19,400 --> 00:16:21,600 THAT. 388 00:16:21,600 --> 00:16:24,920 TEAM MEMBERS MAY ASSIST WITH THE 389 00:16:24,920 --> 00:16:26,960 VISIT VICE ALSO AND OTHER FORMS 390 00:16:26,960 --> 00:16:29,440 OF DOCUMENTATION. 391 00:16:29,440 --> 00:16:32,560 ORDERS AND WRITE SCRIPTS. 392 00:16:32,560 --> 00:16:34,480 WHEREAS IN THE VIRTUAL 393 00:16:34,480 --> 00:16:37,160 ENVIRONMENT THOSE VITALS WON'T 394 00:16:37,160 --> 00:16:40,760 OCCUR UNLESS THEY ARE ELICITED 395 00:16:40,760 --> 00:16:42,560 DURING THE VISIT AND THE 396 00:16:42,560 --> 00:16:43,840 DOCUMENTATION FALLS TO THE 397 00:16:43,840 --> 00:16:45,560 CLINICIANS AS WELL AS ORDERS AND 398 00:16:45,560 --> 00:16:47,760 OTHER THINGS AFTER THE VISIT. 399 00:16:47,760 --> 00:16:50,840 THE AFTER VISIT PLANNING. 400 00:16:50,840 --> 00:16:52,160 SOMETIMES IT GETS LOST IN THE 401 00:16:52,160 --> 00:16:53,480 MIX. 402 00:16:53,480 --> 00:16:55,360 THE NOTE GETS WRITTEN AND 403 00:16:55,360 --> 00:16:56,920 NOTHING ELSE HAPPENS. 404 00:16:56,920 --> 00:16:59,960 BUT IN THE IN PERSON ENCOUNTER 405 00:16:59,960 --> 00:17:02,440 THERE IS INSTRUCTIONS. 406 00:17:02,440 --> 00:17:05,480 PATIENT HANDOUTS PROVIDED. 407 00:17:05,480 --> 00:17:07,480 ADDITIONAL TEACHING MIGHT OCCUR. 408 00:17:07,480 --> 00:17:10,720 HOW TO ADMIN MEDICATIONS. 409 00:17:10,720 --> 00:17:12,680 THINGS LIKE THAT. 410 00:17:12,680 --> 00:17:13,720 AND THOSE THINGS OFTEN AGAIN 411 00:17:13,720 --> 00:17:16,680 OCCUR BY THE CLINICIAN DURING 412 00:17:16,680 --> 00:17:18,960 THE ONE TELEHEALTH VISIT THAT 413 00:17:18,960 --> 00:17:20,320 OCCURS. 414 00:17:20,320 --> 00:17:21,680 SO AS YOU CAN IMAGINE THIS MIGHT 415 00:17:21,680 --> 00:17:25,760 LEAD TO QUITE A BIT OF DISTRESS 416 00:17:25,760 --> 00:17:27,600 FOR THE CLINICIANS THAT HAVE TO 417 00:17:27,600 --> 00:17:28,920 DO ALL OF THIS. 418 00:17:28,920 --> 00:17:30,480 AND ONE THINGS THAT WE DON'T 419 00:17:30,480 --> 00:17:32,680 WANT TO DO IS CREATE ADDITIONAL 420 00:17:32,680 --> 00:17:35,200 CLINICIAN BURN OUT. 421 00:17:35,200 --> 00:17:38,040 SO IT IS IMPORTANT AS YOU ENGAGE 422 00:17:38,040 --> 00:17:41,040 IN TELEHEALTH TO OPTIMIZE THE 423 00:17:41,040 --> 00:17:42,480 WORKFLOWS FOR TEAM BASED CARE. 424 00:17:42,480 --> 00:17:45,120 SO MOVING FROM JUST A PHYSICIAN 425 00:17:45,120 --> 00:17:48,120 OR CLINICIAN LED VISIT TO 426 00:17:48,120 --> 00:17:49,320 INCORPORATING THE OTHER MEMBERS 427 00:17:49,320 --> 00:17:52,320 OF THE TEAM TO YOUR DAY. 428 00:17:52,320 --> 00:17:54,000 AND IN THE FUTURE HOPEFULLY 429 00:17:54,000 --> 00:17:58,480 THERE MIGHT BE SOME INTEGRATION. 430 00:17:58,480 --> 00:18:03,160 SO THINGS -- THAT WON'T REQUIRE 431 00:18:03,160 --> 00:18:06,080 ALL OF THE DOCUMENTATION. 432 00:18:06,080 --> 00:18:08,440 SO WHEN WE WERE USING MS TEAMS 433 00:18:08,440 --> 00:18:09,960 THERE WAS NO ROOMING OF THE 434 00:18:09,960 --> 00:18:10,680 PATIENT. 435 00:18:10,680 --> 00:18:12,160 THE PATIENT JUST APPEARED. 436 00:18:12,160 --> 00:18:14,280 THERE WAS NO VIRTUAL WAITING 437 00:18:14,280 --> 00:18:16,480 ROOM AND MEDICATION 438 00:18:16,480 --> 00:18:17,920 RECONCILIATION CAN OCCUR BY 439 00:18:17,920 --> 00:18:19,080 OTHER PEOPLE. 440 00:18:19,080 --> 00:18:22,600 SO IN OUR TEAM WE'VE HAD -- THIS 441 00:18:22,600 --> 00:18:24,320 HAPPEN BEFORE THE VISIT USING 442 00:18:24,320 --> 00:18:26,560 CASE MANAGERS TO CALL THE 443 00:18:26,560 --> 00:18:26,960 PATIENT. 444 00:18:26,960 --> 00:18:29,160 SOMETIMES THEY'VE NEVER MET THE 445 00:18:29,160 --> 00:18:32,000 PATIENT BEFORE OR ESTABLISHED 446 00:18:32,000 --> 00:18:34,120 RAPPORT BEFORE THE PATIENT 447 00:18:34,120 --> 00:18:35,760 ARRIVES EITHER IN THE CLINIC OR 448 00:18:35,760 --> 00:18:38,600 ON THE TELEHEALTH VISIT. 449 00:18:38,600 --> 00:18:40,520 SO WE APPRECIATE THAT TEAM BASED 450 00:18:40,520 --> 00:18:41,360 CARE. 451 00:18:41,360 --> 00:18:44,040 REFILLS AND LAB ORDERS CAN OCCUR 452 00:18:44,040 --> 00:18:46,360 AFTER TH VISIT UTILIZING 453 00:18:46,360 --> 00:18:47,680 ADDITIONAL MEMBERS OF THE TEAM. 454 00:18:47,680 --> 00:18:49,200 THESE JUST HAVE TO BE DISCUSSED 455 00:18:49,200 --> 00:18:51,080 IN ADVANCE. 456 00:18:51,080 --> 00:18:53,400 SO THE FACULTY DEVELOPMENT TIP 457 00:18:53,400 --> 00:18:56,720 HERE IS THAT IT'S IMPORTANT TO 458 00:18:56,720 --> 00:18:58,800 SPREAD THE ROLES ACROSS THE TEAM 459 00:18:58,800 --> 00:19:01,040 AND YOU CAN PRACTICE AND DISCUSS 460 00:19:01,040 --> 00:19:03,240 SOME OF THE WAYS TO ACTUALLY 461 00:19:03,240 --> 00:19:06,160 IMPROVE DATA GATHERING AND BY 462 00:19:06,160 --> 00:19:10,480 DOING SOME WORKSHOPS OR KEY 463 00:19:10,480 --> 00:19:12,560 SPACE ROLE PLAYS. 464 00:19:12,560 --> 00:19:14,800 MODELING THESE VISITS IN A 465 00:19:14,800 --> 00:19:18,600 WORKPLACE SCENARIO SO YOU CAN 466 00:19:18,600 --> 00:19:22,600 INCREASE YOUR CONFIDENCE FOR THE 467 00:19:22,600 --> 00:19:23,680 ENTIRE TEAM. 468 00:19:23,680 --> 00:19:27,640 SO HOW DO WE PROVIDE TEAM BASED 469 00:19:27,640 --> 00:19:28,320 CARE AT NIH? 470 00:19:28,320 --> 00:19:31,520 WE HAVE LARGE TEAMS. 471 00:19:31,520 --> 00:19:34,360 INCLUDING MANY PEOPLE. 472 00:19:34,360 --> 00:19:35,400 INVESTIGATORS, RESEARCH 473 00:19:35,400 --> 00:19:37,440 PHYSICIAN, STAFF CLINICIANS, 474 00:19:37,440 --> 00:19:38,720 STUDY COORDINATORS. 475 00:19:38,720 --> 00:19:39,960 CASE MANAGERS. 476 00:19:39,960 --> 00:19:42,000 SOCIAL WORK. 477 00:19:42,000 --> 00:19:43,120 AND RESEARCH LABORATORY STAFF. 478 00:19:43,120 --> 00:19:46,440 ALL OF THESE PEOPLE ARE OFTEN 479 00:19:46,440 --> 00:19:48,600 INVOLVED BEFORE THE PATIENT EVEN 480 00:19:48,600 --> 00:19:49,560 ARRIVES AT NIH. 481 00:19:49,560 --> 00:19:51,720 SO JUST GETTING TO THE NIH TAKES 482 00:19:51,720 --> 00:19:54,360 QUITE A LOT OF TIME AND 483 00:19:54,360 --> 00:19:55,040 COORDINATION. 484 00:19:55,040 --> 00:19:57,480 THAT CARE COORDINATION AND THAT 485 00:19:57,480 --> 00:20:01,640 IS JUST A BIG COMPLEX TASK. 486 00:20:01,640 --> 00:20:05,440 SO WHAT SOME PEOPLE HAVE DONE IS 487 00:20:05,440 --> 00:20:06,560 INCORPORATE CONSENT LANGUAGE 488 00:20:06,560 --> 00:20:08,960 INTO THEIR PROTOCOLS TO DO A 489 00:20:08,960 --> 00:20:11,840 TELEHEALTH VISIT IN ADVANCE. 490 00:20:11,840 --> 00:20:13,840 AND SOME MIGHT SAY IT'S HARD TO 491 00:20:13,840 --> 00:20:15,840 PROVIDE THE SAME EXPERIENCE IN A 492 00:20:15,840 --> 00:20:16,760 VIRTUAL FORMAT. 493 00:20:16,760 --> 00:20:19,240 I AGREE WITH THAT. 494 00:20:19,240 --> 00:20:21,400 THE KIND OF CARE THAT WE PROVIDE 495 00:20:21,400 --> 00:20:24,160 FOR COMPLEX PATIENTS IS REALLY 496 00:20:24,160 --> 00:20:26,080 DIFFICULT TO DO IN ONE 497 00:20:26,080 --> 00:20:27,560 TELEHEALTH VISIT. 498 00:20:27,560 --> 00:20:29,160 BUT IN THE NEXT FEW SLIDES I 499 00:20:29,160 --> 00:20:31,080 WOULD LIKE TO DESCRIBE SOME OF 500 00:20:31,080 --> 00:20:33,280 THE WAYS THAT TELEHEALTH CAN 501 00:20:33,280 --> 00:20:36,360 BENEFIT YOUR PRACTICES IN 502 00:20:36,360 --> 00:20:40,120 INCORPORATING THIS INTO YOUR 503 00:20:40,120 --> 00:20:41,760 PLANS. 504 00:20:41,760 --> 00:20:46,200 SO REASON NUMBER ONE WE'LL CALL 505 00:20:46,200 --> 00:20:47,480 EFFICIENCY. 506 00:20:47,480 --> 00:20:50,200 WE'VE HAD PATIENTS THAT CAME 507 00:20:50,200 --> 00:20:53,320 FROM AFAR -- MANY CONVERSATIONS 508 00:20:53,320 --> 00:20:55,360 WITH VARIOUS TEAM MEMBERS TO 509 00:20:55,360 --> 00:20:57,320 PLAN IN ADVANCE. 510 00:20:57,320 --> 00:21:01,000 LABS, TESTING -- THAT IS CREATED 511 00:21:01,000 --> 00:21:04,800 AND DESIGNED IN ADVANCE TO 512 00:21:04,800 --> 00:21:06,920 DISCERN THE CAUSE OF THEIR 513 00:21:06,920 --> 00:21:07,320 ILLNESS. 514 00:21:07,320 --> 00:21:09,920 ONE THEY ARRIVE PATIENTS MIGHT 515 00:21:09,920 --> 00:21:11,800 SEE MULTIPLE PROVIDERS, 516 00:21:11,800 --> 00:21:12,960 DIFFERENT CONSULTS. 517 00:21:12,960 --> 00:21:15,160 SIGN ON TO SEVERAL PROTOCOLS. 518 00:21:15,160 --> 00:21:17,760 HAVE A BUNCH OF TESTING. 519 00:21:17,760 --> 00:21:19,600 IMAGING STUDIES. 520 00:21:19,600 --> 00:21:23,560 AND THEN THEY WAY. 521 00:21:23,560 --> 00:21:24,160 -- WAIT. 522 00:21:24,160 --> 00:21:25,960 SOMETIMES THEY ARE IN TOWN A FEW 523 00:21:25,960 --> 00:21:26,480 DAYS. 524 00:21:26,480 --> 00:21:29,520 MAYBE THEY CAN SEE THE CHERRY 525 00:21:29,520 --> 00:21:31,200 BLOSSOMS BUT IN REALITY THEY 526 00:21:31,200 --> 00:21:32,920 SPEND A LOT OF TIME WAITING FOR 527 00:21:32,920 --> 00:21:35,160 RESULTS TO COME BACK AND THIS IS 528 00:21:35,160 --> 00:21:37,040 WHERE THE PATIENT BECOMES 529 00:21:37,040 --> 00:21:38,920 INPATIENT BECAUSE IN A REGULAR 530 00:21:38,920 --> 00:21:41,920 HEALTH CARE SETTING IT'S IN 531 00:21:41,920 --> 00:21:43,800 MINUTES. 532 00:21:43,800 --> 00:21:46,520 BUT AT NIH THAT IS DAYS. 533 00:21:46,520 --> 00:21:48,320 SO AS MUCH AS THE SERVICE AND 534 00:21:48,320 --> 00:21:49,920 QUALITY OF CARE THAT WE PROVIDE 535 00:21:49,920 --> 00:21:52,640 IS FANTASTIC IT CAN BE SOMEWHAT 536 00:21:52,640 --> 00:21:54,120 DISRUPTIVE FOR PATIENTS 537 00:21:54,120 --> 00:21:55,200 ESPECIALLY THOSE WHO ARE 538 00:21:55,200 --> 00:21:55,880 OUTPATIENTS. 539 00:21:55,880 --> 00:21:59,520 WHO HAVE KIDS OUT OF SCHOOL. 540 00:21:59,520 --> 00:22:01,320 PEDIATRIC PATIENTS TO REMAIN AT 541 00:22:01,320 --> 00:22:03,480 THE NIH FOR SO LONG. 542 00:22:03,480 --> 00:22:06,400 SO THAT'S AN OPTIMAL USE OF 543 00:22:06,400 --> 00:22:08,280 TELEHEALTH. 544 00:22:08,280 --> 00:22:10,880 THE PATIENT CAN RETURN HOME. 545 00:22:10,880 --> 00:22:13,880 WITH PLANNED FOLLOW-UP IN A FEW 546 00:22:13,880 --> 00:22:15,640 DAYS OR WEEKS TO DISCUSS THE 547 00:22:15,640 --> 00:22:17,320 NEXT STEPS IN THE PLAN AND IF 548 00:22:17,320 --> 00:22:21,280 YOU'RE INCORPORATING LEARNERS 549 00:22:21,280 --> 00:22:23,840 THAT CAN BE AS SHORT OR AS LONG 550 00:22:23,840 --> 00:22:27,160 AS NEEDED TO ENSURE THAT THERE 551 00:22:27,160 --> 00:22:29,880 IS CONTINUITY IN THE CARE. 552 00:22:29,880 --> 00:22:31,760 THEY CAN CONTINUE TO SEE THE 553 00:22:31,760 --> 00:22:33,080 PATIENT BUT IN TELEHEALTH 554 00:22:33,080 --> 00:22:34,960 FORMAT. 555 00:22:34,960 --> 00:22:39,120 SO REASON NUMBER TWO IS 556 00:22:39,120 --> 00:22:40,400 COMMUNICATION AND TEAM 557 00:22:40,400 --> 00:22:42,320 COORDINATION. 558 00:22:42,320 --> 00:22:43,920 YOU DON'T FREQUENTLY SEE THIS 559 00:22:43,920 --> 00:22:46,520 MANY DOCTORS IN ONE ROOM. 560 00:22:46,520 --> 00:22:49,120 THIS IS NOT AN ISSUE AS MUCH 561 00:22:49,120 --> 00:22:52,600 WITH TELEHEALTH SO YOU CAN 562 00:22:52,600 --> 00:22:53,840 FREQUENTLY ACHIEVE ONE OF 563 00:22:53,840 --> 00:22:54,400 SEVERAL THINGS. 564 00:22:54,400 --> 00:22:56,080 YOU CAN HAVE MULTIPLE IT WILL 565 00:22:56,080 --> 00:22:58,080 DOCTORS ON A VIDEO CALL. 566 00:22:58,080 --> 00:22:59,920 YOU CAN HAVE ADDITIONAL 567 00:22:59,920 --> 00:23:01,560 SPECIALISTS THAT HAVE SEEN THE 568 00:23:01,560 --> 00:23:04,600 PATIENT ON A TELEHEALTH CALL 569 00:23:04,600 --> 00:23:07,560 ALSO PRESENT. 570 00:23:07,560 --> 00:23:09,120 YOU CAN HAVE SPECIALISTS FROM 571 00:23:09,120 --> 00:23:12,040 THE PATIENT'S HOME TEAM ALSO 572 00:23:12,040 --> 00:23:14,000 PRESENT ON THE TELEHEALTH VISIT. 573 00:23:14,000 --> 00:23:16,200 ALSO INCORPORATE THE OTHER 574 00:23:16,200 --> 00:23:18,640 MEMBERS OF THE TEAM. 575 00:23:18,640 --> 00:23:21,080 CASE MANAGERS AND BE AWARE OF 576 00:23:21,080 --> 00:23:23,160 THE CARE PLANS SO THE HAND OFFS 577 00:23:23,160 --> 00:23:26,400 AND THE CONTINUITY EXIST. 578 00:23:26,400 --> 00:23:28,520 SO WHEN THINKING ABOUT THIS IT 579 00:23:28,520 --> 00:23:31,000 DOES REQUIRE SOME THOUGHT ABOUT 580 00:23:31,000 --> 00:23:33,920 WHEN PEOPLE MIGHT JOIN AND IT'S 581 00:23:33,920 --> 00:23:36,080 REALLY POSSIBLE TO DO THAT IN A 582 00:23:36,080 --> 00:23:39,520 TELEHEALTH VISIT WHERE IT'S MUCH 583 00:23:39,520 --> 00:23:46,440 MORE DIFFICULT FOR INPERSON. 584 00:23:46,440 --> 00:23:50,440 REASON THREE ... FAMILY 585 00:23:50,440 --> 00:24:00,640 INCLUSIVITY. 586 00:24:02,960 --> 00:24:04,560 TELEHEALTH IS ONE WAY TO INCLUDE 587 00:24:04,560 --> 00:24:07,120 THE FAMILY MEMBERS IN THE CARE 588 00:24:07,120 --> 00:24:08,360 OF THE PATIENT AND WHEN THIS IS 589 00:24:08,360 --> 00:24:12,360 DONE REMOTELY -- OR IF THE 590 00:24:12,360 --> 00:24:13,800 PATIENT IS HERE AND THE FAMILY 591 00:24:13,800 --> 00:24:15,640 IS SOME WHERE ELSE THIS CAN BE 592 00:24:15,640 --> 00:24:16,440 ACCOMPLISHED WITH A LITTLE BIT 593 00:24:16,440 --> 00:24:19,680 OF PLANNING TO INCLUDE THE OTHER 594 00:24:19,680 --> 00:24:19,920 MEMBERS 595 00:24:19,920 --> 00:24:21,120 FAMILY WHO MIGHT BE RESPONSIBLE 596 00:24:21,120 --> 00:24:22,480 FOR THE CARE OF THE PATIENT INTO 597 00:24:22,480 --> 00:24:24,080 THE PROCESS SO THAT THEY CAN BE 598 00:24:24,080 --> 00:24:30,560 AWARE OF WHAT IS GOING ON. 599 00:24:30,560 --> 00:24:32,760 SO AS YOU'RE AWARE WE STARTED 600 00:24:32,760 --> 00:24:37,280 WITH MS TEAMS AND SOME OF I 601 00:24:37,280 --> 00:24:38,280 MENTIONED VIDEO QUALITY. 602 00:24:38,280 --> 00:24:41,800 IT WAS HARD TO GET A GOOD LOOK 603 00:24:41,800 --> 00:24:44,440 WHEN DOING A PHYSICAL EXAM. 604 00:24:44,440 --> 00:24:46,920 THE QUALITY WAS NOT SO GREAT. 605 00:24:46,920 --> 00:24:48,440 CONNECTIVITY WAS A PROBLEM. 606 00:24:48,440 --> 00:24:50,680 I PERSONALLY HAVE A HARD TIME 607 00:24:50,680 --> 00:24:55,000 SHARING ON TEAMS. 608 00:24:55,000 --> 00:24:56,360 THERE ARE DEFINITELY ISSUES AND 609 00:24:56,360 --> 00:24:59,120 THAT IS ONE OF THE REASONS FOR 610 00:24:59,120 --> 00:25:01,680 PICKING A DIFFERENT TELEHEALTH 611 00:25:01,680 --> 00:25:07,680 PLATFORM AND THIS MOVE TO A NEW 612 00:25:07,680 --> 00:25:18,120 -- ENTITY CALLED AN DOOR. 613 00:25:23,040 --> 00:25:24,400 THERE WILL BE OTHER INTEGRATION 614 00:25:24,400 --> 00:25:27,840 -- INCLUDING QUESTIONNAIRES THAT 615 00:25:27,840 --> 00:25:31,640 CAN BE PERFORMED IN ADVANCE. 616 00:25:31,640 --> 00:25:34,200 AND SO THERE ARE SOME 617 00:25:34,200 --> 00:25:34,760 FUNCTIONALITIES AND WE'LL GO 618 00:25:34,760 --> 00:25:35,840 THROUGH SOME OF THEM IN A 619 00:25:35,840 --> 00:25:38,240 MINUTE. 620 00:25:38,240 --> 00:25:41,600 SO THE BIG ONE IS THE WAITING 621 00:25:41,600 --> 00:25:43,360 ROOM POSSIBILITY. 622 00:25:43,360 --> 00:25:44,800 LET'S SAY THE PATIENT IS IN 623 00:25:44,800 --> 00:25:45,200 PERSON. 624 00:25:45,200 --> 00:25:47,960 THEY CAN ARRIVE AND JOIN A 625 00:25:47,960 --> 00:25:50,360 WAITING ROOM. 626 00:25:50,360 --> 00:25:51,920 THEY CAN MOVE FREELY. 627 00:25:51,920 --> 00:25:54,880 GO GET COFFEE AND AWAIT FURTHER 628 00:25:54,880 --> 00:25:56,480 INSTRUCTIONS AND GET UPDATES AND 629 00:25:56,480 --> 00:25:58,280 TEXT MESSAGES TO RETURN TO THE 630 00:25:58,280 --> 00:26:00,880 CLINIC BECAUSE THE TEAM OR THE 631 00:26:00,880 --> 00:26:02,640 PHYSICIAN IS READY TO SEE THEM. 632 00:26:02,640 --> 00:26:04,960 AND THIS ALSO HAPPENS IF THEY 633 00:26:04,960 --> 00:26:07,360 ARE REMOTE. 634 00:26:07,360 --> 00:26:09,800 SO IF THEY ARE VIRTUAL THE 635 00:26:09,800 --> 00:26:11,600 PATIENT CAN RECEIVE A TEXT TO 636 00:26:11,600 --> 00:26:13,280 LET THEM KNOW THEY SHOULD JOIN 637 00:26:13,280 --> 00:26:15,680 THE VISIT AND ALL OF THESE 638 00:26:15,680 --> 00:26:20,640 THINGS DO STREAMLINE THE VISIT. 639 00:26:20,640 --> 00:26:24,120 SO AS MENTIONED YOU MIGHT GET A 640 00:26:24,120 --> 00:26:26,040 TEXT MESSAGE THAT REMINDS YOU 641 00:26:26,040 --> 00:26:28,360 THAT YOU HAVE AN APPOINTMENT IN 642 00:26:28,360 --> 00:26:30,880 THE FUTURE AND THEN WHAT IS NICE 643 00:26:30,880 --> 00:26:33,360 ABOUT ANDOR IS THAT THE PATIENT 644 00:26:33,360 --> 00:26:37,680 AND YOU WILL ALSO RECEIVE A URL 645 00:26:37,680 --> 00:26:39,720 AND A WAY TO JOIN. 646 00:26:39,720 --> 00:26:41,640 THAT MAKES IT EASIER RATHER THAN 647 00:26:41,640 --> 00:26:43,680 DOWNLOADING AN APP. 648 00:26:43,680 --> 00:26:45,920 HAVE THE SERVICE CONTACT THE 649 00:26:45,920 --> 00:26:47,560 PATIENT AND MAKE SURE THEY CAN 650 00:26:47,560 --> 00:26:48,520 JOIN MS TEAMS. 651 00:26:48,520 --> 00:26:51,120 THERE ARE A LOT OF PATIENT 652 00:26:51,120 --> 00:26:52,440 THAT'S HAD DIFFICULTY WITH THAT. 653 00:26:52,440 --> 00:26:57,080 THE EASE OF USING CERTAINLY A 654 00:26:57,080 --> 00:27:00,320 BIG IMPROVEMENT. 655 00:27:00,320 --> 00:27:04,560 SO TO ACCOMPLISH THE TEAM BASED 656 00:27:04,560 --> 00:27:08,120 CARE IT DOES REQUIRE PREPPING 657 00:27:08,120 --> 00:27:09,080 YOUR TEAM. 658 00:27:09,080 --> 00:27:11,680 TALKING ABOUT -- WHAT THEIR ROLE 659 00:27:11,680 --> 00:27:13,440 IS IN THE PROCESS. 660 00:27:13,440 --> 00:27:15,400 TALKING TO THE NURSING STAFF AND 661 00:27:15,400 --> 00:27:17,280 OTHER MEMBERS OF YOUR TEAM. 662 00:27:17,280 --> 00:27:19,520 WHEN WILL MEDICATION 663 00:27:19,520 --> 00:27:20,560 RECONCILIATION OCCUR? 664 00:27:20,560 --> 00:27:21,640 BEFORE THE VISIT. 665 00:27:21,640 --> 00:27:24,760 IN A PRECALL OR AT THE BEGINNING 666 00:27:24,760 --> 00:27:28,080 OF THE VISIT AND PLANNING THE 667 00:27:28,080 --> 00:27:31,640 SEQUENCE OF THE VISIT. 668 00:27:31,640 --> 00:27:33,760 WE TALK ABOUT THE BACK CHANNEL 669 00:27:33,760 --> 00:27:34,440 IN A SECOND. 670 00:27:34,440 --> 00:27:36,600 WHO WILL DO THE INTRODUCTIONS AS 671 00:27:36,600 --> 00:27:37,960 THE PROVIDER. 672 00:27:37,960 --> 00:27:39,680 YOU'LL DO THE INITIAL 673 00:27:39,680 --> 00:27:41,400 INSTRUCTIONS AND LET THE EARNER 674 00:27:41,400 --> 00:27:43,640 TAKE THE HISTORY AND PHYSICAL 675 00:27:43,640 --> 00:27:46,360 EXAM AND THEN COME IN WITH SOME 676 00:27:46,360 --> 00:27:47,400 ADVICE. 677 00:27:47,400 --> 00:27:50,560 DETERMINING THE LEARNER SKILL 678 00:27:50,560 --> 00:27:53,080 AND TELEHEALTH COMPETENCY IS 679 00:27:53,080 --> 00:27:54,000 IMPORTANT. 680 00:27:54,000 --> 00:27:58,120 NOT ALL ARE AS ADEPT AT USING 681 00:27:58,120 --> 00:28:01,520 THE TECHNOLOGY. 682 00:28:01,520 --> 00:28:04,000 SO UNDERSTANDING THE 683 00:28:04,000 --> 00:28:04,720 CAPABILITIES BEFORE. 684 00:28:04,720 --> 00:28:06,320 AND WHAT EXPECT THE LEARNER TO 685 00:28:06,320 --> 00:28:08,040 DO AND THE REST OF THE TEAM 686 00:28:08,040 --> 00:28:09,240 MEMBERS TO DO. 687 00:28:09,240 --> 00:28:11,640 THE BACK CHANNEL IS IMPORTANT. 688 00:28:11,640 --> 00:28:13,960 TALKING ABOUT YOU MIGHT TEXT 689 00:28:13,960 --> 00:28:16,280 THEM FOR VARIOUS REASONS. 690 00:28:16,280 --> 00:28:18,880 OR YOU WANT THEM TO TEXT YOU TO 691 00:28:18,880 --> 00:28:20,520 JOIN THE CALL AFTER THE INITIAL 692 00:28:20,520 --> 00:28:24,040 PART IS CERTAINLY POSSIBLE. 693 00:28:24,040 --> 00:28:26,560 SO ONE OF THE ISSUES THAT CAME 694 00:28:26,560 --> 00:28:28,360 UP ABOUT THE BEGINNING OF THE 695 00:28:28,360 --> 00:28:30,200 PANDEMIC -- WAS IS THIS GOING TO 696 00:28:30,200 --> 00:28:32,120 BE A PROBLEM? 697 00:28:32,120 --> 00:28:34,120 ARE THERE GOING TO BE PEOPLE WHO 698 00:28:34,120 --> 00:28:38,600 CANNOT ACCESS TELEHEALTH. 699 00:28:38,600 --> 00:28:42,640 SO THIS STUDY TOOK FROM 700 00:28:42,640 --> 00:28:44,520 30 MILLION MEDICARE SERVICE 701 00:28:44,520 --> 00:28:46,480 CLAIMS AND ANALYZED BOTH BEFORE 702 00:28:46,480 --> 00:28:50,800 AND AFTER THE MEDICARE 703 00:28:50,800 --> 00:28:52,520 TELEMEDICINE COVERAGE WAIVER WAS 704 00:28:52,520 --> 00:28:53,480 IMPLEMENTED. 705 00:28:53,480 --> 00:28:56,160 THEY ASSESSED THE USAGE. 706 00:28:56,160 --> 00:29:00,160 A COMPREHENSIVE MEASURE OF 707 00:29:00,160 --> 00:29:00,760 NEIGHBORHOOD SOCIO ECONOMIC 708 00:29:00,760 --> 00:29:06,000 ADVANTAGE. 709 00:29:06,000 --> 00:29:15,880 BEFORE OWITH THE HIGHEST ODDS OF 710 00:29:15,880 --> 00:29:18,520 UTILIZATION SEEN IN THOSE IN THE 711 00:29:18,520 --> 00:29:19,800 MOST DISADVANTAGED NEIGHBORHOODS 712 00:29:19,800 --> 00:29:23,320 SO THIS STUDY DEMONSTRATED THAT 713 00:29:23,320 --> 00:29:25,200 INCREASING ACCESSIBILITY -- 714 00:29:25,200 --> 00:29:26,680 ALTHOUGH THERE WERE SOME 715 00:29:26,680 --> 00:29:30,640 DIFFICULTIES IN ACCESSING 716 00:29:30,640 --> 00:29:38,000 TELEMEDICINE DUE TO AGE -- ALL 717 00:29:38,000 --> 00:29:40,800 OF THOSE THINGS DO MAKE IT 718 00:29:40,800 --> 00:29:45,040 EASIER FOR PATIENTS. 719 00:29:45,040 --> 00:29:47,480 IT'S IMPORTANT TO DESIGN THESE 720 00:29:47,480 --> 00:29:50,480 PROCESSES FOR EQUITY. 721 00:29:50,480 --> 00:29:53,680 AND THIS IS A PHOTO CREDIT FROM 722 00:29:53,680 --> 00:29:54,080 UNITE. 723 00:29:54,080 --> 00:29:55,680 TALKING ABOUT DIVERSITY AND 724 00:29:55,680 --> 00:29:58,440 INCLUSION IN ALL OF THE VARIOUS 725 00:29:58,440 --> 00:30:00,440 ASPECTS OF HEALTH CARE FROM THE 726 00:30:00,440 --> 00:30:02,440 PROVIDER TO ASSURING THAT THE 727 00:30:02,440 --> 00:30:07,280 DISPARITIES ARE NOT WORSENED. 728 00:30:07,280 --> 00:30:11,560 SO ASSURING THAT THE TELEHEALTH 729 00:30:11,560 --> 00:30:13,600 PLATFORM HAS ACTIVATED 730 00:30:13,600 --> 00:30:14,240 TECHNOLOGY. 731 00:30:14,240 --> 00:30:17,000 TURNING ON CLOSED CAPTIONING IF 732 00:30:17,000 --> 00:30:17,520 REQUIRED. 733 00:30:17,520 --> 00:30:19,760 ASSURING THAT IT'S EASY TO USE. 734 00:30:19,760 --> 00:30:22,400 THE URLs AND TEXT THAT WE 735 00:30:22,400 --> 00:30:26,560 TALKED B. APP DOWNLOADS. 736 00:30:26,560 --> 00:30:29,080 CONSENT SURROUNDING LANGUAGE AND 737 00:30:29,080 --> 00:30:30,360 LITERACY. 738 00:30:30,360 --> 00:30:32,680 ASSURING THAT TRANSLATOR SERVICE 739 00:30:32,680 --> 00:30:35,960 ARE AVAILABLE. 740 00:30:35,960 --> 00:30:37,720 AND FOR THE PATIENT TO BE ABLE 741 00:30:37,720 --> 00:30:41,040 TO TAKE A LINK THAT THEY'VE 742 00:30:41,040 --> 00:30:42,800 RECEIVED AND FORWARD IT TO A 743 00:30:42,800 --> 00:30:46,360 FAMILY MEMBER TO JOIN. 744 00:30:46,360 --> 00:30:49,000 DIGITAL LITERACY IS A BIG 745 00:30:49,000 --> 00:30:50,880 CONSIDERATION AND WE HAVE A 746 00:30:50,880 --> 00:30:52,200 SERVICE THAT WOULD CHECK-IN WITH 747 00:30:52,200 --> 00:30:55,040 THE PATIENT TO SEE IF THEY COULD 748 00:30:55,040 --> 00:30:57,440 JOIN AND SOMETIMES WE WOULD GET 749 00:30:57,440 --> 00:30:59,200 AN E-MAIL SAYING THEY COULD NOT 750 00:30:59,200 --> 00:31:01,280 CONTACT THE PATIENT BUT WITH THE 751 00:31:01,280 --> 00:31:05,280 NEW PLATFORM THERE IS A SERVICE 752 00:31:05,280 --> 00:31:09,920 THAT CAN VISUALIZE AND BE ABLE 753 00:31:09,920 --> 00:31:11,200 TO HELP. 754 00:31:11,200 --> 00:31:14,960 COST IS A CONSIDERATION. 755 00:31:14,960 --> 00:31:16,760 PHYSICIANS STILL BILL FOR 756 00:31:16,760 --> 00:31:26,840 SERVICES USING TELEMEDICINE. 757 00:31:26,840 --> 00:31:30,320 THERE ARE PATIENTS WITH OTHER 758 00:31:30,320 --> 00:31:30,640 DISABILITIES. 759 00:31:30,640 --> 00:31:32,800 AND IT'S IMPORTANT NOT TO FORGET 760 00:31:32,800 --> 00:31:34,680 THOSE VISUAL DISABILITIES MIGHT 761 00:31:34,680 --> 00:31:35,840 BE A PROBLEM. 762 00:31:35,840 --> 00:31:37,720 HEARING DISABILITIES AND OTHERS 763 00:31:37,720 --> 00:31:38,880 THAT NEED TO BE CONSIDERED IN 764 00:31:38,880 --> 00:31:43,200 TERMS OF ASSURING ACCESS. 765 00:31:43,200 --> 00:31:45,960 SO I'M GOING TO GO THROUGH A 766 00:31:45,960 --> 00:31:48,240 LITTLE BIT, A VIDEO SHOWING ME 767 00:31:48,240 --> 00:31:50,280 ABOUT HOW TO ASSURE THAT YOUR 768 00:31:50,280 --> 00:31:52,520 WEBSITE MANNER IS PROTECT WHEN 769 00:31:52,520 --> 00:31:59,200 DOING A TELEHEALTH VISIT. 770 00:31:59,200 --> 00:32:02,400 SO THINK ABOUT WHETHER AND HOW 771 00:32:02,400 --> 00:32:02,720 PRECIPITATION. 772 00:32:02,720 --> 00:32:04,560 DO YOU OPEN UP A ZOOM TO SEE 773 00:32:04,560 --> 00:32:06,400 WHAT YOUR BACKGROUND LOOKS LIKE 774 00:32:06,400 --> 00:32:08,440 AND LOOK AT YOUR FACE AND BODY 775 00:32:08,440 --> 00:32:10,080 WITHIN THE FRAME. 776 00:32:10,080 --> 00:32:12,200 YOU MAY INTO THE BE ABLE TO DO 777 00:32:12,200 --> 00:32:13,920 MUCH ABOUT THE LIGHTING BUT MAKE 778 00:32:13,920 --> 00:32:15,520 SURE THERE IS NOT A WINDOW 779 00:32:15,520 --> 00:32:18,680 BEHIND YOU. 780 00:32:18,680 --> 00:32:20,360 MAKE ADJUSTMENTS BEFORE YOU 781 00:32:20,360 --> 00:32:21,080 START. 782 00:32:21,080 --> 00:32:22,920 SO YOU CAN MOVE YOUR CAMERA DOWN 783 00:32:22,920 --> 00:32:25,560 OR UP TO MAKE SURE THAT YOU'RE 784 00:32:25,560 --> 00:32:27,000 IN THE FRAME AND IT'S ALSO 785 00:32:27,000 --> 00:32:29,400 IMPORTANT TO MAKE SURE THAT YOU 786 00:32:29,400 --> 00:32:32,440 DRESS IN THE APPROPRIATE DRESS 787 00:32:32,440 --> 00:32:35,440 ATTIRE. 788 00:32:35,440 --> 00:32:38,280 JUST LOOK PROFESSIONAL. 789 00:32:38,280 --> 00:32:41,800 LOOK AT ALL OF YOUR TECH AND 790 00:32:41,800 --> 00:32:45,200 MAKE SURE YOUR PHONE IS SILENCED 791 00:32:45,200 --> 00:32:48,200 AND TAKE ONE LAST SIP OF YOUR 792 00:32:48,200 --> 00:32:55,360 MORNING COFFEE SO YOU CAN AVOID 793 00:32:55,360 --> 00:32:59,360 -- DISTRACTSES. 794 00:32:59,360 --> 00:33:03,400 * RESPOND TO SOMETHING THAT YOU 795 00:33:03,400 --> 00:33:05,520 HAD MENTIONED -- USE ACTIVE 796 00:33:05,520 --> 00:33:07,920 LISTENING. 797 00:33:07,920 --> 00:33:10,600 IT IS IMPORTANT SO SOME PEOPLE 798 00:33:10,600 --> 00:33:12,440 MIGHT LOOK UP AT ANOTHER SCREEN 799 00:33:12,440 --> 00:33:15,480 AND IT'S IMPORTANT TO TELL THE 800 00:33:15,480 --> 00:33:17,240 PATIENT THAT YOU HAVE ANOTHER 801 00:33:17,240 --> 00:33:19,120 SCREEN OPEN ON ANOTHER DISPLAY 802 00:33:19,120 --> 00:33:21,760 SO WHEN YOU LOOK OFF THEY DON'T 803 00:33:21,760 --> 00:33:24,720 THINK YOU'RE DISTRACTED. 804 00:33:24,720 --> 00:33:26,480 IT'S VERY NATURAL TO LOOK AT 805 00:33:26,480 --> 00:33:34,000 YOUR OWN SELF WHEN YOU'RE ON A 806 00:33:34,000 --> 00:33:36,160 TELEMEDICINE VISIT. 807 00:33:36,160 --> 00:33:38,000 BUT MAINTAIN EYE CONTACT. 808 00:33:38,000 --> 00:33:42,280 LOOK AT THE GREEN DOT ON YOUR 809 00:33:42,280 --> 00:33:42,880 CAMERA. 810 00:33:42,880 --> 00:33:46,360 BECAUSE THAT REALLY DOES EMULATE 811 00:33:46,360 --> 00:33:51,760 THE EXPERIENCE. 812 00:33:51,760 --> 00:33:53,520 SO OTHER THAN YOUR PERSONAL 813 00:33:53,520 --> 00:33:56,040 FACTORS AND HOW YOU LOOK ON 814 00:33:56,040 --> 00:33:57,600 CAMERA THERE ARE SOME ADDITIONAL 815 00:33:57,600 --> 00:33:58,720 PATIENT FACTORS THAT ARE 816 00:33:58,720 --> 00:34:00,960 IMPORTANT TO CONSIDER. 817 00:34:00,960 --> 00:34:02,400 ESTABLISHING THE CONNECTION. 818 00:34:02,400 --> 00:34:05,120 PAYING ATTENTION TO THE PATIENTS 819 00:34:05,120 --> 00:34:07,680 BODY CUES. 820 00:34:07,680 --> 00:34:11,240 CHANGES IN THEIR TONE. 821 00:34:11,240 --> 00:34:13,040 JUST LIKE IN THE CLINIC WHERE 822 00:34:13,040 --> 00:34:14,600 YOU MIGHT ASK WHO THEY HAVE WITH 823 00:34:14,600 --> 00:34:16,040 THEM TODAY YOU MIGHT WANT TO DO 824 00:34:16,040 --> 00:34:16,680 THAT TOO. 825 00:34:16,680 --> 00:34:18,640 THERE MAY BE PEOPLE NOT SHOWN IN 826 00:34:18,640 --> 00:34:20,160 THE VIDEO AND ASKING IF THERE 827 00:34:20,160 --> 00:34:21,600 ARE OTHER FAMILY MEMBERS THAT 828 00:34:21,600 --> 00:34:24,040 ARE THERE WITH THEM DURING THE 829 00:34:24,040 --> 00:34:24,520 VISIT. 830 00:34:24,520 --> 00:34:26,600 YOU CAN ADDRESS THESE THINGS IN 831 00:34:26,600 --> 00:34:28,840 YOUR OWN PRACTICE AS WELL AS 832 00:34:28,840 --> 00:34:31,640 OBSERVED LEARNERS USING THESE 833 00:34:31,640 --> 00:34:31,880 SKILLS. 834 00:34:31,880 --> 00:34:33,680 SO THINKING ABOUT YOUR OWN 835 00:34:33,680 --> 00:34:38,360 APPEARANCE AS WELL AS HOW OTHER 836 00:34:38,360 --> 00:34:41,120 LEARNERS ARE INTERACTING IS 837 00:34:41,120 --> 00:34:42,600 IMPORTANT AND IF SOME OF THESE 838 00:34:42,600 --> 00:34:46,040 THINGS DON'T HAPPEN YOU CAN 839 00:34:46,040 --> 00:34:49,120 PROVIDE SOME GUIDANCE TO THE 840 00:34:49,120 --> 00:34:53,120 PATIENT ABOUT WHAT TO DO IN 841 00:34:53,120 --> 00:34:55,840 SETTING UP A TECH FAILURE. 842 00:34:55,840 --> 00:34:56,880 LEAVE TIME FOR QUESTIONS. 843 00:34:56,880 --> 00:35:03,320 ALL OF THESE ARE PART OF WHAT WE 844 00:35:03,320 --> 00:35:06,040 DESCRIBE. 845 00:35:06,040 --> 00:35:08,960 THIS IS NOT A VALID INSTRUMENT 846 00:35:08,960 --> 00:35:12,600 FOR MEASURING BUT THERE ARE SOME 847 00:35:12,600 --> 00:35:16,680 POTENTIAL LESSONS LEARNED. 848 00:35:16,680 --> 00:35:20,000 WHAT THEY USED TO DO IS TAKE 849 00:35:20,000 --> 00:35:21,400 SCREEN SHOTS OF JOURNALISTS ON 850 00:35:21,400 --> 00:35:23,760 THE NEWS AND SHOW WHETHER OR NOT 851 00:35:23,760 --> 00:35:25,560 THEY DID A GOOD JOB WITH THEIR 852 00:35:25,560 --> 00:35:26,440 BACKGROUND. 853 00:35:26,440 --> 00:35:29,640 SO YOU CAN SEE HERE -- IS A 854 00:35:29,640 --> 00:35:31,600 PERSON TALKING ON THE NEWS. 855 00:35:31,600 --> 00:35:34,600 THEY HAVE TWO DOORS BEHIND THEM. 856 00:35:34,600 --> 00:35:36,560 SO THERE IS DATA THAT 857 00:35:36,560 --> 00:35:41,160 DEMONSTRATES HAVING A DOOR 858 00:35:41,160 --> 00:35:42,640 BEHIND YOU IS SIMILAR TO THE 859 00:35:42,640 --> 00:35:44,080 DOOR PHENOMENA. 860 00:35:44,080 --> 00:35:48,120 THE CLINICIANS WITH THEIR DOOR 861 00:35:48,120 --> 00:35:49,480 ON THE KNOB ABOUT TO LEAVE THE 862 00:35:49,480 --> 00:35:49,960 ROOM. 863 00:35:49,960 --> 00:35:52,160 THE PATIENT DOESN'T FEEL LIKE 864 00:35:52,160 --> 00:35:54,280 THEY HAVE THE ABILITY TO SAY 865 00:35:54,280 --> 00:35:58,320 WHAT THEIR LAST THOUGHTS ARE. 866 00:35:58,320 --> 00:36:01,160 SO POSITION YOUR CAMERA TO MAKE 867 00:36:01,160 --> 00:36:03,000 SURE THERE IS NOT A DOOR BEHIND 868 00:36:03,000 --> 00:36:03,400 YOU. 869 00:36:03,400 --> 00:36:05,480 THAT IS IMPORTANT. 870 00:36:05,480 --> 00:36:12,360 NOT TO GET TOO SAPPY BUT -- BUT 871 00:36:12,360 --> 00:36:15,360 HAVING MORE WARMTH ITEMS BEFORE 872 00:36:15,360 --> 00:36:19,520 YOU TO DEMONSTRATE HUMANITY. 873 00:36:19,520 --> 00:36:23,080 SO THAT IT DOES DEMONSTRATE MORE 874 00:36:23,080 --> 00:36:25,600 EMPATHY AND TRUST FOR THE 875 00:36:25,600 --> 00:36:25,800 PATIENT. 876 00:36:25,800 --> 00:36:28,120 I DON'T KEEP PLANTS BEHIND ME 877 00:36:28,120 --> 00:36:30,160 BECAUSE I CANNOT KEEP THEM ALIVE 878 00:36:30,160 --> 00:36:31,720 BUT THERE ARE OTHER WAYS. 879 00:36:31,720 --> 00:36:32,720 PICTURES OR OTHER THINGS THAT 880 00:36:32,720 --> 00:36:34,880 YOU CAN PUT BEHIND YOU TO MAKE 881 00:36:34,880 --> 00:36:38,320 SURE THAT YOU'RE DEMONSTRATING 882 00:36:38,320 --> 00:36:38,560 EMPATHY. 883 00:36:38,560 --> 00:36:46,600 SO SOME OF THESE -- -- THEY CAME 884 00:36:46,600 --> 00:36:48,160 ABOUT BECAUSE PATIENTS HAD A 885 00:36:48,160 --> 00:36:50,080 VOICE IN DESCRIBING THEIR 886 00:36:50,080 --> 00:36:51,280 TELEHEALTH EXPERIENCES. 887 00:36:51,280 --> 00:36:53,800 BEFORE THE PANDEMIC 65% OF 888 00:36:53,800 --> 00:36:56,000 AMERICANS FELT HESITANT OR 889 00:36:56,000 --> 00:37:00,440 DOUBTFUL ABOUT THE QUALITY OF 890 00:37:00,440 --> 00:37:00,880 TELEMEDICINE VISITSES. 891 00:37:00,880 --> 00:37:03,840 NOW MANY WANT TO CONTINUE USING 892 00:37:03,840 --> 00:37:07,840 TELEHEALTH SERVICES AND BELIEVE 893 00:37:07,840 --> 00:37:13,520 THAT THEY WILL BECOME THE NORM 894 00:37:13,520 --> 00:37:22,600 FOR NONEMERGENCY CONSULTATIONS. 895 00:37:22,600 --> 00:37:24,840 THERE MAY BE SPECIALISTS THAT 896 00:37:24,840 --> 00:37:27,000 ARE NOT PRESENT IN THE PATIENT'S 897 00:37:27,000 --> 00:37:31,040 LOCALE BUT THEY MAY BE ABLE TO 898 00:37:31,040 --> 00:37:35,440 ACCESS SOMEONE IN A DISTANT AR 899 00:37:35,440 --> 00:37:35,640 AREA. 900 00:37:35,640 --> 00:37:39,320 IF YOU HAVE A RARE DISEASE -- 901 00:37:39,320 --> 00:37:41,360 SOME OF THE THINGS THAT WE DO 902 00:37:41,360 --> 00:37:43,560 HERE ARE NOT POSSIBLE TO OBTAIN 903 00:37:43,560 --> 00:37:46,280 IN TERMS OFND OTHER 904 00:37:46,280 --> 00:37:46,800 PLACES. 905 00:37:46,800 --> 00:37:51,560 RARE DISEASES WOULD BENEFIT FROM 906 00:37:51,560 --> 00:37:53,240 CONTINUED TELL HEALTH ACCESS. 907 00:37:53,240 --> 00:37:55,120 THE PATIENT'S VOICE IS IMPORTANT 908 00:37:55,120 --> 00:37:57,080 IN TERMS OF BEING INVOLVED AS A 909 00:37:57,080 --> 00:37:58,160 PATIENT PARTNER. 910 00:37:58,160 --> 00:38:02,600 AND ASSURING THAT THE PATIENT'S 911 00:38:02,600 --> 00:38:04,520 VOICE IS IMPORTANT IN THE DESIGN 912 00:38:04,520 --> 00:38:06,760 OF SOME OF THE PROCESSES FOUND 913 00:38:06,760 --> 00:38:12,520 IN TELEHEALTH. 914 00:38:12,520 --> 00:38:15,320 SO, IT'S -- ONE THING THAT CAME 915 00:38:15,320 --> 00:38:19,320 ABOUT IS UNDERSTANDING WHAT 916 00:38:19,320 --> 00:38:20,680 THESE MEAN IN THE GLOBAL 917 00:38:20,680 --> 00:38:22,120 CONTEXT. 918 00:38:22,120 --> 00:38:23,840 SO ONE OF THE WAYS IS TO FOLLOW 919 00:38:23,840 --> 00:38:25,160 THE MONEY. 920 00:38:25,160 --> 00:38:27,360 INVESTMENT IN TOTAL VENTURE 921 00:38:27,360 --> 00:38:29,160 FUNDING TO THE TUNE OF TENS OF 922 00:38:29,160 --> 00:38:30,720 BILLIONS OF DOLLARS HIGHLIGHTS 923 00:38:30,720 --> 00:38:32,800 THE FACT THAT THIS FORM OF CARE 924 00:38:32,800 --> 00:38:36,040 IS LIKELY TO STAY AND THEN AS 925 00:38:36,040 --> 00:38:38,200 RESEARCHERS AND CLINICIANS WE 926 00:38:38,200 --> 00:38:41,160 SHOULD BE AT THE FOREFRONT OF 927 00:38:41,160 --> 00:38:43,120 THE TECHNOLOGY AS KEY 928 00:38:43,120 --> 00:38:43,720 STAKEHOLDERS. 929 00:38:43,720 --> 00:38:45,240 IN ADDITION TO PATIENTS DESIRING 930 00:38:45,240 --> 00:38:47,720 THIS PROCESS WE HAVE TO BE 931 00:38:47,720 --> 00:38:51,240 INVOLVED TO ASSURE THE BEST 932 00:38:51,240 --> 00:38:54,320 PRACTICES ARE IN EFFECT. 933 00:38:54,320 --> 00:38:58,320 THE OTHER PIECE IS THAT WHEN THE 934 00:38:58,320 --> 00:39:00,480 EMR WAS ROLLED OUT THEY WERE NOT 935 00:39:00,480 --> 00:39:02,760 A PART OF THE PROCESS. 936 00:39:02,760 --> 00:39:06,680 IT WAS ROLLED OUT FOR BILLING 937 00:39:06,680 --> 00:39:06,960 PURPOSES. 938 00:39:06,960 --> 00:39:10,720 AS TELEHEALTH GAINS TRACTION 939 00:39:10,720 --> 00:39:13,560 OTHER TELL OPPORTUNITIES GAIN 940 00:39:13,560 --> 00:39:15,640 TRACTION, WE HAVE TO BE AT THE 941 00:39:15,640 --> 00:39:18,400 TABLE AS KEY STAKEHOLDERS TO 942 00:39:18,400 --> 00:39:19,840 ASSURE THAT THESE PROCESSES 943 00:39:19,840 --> 00:39:23,560 DON'T CREATE A WORSE CLINICIAN 944 00:39:23,560 --> 00:39:25,800 BURN OUT FOR US. 945 00:39:25,800 --> 00:39:27,840 SO I WOULD LIKE TO PIVOT AND 946 00:39:27,840 --> 00:39:30,400 TALK ABOUT ASPECTS RELATED TO 947 00:39:30,400 --> 00:39:31,880 MEDICAL EDUCATION. 948 00:39:31,880 --> 00:39:33,840 I'LL POINT OUT SOME KEY TAKE 949 00:39:33,840 --> 00:39:36,360 AWAYS AND RESOURCES. 950 00:39:36,360 --> 00:39:40,320 YOU SEE THE KEY THAT IS A 951 00:39:40,320 --> 00:39:41,120 REFERRAL. 952 00:39:41,120 --> 00:39:45,080 AND THE FACULTY DEVELOPMENT 953 00:39:45,080 --> 00:39:45,560 OPPORTUNITIES. 954 00:39:45,560 --> 00:39:48,400 AS WELL AS SOME RESOURCES THAT 955 00:39:48,400 --> 00:39:51,040 CAN BE USED. 956 00:39:51,040 --> 00:39:53,680 PRETTY EARLY IN THE PANDEMIC WE 957 00:39:53,680 --> 00:39:55,680 REALIZED THAT USING TELEHEALTH 958 00:39:55,680 --> 00:39:57,120 AND TELA TRAINING WAS GOING TO 959 00:39:57,120 --> 00:39:59,520 BE VERY IMPORTANT AND THIS IS A 960 00:39:59,520 --> 00:40:01,200 PUBLICATION MYSELF AND THE SITE 961 00:40:01,200 --> 00:40:03,600 DIRECTORS AND THE PROGRAM HEADED 962 00:40:03,600 --> 00:40:05,120 PUT OUT TALKING ABOUT THE 963 00:40:05,120 --> 00:40:06,400 ELEMENTS THAT MIGHT BE IMPORTANT 964 00:40:06,400 --> 00:40:08,920 IN TERMS OF VIRTUAL TRAINING. 965 00:40:08,920 --> 00:40:10,600 ISSUES RELATED TO SUPERVISION. 966 00:40:10,600 --> 00:40:13,200 ASSESSING AND ADDRESSING ISSUES 967 00:40:13,200 --> 00:40:17,160 RELATED TO PROFESSIONALISM. 968 00:40:17,160 --> 00:40:18,280 HAVING PATIENT CENTERED 969 00:40:18,280 --> 00:40:19,840 DISCUSSIONS AND COUNSELING IN 970 00:40:19,840 --> 00:40:21,600 THE PROCESS. 971 00:40:21,600 --> 00:40:23,920 ACTUALLY UTILIZING THE 972 00:40:23,920 --> 00:40:25,800 OPPORTUNITIES FROM VIRTUAL 973 00:40:25,800 --> 00:40:26,680 CONNECTIONS. 974 00:40:26,680 --> 00:40:28,480 PROVIDING SPONSORSHIP AND 975 00:40:28,480 --> 00:40:29,680 MENTORSHIP AND CONNECTING 976 00:40:29,680 --> 00:40:31,600 TRAINEES WITH PEOPLE OUTSIDE OF 977 00:40:31,600 --> 00:40:33,880 OUR LOCAL REGION WERE IMPORTANT. 978 00:40:33,880 --> 00:40:36,160 WE DEVELOPED VIRTUAL CLASSROOMS 979 00:40:36,160 --> 00:40:39,200 AND MANY HAVE CREATED HUGE 980 00:40:39,200 --> 00:40:41,880 LIBRARIES OF VIDEOS OF TALKS AND 981 00:40:41,880 --> 00:40:43,560 THINGS THAT WERE GIVEN DURING 982 00:40:43,560 --> 00:40:44,240 THE PANDEMIC. 983 00:40:44,240 --> 00:40:48,000 AND THEN GETTING OPPORTUNITIES 984 00:40:48,000 --> 00:40:51,080 FOR TRAINERS TO PRESENT SOME OF 985 00:40:51,080 --> 00:40:55,720 THEIR SCIENCE. 986 00:40:55,720 --> 00:40:57,680 AND THAT ALLOWS YOU TO CONTINUE 987 00:40:57,680 --> 00:41:02,520 TO INTERACT WHEN THERE ARE 988 00:41:02,520 --> 00:41:03,480 DISRUPTIONS IN THE NORMAL 989 00:41:03,480 --> 00:41:07,400 PROCESS. 990 00:41:07,400 --> 00:41:10,800 FAST-FORWARD -- WE HAD TALKED 991 00:41:10,800 --> 00:41:12,960 ABOUT SOME OF THE COMPETENCIES 992 00:41:12,960 --> 00:41:14,240 IN THIS PAPER ABOUT THINGS THAT 993 00:41:14,240 --> 00:41:15,160 WE HAVE TO YOUR TICKET TO A 994 00:41:15,160 --> 00:41:16,960 BETTER NIGHT'S SLEEP. EASE FOR. 995 00:41:16,960 --> 00:41:21,400 FAST-FORWARD TO 2021 THE AMC PUT 996 00:41:21,400 --> 00:41:23,960 OUT DOCUMENTS THAT TALK ABOUT 997 00:41:23,960 --> 00:41:26,320 COMPETENCIES ACROSS THE LEARNING 998 00:41:26,320 --> 00:41:29,600 CONTINUUM AND THESE INCORPORATE 999 00:41:29,600 --> 00:41:31,960 -- RELATED TO PATIENT SAFETY AND 1000 00:41:31,960 --> 00:41:34,800 TECHNOLOGY ACCESS. 1001 00:41:34,800 --> 00:41:37,080 ASSURING EQUITY. 1002 00:41:37,080 --> 00:41:40,720 DATA ACQUISITION AND ASSESSMENT. 1003 00:41:40,720 --> 00:41:42,880 COMMUNICATION PRINCIPLES AND 1004 00:41:42,880 --> 00:41:44,960 ETHICAL PRACTICES AND THE LEGAL 1005 00:41:44,960 --> 00:41:48,080 REQUIREMENTS THAT ARE NECESSARY 1006 00:41:48,080 --> 00:41:48,400 TO UNDERSTAND. 1007 00:41:48,400 --> 00:41:50,600 SO THERE ARE SOME POTENTIAL 1008 00:41:50,600 --> 00:41:53,360 PITFALLS AND SAFETY CONCERNS. 1009 00:41:53,360 --> 00:41:58,520 THE FIRST ONE IS DIAGNOSTICS. 1010 00:41:58,520 --> 00:42:01,160 INCOMPLETE HISTORY. 1011 00:42:01,160 --> 00:42:05,240 COMPETENCY IN ELICITING THE 1012 00:42:05,240 --> 00:42:08,680 PHYSICAL EXAM. 1013 00:42:08,680 --> 00:42:10,320 INADEQUATE MEDICATION 1014 00:42:10,320 --> 00:42:12,160 RECONCILIATION. 1015 00:42:12,160 --> 00:42:13,920 YOU ALSO HAVE TEAM BASED CARE AS 1016 00:42:13,920 --> 00:42:16,960 WE TALKED ABOUT. 1017 00:42:16,960 --> 00:42:18,320 LOSS OF CONTINUITY IN THE FORM 1018 00:42:18,320 --> 00:42:21,120 OF FOLLOW-UP. 1019 00:42:21,120 --> 00:42:24,280 THEY HAVE A TELEHEALTH VISIT AND 1020 00:42:24,280 --> 00:42:25,720 NEVER BE CONTACTED AGAIN. 1021 00:42:25,720 --> 00:42:28,360 LACK OF SUMMARIES. 1022 00:42:28,360 --> 00:42:31,000 AND THEN FROM THE RESEARCH 1023 00:42:31,000 --> 00:42:34,080 PERSPECTIVE THE CONCERNS CAN BE 1024 00:42:34,080 --> 00:42:36,240 LOSS OF STRUCTURED ASSESSMENT. 1025 00:42:36,240 --> 00:42:40,080 MISSING SAFETY LABS. 1026 00:42:40,080 --> 00:42:43,080 MISSING RESEARCH END POINTS. 1027 00:42:43,080 --> 00:42:44,400 PROTOCOL DEVIATIONS AND 1028 00:42:44,400 --> 00:42:48,520 REPORTING AS WELL AS CONSENT AND 1029 00:42:48,520 --> 00:42:50,400 PROTOCOL CONSIDERATIONS. 1030 00:42:50,400 --> 00:42:54,080 ONE OF THE THINGS THAT WE 1031 00:42:54,080 --> 00:42:55,560 REALIZED IS THAT WE HAVE TO 1032 00:42:55,560 --> 00:42:58,160 DESIGN FOR THIS UP FRONT. 1033 00:42:58,160 --> 00:42:59,760 PUTTING TELEHEALTH AT THE 1034 00:42:59,760 --> 00:43:02,400 FOREFRONT OF YOUR DESIGN OF YOUR 1035 00:43:02,400 --> 00:43:05,080 CLINICAL TRIAL, ASSURING THAT 1036 00:43:05,080 --> 00:43:07,480 THE END POINT COULD BE DONE BOTH 1037 00:43:07,480 --> 00:43:08,200 WAYS. 1038 00:43:08,200 --> 00:43:11,200 WHETHER VIRTUAL OR IN PERSON. 1039 00:43:11,200 --> 00:43:15,920 AND THEN ASSURING THAT WE TEACH 1040 00:43:15,920 --> 00:43:17,600 AND THE WAY THAT WE THINK ABOUT 1041 00:43:17,600 --> 00:43:20,120 HOW TO ACTUALLY INCORPORATE THIS 1042 00:43:20,120 --> 00:43:21,280 MODALITY INTO OUR RESEARCH IS 1043 00:43:21,280 --> 00:43:23,920 IMPORTANT. 1044 00:43:23,920 --> 00:43:25,520 SO HOW DO WE DO THAT? 1045 00:43:25,520 --> 00:43:28,280 WE HAVE TO EDUCATE OURSELVES. 1046 00:43:28,280 --> 00:43:31,400 HERE I'VE PUT A LINK. 1047 00:43:31,400 --> 00:43:35,480 SOME OF THE KEY VIDEOS -- TOPICS 1048 00:43:35,480 --> 00:43:37,360 THAT ARE RELATED TO TELEHEALTH. 1049 00:43:37,360 --> 00:43:39,880 YOU CAN GO TO AND TRAIN YOURSELF 1050 00:43:39,880 --> 00:43:43,120 ON HOW TO DO AN APPROPRIATE 1051 00:43:43,120 --> 00:43:44,880 PHYSICAL EXACT THAT IS SPECIALTY 1052 00:43:44,880 --> 00:43:46,160 SPECIFIC. 1053 00:43:46,160 --> 00:43:49,360 THERE ARE NO WAYS TO MITIGATE 1054 00:43:49,360 --> 00:43:53,800 FOR HEARING IMPAIRMENT. 1055 00:43:53,800 --> 00:43:56,240 UNDERSTANDING OF FUNDAMENTALS OF 1056 00:43:56,240 --> 00:43:56,640 TELEMEDICINE. 1057 00:43:56,640 --> 00:43:59,200 SO VISIT THE SITE. 1058 00:43:59,200 --> 00:44:01,640 YOU CAN TYPE IT IN SO YOU CAN 1059 00:44:01,640 --> 00:44:03,440 ACCESS IT LATER. 1060 00:44:03,440 --> 00:44:05,280 WAYS THAT YOU CAN TRY AND 1061 00:44:05,280 --> 00:44:09,000 IMPROVE YOUR OWN ADMINISTRATION 1062 00:44:09,000 --> 00:44:11,200 AND TELEHEALTH SERVICES. 1063 00:44:11,200 --> 00:44:16,240 I WILL SHOW A LITTLE BIT -- OF A 1064 00:44:16,240 --> 00:44:25,080 YOU TOOOH, -- YouTube CLICK. 1065 00:44:25,080 --> 00:44:29,360 * IT WILL BE NICE TO WATCH PART 1066 00:44:29,360 --> 00:44:31,320 OF IT. 1067 00:44:31,320 --> 00:44:32,880 >> RESPIRATORY RATE IS SOMETHING 1068 00:44:32,880 --> 00:44:34,360 THAT YOU CAN CALCULATE AS THE 1069 00:44:34,360 --> 00:44:36,320 PATIENT IS SPEAKING WITH YOU. 1070 00:44:36,320 --> 00:44:43,440 NEXT LET'S DO THE -- HE -- 1071 00:44:43,440 --> 00:44:43,760 EXAMINATION. 1072 00:44:43,760 --> 00:44:47,640 NEXT LOOK AT THE EYES. 1073 00:44:47,640 --> 00:44:49,640 YOU CAN ASK THEM TO LOOK UP. 1074 00:44:49,640 --> 00:44:53,320 DOWN, TO THEIR LEFT TO THEIR 1075 00:44:53,320 --> 00:44:54,280 RIGHT. 1076 00:44:54,280 --> 00:44:55,200 DIAGONALLY. 1077 00:44:55,200 --> 00:44:57,040 AND WITH THAT YOU'RE ALSO 1078 00:44:57,040 --> 00:45:01,920 DOCUMENTING ASPECTS OF A 1079 00:45:01,920 --> 00:45:07,480 NEUROLOGICAL EXAM. 1080 00:45:07,480 --> 00:45:10,120 IF YOU WANT TO LOOK IN THE BACK 1081 00:45:10,120 --> 00:45:12,640 OF THE THROAT HAVE THEM OPEN 1082 00:45:12,640 --> 00:45:15,760 THEIR MOUTH AND DO A BIG AAAH 1083 00:45:15,760 --> 00:45:18,400 INTO THE CAMERA. 1084 00:45:18,400 --> 00:45:19,520 IF YOU CANNOT SEE YOU CAN ASK 1085 00:45:19,520 --> 00:45:23,040 THEM TO ADJUST THEIR ANGLE. 1086 00:45:23,040 --> 00:45:26,880 I ALSO SOMETIMES ASK PATIENTS TO 1087 00:45:26,880 --> 00:45:30,080 GRAB A FLASHLIGHT TO SEE DOWN 1088 00:45:30,080 --> 00:45:32,000 INTO THE BACK OF THEIR THROAT. 1089 00:45:32,000 --> 00:45:33,680 >> AS YOU CAN SEE IT CAN BE 1090 00:45:33,680 --> 00:45:36,200 AWKWARD AND YOU HAVE TO BE 1091 00:45:36,200 --> 00:45:38,680 COMFORTABLE TO ASK THE PATIENT 1092 00:45:38,680 --> 00:45:43,400 TO DO A FACILITATIVE TELL HEALTH 1093 00:45:43,400 --> 00:45:52,920 EXAM. 1094 00:45:52,920 --> 00:45:54,480 AND YOU HAVE TO BE CREATIVE IN 1095 00:45:54,480 --> 00:45:56,680 TERMS OF THINKING ABOUT THEIR 1096 00:45:56,680 --> 00:45:57,280 ENVIRONMENT. 1097 00:45:57,280 --> 00:46:03,840 SOME PATIENTS HAVE BLOOD 1098 00:46:03,840 --> 00:46:04,880 PRESSURE CUPS. 1099 00:46:04,880 --> 00:46:12,080 THEY MIGHT HAVE A PULSE OX 1100 00:46:12,080 --> 00:46:13,920 METER. 1101 00:46:13,920 --> 00:46:20,000 * WHAT ABOUT COUNSELING? 1102 00:46:20,000 --> 00:46:22,120 TALKING ABOUT MENTAL HEALTH 1103 00:46:22,120 --> 00:46:22,640 COUNSELING. 1104 00:46:22,640 --> 00:46:27,000 TELEHEALTH IS A VERY NICE 1105 00:46:27,000 --> 00:46:31,040 OPPORTUNE TIME TO OBSERVE 1106 00:46:31,040 --> 00:46:32,480 LEARNERS DOING COUNSELING AND 1107 00:46:32,480 --> 00:46:33,720 GIVING PATIENT INFORMATION. 1108 00:46:33,720 --> 00:46:35,200 YOU CAN BE THERE FOR THE WHOLE 1109 00:46:35,200 --> 00:46:37,200 TIME AND SOMETIMES YOU MIGHT SAY 1110 00:46:37,200 --> 00:46:39,200 -- INTRODUCE THE PATIENT TO THE 1111 00:46:39,200 --> 00:46:41,160 LEARNER AND TELL THEM THAT 1112 00:46:41,160 --> 00:46:43,720 YOU'RE GOING TO TURN THE VIDEO 1113 00:46:43,720 --> 00:46:44,600 OFF. 1114 00:46:44,600 --> 00:46:45,880 YOU CAN ALSO JOIN THE VISIT 1115 00:46:45,880 --> 00:46:46,320 LATER. 1116 00:46:46,320 --> 00:46:49,520 SO DEPENDING ON TIME FRAMES. 1117 00:46:49,520 --> 00:46:55,080 AND THEN ALLOW THE TRAINEE TO 1118 00:46:55,080 --> 00:47:00,720 GET THE HISTORY EXAM AND THIS -- 1119 00:47:00,720 --> 00:47:03,880 ALLOWS THE PATIENT TO PROVIDE 1120 00:47:03,880 --> 00:47:04,920 ADDITIONAL INFORMATION IF 1121 00:47:04,920 --> 00:47:07,200 NEEDED. 1122 00:47:07,200 --> 00:47:10,360 SO AS THE LEARNER IS GIVING 1123 00:47:10,360 --> 00:47:11,920 INFORMATION TO THE PATIENT THIS 1124 00:47:11,920 --> 00:47:16,040 IS ALSO A GOOD TIME TO ASSESS 1125 00:47:16,040 --> 00:47:17,200 COMMUNICATION SKILLS. 1126 00:47:17,200 --> 00:47:19,560 RAPPORT BUILDING AS WELL AS 1127 00:47:19,560 --> 00:47:21,400 DEMONSTRATION OF THEIR MEDICAL 1128 00:47:21,400 --> 00:47:22,640 KNOWLEDGE AND MANAGEMENT 1129 00:47:22,640 --> 00:47:27,200 REASONING. 1130 00:47:27,200 --> 00:47:30,600 I MEANT TO MENTION THAT THE -- 1131 00:47:30,600 --> 00:47:33,000 EDUCATION PLAYBOOK IS A GOOD 1132 00:47:33,000 --> 00:47:35,240 RESOURCE AND GOOD RESOURCE FOR 1133 00:47:35,240 --> 00:47:37,440 BOTH LEARNERS AS WELL AS FACULTY 1134 00:47:37,440 --> 00:47:40,360 TO THINK ABOUT SOME OF THE 1135 00:47:40,360 --> 00:47:43,280 ASPECTS OF THE TELEHEALTH 1136 00:47:43,280 --> 00:47:44,760 ENCOUNTER WHEN INCORPORATING A 1137 00:47:44,760 --> 00:47:46,560 LEARNING. 1138 00:47:46,560 --> 00:47:47,760 -- LEARNER. 1139 00:47:47,760 --> 00:47:48,680 *. 1140 00:47:48,680 --> 00:47:52,440 ALSO THE AMC COMPETENCIES. 1141 00:47:52,440 --> 00:47:54,840 THIS IS ACTUALLY A DOCUMENT THAT 1142 00:47:54,840 --> 00:47:56,840 TALKS ABOUT THE VARIOUS 1143 00:47:56,840 --> 00:47:58,160 COMPETENCIES. 1144 00:47:58,160 --> 00:47:59,680 I'LL MENTION SOME HIGHLIGHTS. 1145 00:47:59,680 --> 00:48:01,400 THE FIRST ONE IS ACCESS AND 1146 00:48:01,400 --> 00:48:03,040 EQUITY. 1147 00:48:03,040 --> 00:48:05,600 YOU WANT AS FACULTY MEMBER TO 1148 00:48:05,600 --> 00:48:06,960 ASSESS SOME OF THE THINGS DURING 1149 00:48:06,960 --> 00:48:09,040 A TELEHEALTH ENCOUNTER. 1150 00:48:09,040 --> 00:48:12,000 SO OBSERVING WHETHER THE 1151 00:48:12,000 --> 00:48:14,360 TRAINING MITIGATES IMPLICIT AND 1152 00:48:14,360 --> 00:48:17,080 EXPLICIT BIASES DURING A DEATH 1153 00:48:17,080 --> 00:48:21,080 HEALTH ENCOUNTER. 1154 00:48:21,080 --> 00:48:23,480 WHETHER THEY ARE ACCOMMODATING 1155 00:48:23,480 --> 00:48:28,120 OF THE PATIENT'S NEEDS AND 1156 00:48:28,120 --> 00:48:29,080 PREFERENCES. 1157 00:48:29,080 --> 00:48:32,800 AS WELL AS ABILITY TO MITIGATE 1158 00:48:32,800 --> 00:48:35,720 FOR LINGUISTIC BARRIERS DURING 1159 00:48:35,720 --> 00:48:40,040 USE OF THE TECHNOLOGY. 1160 00:48:40,040 --> 00:48:42,440 AND IF THE TRAINEE IS NOT ABLE 1161 00:48:42,440 --> 00:48:44,440 TO DO THOSE THINGS THIS IS AN 1162 00:48:44,440 --> 00:48:45,440 OPPORTUNITY FOR TEACHING. 1163 00:48:45,440 --> 00:48:47,760 WHEN THE FACULTY MEMBER STEPS IN 1164 00:48:47,760 --> 00:48:49,920 THEY CAN ROLE MODEL HOW TO TALK 1165 00:48:49,920 --> 00:48:52,080 TO THE PATIENT ABOUT SOME OF THE 1166 00:48:52,080 --> 00:48:55,520 ISSUES AND ADVOCATE FOR IMPROVED 1167 00:48:55,520 --> 00:48:56,600 ACCESS. 1168 00:48:56,600 --> 00:48:59,280 TALKING ABOUT COMMUNICATION. 1169 00:48:59,280 --> 00:49:03,000 OBSERVING WHETHER TRAINEE CAN 1170 00:49:03,000 --> 00:49:04,800 BUILD RAPPORT WITH THE PATIENT 1171 00:49:04,800 --> 00:49:07,240 USING EYE CONTACT. 1172 00:49:07,240 --> 00:49:09,000 APPROPRIATE TONE AND BODY 1173 00:49:09,000 --> 00:49:11,120 LANGUAGE AND UNDERSTANDING 1174 00:49:11,120 --> 00:49:13,440 NONVERBAL CUES OF THE PATIENT. 1175 00:49:13,440 --> 00:49:15,440 CAN THEY READ THE ROOM. 1176 00:49:15,440 --> 00:49:18,200 ARE THEY ABLE TO ESTABLISH A 1177 00:49:18,200 --> 00:49:18,840 RELATIONSHIP. 1178 00:49:18,840 --> 00:49:22,200 DO THEY HAVE GOOD LIGHTING. 1179 00:49:22,200 --> 00:49:23,640 GOOD SOUND? 1180 00:49:23,640 --> 00:49:26,600 DO THEY INCORPORATE PATIENT'S 1181 00:49:26,600 --> 00:49:29,240 SOCIAL SUPPORTS WITH THE 1182 00:49:29,240 --> 00:49:31,440 PATIENT'S CONSENT. 1183 00:49:31,440 --> 00:49:34,160 AND THEN AGAIN A NICE TIME TO 1184 00:49:34,160 --> 00:49:35,440 DEMONSTRATE SOME OF THE 1185 00:49:35,440 --> 00:49:36,640 COMMUNICATION SKILLS AND 1186 00:49:36,640 --> 00:49:38,640 COUNSELING IF NOT PERFORMED BY 1187 00:49:38,640 --> 00:49:42,040 THE TRAINER DURING THE VISIT. 1188 00:49:42,040 --> 00:49:44,200 WHAT ABOUT DATA COLLECTION AND 1189 00:49:44,200 --> 00:49:44,920 ASSESSMENT? 1190 00:49:44,920 --> 00:49:47,360 THIS IS ALSO A GOOD TIME TO 1191 00:49:47,360 --> 00:49:50,640 ASSESS WHETHER THE TRAINEE CAN 1192 00:49:50,640 --> 00:49:54,280 GATHER THE HISTORY PERFORM THE 1193 00:49:54,280 --> 00:49:55,880 EXAM AND INCORPORATE THAT INTO 1194 00:49:55,880 --> 00:49:57,560 THE MANAGEMENT PLAN. 1195 00:49:57,560 --> 00:50:02,120 DO THEY RECOGNIZE AND CLINICAL 1196 00:50:02,120 --> 00:50:04,840 RESEARCH LIMITS. 1197 00:50:04,840 --> 00:50:13,560 DO THCAN THEY UTILIZE REMOTE PAT 1198 00:50:13,560 --> 00:50:16,200 MONITORING TECHNOLOGY AND 1199 00:50:16,200 --> 00:50:19,080 ILLICIT DATA COLLECTION. 1200 00:50:19,080 --> 00:50:20,880 AND IF NOT AN OPPORTUNITY TO 1201 00:50:20,880 --> 00:50:26,760 ROLE MODEL AND GUIDE THAT ARE 1202 00:50:26,760 --> 00:50:32,640 SPECIALTY SPECIFIC. 1203 00:50:32,640 --> 00:50:36,720 SO ALL OF THIS REQUIRES AGAIN 1204 00:50:36,720 --> 00:50:39,640 PLANNING ON THE PART OF THE 1205 00:50:39,640 --> 00:50:41,800 FACULTY. 1206 00:50:41,800 --> 00:50:42,400 TALKING ABOUT SOME OF THE 1207 00:50:42,400 --> 00:50:43,320 OPPORTUNITIES. 1208 00:50:43,320 --> 00:50:47,800 IF THERE ARE TECH FAILURES. 1209 00:50:47,800 --> 00:50:49,400 PRESPECIFY A BACK UP PLAN SO YOU 1210 00:50:49,400 --> 00:50:53,680 CAN USE A TELEPHONE OR 1211 00:50:53,680 --> 00:50:55,440 RESCHEDULE A VISIT. 1212 00:50:55,440 --> 00:50:58,120 AND THEN ONE OF THE THINGS THAT 1213 00:50:58,120 --> 00:51:01,600 AS FACULTY IN A VIRTUAL SETTING 1214 00:51:01,600 --> 00:51:09,680 -- IS WHAT HAPPENS IF THERE IS A 1215 00:51:09,680 --> 00:51:11,560 DISAGREEMENT WITH AN ASSESSMENT. 1216 00:51:11,560 --> 00:51:14,240 YOU MIGHT WANT TO TALK ABOUT AND 1217 00:51:14,240 --> 00:51:16,320 PRESPECIFY WHEN YOU'RE GOING TO 1218 00:51:16,320 --> 00:51:17,080 STEP IN. 1219 00:51:17,080 --> 00:51:20,240 IT'S IMPORTANT TO BE ABLE TO DO 1220 00:51:20,240 --> 00:51:25,280 THIS IN AN APPROPRIATE WAY AND 1221 00:51:25,280 --> 00:51:26,600 INCORPORATE SOME TEACHING DURING 1222 00:51:26,600 --> 00:51:29,560 THE VIDEO CALL FOR BOTH THE 1223 00:51:29,560 --> 00:51:30,840 TRAINEE AND THE PATIENT. 1224 00:51:30,840 --> 00:51:35,760 THERE ARE WAYS TO MITIGATE 1225 00:51:35,760 --> 00:51:39,760 WITHOUT IT BEING REALLY AWKWARD. 1226 00:51:39,760 --> 00:51:42,360 SO NOW I'LL TALK ABOUT SOME OF 1227 00:51:42,360 --> 00:51:43,400 THE RESOURCES. 1228 00:51:43,400 --> 00:51:45,920 A LOT OF THE CONCERNS OUTSIDE OF 1229 00:51:45,920 --> 00:51:48,040 NIH ENVIRONMENT ARE RELATED TO 1230 00:51:48,040 --> 00:51:49,680 POLICY AND LEGAL REQUIREMENTS. 1231 00:51:49,680 --> 00:51:53,000 THESE ARE TOPICS THAT WE NEED TO 1232 00:51:53,000 --> 00:51:54,040 BE AWARE OF. 1233 00:51:54,040 --> 00:51:56,240 THERE ARE A FEW RESOURCES. 1234 00:51:56,240 --> 00:51:57,880 ONE IS THE CENTER FOR CONNECTED 1235 00:51:57,880 --> 00:51:59,800 HEALTH POLICY. 1236 00:51:59,800 --> 00:52:01,800 THAT IS SHOWN DOWN ON THE BOTTOM 1237 00:52:01,800 --> 00:52:03,600 LEFT AND THAT SHOWS SOME OF THE 1238 00:52:03,600 --> 00:52:05,320 STATE BY STATE GUIDANCE FOR 1239 00:52:05,320 --> 00:52:07,360 USAGE OF TELEHEALTH. 1240 00:52:07,360 --> 00:52:10,240 THERE IS A FULL PAGE THAT TALKS 1241 00:52:10,240 --> 00:52:12,560 ABOUT TELEHEALTH TRENDS AND 1242 00:52:12,560 --> 00:52:14,400 POLICY RELATED ISSUES. 1243 00:52:14,400 --> 00:52:18,920 YOU CAN NAVIGATE THERE. 1244 00:52:18,920 --> 00:52:24,240 AND THERE ARE VIDEOS. 1245 00:52:24,240 --> 00:52:26,240 AND AMERICA TELEMEDICINE 1246 00:52:26,240 --> 00:52:27,840 ASSOCIATION HAS A LOT OF 1247 00:52:27,840 --> 00:52:31,000 DOCUMENTS AND ALSO MEET UPS AND 1248 00:52:31,000 --> 00:52:33,120 OTHER VIDEOS THAT ARE PART OF 1249 00:52:33,120 --> 00:52:35,040 THEIR PAGE. 1250 00:52:35,040 --> 00:52:37,000 SO I WOULD ENCOURAGE TO YOU GO 1251 00:52:37,000 --> 00:52:41,360 THERE FOR ADDITIONAL RESOURCES. 1252 00:52:41,360 --> 00:52:43,480 AND BEFORE WE RUN OUT OF TIME 1253 00:52:43,480 --> 00:52:47,000 WE'RE GOING TO SHOW A SIMULATED 1254 00:52:47,000 --> 00:52:47,440 ENCOUNTER. 1255 00:52:47,440 --> 00:52:49,520 NO PATIENTS WERE USED FOR THIS 1256 00:52:49,520 --> 00:52:53,760 VIDEO BUT I DO CREDIT MEGHAN AND 1257 00:52:53,760 --> 00:52:55,840 TRICIA FOR OBLIGING ME WITH 1258 00:52:55,840 --> 00:53:06,400 CREATING A SIMULATED ENCOUNTER. 1259 00:53:14,000 --> 00:53:16,480 >> AS YOU CAN SEE I'M ADJUSTING 1260 00:53:16,480 --> 00:53:20,120 MY SCREEN. 1261 00:53:20,120 --> 00:53:21,760 >> I THINK OUR PATIENT WILL BE 1262 00:53:21,760 --> 00:53:22,800 JOINING US SHORTLY. 1263 00:53:22,800 --> 00:53:24,920 I'M GOING TO INTRODUCE YOU AND 1264 00:53:24,920 --> 00:53:27,600 MAKE SURE SHE IS OKAY WITH YOU 1265 00:53:27,600 --> 00:53:30,160 JOINING BEFORE WE PROCEED. 1266 00:53:30,160 --> 00:53:32,040 >> IS THIS A GOOD PLACE FOR YOU 1267 00:53:32,040 --> 00:53:34,480 TO DO THE TELEHEALTH VISIT 1268 00:53:34,480 --> 00:53:34,960 >> YES. 1269 00:53:34,960 --> 00:53:37,000 I HAVE MY DOOR SHUT 1270 00:53:37,000 --> 00:53:39,320 >> I JUST WANT TO DO OUR 1271 00:53:39,320 --> 00:53:40,720 TELEHEALTH CONSENT BEFORE WE 1272 00:53:40,720 --> 00:53:45,400 START SO YOU KNOW WE'RE USING A 1273 00:53:45,400 --> 00:53:47,680 SECURE NIH NETWORK AND WE'LL 1274 00:53:47,680 --> 00:53:48,840 KEEP YOUR INFORMATION PRIVATE 1275 00:53:48,840 --> 00:53:51,760 AND TALKING ABOUT YOUR ASTHMA 1276 00:53:51,760 --> 00:53:52,480 TODAY. 1277 00:53:52,480 --> 00:53:54,280 IT'S APPROPRIATE FOR A 1278 00:53:54,280 --> 00:53:57,160 TELEHEALTH VISIT. 1279 00:53:57,160 --> 00:53:58,520 UNLESS WE FIND SOMETHING OUT 1280 00:53:58,520 --> 00:54:00,720 DURING THIS VISIT THAT REQUIRES 1281 00:54:00,720 --> 00:54:03,560 AN IN PERSON VISIT WE CAN 1282 00:54:03,560 --> 00:54:03,760 PROCEED. 1283 00:54:03,760 --> 00:54:05,120 I JUST WANT TO TELL YOU THAT I 1284 00:54:05,120 --> 00:54:06,960 HAVE A STUDENT WITH ME TODAY. 1285 00:54:06,960 --> 00:54:09,160 MEGHAN IS WITH US TODAY. 1286 00:54:09,160 --> 00:54:11,480 AND AS LONG AS YOU'RE OKAY WITH 1287 00:54:11,480 --> 00:54:13,440 HER BEING HERE WE'LL PROCEED 1288 00:54:13,440 --> 00:54:13,920 >> SURE. 1289 00:54:13,920 --> 00:54:16,440 THAT SOUNDS GREAT. 1290 00:54:16,440 --> 00:54:19,640 >> SO TO INFORM YOU I HAVE A 1291 00:54:19,640 --> 00:54:21,840 SCREEN WHERE YOUR PATIENT 1292 00:54:21,840 --> 00:54:23,320 RECORDS ARE UP THERE. 1293 00:54:23,320 --> 00:54:25,680 IF I LOOK AWAY I'M NOT 1294 00:54:25,680 --> 00:54:26,280 DISTRACTED. 1295 00:54:26,280 --> 00:54:27,920 I'M JUST LOOKING AT YOUR 1296 00:54:27,920 --> 00:54:28,360 RECORDS. 1297 00:54:28,360 --> 00:54:30,640 YOUR ASTHMA IS DOING WELL. 1298 00:54:30,640 --> 00:54:34,280 OUR NURSE NOTATED THAT WHEN SHE 1299 00:54:34,280 --> 00:54:35,880 CALLED THAT YOU'RE DOING WELL 1300 00:54:35,880 --> 00:54:37,400 AND NOT HAVING ANY PROBLEMS. 1301 00:54:37,400 --> 00:54:39,520 CAN YOU TELL US MORE ABOUT HOW 1302 00:54:39,520 --> 00:54:41,880 THINGS ARE GOING? 1303 00:54:41,880 --> 00:54:44,320 >> THEY'VE BEEN GOING WELL. 1304 00:54:44,320 --> 00:54:46,160 I HAVE BEEN CONTINUING MY 1305 00:54:46,160 --> 00:54:49,200 MEDICATION AND I HAVE NOT HAD 1306 00:54:49,200 --> 00:54:51,760 TOO MANY SYMPTOMS. 1307 00:54:51,760 --> 00:54:53,040 OCCASIONALLY WHEN I'M OUTSIDE 1308 00:54:53,040 --> 00:54:55,240 AND THERE IS A LOT OF HEAT AND 1309 00:54:55,240 --> 00:54:58,600 THE HUMIDITY IN THE AIR TENDS TO 1310 00:54:58,600 --> 00:54:59,840 ACTIVATE THINGS BUT OTHERWISE 1311 00:54:59,840 --> 00:55:06,600 I'M DOING GREAT. 1312 00:55:06,600 --> 00:55:08,160 >> 80 -- TWICE A DAY. 1313 00:55:08,160 --> 00:55:10,800 ARE YOU STILL ON THE MEDICATION? 1314 00:55:10,800 --> 00:55:11,080 >> YES. 1315 00:55:11,080 --> 00:55:13,000 I THINK THAT IS THE CORRECT 1316 00:55:13,000 --> 00:55:13,440 DOSAGE. 1317 00:55:13,440 --> 00:55:16,600 I DON'T HAVE IT WITH ME BUT I'M 1318 00:55:16,600 --> 00:55:18,240 PRETTY SURE THAT IS RIGHT 1319 00:55:18,240 --> 00:55:20,400 >> AND -- AS NEEDED. 1320 00:55:20,400 --> 00:55:21,040 >> CORRECT. 1321 00:55:21,040 --> 00:55:25,080 >> HAVE YOU NEEDED TO USE IT 1322 00:55:25,080 --> 00:55:27,040 >> NO. 1323 00:55:27,040 --> 00:55:31,240 >> IN NIGHTTIME SYMPTOMS? 1324 00:55:31,240 --> 00:55:33,400 COUGHING OR ANYTHING AT NIGHT? 1325 00:55:33,400 --> 00:55:34,800 >> SOME MILD COUGHING BUT 1326 00:55:34,800 --> 00:55:36,520 NOTHING THAT KEEPS ME AWAKE. 1327 00:55:36,520 --> 00:55:38,920 I'VE BEEN DOING GREAT 1328 00:55:38,920 --> 00:55:40,000 >> AND HOW OFTEN WOULD YOU SAY 1329 00:55:40,000 --> 00:55:41,360 THAT HAPPENS? 1330 00:55:41,360 --> 00:55:43,200 >> MAYBE ONCE A MONTH. 1331 00:55:43,200 --> 00:55:44,560 NOT MUCH AT ALL 1332 00:55:44,560 --> 00:55:47,880 >> AND WHEN YOU'RE EXERCISING OR 1333 00:55:47,880 --> 00:55:49,240 DOING ACTIVITY YOU DON'T HAVE 1334 00:55:49,240 --> 00:55:51,000 ANY LIMITATIONS? 1335 00:55:51,000 --> 00:55:51,200 >> NO. 1336 00:55:51,200 --> 00:55:53,080 NO PROBLEMS. 1337 00:55:53,080 --> 00:55:53,480 >> GREAT. 1338 00:55:53,480 --> 00:55:54,640 THAT ALL SOUNDS GREAT. 1339 00:55:54,640 --> 00:55:57,520 I'M WONDERING SINCE THE LAST 1340 00:55:57,520 --> 00:56:01,040 TIME THAT WE SAW YOU I SAW THAT 1341 00:56:01,040 --> 00:56:02,960 YOUR RECORD NOTE STATED THAT YOU 1342 00:56:02,960 --> 00:56:04,040 HAD SEVERAL PETS. 1343 00:56:04,040 --> 00:56:05,600 WHAT ARE YOUR PETS? 1344 00:56:05,600 --> 00:56:07,320 >> YES, I DO. 1345 00:56:07,320 --> 00:56:09,440 PROBABLY NOT THE BEST IDEA WITH 1346 00:56:09,440 --> 00:56:12,640 MY ALLERGIES BUT I HAVE TWO DOGS 1347 00:56:12,640 --> 00:56:14,040 AND TWO CATS. 1348 00:56:14,040 --> 00:56:16,560 BUT THAT HAS BEEN GOING WELL AND 1349 00:56:16,560 --> 00:56:18,680 WE'VE ALL BEEN GETTING ALONG 1350 00:56:18,680 --> 00:56:21,680 GREAT IN THE HOUSE SINCE I'VE 1351 00:56:21,680 --> 00:56:24,080 BEEN TAKING THE ALLERGY SHOTS. 1352 00:56:24,080 --> 00:56:26,040 >> AND THE SHOTS ARE GOING WELL, 1353 00:56:26,040 --> 00:56:28,120 ACCORDING TO THE RECORD. 1354 00:56:28,120 --> 00:56:31,040 I SEE THAT YOU'RE TOLERATING 1355 00:56:31,040 --> 00:56:32,840 THEM FINE AND YOU'RE NOT HAVING 1356 00:56:32,840 --> 00:56:35,880 ANY ADVERSE REACTIONS OR 1357 00:56:35,880 --> 00:56:37,680 PROBLEMS IN TERMS OF THE SHOTS. 1358 00:56:37,680 --> 00:56:39,680 >> NO PROBLEMS. 1359 00:56:39,680 --> 00:56:41,880 >> WELL THAT SOUNDS GREAT. 1360 00:56:41,880 --> 00:56:43,720 A SHORT VISIT. 1361 00:56:43,720 --> 00:56:46,440 YOU SEEM LIKE YOU'RE DOING VERY 1362 00:56:46,440 --> 00:56:48,960 WELL AND WE CAN SEE YOU BACK IN 1363 00:56:48,960 --> 00:56:51,320 THE OFFICE FOR YOUR REGULAR 1364 00:56:51,320 --> 00:56:53,360 CHECK UP FOR SIX MONTHS. 1365 00:56:53,360 --> 00:56:53,920 >> OK. 1366 00:56:53,920 --> 00:56:56,200 AND SHOULD I CALL TO SCHEDULE 1367 00:56:56,200 --> 00:56:58,000 THE APPOINTMENT. 1368 00:56:58,000 --> 00:57:00,400 >> DO YOU NEED ANY REFILLS? 1369 00:57:00,400 --> 00:57:00,800 >> NO. 1370 00:57:00,800 --> 00:57:02,880 I THINK I'M GOOD. 1371 00:57:02,880 --> 00:57:06,600 BUT I KNOW HOW TO GET A HOLD OF 1372 00:57:06,600 --> 00:57:08,240 THE NURSE. 1373 00:57:08,240 --> 00:57:10,960 >> OUR NURSE WILL REACH OUT JUST 1374 00:57:10,960 --> 00:57:13,480 TO VERIFY FOR APPOINTMENTS AND 1375 00:57:13,480 --> 00:57:15,360 REVILLES AFTER WE'RE DONE. 1376 00:57:15,360 --> 00:57:17,600 WE'RE GOING TO STAY ON THE LINK 1377 00:57:17,600 --> 00:57:19,160 AND YOU CAN TAKE OFF AND ENJOY 1378 00:57:19,160 --> 00:57:23,920 THE REST OF YOUR DAY. 1379 00:57:23,920 --> 00:57:25,480 >> OVER-ALL I THINK IT WENT 1380 00:57:25,480 --> 00:57:26,640 REALLY WELL. 1381 00:57:26,640 --> 00:57:29,000 SHE WAS ABLE TO REPORT HER 1382 00:57:29,000 --> 00:57:31,080 SYMPTOMS AND THERE WAS A FULL 1383 00:57:31,080 --> 00:57:34,120 PICTURE OF WHAT WHAT WAS GOING 1384 00:57:34,120 --> 00:57:34,720 ON. 1385 00:57:34,720 --> 00:57:39,040 MY ONLY QUESTION IS -- HOW MUCH 1386 00:57:39,040 --> 00:57:40,680 INSTRUCTION DO WE GIVE A PATIENT 1387 00:57:40,680 --> 00:57:45,360 TO DO SOMETHING LIKE THIS -- 1388 00:57:45,360 --> 00:57:48,160 [ INDISCERNIBLE ] 1389 00:57:48,160 --> 00:57:48,640 >> YEAH. 1390 00:57:48,640 --> 00:57:50,640 THAT IS A GOOD QUESTION. 1391 00:57:50,640 --> 00:57:53,560 SHE LOOKED VERY CALM. 1392 00:57:53,560 --> 00:57:56,880 SHE DIDN'T HAVE ANY DIFFICULTY 1393 00:57:56,880 --> 00:57:59,640 TALKING. 1394 00:57:59,640 --> 00:58:02,840 SHE WAS IN THE OFFICE. 1395 00:58:02,840 --> 00:58:05,600 I WAS NOT GOING TO ASK HER TO 1396 00:58:05,600 --> 00:58:08,120 RUNAROUND. 1397 00:58:08,120 --> 00:58:10,240 IF THEY ARE AT HOME YOU CAN ASK 1398 00:58:10,240 --> 00:58:15,520 THEM TO RUN UP THE STAIRS TO 1399 00:58:15,520 --> 00:58:17,280 ASSESS HOW THEY ARE DOING. 1400 00:58:17,280 --> 00:58:19,800 MOST OF THE EXAM WAS OBSERVATION 1401 00:58:19,800 --> 00:58:23,960 FROM MY PERSPECTIVE IN TERMS OF 1402 00:58:23,960 --> 00:58:29,120 LOOKING AT HER RESPIRATORY RATE. 1403 00:58:29,120 --> 00:58:32,360 AND SO THOSE ARE THINGS THAT 1404 00:58:32,360 --> 00:58:33,760 I'LL DOCUMENT THAT SHE LOOKED 1405 00:58:33,760 --> 00:58:36,360 GOOD AND DEPARTMENT HAVE ANY 1406 00:58:36,360 --> 00:58:39,640 PROBLEMS WITH HER * REPOSITORY 1407 00:58:39,640 --> 00:58:40,920 STATUS. 1408 00:58:40,920 --> 00:58:44,280 I JUST NOTICED THERE WAS SOME 1409 00:58:44,280 --> 00:58:47,720 CRACKING WHEN UNMUTED YOURSELF. 1410 00:58:47,720 --> 00:58:50,720 CERTAINLY ONE OF THE THINGS TO 1411 00:58:50,720 --> 00:58:52,200 MENTION, WE DON'T HAVE A CHOICE 1412 00:58:52,200 --> 00:58:53,560 OF WHERE YOU SIT. 1413 00:58:53,560 --> 00:58:55,120 YOU'RE IN THE LAB AND WE TALKED 1414 00:58:55,120 --> 00:58:57,000 ABOUT THIS BEFORE AND THERE ARE 1415 00:58:57,000 --> 00:58:58,560 ALSO PEOPLE WALKING AROUND YOU 1416 00:58:58,560 --> 00:59:00,640 SO WHEN YOU DO A TELEHEALTH 1417 00:59:00,640 --> 00:59:02,160 VISIT IT'S IMPORTANT TO MAKE 1418 00:59:02,160 --> 00:59:04,160 SURE THAT YOU'RE IN A PRIVATE 1419 00:59:04,160 --> 00:59:10,400 SPOT. 1420 00:59:10,400 --> 00:59:12,400 JUST ONE OF THE THINGS THAT 1421 00:59:12,400 --> 00:59:14,440 THINK ABOUT AND MAKE SURE YOUR 1422 00:59:14,440 --> 00:59:18,280 BROADBAND IS OKAY AND NOT HAVING 1423 00:59:18,280 --> 00:59:19,920 ANY TECHNICAL DIFFICULTIES. 1424 00:59:19,920 --> 00:59:21,760 WE CAN TROUBLESHOOT BUT ONE OF 1425 00:59:21,760 --> 00:59:23,760 THE THINGS TO BE AWARE OF DURING 1426 00:59:23,760 --> 00:59:26,280 TELEHEALTH VISITS. 1427 00:59:26,280 --> 00:59:26,520 >> OKAY. 1428 00:59:26,520 --> 00:59:28,120 THANK YOU. 1429 00:59:28,120 --> 00:59:28,600 >> OKAY. 1430 00:59:28,600 --> 00:59:30,240 WE HAVE SEVERAL MORE OF THESE. 1431 00:59:30,240 --> 00:59:33,000 WE'LL GO OVER THE SCHEDULE AND 1432 00:59:33,000 --> 00:59:34,560 SEE IF THERE ARE OTHERS THAT ARE 1433 00:59:34,560 --> 00:59:35,600 APPROPRIATE FOR YOU TO JOIN. 1434 00:59:35,600 --> 00:59:38,200 THANK YOU FOR JOINING ME AND LET 1435 00:59:38,200 --> 00:59:39,480 ME KNOW IF YOU HAVE ANY OTHER 1436 00:59:39,480 --> 00:59:40,880 QUESTIONS. 1437 00:59:40,880 --> 00:59:42,560 >> SO ONE OF THE THINGS THAT YOU 1438 00:59:42,560 --> 00:59:45,960 CAN DO DURING A TELEHEALTH VISIT 1439 00:59:45,960 --> 00:59:48,600 IS -- YOU CAN UTILIZE THE 1440 00:59:48,600 --> 00:59:50,960 TECHNOLOGY SO SHOW AND SHARE. 1441 00:59:50,960 --> 00:59:54,280 YOU CAN PULL UP ARTICLES * 1442 00:59:54,280 --> 01:00:01,920 PRECEPT -- AND THE LEARNER CAN 1443 01:00:01,920 --> 01:00:02,800 ILLICIT THESE. 1444 01:00:02,800 --> 01:00:04,920 YOU CAN ASK THEM IF THEY 1445 01:00:04,920 --> 01:00:06,440 WOULDN'T MIND SHOWING YOU THE 1446 01:00:06,440 --> 01:00:07,800 ARTICLE THAT THEY ARE TALKING 1447 01:00:07,800 --> 01:00:10,360 ABOUT SO IT'S A TWO-WAY PROCESS. 1448 01:00:10,360 --> 01:00:13,360 YOU CAN DISCUSS LEARNING 1449 01:00:13,360 --> 01:00:14,920 POINTERS AND SOME OF THE 1450 01:00:14,920 --> 01:00:15,680 OBJECTIVES AND THE FOLLOW-UP 1451 01:00:15,680 --> 01:00:16,640 PLAN. 1452 01:00:16,640 --> 01:00:18,440 IS IT GOING TO BE IMMEDIATELY 1453 01:00:18,440 --> 01:00:19,880 AFTER ONCE YOU TELL THE PATIENT 1454 01:00:19,880 --> 01:00:22,520 TO LEAVE OR LATER IN THE DAY. 1455 01:00:22,520 --> 01:00:28,440 AS WE MENTIONED BEFORE ASSESSING 1456 01:00:28,440 --> 01:00:31,680 COMPETENCY DEVELOPMENTS CAN BE 1457 01:00:31,680 --> 01:00:35,080 CONFIRMED DURING THE ENCOUNTER. 1458 01:00:35,080 --> 01:00:37,560 SO FOR CLINICIAN RESEARCHERS TO 1459 01:00:37,560 --> 01:00:39,680 OVERCOME THE TELEHEALTH 1460 01:00:39,680 --> 01:00:40,480 HESITANCY THERE ARE 1461 01:00:40,480 --> 01:00:42,640 OPPORTUNITIES. 1462 01:00:42,640 --> 01:00:46,720 ONE IS THAT WE CAN TRACK DATA 1463 01:00:46,720 --> 01:00:48,200 STREAMS. 1464 01:00:48,200 --> 01:00:49,960 AS LONG AS PHYSICIAN HAVE INPUTS 1465 01:00:49,960 --> 01:00:53,040 INTO THE DESIGN AND 1466 01:00:53,040 --> 01:00:58,160 IMPLEMENTATION OF TELEHEALTH 1467 01:00:58,160 --> 01:00:59,640 THESE ARE TECHNOLOGIES THAT ARE 1468 01:00:59,640 --> 01:01:00,920 PRIME FOR USE. 1469 01:01:00,920 --> 01:01:08,160 THERE IS POTENTIAL FOR -- 1470 01:01:08,160 --> 01:01:09,880 SAMPLES. 1471 01:01:09,880 --> 01:01:11,880 YOU'RE DOING A TELEHEALTH VISIT 1472 01:01:11,880 --> 01:01:15,800 BUT THEY ARE SENDING IN A 1473 01:01:15,800 --> 01:01:17,960 SAMPLE. 1474 01:01:17,960 --> 01:01:21,120 THERE ARE OTHER OPPORTUNITIES. 1475 01:01:21,120 --> 01:01:23,800 AUGMENTED INTELLIGENCE MACHINE 1476 01:01:23,800 --> 01:01:25,640 LEARNING APPROACHES. 1477 01:01:25,640 --> 01:01:26,480 ASSESSING PATIENT RELATED 1478 01:01:26,480 --> 01:01:28,960 OUTCOMES. 1479 01:01:28,960 --> 01:01:31,160 AND MOBILE HEALTH POTENTIALLY 1480 01:01:31,160 --> 01:01:34,040 USING TELEHEALTH. 1481 01:01:34,040 --> 01:01:37,080 AND SO I'M GOING TO WRAP UP BUT 1482 01:01:37,080 --> 01:01:41,480 I WANTED TO POINT OUT THAT 1483 01:01:41,480 --> 01:01:45,640 HASHTAG TELL MED HEALTH NOW. 1484 01:01:45,640 --> 01:01:46,920 YOU CAN LOOK THERE FOR 1485 01:01:46,920 --> 01:01:48,680 ADDITIONAL INFORMATION AND 1486 01:01:48,680 --> 01:01:50,440 TOPICS RELATED TO TELEMEDICINE. 1487 01:01:50,440 --> 01:01:52,880 THERE ARE RESOURCES THAT I 1488 01:01:52,880 --> 01:02:00,120 PROVIDED ON MY PRIOR SLIDE. 1489 01:02:00,120 --> 01:02:02,680 AND I'M HAPPY TO TAKE QUESTIONS. 1490 01:02:02,680 --> 01:02:05,000 BUT BEFORE WE DO THAT I WOULD 1491 01:02:05,000 --> 01:02:08,040 LIKE YOU TO DO ONE MORE THING 1492 01:02:08,040 --> 01:02:08,280 FOR ME. 1493 01:02:08,280 --> 01:02:10,880 SO AFTER THIS TALK -- YOU'VE GOT 1494 01:02:10,880 --> 01:02:13,480 A LOT OF INFORMATION. 1495 01:02:13,480 --> 01:02:15,360 SO PLEASE TAKE A MOMENT TO THINK 1496 01:02:15,360 --> 01:02:17,080 ABOUT WHAT ARE THE WAYS THAT YOU 1497 01:02:17,080 --> 01:02:18,800 MIGHT IMPLEMENTOR CHANGE 1498 01:02:18,800 --> 01:02:20,360 SOMETHING ABOUT YOUR TELEHEALTH 1499 01:02:20,360 --> 01:02:21,560 APPROACH. 1500 01:02:21,560 --> 01:02:24,440 WHETHER TO PATIENTS OR OBTAINING 1501 01:02:24,440 --> 01:02:25,560 CLINICAL RESEARCH INFORMATION. 1502 01:02:25,560 --> 01:02:29,080 IF YOU'RE A TRAINEE HOW YOU 1503 01:02:29,080 --> 01:02:31,400 MIGHT ENGAGE BETTER IN A 1504 01:02:31,400 --> 01:02:32,760 TELEHEALTH FORMAT. 1505 01:02:32,760 --> 01:02:35,960 IF YOU'RE FACULTY WHAT YOU MIGHT 1506 01:02:35,960 --> 01:02:39,600 CHANGE AS A RESULT OF THE TALK 1507 01:02:39,600 --> 01:02:40,360 TODAY. 1508 01:02:40,360 --> 01:02:49,560 NAVIGATE TO MENTEE .C -- 1509 01:02:49,560 --> 01:02:54,120 MENTI.com. 1510 01:02:54,120 --> 01:02:56,200 63163554 AND THEN AFTER A FEW 1511 01:02:56,200 --> 01:02:58,920 MINUTES I'M GOING TO SHARE THE 1512 01:02:58,920 --> 01:03:00,320 SCREEN AND SHOW YOU SOME OF THE 1513 01:03:00,320 --> 01:03:10,480 COMMENTS. 1514 01:03:23,320 --> 01:03:25,280 >> ONE PERSON HAS RESPONDED. 1515 01:03:25,280 --> 01:03:26,760 CONSIDER BACKGROUND AND SOUND 1516 01:03:26,760 --> 01:03:28,560 QUALITY. 1517 01:03:28,560 --> 01:03:30,440 MUCH MORE PLANNING FOR SESSIONS 1518 01:03:30,440 --> 01:03:39,920 AND ATTENTION TO ENVIRONMENT. 1519 01:03:39,920 --> 01:03:43,600 -- PHYSICAL EXAM. 1520 01:03:43,600 --> 01:03:47,560 PROFESSIONAL SET UP. 1521 01:03:47,560 --> 01:03:49,480 SO WE ARE AT TIME. 1522 01:03:49,480 --> 01:03:52,280 SO PERHAPS WE CAN WRAP UP THE 1523 01:03:52,280 --> 01:03:54,320 SESSION. 1524 01:03:54,320 --> 01:03:56,240 AND WE CAN FORWARD QUESTIONS TO 1525 01:03:56,240 --> 01:03:57,320 YOU DR. KHOURY. 1526 01:03:57,320 --> 01:04:00,920 THANK YOU VERY MUCH FOR AN 1527 01:04:00,920 --> 01:04:03,960 INCREDIBLY RICH TELEMEDICINE 1528 01:04:03,960 --> 01:04:05,400 LECTURE THAT HAS REALLY HELPED 1529 01:04:05,400 --> 01:04:09,880 EVERYONE I'M SURE. 1530 01:04:09,880 --> 01:04:13,200 BEING THOUGHTFUL ABOUT THIS NEW 1531 01:04:13,200 --> 01:04:15,520 TECHNOLOGY TO INCORPORATE IT. 1532 01:04:15,520 --> 01:04:16,440 AND GET OVER THEIR BARRIERS. 1533 01:04:16,440 --> 00:00:00,000 >>THANK YOU SO MUCH.