ALYNMENT - Private Networks Technology to Business Alignment for Enterprises

Ep #10: Dr Chris Clark Shares How His Team Flipped the Switch to Virtual Visits in 4 Days

• Ashish Jain • Season 1 • Episode 10

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Many medical providers had telehealth as a tool for conducting virtual patient visits, but patients and providers had not had much need or desire to use it. Until now. The pandemic hit hard in mid-March, and the shelter-in-home orders pushed medical practices to find ways to treat patients without seeing them in their offices. Can telehealth rise to the occasion to meet the medical treatment needs using virtual visits? And if it can, will doctors, nurse practitioners, and more importantly, patients continue to use it? Let’s find out.

Our guest today, Dr Chris Clark, is an experienced family medicine specialist in the Dallas area, and he has been practicing medicine for 26 years. He graduated from The Texas A&M University College of Medicine in 1994 and is currently affiliated with Baylor Scott & White Medical Center.

I recently got introduced to Dr. Clark, and I was intrigued by how his practice went through the transformation journey to tele-health. It was amazing to learn about “what matters” to a medical facility in deciding which technology is available and, more importantly, what is viable for virtual medical visits services. My goal today is to learn more about their journey with you and discuss the alignment gaps that still exist in making telehealth mainstream. 




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Speaker 1:

Many medical providers had access to telehealth as a tool to provide remote care. But both patients and providers did not have motivation to use it until now the pandemic and the shelter in home orders finally pushed the regulators and the payers who align, but are getting health applications aligned with the needs to provide high quality video based what we're treatment. And even if they rise to the occasion, our doctors, nurse practitioners, and more importantly, patients ready for the cultural shift. Let's find out

Speaker 2:

[inaudible]

Speaker 1:

hi guys, this is your host star, sheesh Jen. And you're listening to the alignment podcast where we go beyond the buzzwords and connect the dots between technology and its business impact our guest today. Dr. Chris Clark is an experienced healthcare professional in Dallas area, and he has been practicing family medicine for 26 years. He graduated from the Texas a and M university college of medicine in 1994 and is currently affiliated with Baylor Scott and white medical center. I recently got introduced to dr. Clark and I was intrigued by how his practice went through the transformation journey to telehealth in less than four days. It was amazing to learn about what matters to our medical facility in deciding which technology is ready. And more importantly, what is viable for what your service is? My goal today is to learn more about their journey with you and discuss the alignment gap that still exists in the telehealth mainstream. Dr. Clark, welcome to the show.

Speaker 3:

Thank you very much. I'm glad to be here.

Speaker 4:

Well, so I was very much so intrigued about your story. So before we get into it, um, a brief introduction,

Speaker 3:

you kind of hit the nail on the head. I'm a family medicine physician I've been working in the North Dallas area for over 20 years. I've had multiple different types of medical practice. I was in the military for a few years. I've done private practice. I've been involved in administrative roles, both in terms of peer review committees and quality committees. And so I've kind of been exposed to all different aspects of primary care. It's one of the things I'm passionate about. I'm very happy to be doing it on a daily basis.

Speaker 4:

That was great. I didn't know you were in the military before, so, um, yeah, that's, uh, that's, that's another new information for me. Um, so deli health it's short is pretty disruptive for the entire industry and um, when you and I were talking about it, I was like, okay, wow, this is a good use case of, you know, somebody in the medical medical industry, thinking about how this really changes their day to day life, a little bit about your center, how big it is and what is going on from a telehealth perspective in your life,

Speaker 3:

right? I am a I'm part of a very large primary care group. Um, we are in North Dallas, as I mentioned, I have 21 physician and 17 advanced advanced practitioners or physician's assistant partners. So there's almost 40 of us as part of a group. We look after about 67,000 patients collectively, and the group's been around for almost 46 years when the whole Corona virus situation came up, we were forced to try to consider some care options. Of course, patients didn't want to get out. They were hesitant to go into the community and we still had to provide care. Uh, what a lot of people forget is with the COVID-19 situation. You still have patients that have other medical problems. You have the diabetic patient, you have the high blood pressure, the heart patients you'll have people that have cancer. You have people that have, you know, weekend injuries. We still had to be able to provide healthcare to all of them. And so tele-health was really the only option that we had, especially when the system made the decision to have our clinic or have all of the primary care clinics in essence, quote, go dark unquote. They wanted us to try to implement something. The trick was is that we didn't have a lot of time to implement it, but we probably made the conversion in the matter about four days of deciding that we needed to do something, how are we going to do it? We had no idea, but we knew we needed to do something.

Speaker 4:

Please go ahead. And I would definitely want to, you know, throw some light on what do you mean by go dark? What does that mean?

Speaker 3:

Yeah. Yeah. So, uh, the reason they, they use the term go dark, cause they didn't want to say that a clinic was closed. So by saying they were going to go dark meant that we decided that we took our office and made it a virtual clinic only. We would only see patients virtually all of my partners, all the nurse practitioners who were located in my office, the doors were basically closed. And so the only way that we would have contact with patients would be in a virtual capacity. So that was what their, their definition of was going dark was saying not close. So it's just a different terminology. When we decided that we were going to do that, we had several hurdles that we had to go over. One of the interesting things is we had to try to really hammer out the actual terminology, what it means, um, a telehealth visit versus a virtual visit versus an ER, visit. All of those things meant something totally different. And every time you talk to a partner or talk to somebody in administration, everybody had a different perspective on what that meant. We kinda settled on the idea that each visit would be something that was strictly web based. The patient could email in through the app that our system has. They could list their complaints and then an email or text message response would go through a secure system to give the patient the advice on what to do. So we settled on that as an ER, visit a telephone visit or a telehealth visit for us was just something that we decided was going to be done strictly by telephone. And then a virtual visit would be actually something that allowed for video visualization of the patient, of their problem. And that allowed us once we define those three terms, it made it a little bit easier for us. The implementation of that though, was a lot more complicated. We tried to use the systems app because it has video capability. And when we first rolled that out, the first hurdle that we ran into was that the system had only purchased a certain number of licenses for use I'm part of a much larger system. And it wasn't just my 40 member group practice. We have several hundred other physicians who are in my system. They are in multiple specialties, not just primary care. And when the system decided that they were going to convert virtual and everybody tried to go on to this web based application based app approach to taking care of the patient. We ran out of licenses. And so in the very beginning, a couple of people could get on, but then a couple of people in my office couldn't, and that was the first big hurdle was getting more licenses. And then once we were able to do that, we had other options to look at as far as which application worked the best, my system would prefer us to use the application that works through the electronic health record. The problem is, is that we would have frequent dropped calls or we'd have pixelated images or the patient use of the app on their side became a little bit challenging, especially for somebody who's a little bit older. And so we had to try to come up with some solutions on the fly for when those occurred. Fortunately, my group being in North Dallas, we have a pretty broad base of experience with partners and many of our spouses are in technical industries. And so we were able to fall back on some of the other more traditional ways of communicating with people. Um, one of the first things that we tried to tap into was zoom. Um, there's a lot of people who were very comfortable with zoom applications. And when we started to use zoom, we all had a very positive response. We started to type up tip sheets for each one of the physicians. Who've never used it before was screenshots. So we could all learn how to do it. And then the system, my overall big medical system got involved and says, well, we have some concerns about security. And so zoom became something that was accepted, but then eventually became something that they were hesitant to let us use. And so we were left scrambling for other things. We tried things like teams. We tried doing WebExes. We tried using doxy.me, which an application that was out there. And in the end personally, just speaking for me, the three that I settled on were using the system based EHR program through a phone application, I found that FaceTime with the iPhone was just the easiest thing to do. But when you had patients who had a Google phone or an Android phone and you couldn't do a straight FaceTime, then what we would have to do is have a backup plan. And I found that Doximity was probably the best of those. And so we settled on those three options to be able to do virtual visits. Interesting.

Speaker 4:

Okay. So you did all of this in four days

Speaker 3:

in four days. Yeah. We didn't have a choice. Yeah. And so it was, it really, wasn't hard. We have several people in my office who are teachers for the computer software that we use for the electronic health record software that we use. And when we decided that we were going to be using that, it wasn't difficult. It took about, um, it took about a day for us to do some trial runs with patients to try to figure out exactly how it works. We had to do screenshots from the patient side cause so we call people who we knew would work with us and we would do screenshots from their side so we could understand what they were seeing. And then we compiled all that information. And these people who teach the software programs dot all of our group together and said, okay, here's what they're going to do. And here's what we're going to go for. We're going to use this computer based program, the software based program. And that actually worked really great, but then we ran into the license agreement problem. And then we jumped on to all the other possibilities that were out there. And we just, that was the benefit of being part of a large group. Yeah. So we figured we figured it out pretty quick.

Speaker 4:

That's amazing. And do you have an it team of your own or you guys just figured it out, the doctors yourself?

Speaker 3:

Oh, we do. Yeah. We were part of a very, very large organization. I'm actually, my group's actually big enough that we have a, an individual who works in the office, who does all of our tech support. And so he rotates between different clinics. And if we ever had a problem, we could call him, it. Wouldn't be difficult to have him come out and load software onto the system or do things. But we all had to still figure it out because the software was there. We just never turned it on. It would like, it'd be like using some computer program that I've never downloaded on my system before you have to, it can be there, but you still have to have functional knowledge of how the, how it works. And that's what we had to figure out.

Speaker 4:

So you're saying the assuming when you say computer software, you're talking about the EHR software that comes with some sort of a video conferencing or calling capability. Okay. So there was no need. And now there is a tremendous need.

Speaker 3:

We, the software that we use, this, the computer system that we use is a very nationally well-known programming. And I actually love it as an electronic health record. I've actually used five or six different EHR. And this one that we're currently using is by far my favorite. I love its functionality. We have the functionality for virtual visits ever since we rolled on to that EHR three or four years ago, but we never needed it if we knew it was there, but we never really had the desire to do it. And part of the reason that we never did virtual visits all gets back to insurance coverage. And so we never really went that direction. But then when the COVID-19 pandemic hit and we decided to make our clinic dark, so we had to process things differently. We just tapped into the resource that was there. It was there, it was up, it was running, it was available the whole time. We just never needed it. But then once we needed it, we had to quickly figure out how to do it.

Speaker 4:

Interesting. Walk us through that a little bit. And I'm, I'll go back to, you know, what you mentioned about three terms in terms of a telehealth visit versus a virtual visit versus an eave. Is it, and how are they correlated with the insurance? I mean, are these dorms very long and well-defined by insurances and how they reimburse or

Speaker 3:

how does that work? Yeah. Insurance companies, from what I understand have always been reticent about allowing physicians, providers to do virtual visits in all capacity, I can call a patient with test results and that's not reimbursed time. However, if I call a patient and discuss a brand new issue and do a assessment over the phone and a diagnosis over the phone, you would think that that would be reimbursable, but it's not physicians and providers are not compensated by insurance companies for any sort of virtual visit, whether it's telephone, whether it's an ER visit or whether it's a virtual visit with a video component. When the COVID-19 situation came out, Medicare, the CMS center for Medicare services passed a law to grant temporary permission. And as typical, when the Medicare component passes something many other insurance companies will fall lockstep step with what they're doing. So once Medicare said it was okay to start doing things remotely, a lot of the other large insurance payers that we have in the North Dallas area started to say, okay, we're going to let you do that. So as of two months ago, six weeks ago, when the insurance company said that we will then pay it, then it became possible for us to do probably everything that we would normally need to do. I can do any sort of visit now under this temporary agreement with the exception of a routine physical. So anybody under the age of 65, I still can't do a physical thing. Everything else that I can do for Medicare people over the age of 65 or anything else I can do for somebody under the age of 65, those services now be covered. And that was a huge, a huge thing. Um, we had really liked the idea of virtual visits. You have a lot of patients who worked odd hours, where they live remotely. And I have some patients of mine who lived, you know, an hour and a half away. That it's a difficult thing for them to drive in just for a simple process that I could have handled over the phone. So we really want insurance companies to start covering this. And once they said it was okay, that made the motivation for being able to do this a lot better. We jumped on the opportunity and I think this might be the new norm going forward. At least we hope it will be,

Speaker 4:

Oh, we hope as well. Um, so why video, right? Is there a difference in reimbursements between if you're doing a telecom telecall just at phone base versus a video based?

Speaker 3:

Yeah. It's a significant difference when you look at how reimbursement occurs. One of the ways that it occurs is based upon what's called an RVU, a relative value unit. And if you assume that a standard office visit had enough relative value unit of a 1.0 Medicare, always reimburses just a little bit less. So a standard office visit for Medicare might be a 0.9. So you lose a little bit by doing contract negotiation with Medicare. That's fine. If I do a virtual visit with a video component because of the current guidelines, I can charge that 0.9 RVU for that patient care. If there's a telephone component to it only it's automatically a 0.5. Oh really? Yeah. You lose that drop. And the reason is, is because you get a lot more information by actually seeing someone I can see the rash better. They could certainly describe it over the phone, but seeing the rash helps, I can see the way the person looks. You've seen someone who's sick before. You've seen someone who's healthy. You have a very good idea, sick versus healthy, just based upon that visual inspection. And so by adding the video component, Medicare puts a lot more emphasis on that. So our motivation was not to do really any telephone visits unless we had to. We tried to do everything video.

Speaker 4:

Interesting. So how do you rate the quality of the video? I know we, I had a conversation with another physician in the past and he's a brain surgeon and his perspective was the quantity of the video is not as great, right? I mean, if you really want to go into telehealth, I really need to see sometimes things. And now of course, this was done before granola Suarez and his perspective might change now. Well, what, what's your, what's your feeling in terms of when you're doing video visits, generally, are you able to get the right connectivity that I'd call it the, of the video and things like that?

Speaker 3:

And you can, that was when we started using the system that was running through our EHR. When we started using that software, it was a bit more pixelated. You would drop more images. You would have patients freeze. You could always hear the audio, but the video wasn't as great. If you imagine, and let's just consider FaceTime. If you do an iPhone FaceTime with somebody, that's about the typical video quality that a person would need. When you look at some of the other software that we had tried, whether it was zoom, whether it was Doximity, whether it was doxy.me, there's others that we kind of played with. I would say the video quality for all of them would be about the same as an iPhone FaceTime, perhaps a little bit less. I thought Doximity, again, me personally, I think Doximity and I phone are really probably the best I've rarely get dropped calls, broken images. When I use either of those two platforms, I had some pretty good success with some others, but that's about the video quality on the level of what you would see with an iPhone. And so that is a key for us. I certainly am not doing anything that's neurosurgically related. I just need to be able to see and assess some basic stuff. I would imagine if I'm a neurosurgeon using the example that you gave, you need to have a higher quality video. And certainly I don't see that, but what we're seeing is, you know, iPhone capability, you know, FaceTime capability and that's actually really pretty good. So what was your, what were some of your decision criteria when you're evaluating all these applications? Of course, you know, we recorded, they being one of them or what were the others? The biggest, probably the biggest thing that we need to have is the ability for the system to be reliable. I'm not going to use something that consistently has drops. If I get on a call with a patient, and I know in five minutes, I'm going to get dropped. Why would I even want to use that? Because I'm probably going to be on the phone with the patient, doing a video virtual visit for probably 20 minutes. And I don't want to have that risk of multiple drops. So I need reliability. That's the first thing, second thing I need. And this is probably the most important. One of the things that we learned is when we were trying to implement this sort of system and get it rolled out, the part that we hadn't really wrapped our brain around was getting it on our side was pretty straightforward. We could teach all of our physicians and providers how to do it. It was the other side of the equation. What does the patient see? The web based program that we're using through our EHR is really pretty difficult. There's multiple steps. It's not really crisp. It's very difficult to do compare that. And it's five or six steps that the patient has to go through in order to get to the video to an iPhone. Or I could either do a direct FaceTime, or I could call the patient, recognize their voice and say, do you mind if I convert this to video? And they say, no. And I tucked one simple button on my phone. And the patient is immediately there. That was a very key component, multiple steps on the patient's side versus limited steps. So that was a big hurdle that we had to get over. Another big hurdle that you have to get over is Medicare. And the insurance companies are requiring documentation that you have tried to maintain as much confidentiality and security as possible. Plus some sort of consent. You have to be able to let the patient consent to this sort of visit having something in the system like that is not only important. It's required the iPhone. You could do that by saying, do you mind me converting this to visual visual? They then are giving a verbal consent. If I use my system based program, that consent is built within. And that's part of all the steps. Part of the reason that I settled on doxy on Doximity is because using that program became very easy. I would type in the patient's phone number. I would touch one button to do a video call, and then I could actually close the phone down. And when a text message popped up telling him the patient was on, all I had to do was touch the text message. And I would see the patient's video for the patient. They would receive a text message. All they had to do was click one link. It would take them to a second page that would say, are you consenting to use your data and to have a video conversation with your provider? And they would just touch the second link and they're immediately on. So that was a much more streamlined. So with the three platforms that we've used, we've got the reliability, we've got different levels of ease of use, which is very important. And we've got that consent all built in, and that's kind of why we settled on those three. Do you think this is temporary from a perspective of just because of the situation, you know, everything is acceptable and then it will become more stringent. I do. Absolutely. What I think is going to happen is they did this because they know that people needed healthcare. And it's not just a COVID-19 situation that, as I mentioned earlier, there are lots of other medical problems that people have, especially in a primary care setting. And they've allowed us to be able to do just about whatever we need to do to accomplish the goal. But I think as time goes on, if they allow us to continue to do virtual visits, because it's still in my mind completely possible that three months from now, we're starting, that's just arbitrarily say January 20, 21, they might say effective immediately, no more virtual visits are going to be paid for. And then all of this becomes an irrelevant discussion, but if we assume that they would allow us to continue to do that, then you'll see one of two things, you'll see more stringent requirements. And I think you will see the void get filled by multiple companies to give you a good example Doximity which is a physicians based network building program. They did not have a video capability to my understanding I wasn't on Doximity. I never used it. And all of a sudden, some of my partners who were on it mentioned that they have now rolled out a beta version for a video and Doximity in my opinion, got it. Right? Because that ability for me to call somebody and then not have to just sit there and wait for them to come on. I could wait for the text message response and then have a good video quality. That is an example of how everything changed to fill the need. And I think when the government or insurance companies come out and say that these are the needs, I think that, you know, the free market is going to allow different companies to build better quality products that are going to fill exactly what those needs are.

Speaker 4:

So what's the, what's the customer perspective on this, right? So if I am as a patient talking right now and I have to pay the same amount of money or a dime with doctor, what sort of visit versus going to a facility, right? Do you, do you see that as a resistance? I know right now is, you know, the undo, anything about it. They have, this is a need for them, but as things settle down, even if the insurance allows the technology's there, do you think the patients will adopt it?

Speaker 3:

I do. Um, and the reason I do is based upon two things, one, if you imagine that the average person who comes to a clinic, they're going to come to the office and they're going to have their copayment that they're going to have to pay. Let's just say it was$20 to come see the primary care physician, a$20 copay that copay would remain the same. Whether you came to the clinic or you did it virtually. If I told you, you could pay$20 to come see me for a, let's just say a sore throat. You could pay$20 to be able to come see me to do that. Or you could pay$20. I will call you on the phone and from your bedroom where you were staying, because you don't feel well and you don't want to get out and you didn't want to get in the car and you didn't want to drive to the office and you didn't want to wait in line or didn't want to be around other people. If I could do all of that for the, just the convenience factor alone, that's why we're seeing most the statistics. My organization has been really good about tracking quality and tracking patient satisfaction scores. 20% of all, patients that come in to see us automatically get a survey sent to them. And they've managed to continue that even in the middle of this conversion, to everything virtual and the pretty clear response is that a lot of patients like the virtual visit, they like the convenience. They like not having to come in. Now, part of them are saying that because they don't want to be out in a community with the COVID-19 concerns. But I think being able to have that convenience is really going to be an important piece to this puzzle. Now, the other statistic that I'll give you is if you look at the overwhelming response of patients, my numbers pretty much mirror the system's number. So my system tracks the number of patient visits that are seen in the primary care setting. And my system has seen this precipitous drop in the number of people coming to the office. If you look at my numbers and I'll just give you hard values, I average about 400 office visits a month. And of those 400 office visits a month that breaks down to be about a hundred a week. So if you look at what I've done weekend and week out in the very beginning, when the COVID-19 situation occurred, and we realized that we needed to convert to virtual, I went from having basically 20 patient visits today down to two or three. And then once we shifted it back over to virtual, I'm now up to about 16 or 17 a day. So I had a very large drop about 90% of my patients visits had disappeared. And now I've worked it back up to 75, 80% consistently. And the system is seeing the same thing. Well, so we've been able to recapture and just change everything to where I'm getting about 75 to 80% of the office visits I would have received. Now, the reason I bring that up is because had it been a dissatisfier for patients, had patients not liked it or not want it to do it. I don't think we'd be anywhere close to 80%. I think we're going to be able to work it back up to where we typically we're seeing close to that hundred percent. If you will, that 20 patients a day, once we get, once we, as a group, get more efficient with the system, get more efficient with that software use, get more efficient with communication and instructing the patients. Then some of that wasted time during the day will disappear and you can fill that with other office visits. So I really think this is going to be something that the patients are going to want to continue for convenience.

Speaker 4:

That's an interesting point. There was a drop because of course of the situation, and then you're able to bring it back up from a virtualization perspective. What are the sort of sticks I was actually looking into is whether going virtual will actually increase the number of visits you can do in a day. I mean, considering your physical setup, right? So there's time for it. There's time for documentation. There's a lot of other things that go in. If you're doing everything virtual, does that mean you can do more?

Speaker 3:

Yeah, absolutely. And that's, and we were just having a discussion as a group about that last week. One of the things that we've started to figure out is, okay, well, the Corona virus situation is not going to continue indefinitely. What we eventually need to do is figure out, okay, how are we going to transition back to the way we did things. Now, if we assume that insurance companies are going to continue to cover virtual visits, it would be naive of us to think that we are just going to go back to business as usual. No, we have to incorporate the virtual visit component. Now, how would we do that? It would be difficult. And this is from a, a physician perspective. It would be difficult to be in an exam room and see somebody with a problem that is much better served. Face-to-face say an orthopedic injury where I need to get my hands on the joint and be able to assess things or a laceration where I have to be able to fix the problem right in front of me. It'd be very difficult to be in a room where I'm with somebody and then walk out of that room and go log in and do a virtual visit and then go back to an exam room and go back and forth. It just, it's difficult. It's like trying to talk between two different languages. If I'm going to try to speak English. And if I'm going to try to speak Spanish, you bounce back and forth between the two languages gets a little difficult. It's better to stay in one or the other. So probably what we would do is we would probably compartmentalize. I might make the first, let's just say five visits of my morning in person, and then make the next five visits of my morning. Virtual. Now we would have to do the scheduling to be able to make that happen, but it's definitely part of the equation. If virtual visits are going to stay, then we need to incorporate it. Now, will it add more volume? I absolutely think it can. And the reason I think it can is because there are certain visits I can handle over the phone. There are certain patients who it's difficult to get them to come in for a multitude of reasons. So I could easily imagine if you go back to what I was saying about 20 patients per day, I would easily think that I could probably get a 10, maybe a 15% increase another two to three patients into the clinic. So to speak virtually. I think I could probably increase my productivity by 10 to 15% without much hesitation.

Speaker 4:

So in current visit, are you just doing one on one or do you have, you know, nurse practitioner or somebody else involved? Let's say you need two doctors. Does that bring another level of efficiency here where, you know, you need to concern another doctor, for example, right? Early, generally earlier in physical village, you will say, okay, I'm gonna write you a recommendation, go see him right here, because you have a system, you have a practice of 40 physicians. Are you able to now say, okay, um, let me bridge in dr. James, who may be able to answer this question quickly, or are you, do you see such efficiencies mean again?

Speaker 3:

Absolutely. So there's two ways that I look at that. So the first way I look at it is the fact that again, the technology is changing quickly. For example, just this weekend I was on Doximity looking at it. And I noticed in the upper right hand corner, there is a circle with a plus sign in it. And I'm pretty sure that means that if I hit that button, I can add somebody to the process. I haven't even had a chance to figure it out, but I would think that I could add another partner. I would think I could add a family member if I'm dealing with an elderly patient and I want to get the son or daughter's perspective, I would think that I could hit the plus button, send them a link, and then they can come in. And then the three of us would all be on this. If you will group video chat, I'm almost certain that that's what that button is. I haven't had a chance to experiment with it. If that's the situation, I could fully understand how I can loop in one of my partners remotely or a specialist remotely. That would be a nice way to be able to increase the efficiency. Now I do know that the web based electronic health record system that we have, I do know for a fact that I have the ability to securely send information to the another provider to say, Hey, can you look at this x-ray or looked at this EKG or looking at this chest x-ray or image. And can you give me your input on this as is this something that I need to deal with? The problem is it's a static thing. I can send a still photo. I can't necessarily do video real time with the patient now, does that mean it's not there? I don't know, but all I know is six weeks ago, we weren't using it. And again, I think as we start to use it and we can see this necessity, I think those sorts of things we're going to get added, or those sorts of things are going to get discovered and we're going to be able to incorporate it. It's going to be important to be able to do that because it'd be wonderful if I could loop in, for example, a cardiologist on an abnormality on the EKG, especially if the cardiologist has an established visit with or established relationship with the patient. I could say dr. Jones, you know, ms. Smith, let's talk about her together. And we put all three of us on the line, but that's going to require that physician scheduled to have the availability, to be able to be looped in. They could be in a procedure or they could be seeing another patient. So there's a lot of things that we have to try to in, and that's where the scheduling part comes into play.

Speaker 4:

That was great. So one thing I'll want to ask you is in the last six weeks, right, you've gone from doing zero virtual visits to pretty much 90% or 80% of all your visits virtually. Did you ever come across an aha moment and be like, okay, why haven't we been doing, doing this before?

Speaker 3:

Well, we all know. I mean, to be totally candid, we all know that doing things virtually would be a nice advantage. We knew that doing virtual office visits can improve patient satisfaction because of the time that they wouldn't have to wait at the office, they could still stay at work, get their job done. And then just take 15, 20 minutes step away from their desk to be able to handle an issue with their position. We all knew the capability was there. The aha moment came the day the insurance company said they would pay for it. That's the key thing. If the insurance companies will continue to pay for the service, I have no doubt that there are going to be patients who are out there that want to continue the service. And there's going to be ways that we, as a group are going to be able to incorporate those many patients, love the idea of an ER, visit, where it's all done, purely electronically to where I log into a service. I pay a minimal fee or my insurance company will pay for one or two ER visits. And then I can text in my symptoms or check boxes of my symptoms that gets texted or emailed through a system to a provider who can look at the symptoms, get a feel for what's going on and then text message or email the patient back securely to tell them that this is what I think you have. And this is what we need to do. That is a very quick, convenient, easy thing. People like immediacy. The problem is, is that that video component is really, really important. And having a knowledge base of the patient is really important. And when you send a text off, there's no established relationship and that that's a piece of the puzzle that becomes critically important in making your decision. So the point would be is that I really think that that's going to continue, but it's going to depend a hundred percent on whether or not insurance companies are going to pay for it. I really hope that this, if you will, aha moment is at the insurance companies are going to see the benefit of it and the patients are going to see the benefit. And hopefully, you know, we can keep this process going. The

Speaker 1:

two of y'all love convenience. And thank you, dr. Clark, this was a great conversation. I really appreciate your time. And really pink is genie that I call it is out of the bottle upstairs out of the bottle. And we don't put that podcast. Thank you very much. Thank you. I appreciate your time. Wow. What a great journey. Thank you, dr. Clark, for sharing, how you and your team ramped up virtual patient care in such a short time, your Dean's effort to identify the right applications and defined processes is not only helping people in need, but also creating a model for many healthcare professionals who are undergoing a similar transformation. Let's hope that telehealth services continue as a new norm. Thanks everyone for listening. Don't forget to subscribe to the alignment podcast on your favorite platform, and please share your thoughts on this week's episode. You can also reach out to me on my email[inaudible] dot com and drop me a note on my LinkedIn until next time, stay inside safe and healthy.