Welcome to the Get'n Down With Digital Health podcast sponsored by Mend. We hope to inform you and inspire you on a wide variety of healthcare topics. We're grateful you're joining us today. Now, onto the show. Brandon: What's up everybody? Welcome to another episode of Get'n Down With Digital Health. I'm your host, Brandon Worley, and joining me today as co-host is none other than my fellow co-founder and CEO of Mend, Matt McBride. Good morning, Matt. How are you doing, man? Matt: Hey, good morning. Doing great. It will be a great show. Brandon: Very much looking forward to it. Matt and I are very excited about the special guest we have joining us on the show today. This is somebody who comes with a wealth of experience both as a clinician caring for patients, leveraging digital health solutions, but also from an administrative and consulting standpoint in helping design, select, and implement digital health solutions across larger organizations. Please join Matt and I in welcoming Dr. Aditi Joshi to the show. Good morning Dr. Joshi. How are you? Aditi: Good morning guys. Thank you for having me. I'm doing really well. Brandon: Good. We are very excited for our time together. I mentioned just a little bit about your experience and history in digital health, but for the benefit of the audience, would you mind giving a little bit more about your background? Aditi: Absolutely. I'll try to make this as short as possible because it can get very detailed very quickly. I'm an emergency medicine physician so I have been since 2009 when I graduated residency. In 2013, I actually joined a telemedicine startup. I worked there for about two and a half years until I got recruited into Jefferson in 2016 which is a huge academic center. There I run operations for direct-to-consumer programs. We did a lot of other things within telehealth from any aspect of medicine or different specialties you can think of. Aside from that, we did a lot of education and then we re-evaluated other digital health solutions that may come into a health system that needed to be used by other specialists. How do you evaluate it? How do we know that we need to use it? There's a lot of experience there. Since last year, I've been doing more consulting—working with telemedicine companies, digital health companies, health systems, looking at the strategy, how they implement telemedicine programs, and then also working on digital health intelligence, which is how I met you guys. Looking at the whole digital health ecosystem and marketplace as a whole, really figuring out, hey, what are we doing here? What is going to be the next step? What is valuable to patients, clinicians, and health systems? Brandon: Thank you very much for that and I know in doing a little bit of research about you in preparation for this show, we found out in 2020, that you are recognized for something that is pretty awesome. You are awarded the Emergency Medicine Residents Association Top 25 Under 45 Influencers in Emergency Medicine. First of all, congratulations on that award. That's outstanding. Aditi: Thank you. It was great to hear it that way. Brandon: What does receiving an award like that mean to you? Aditi: I do a lot of work with the American College of Emergency Physicians—just looking at telemedicine and what that means for emergency medicine as a whole. When I started out, as you guys know, there wasn't a lot of engagement like when you started either. It's really been an uphill battle in some ways. Then during the pandemic, everything changed and that's very true for emergency medicine in many ways, but telehealth, of course, is one of the ways that we had to really implement, improve our care, and decrease exposure. Winning that award really felt like there was finally a recognition within my specialty that this is something that we need to do, this is something that we need to learn about, and this is something we need to figure out. How are we going to change the practice? Or, is it going to change the practice and how of emergency medicine in the future? I was really honored to receive that. Matt: Aditi, serving as the chair for telehealth for the American College of Emergency Physicians, just kind of switching gears into telemedicine here—we usually bring this up before we start the show—that there's a lot of people online talking about how they figured out virtual care already. Everybody survived the pandemic, so we figured everything out. What's the current state today and what is the future state look like for telehealth in emergency medicine or even outside emergency medicine? Aditi: Absolutely, that's a huge question. What I meant by that is, when we think about virtual care, everyone said all right, the pandemic happened. Now everybody understands what telemedicine is—how we do it and who is going to use it. Now let's move on to RPM and hospital at home, which are really just steps forwards in virtual care. The reality is there's still a lot of work to do, even with the first type of virtual care that we're doing. As we all know here, how do you determine what's best for clinicians and health systems with the platform you're using? What text specifications? How do you design it? What's the best use case? Then after the fact, what is quality and how do you educate everybody to use it? When I see some of these discussions, I realize that there is still a lot of disconnect in where people think we are and what is actually happening in telemedicine. Some of these things have not been figured out and then there's also, on the flip side, less recognition of the work that people are doing. There are a lot of people doing research and figuring out quality standard guidelines, et cetera, and trying to say hey, okay, we are going to be using this in the future, so how are we going to do that? I think that's, as a whole, some of the different discussions that are happening. In emergency medicine, I have been surprised at the amount of groups, associations, or people that don't realize that emergency medicine has done telehealth for a long time. It almost feels like people think that we don't know how to do it. Frankly, if people think of emergency medicine, they think, of course, people come to the ER, they're really sick, and they might be close to death. How can that be possibly a group of physicians that are going to use telehealth? The reality is there have been people working in it for a really long time. We have a lot of data and research on how we're going to use it in emergency medicine. I don't want to take up too much time with that answer, but if you think about even the teleconsults, when we think about telestroke programs, the groups of doctors that were receiving consults from the stroke neurologists were emergency physicians as a whole. Of course, they're a part of that program from the beginning. Then you look forward and we look directly at the consumer. A lot of that is staffed by emergency physicians. Teletriage is coming through the ER, teleconsults, and specialist care trying to get care to rural or areas that don't have a lot of physicians. There are a lot of ways that we use it in emergency medicine already. Trying to get the word out a little bit that we have a lot of information, we do know what we've been doing, and how do we all work together to make sure that the entire health care system gets information from every specialty who might have answers for each other. Matt: Just one quick follow-up to this. In emergency medicine specifically, a lot of what may come in is just maybe more urgent care, maybe it's not life-threatening at all. Do you really see it as more of triage or let's triage, take minor situations, and maybe see if there's a virtual option? Is it sort of really trying to segment between, all right, this is a real emergency, and this is a little bit more urgent care and trying to sort of route patients that way? Aditi: Yes, absolutely. Ideally, we could even do that before the patient gets to the ER. Now, saying that, I will say the ER's doors are open all the time so no one mistakes me. Our doors are open to anyone at any time. Ideally, we would like to be able to go to the right level of care for their own comfort, their timing, and so the ERs are not overburdened all the time because it really has become a huge problem in the country. Yes, ideally, but we can use it within the ER itself to get consultations from our specialists or even see our patients remotely. For example, when I mentioned teletriage, that was somebody who is triaging a patient virtually, putting in orders, and then having them see for the rest of their stay in the ER. There are a lot of different ways we can do it. It's an interesting specialty because we really bridge the community and then the inpatient system. We have a lot of places that we can work and influence. Brandon: In the conversations that I've had with thousands of providers over the last seven or eight years, you have providers who are as early as being residents, all the way to seasoned providers who may be nearing retirement. What I'm really interested in are the newer providers that are coming on. I know you ran a telehealth fellowship and co-directed the Digital Health Scholarly Inquiry Track, teaching medical students, residents, and fellows about telemedicine and digital health. I'm curious, in your findings, what are residents being taught about telehealth today? Aditi: I'll back up and say that there is still a great need to standardize our education. The reality is that it isn't still part of standard training for medical students or residents anywhere. We were lucky enough, our residents are lucky enough, for medical students also to be able to access telemedicine education at Jefferson because we provided that. What I'm hearing a lot from residents around the country through [...]—these are emergency medicine residents specifically, but it's probably true for all of them—is that they really want more training, they want to learn about it. For those who have access to it—they're in institutions that treat it or have a program—they're able to access it and take advantage of that. There's a whole need for a whole group of them who don't have access to that. They don't really know where to look. One of the things we really need to do is provide that for them. We should make it part of the residency or medical school, just even a small part of it, and it can depend on where you're teaching it. In medical school, it would be the basics. What is it? How can you use it? In residency, it should be specialty-specific, because the way that we're going to use it and training emergency medicine residents is not the way we are going to use it in ophthalmology, nephrology, et cetera. It should be also tailored to the type of students and trainees that it is but yes, there's a huge need to expand that. Brandon: Well, I couldn't agree more. It seems like there's just such an opportunity to move digital health and just access to care just more broadly on a going-forward basis. It sounds to me like you are really passionate about being a change agent towards that initiative. I know you run a very successful digital health consultancy and you're doing a ton of really positive work in that regard, but what are you most passionate about in regards to digital health at this point? Aditi: One thing I really enjoy doing over this last year is looking at the market as a whole. We can all say that we don't really know what's out there, what other companies are providing, and what our health system is using. Just being able to take the experience I had both at a startup and then in an academic center and say okay, what's out there? Who's using it? How can I help most to make it successful on both ends so that the health system is using the right product and that the company has the right information so that they know what they need to provide to be successful to their customers? Everyone I've met really wants to make a difference in this space. That's one thing that's really interesting and great about digital health—that people really want to make a difference in people's lives. There are so many great people I've met who are trying to do it, and part of it is just being able to bridge that and say, okay, this is what would be most useful. I've also really wanted to be that clinician voice because a lot of times there has been a lack of that, just basically because of logistics. Sometimes a lot of physicians don't have time for it, companies may not have access to help systems, and the people making decisions aren't necessarily the ones that are working clinically. I wanted to bridge that gap and say we all are trying to do the right thing here. How do we make that happen? Matt: Just to follow on to that, I think we try to push for provider town halls because there's almost this administrative layer and we don't always know how dialed in are they to the front lines. We always try to push and have regular provider town halls. It could be staff, or anybody on the front lines, because when you get into the specifics and we may even be getting into clicks. This is a click we could eliminate. Have you seen that as well? Are you able to provide that sort of frontline feedback to organizations so that they can design workflows or design products? Aditi: I'd be interested in general, has it really changed the way you fix your models having these town halls and taking that input? I will say that sometimes, in my experience when I was in the health system, we would certainly take people's information. We would ask all of the people who are working these shifts to say, hey, what would be useful to change? If it was something very easy that we didn't realize, we would try to do it within a week or even overnight if we could. Some of the larger ones, depending on what they were, we would at least take it into account to see if we could change them up. But yes, getting that feedback was really helpful but it was also helpful that, for the telemedicine program at least, I was running it, but I was also working it, so that made a big difference. I'd be curious to see if you guys have to change things fairly often after your town halls as well? Matt: Yeah, I do think we get a lot of feedback that we can react to. The biggest help for us is that it allows us to understand the problem. It could be that the feedback starts with somebody suggesting a solution or something like that. If we can kind of drill in to understand the problem and just get those additional details, that might get lost as maybe this moves up the chain or moves through a project manager or some sort of project champion, it just allows us to go right to the source to really understand the problem so then we can fix it. Usually, we're coming out of those sessions with action items. A big one is just provider training. A lot of times it's provider training because there just isn't a lot of time to invest in provider training, but we can also find that out. Then it's okay, how do we have additional layers of training—bite-sized training—so that we can educate folks on the different tools and things that they have at their disposal? Even if it's just a knowledge gap in understanding a population or a very specific scenario, I think we find it very valuable and we're usually coming out with a number of actionable items that we can work on and ultimately get improvements out there for clinicians that are helping patients. Aditi: One thing you said that I really like and just want to highlight is doing the bite-size type of training. Throwing a lot of things at anyone at any time tends to create a barrier—people push back a little bit. Doing it a little bit at a time, so they feel like they're really just getting into it, understanding it, and then improving their skills in virtual care is really important. Brandon: Yeah, and oftentimes it's not just they're just doing telehealth. There are other workflows that need to be taken into consideration. Our view is that we want to be your partner, not just your vendor. It's just really going through and making sure everybody understands the top objective and then, as you said, just little bite-sized pieces on how we can make it successful as we move forward. We found them to be very helpful. Matt: I think a lot of clinicians have felt like the feedback falls on deaf ears and so we always come out of it alright. We need to show some momentum here coming out of that. We need to show that the change is happening, and that this is not falling on deaf ears. Maybe in a lot of cases, people won't speak up or provide feedback. In some cases, we're really having to pull it out of people and then show them that we will react to it. I do think that another hurdle is maybe folks have provided feedback in the past that they felt has fallen on deaf ears. Aditi: That's a common feeling just in general, not even specific to virtual care, in general, in our healthcare system. We're really at a point of crisis in that way. We're seeing some of that just drip into digital health. We all know there are all these discussions about there's less investment in digital health and validation is an issue. The reality is it's not specific to digital health. This is just the way the healthcare system has worked. It's like a cycle within when we change anything in clinical practice. It's just showing up in digital health because it works in the space of health care as well. Matt: Agreed. Aditi, I know that you're an advisor for Panda Health and we're a new partner with Panda Health. What does Panda Health do and how are you going to have an impact there? Aditi: Congratulations, you guys, for coming on to Panda Health. Panda Health, in general, I was asked to be a consultant. Essentially, they're creating a marketplace where they look at specific pillars in digital health. Obviously, that's over the telemedicine pillar. I'm also working on RPM and hospital at home and looking and determining, hey, what's out there? Then going back and forth, looking at the business cases, functionality, how the tech works, how the clinician, patient, and health system experience putting them all together and making this marketplace. Then when health systems come and they have specific needs, we have the exact right vendor to send to them. It's really been interesting. I've really enjoyed learning about the ecosystem and also evaluating it. It really needed to be done. Otherwise, it's really hard for anyone to choose the right solution. We all know, and you at Mend too, that your solution is great, and I really like Mend a lot, but it's not going to be for everybody. You want to make sure that you're as successful. The health system wants to be as successful and maybe they need something simpler. They don't need all of the great parts that Mend has of digital patient intake, et cetera. It really is meant to do that. Matt: That's awesome and it sounds like there's more and more interest from health systems to really make Panda Health the procurement arm. That's awesome. There are a lot of solutions out there, so anybody who can cut through some of that noise is going to be helpful. Brandon: Yeah, I couldn't agree more. There are a lot of solutions out there, and not everyone does the same thing. Panda is really filling a large gap in health care right now. We're very grateful to be a part of it. We're very grateful for your participation through that vetting process, Aditi. We're excited. Everything is moving forward in terms of digital health. Since you have your hands on a lot of things, we also know that you're affiliated with MDisrupt to build the standards and benchmarks for digital health. If you wouldn't mind, please just share a little bit about what you're doing there. Aditi: Absolutely. MDisrupt started out being a place for finding digital clinical consultants for digital health companies who might have needed either a small engagement or a large engagement. They're pivoting also to really look and determine how to ensure that the companies out there have clinical validity. I'm there being part of that, looking at the ecosystem from a different avenue than Panda Health is and really saying okay if you're a clinician, what do they do? What does this company do? What's their research arm? Is there a clinician who is on the board, who is giving information, and advising? All of these things that clinicians want to know about. We're looking at creating that kind of database also. It's a different aspect of the ecosystem as well, but one that I find is really necessary also. Matt: You mentioned standards and maybe a need for more standards. Is there anything more specific around these standards for digital health that you think are important? Aditi: It's a complicated question because it would depend on what you're providing. The short answer, there are no real deal standardized guidelines unless you're looking at the text specifications—the ones that are out there that you have to fulfill to be a secure channel, et cetera. Then there are also ones that might be for devices that need to go through the FDA process. Not everybody has to do that, but those standards, yes, of course, are there. When we're talking about clinical guidelines or what's required to be successful, that is really an open book. When I started telemedicine, we were trying to determine how you create clinical guidelines for the types of visits you see in virtual urgent care. We really just took what we did in person and applied it to telehealth. That was the very beginning and it works. It does work. We are still providing health care, but eventually, we didn't really validate it. Meaning we didn't look at it and study it in a way we just sort of gave it out. Saying that, the actual in-person versions can be validated. Research is part of it, just making sure that people understand it. Does it adhere to the in-person guidelines? If it doesn't, are we making sure that people are still safe? I've also seen the last few years that there's a lot of emphasis on making sure that the virtual care skills are going to be there. When I think of validating it, it's difficult. It's really just depending on what people find useful. We're going to see probably within the medical school and residency training, there's going to be more of a way to do that, the way that we validate education. We'll see it out of there a little bit more, but it's very slow to happen. Matt: Awesome. I've seen a lot of the different associations, even specialty-specific associations, try to put some guidelines out there for the type of care that would be appropriate for virtual because not everything is appropriate. That could be a good resource for clinicians and organizations to look at. Since the start of the pandemic, there's been a lot of telehealth playbooks that have really been expanded across the different associations so there is some more guidance out there to help folks. Aditi: Absolutely. Brandon and Matt, we all live in telehealth so we forget that the vast majority of clinicians don't do this every day. Those handbooks are really helpful just to even get started and say, okay, if I'm having my clinic by myself, how am I going to do this? Especially societies that are trying to help their specialists in that way. I will say one thing interesting about the specialist society is finally pulling this out. Five or six years ago, it was still very much low engagement. You saw organizations like the ATA basically be the ones that set standards, but it was for almost any specialty, it wasn't specialty-specific. Now that we have enough people working on it and understanding it, we can really create a specialty-specific standard and that's really what needs to happen. Again, as I said earlier, it's not the same, we are practicing versus an ophthalmologist. We need different guides and guidelines. Matt: Absolutely. Now we get to switch gears and have a little fun. Today, it's a cool image. It's an optical illusion. We like these because the audience can kind of play along with everybody. We've got something from the Neuroscience News. Aditi: Alright. Matt: Let's see. We’ll get rid of the menu here. This illusion, New to Science, Is Strong Enough to Trick Our Reflexes. I guess 86% of people were able to experience this optical illusion. Brandan: Matt, before you get into this, Aditi, is there a strategy behind why you went off-camera for this optical illusion? Aditi: So you guys can't tell if I'm lying. It was my plan all along. Matt: I'll bring the image up and then you both can just describe what you see. Brandon: That's it? You're bringing it up and we describe it. Whatever we see, we're just going to tell you. Matt: Yeah, here it is. I hope it's not too blurry or anything. That looks pretty clear? Aditi: Yeah. Brandon: Yeah. Matt: Do you see anything? Aditi: Yeah, I see the black hole expanding. It looks like it's expanding to me. Brandon: Yeah, same. Matt: The crazy thing is, the image is not moving. It's not a video. It's not a GIF or anything like that. In the article, it says that the image causes a little bit of pupil dilation and that creates this movement. Brandon: Yeah, it looks like it's expanding and contracting a little bit. Aditi: Yeah, exactly. Going up and down. Brandon: The darker areas just outside of the black kind of oval. Matt: I know and it's not moving at all. Aditi: That's so cool. Does it also have something to do with the parts of our eyes that detect light? I'm wondering, too, or dark. Matt: Yeah. Let's see if I can find that part quickly. It prompts dilation reflexes of the pupils to let in more light. There was more to this, let's see if we can find it. Essentially, that is what's going on. It's causing a reflex and that's what makes it look like it's moving. Aditi: So fascinating, the brain, isn't it? Matt: Absolutely. Brandon: No doubt. Matt: That concludes our optical illusion—our torture. No, our optical illusion for today. Brandon: With that, that actually brings us to a conclusion of this podcast. Dr. Joshi, on behalf of Matt and I, all the folks at Mend, and all the healthcare providers and organizations that you have played a part in helping to benefit and move forward, we want to thank you very much for joining us on the show today. It has been an absolute pleasure. Before we sign off, is there any other thing that you would like to share with the group? If not, certainly no big deal, but just wanted to give you an opportunity. Aditi: No. Brandon and Matt, thank you for having me and allowing me to share with you guys. I'm glad for all the work that you do, too, for telemedicine and it's been great to be here. Brandon: Thank you. For the viewers who may be interested in reaching out to Dr. Joshi to find out a little bit more about her consulting work, you can find her on her LinkedIn page. I'm sure you can reach out to her, connect, and see if there are any opportunities to learn more or potentially work together. She's outstanding and we've heard nothing but positive things about Dr. Joshi and what she's able to do. That concludes it. Please feel free to hit us up with any questions you may have in the comment section. In the next episode, we'll have another great digital health thought leader for you, so please make sure to like and subscribe. Thank you very much for watching. Have a great day. Aditi: Thank you. Brandon: Bye-bye. Thank you. Aditi: Bye-bye. Thank you for watching today's episode from the Get’n Down with Digital Health podcast. To learn more about Mend or to access more content, please visit mend.com.