2021 and Beyond - Perspectives on Telehealth+

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Hey everyone, welcome back to the TechLink Health Podcast. I'm Govind Chandram, and I'll be hosting this podcast. Today's episode focuses on a range of topics from Telehealth Plus to remote patient monitoring to the latest in devices that are all helping to create a healthier future. Today's guest is Dr. Rodney Samaan. Dr. Rodney Samaan is a practicing cardiologist with interests and expertise in technologies that are disrupting the analog healthcare system. He specializes in echocardiography, nuclear medicine, pediatrics, public health epidemiology, and preventive cardiology. Dr. Samaan is the co-founder of Enviva Cure and TechLink Health, as well as an advisor to a variety of health tech startups. It goes without saying that Dr. Samaan is a very accomplished person with a range of interests and expertise. So without further delay, please welcome Dr. Samaan. Thanks for joining us today.

Thanks for having me.

So to give our listeners some background, can you take a moment to introduce yourself in a bit more detail and tell us about your journey into digital health?

Yeah, so I am the founder of my own practice, ProgressiveMD. I'm a preventive cardiologist. I do internal medicine and cardiology. I had been an advisor for Doximity, which is a startup, almost like a Facebook for doctors that does a lot of integration between job postings. So a little bit of LinkedIn, Facebook. From the start, they had an eFax, and I thought it'd be a great model to build a mobile clinical practice off of that eFax. A lot of practices struggle with overhead and costs and margin. And so my goal is to build from the ground up a practice with that in mind to reduce that. So all the faxes for the clinic come through that Doximity fax, which is on my phone. And so I get to make sure that I don't miss any important documents. And post-COVID, they've done some stuff with telemedicine, Kind of like what we're doing with TechLink Health. So that's basically what I'm doing with TechLink Health. We're very excited about the version that we have out linking doctors through different networks and trying to get them connected to consulting or side hustles, working with young startups that need physician feedback and introducing podcasts like this to dig deeper into clinical practice, starting a practice, the business of practice, finance. Preventing burnout, getting into side hustles, and learning more about how to keep healthcare healthy for everyone in the future. I think one thing we've learned from COVID is we have to be very nimble and very forward-thinking when it comes to healthcare. And I think for the most part, the healthcare system did adapt pretty well to most aspects of it, especially the telemedicine aspect of it. I remember last year where Scott Adams from the Dilbert creator and I were Tweeting back and forth about the his it was his idea that, and I don't know if it was his idea originally, but he had thrown it out there on Twitter of basically allowing doctors to practice across state lines. And I had thought this would never happen, and lo and behold, three weeks later they opened it up to doctors practicing across state lines, and then the medical malpractice. carriers followed suit and allowed coverage across state lines, mostly for telehealth for COVID. Who knows what will happen in the future, and we can discuss that further. But so those are some of the ideas out there I think that are going to be useful for the future. In terms of the Envivo Cure, and that's my clinical trials company that I'm a co-founder in, and we are doing some remote monitoring clinical trials in heart failure. with thoracic impedance and digital monitoring of vitals in patients with heart failure, trying to keep them out of the hospital and prevent readmission.

Yeah, that's awesome. I think you've identified perhaps one of the silver linings to the COVID pandemic, and that is that medicine and healthcare has evolved, and many people now appreciate how nimble and adaptable the healthcare system needs to be. For instance, telehealth and remote patient monitoring are really making leaps forward since the pandemic has happened. And I'm curious about this idea of telehealth plus. Can you take a second to maybe describe what telehealth plus is in a bit more detail?

Yeah, sure. So in general, probably 5 years ago, when you thought about telehealth, thought of this expensive software and hardware of video, and these platforms were costing $50,000 to $100,000 to set this up. Obviously now you can do this ideally through FaceTime, through TechLink Health, through a number of platforms. Doximity is one of them. That video sharing is one aspect of telehealth that was very expensive and now is almost free, literally free for most situations. And then the Telehealth Plus is where you add on a number of other features. Well, number one, one thing TechLink Health can do is Send those intake forms that need to be done prior to a patient signing up with the practice. There's legal and HIPAA forms that need to be completed. A lot of telehealth platforms don't do that. You can actually text those forms and also set up payment models through the app. And so I would count that as Telehealth Plus. The other aspects of Telehealth Plus would be the stacking on remote patient monitoring and vitals and different stats. So if you could imagine seeing a new patient and you have levels of data including an EKG, blood work, past medical history, and pull in labs from Quest or other labs. A lot of people don't know this, like that system of integration is starting to be mandated by CMS and Data sharing is going to ramp up very soon. In the next 6 months, I think you're going to see a lot of data sharing requirements come out. And then on top of that, right now you can log into your iPhone and set up an account with Quest and other hospitals and access data from places that you've had care. There's probably ways to just sort of snapshot those pictures and upload them to a platform like TechLink Health and to provide data so that your care is not redundant and not dangerous in that sense. Because at the end of the day, you can't examine the patients, so you need as much information as possible. So, if you can get some more biometric data and more information about the patient, I think that certainly would enhance that process.

So in many ways, it's actually empowering patients with their own data, and it's going beyond simply a video and audio stream. It's amazing. I'm curious, because you're in the cardiology field, have you identified any recent technologies or devices that are at the forefront of cardiology?

Yeah, some of them I can't talk about fully because we're in clinical trials and under confidentiality. Agreements, but I can tell you that the future of monitoring will go beyond the idea of simple vitals like blood pressure and pulse oximeter and heart rate and those things. More physiological parameters could be measured, like I was mentioning thoracic impedance, and even more than that. The point there is that. You should be able to get more data than even in a clinical setting from some of these remote monitoring practices. There was a company in San Francisco, I forgot the name of it, but they have a scale that you put your feet on it with no socks, bare feet, and it could tell you heart pressures, like your right heart pressure, your pulmonary pressures, your intravascular volume status. to offer the pulsation in your feet, which is pretty interesting.

There's recent discussion, particularly around remote patient monitoring, that the physician won't have the classic access to patients as they traditionally have. For instance, using a stethoscope or palpating for a pulse or doing a belly exam. Do you think that technology can supplement this humanistic component In the future of medicine?

Yeah. I mean, there are companies out there. I think one, TytoCare, has remote otoscopes and stethoscopes and nothing for a belly exam that I know of. But there are technologies out there. They're just expensive and not well integrated with insurance coverage and more consumer product right now. Unclear how scalable that is. But those products are out there. I do think that an exam is important, but from a cardiology perspective, we tend to do a lot of echoes and ultrasounds. And so we do get a lot of physiological data. Obviously, we have to bring those patients in the clinic to get that information. But there are companies like Butterfly, I'm sure you've heard of, a handheld ultrasound that I don't see going to a consumer model, but it is—

Mm-hmm.

Bringing down the cost of ultrasound compared to an ultrasound machine that can run $60,000 to $100,000. So we are seeing some scale there and reduction in cost by technologies like that. One thing about Butterfly that's interesting is it has some AI capabilities where it tells where to move the probe to get the best window into the heart. So I think that's interesting. And I haven't tested out a newer model, but I think that is fascinating in that regard. I do think we'll come up with a hybrid model where certain patients will end up coming into clinic and others will have remote care. We've talked before about AI and algorithms and deep learning and machine learning, and we've had a couple of guests talk about those topics. But one thing that I've been thinking about recently is this idea of providers different levels of learning and their own deep learning. We don't talk enough about opening your own practice and starting a clinic from scratch. That deep learning has to occur just to get that going in the sense of the complexities that you have to maneuver around. And I think you're going to see more hyphenated careers in the sense of 2 careers merging together in practice where you have straightforward doctors that want to do clinical medicine, and then you have data scientists come up with algorithms that'll make it easier to figure out which patients need to come into clinic, which patients can be treated from home. data analytics and cloud and healthcare integration with big hospitals and trying to figure out how to distribute vaccines and get medicines and testing. I think you need a model where you can integrate all this data from remote monitoring and come up with algorithms where you can figure out Okay, this is a really sick patient based on these clinical parameters. I need to bring this patient in. And others, based on certain parameters, I can do a telehealth for the next 6 months or a year. One of the hospitals that I work with, Providence Health System, is going to start sharing and analyzing hospital data within a number of health systems, anonymous. hospital data to come up with better treatments and better ideas of what is going on in healthcare. So I think data science is going to continue to grow in that regard. I know Epic EMR is doing stuff like that. Google and their health platforms are doing more and more healthcare analytics.

Yeah, I think you hit on an interesting point, and that is the future workforce in medicine and healthcare Maybe hybrid specialists of sort. And right now we don't have a very good model in our education system, whether that's at the medical school level, the residency level, or at the attending level. And one thing that TechLink Health can do is actually provide for such an ecosystem where we can bring on data scientists and clinicians and startups and business folks and lawyers and allow an idea to come to fruition. Can you maybe talk a little about Can you talk a little bit about the TechLink Health platform and how it can act as that model?

Yeah, I'm glad you brought that up. I'm sure you've heard this term of doctorpreneur. For a long time, doctors getting into the business of healthcare was seen as a negative. I think now it's seen more positively. We always have to be careful of conflict of interest when it comes to patient care. But in general, I think most doctors are trying to make a living, do a good job, and do whatever they can to make their patients healthier and better. I would say that's the 99% of doctors. But I do think you're right in the medical education. Number one, there is still a traditional model where we're learning rote memorization and a little bit of public health. Like, I did a master's in public health, but I almost think you need an MPH in epidemiology plus an MBA, but all in 4 years and still teach medicine. And not a traditional MBA, it's something of a hybrid where you're not just learning accounting, but you're learning about startups and pharmaceutical companies and finance and data analytics and healthcare. You know, TechLink Health is geared towards that 21st century doctor who wants non-traditional lifestyle of almost like the FIRE model of young business entrepreneurs living below their means and trying to do work that is meaningful to them. I think this new generation of doctors will demand that and not want to work a traditional job, or they may want to have 3 jobs or 1 part-time clinical job and 2 consulting jobs. We talked a little bit before this call about Clubhouse, and there was There was an interesting point in that side hustle chat room talking about how the most interesting or less burnt-out doctors were the ones that had side hustles, or the happiest doctors were the ones that had side hustles. And I could identify with that in the sense that there's a difference between burnout and being bored.

Yeah.

And I wouldn't say traditional clinical medicine is boring. But it can get very mundane. I've talked to a lot of my colleagues about that, and in a sense it becomes sort of routine. And if you're working for a hospital or a big clinic, it's very difficult to make it more creative in that sense. I think the future doctor will be attracted to tackling health and will want to do work that is meaningful to them and use their abilities to consult with startups or create their own startup or create their own products. I've had friends that have come to me with ideas. I won't get into the details, but I'll just bring up a couple really quick points. We've talked about one or both of these. One friend of mine called me about an idea when I was doing my mini MBA with Anthony in Louisville. And he saw that I was posting on LinkedIn about startups, and he was an ear, nose, and throat doctor who had an idea with a patent for a device to kind of open up the nasal passage for people with like deviated septums, etc. And 5, 10 years later, he was co-founder and lead inventor for this company, and they were bought. by one company and then sold and bought by another. I think the final purchase after— by a large biotech company was like $100 million. I was like one of the first people he told, um, and I had no idea what he was talking about. Uh, and I wasn't a surgeon, and I didn't even realize that I could be in— well, I sort of understood I could potentially be an investor. I maybe should have put a little more effort into helping him out with getting going. But he went through a lot of pain and process, and there was even patent litigation. But this all did start in Louisville, and he called me about it, and my recommendation was to get involved in an incubator, which he did. And he pitched his idea, and people liked it, and, and he did well off of that deal. He probably could have done better if he had known more about the business end of it at the beginning. And so he came up with this great idea. The other interesting part is this litigation case that you heard about of 2 doctor friends of mine that I'd done some medical mission work with in the Middle East, and they Basically pushed back against the hospital, and they—it's a long convoluted case. I won't get into it, but people can find it pretty easily. But they pushed back against this hospital, and they got terminated from the staff—their staff privileges—and because they reported some safety measures that were concerning to them, and they. Were terminated and fought a legal case and won. That legal case was just finalized recently, and they settled on like $10 million for that case. I think we need doctors always have the interest of the patients and also be those hyphenated doctors that look outside the box. We did talk to one of my friends about having them on as a podcast and talk more about that, that case.

Yeah, I think that would be absolutely fantastic to hear. I think it's no surprise that healthcare is increasingly litigious and doctors are oftentimes walking on eggshells trying to do what's best for the patient while also trying to balance what's in the best financial interest of the hospital or the practice they're in. And it can be very challenging to align all of those incentives. Well, Dr. Samaan, I want to respect your time, and so in closing, I'm curious if you have any final insights for those interested in staying connected to the next wave of innovations in healthcare.

Well, I would encourage them to really dig deep into the TechLink Health app and listen to some of those really great podcasts that we have. Use the telehealth platform and get connected, set up a profile so that we can connect you with consulting opportunities with biotech and startups. We have a great board of advisors too that will bring in a lot of great technical expertise to help you in your career in healthcare. I think back to somebody like Alex Yerginian, who's a former executive at Humana, brings in a lot of expertise on health insurance. And he was talking to you guys about his psychosocial model, but he has a world of expertise in insurance And healthcare and policy and compliance. A lot of things that doctors don't fully understand. And, you know, Alex Kahana and Dr. Nazareth bring a lot of great expertise as well in the future of the internet and where they see healthcare going in the future with blockchain and different things. And even the burnout one that we did, our first podcast, was excellent. I would encourage people to go back and listen to those podcasts.

Awesome. Thank you so much, and we will definitely link to the podcast or previous episodes in the show notes. Thanks again, and we'll wrap it up there.

Thanks for listening to this episode. TechLink Health is a healthcare advisory platform for consumers and organizations to stay informed with the latest insights while connecting with healthcare experts for telehealth, eConsults and consulting services. For more details, visit www.techlink.health.