HEALTHCARE

Kenton Williston: Welcome to the IoT Chat, where we explore the trends that matter for consultants, systems integrators, and end users. I’m Kenton Williston, the Editor-in-Chief of insight.tech. Every episode we talk to a leading expert about the latest developments in the Internet of Things. Today I am exploring the future of telehealth with Yulun Wang, a Fellow at Teladoc Health. The pandemic hugely accelerated the adoption of virtual care, and patients and providers alike discovered that they love the technology. But rush deployments meant that healthcare organizations have yet to unlock the full potential of remote medicine. So where do we go from here? How can care providers better integrate telehealth into their practices? Where are there untapped opportunities for virtual care? And how can the technology be better used to benefit patients and practitioners alike? Let’s find out what Yulun has to say. So, first of all, let me just say, welcome to the podcast.

Yulun Wang: Thank you. Thanks for having me.

Kenton Williston: Can you tell me—what does Teladoc do? And what is your role there?

Yulun Wang: So, Teladoc is really the world leader in virtual care and digital health, as an independent company. And what I do here, I’m a Distinguished Fellow, where I have the opportunity and luxury of working on some very exciting things. One is the advancement of technology—specifically in the area of where AI and telehealth intersect. I have the ability to interact with the marketplace and evangelize what Teladoc is doing, as well as just the broader telehealth movement in general. And then I also have the opportunity to work on the corporate social responsibility of Teladoc Health. Teladoc Health wants to be a good profit company to its shareholders, but it also wants to do good in the world by using Teladoc technology to help deliver care to less fortunate areas of the world.

Kenton Williston: I really look forward to hearing more about that. But first, let me ask you what brought you to Teladoc, and what you did before this.

Yulun Wang: Well, I was the Founder and Chairman/CEO of a company called InTouch Health. InTouch Health became the dominant telehealth-technology provider to healthcare systems. And so then we were acquired about a year and a half ago by Teladoc Health. We were excited to join through the acquisition, because it was becoming clearer and clearer that telehealth, or virtual care, was really starting to take off. And when things start to take off, consolidation is a natural part of the evolution of a marketplace. And so, with joining Teladoc we became the undisputed leader in the telehealth world.

Kenton Williston: Nice. That’s an amazing accomplishment.

Yulun Wang: Thank you.

Kenton Williston: And, to your point, the telehealth space has been something that’s been of interest over the last couple years, but obviously with the pandemic it’s gone from an interesting idea to a must-have. Right? Pretty much everywhere. In fact, just before we jumped onto this recording I was scheduling a doctor’s appointment, and they had the option: do you want to go in person or remote? Right? I mean, that’s every single appointment now.

Yulun Wang: Yeah. So, actually, telehealth was growing at a nice 30% clip prior to the pandemic, but it was still only 2% or 3% of overall healthcare delivery. Then COVID hit, and it jumped to where everything was being done via telehealth—because with the pandemic and trying not to spread the virus, yet also being able to get healthcare, doctors had to see their patients virtually because that was a safe way of doing it. And so COVID really propelled telehealth by orders of magnitude.

And then COVID peaked, and it kind of pulled back some in terms of virtual care. Instead of being close to 100% of healthcare delivery, it has dropped to maybe 30% to 50% of healthcare delivery—which is still significantly above the few percent of healthcare delivery it was prior to the pandemic. So, in summary, COVID really advanced the adoption of telehealth. There was kind of a huge spike, and then it’s backed off to now we’re on a much more sustainable growth trajectory, where telehealth is slowly being incorporated systemically and appropriately into all of healthcare delivery. It’s really amazing the different kinds of use cases that people are coming up with and pursuing.

Kenton Williston: Yeah, for sure. And I think that’s just even speaking from an individual patient’s perspective. It’s pretty easy to see that not just telehealth, but more broadly, some of the concepts around the digitization of care kind of got thrown together at the last second with the pandemic. And now it’s pretty obvious, just from my own patient experience, that people are doing work behind the scenes to actually integrate these things. Like, at the same healthcare provider that I was just scheduling an appointment at, the last time I was in their office they had these screens with the wait times for each doctor, which was so great. Because every time before I’d go in, you’d have no idea if the doctor’s going to be there in five minutes or an hour. And having that digitalization of even just that waiting room experience was amazing.

Yulun Wang: Yeah. You can have an understanding of the wait time while you’re in the doctor’s office. You can also have the wait time while you’re waiting for a telehealth visit as well. And I think what you’re getting at is there’s many kind of trends converging at the same time. One is the acceptance of virtual-care type of delivery. One is the digitization of more and more healthcare capabilities—like showing the wait time in a waiting room, whether the waiting room is virtual or in person. And the other thing is, I think, healthcare is appreciating that it really needs to become very patient or consumer friendly, like other industries. It’s just not acceptable anymore to just do what the doctor says and just follow like a sheep. People are coming equipped with a tremendous amount of knowledge of what’s wrong with them and what they want to have taken care of, or even how to stay well. And the healthcare system has got to be able to adapt to that new kind of customer.

Kenton Williston: Yeah, for sure. And I think it’s safe to say that there are some specific areas of care that have done a better job of this than others. I know one of the big areas, for example, and I know this is something Teladoc has a business in, is the mental health space, and the patient adoption has been very strong there. And it’s really, like, the preferred method now, if I understand correctly.

Yulun Wang: Well, that’s exactly right. Mental health has taken off like crazy, and it’s not because there wasn’t mental health beforehand. It’s just that it was an underappreciated issue within the healthcare system. And, quite honestly, the reimbursement was poor. What the healthcare system at large has realized is that mental health—if you can solve mental health problems early—it solves all kinds of other physical health problems, like obesity perhaps leading to diabetes, or hypertension, and all these kinds of other ailments. If you can get at the root cause of mental health, it stops all these other bad things from happening from a health perspective.

And so, mental health—there has been a stigma associated with getting mental health help. So, for example, going to a psychiatrist or psychologist’s office is kind of a high barrier for people to do. And if you can just do it virtually in the privacy and the comfort of your own home—whether you’re in your bedroom or your living room—and get a therapist or a psychologist or psychiatrist to help you in that environment, it’s much, much more comfortable, and therefore a much better way of delivering the care.

And then, furthermore, what’s very interesting here is that, in the pandemic, where some offices are starting to open up, you would go see a psychologist or a psychiatrist, but you’d have to wear a mask because you’re trying to prevent spread of the virus. And having a mask on in person gives the mental health specialist less information than if you don’t have the mask on in a virtual environment. So it’s actually pretty interesting how that’s all played out.

Kenton Williston: So, I want to turn back around to some of the points you made about how, at the start of the pandemic, things just kind of had to be thrown together to get something going. And I’m sure in that process folks made plenty of mistakes, or had systems that weren’t particularly optimal for the task at hand. I’d be interested in hearing where you think some of the biggest challenges were—how those systems are being modified and updated to serve the patients and the care providers better, and if there are any areas in particular you think that things are still not being quite done the right way, and you think there’s some opportunities for further improvement.

Yulun Wang: When the pandemic hit, it was just frenetic kind of changes to be able to allow healthcare professionals to interact with patients and deliver care. And a lot of the normal things for healthcare were thrown aside. For example, technology which was HIPAA compliant and it ensured patient safety, for example. The other thing which was not taken into good consideration at the beginning of the pandemic was to put in place an infrastructure of virtual care which was well integrated with the continuum of care and well integrated with in-person care, which also inevitably happens. And so there is a fair amount of retooling that’s going on today, as health systems are now—we’re kind of past the frenetic part of the pandemic, and we’re starting to think of how to incorporate virtual care into the overall healthcare-delivery system smartly and well.

And some of the things which have to be taken into account are, first of all: is the platform being used? Is it medical grade? Is it meant for healthcare? Does it have the right kind of encryption? Does it have the right kind of patient safety and patient protection involved in it in order to be used effectively for a healthcare application? The other important thing is that the healthcare delivery system doesn’t end up with a whole bunch of disparate point solutions. Healthcare is often criticized for being very fragmented and very siloed. And that’s true, unfortunately. And we have an opportunity with healthcare delivery going virtual and digital to solve that problem. To have platforms which allow a patient or consumer to have their information ported easily across the entire healthcare system, such that when he or she arrives at a particular provider or particular site, they know who the person is.

They know the person’s history and background. They know perhaps even some of the social considerations for this patient, and they know how to treat the person correctly—as opposed to sending the patient back out in the waiting room with another 20 pages of forms to fill out of the similar types of forms they just filled out a week ago. So, these are the kinds of things which can be done correctly. They weren’t taken into consideration and some of the rapid adoption which COVID drove, but are now being considered as people are now thinking about virtual care for the long term.

Kenton Williston: So, people are interested in hearing what Teladoc is doing to address these issues. And I would say, broadly speaking, I had two areas for folks to consider. Just in general, the first point was, is this platform really meant for virtual care? And the other is, is it something that can play well with your other systems? And so I’m interested in hearing what Teladoc is doing on those two questions.

Yulun Wang: Well, Teladoc is, first of all, taking both of those considerations and building them into our platform. So, obviously we’re working to make sure that all of our data, and in all of our architecture and our systems, are being done in a HIPAA-compliant way. In some cases it butts up against the FDA, and making sure those are appropriately FDA qualified. We manufacture to good manufacturing practices. We do all the things that a healthcare company needs to do, as opposed to, say, a consumer company or something which is not a pure healthcare organization.

The second thing we’re doing is we’re building platforms which allow consumers or patients or members—whatever you want to call them—to be known across the entire Teladoc platform, and are also able to share this data. Teladoc’s working to do this at scale. And so we are now roughly in the range of, say, 15 million virtual consults a year—something like that. And to be able to run a system with the 15 million consults going on, growing at, whatever you want to call it—30% or what have you—that takes some real architecture and some real platform development to do that effectively.

Kenton Williston: Interesting. So, I guess I should step back for a moment and say, what exactly is the Teladoc platform? What does it comprise?

Yulun Wang: There are a few components to the Teladoc platform. In a broad stroke, one is that we do virtual care visits in a similar manner to perhaps an urgent care center. And so we have doctors that we pair up to members as they need to see a physician, in the same manner they might go into an urgent care center, but they can just do it virtually. And then we have identified certain specialties where we can do the same thing but with that specialty, for example, mental health. We can actually connect members up with mental health specialists—whether they’re actually therapists or psychologists or psychiatrists—we can actually connect them in with the right level of care depending upon the situation.

Then we also take care of patients with chronic diseases. The main ones are diabetes, hypertension, obesity. We’re doing congestive heart failure now. I think there’s chronic kidney disease. And we also are treating mental health as a chronic disease as well, where these are solutions which continually interact with these patients with chronic diseases to try to keep them on track. And then, last but not least, our platform is also sold into health systems where the health systems use our platform for them to deliver care using their clinicians.

For example, Mayo Clinic and Cleveland Clinic—a lot of these big systems are using the Teladoc platform in order to help them take care of their patients for that healthcare system. So our platform is comprised of all of those pieces. And what I was talking about a little while ago is a member coming in through any of those use cases will be known to providers, even as they traverse into other use cases, so that we can really get whole-person care, or longitudinal care, as one might call it.

Kenton Williston: I noticed you’ve been using the term virtual care, which I’m imagining might be something that’s broader than just telehealth. So, can you explain to me what those two terms mean to you?

Yulun Wang: Yeah. So, virtual care, telehealth—to be frank, I use them interchangeably. I think those two are roughly the same thing. The other term which you could say is broader is, say, digital health. I would say virtual care and telehealth are basically interactions between providers or clinicians and members or patients, virtually. When you include things like digital health, now you’re including tools like, perhaps, applications—digital applications to help a diabetic take care of their diabetes more seamlessly. They help things like navigate a patient through the healthcare system. So, I would say digital health is the broader term of which virtual care and telehealth fit under.

Kenton Williston: Got it. So, I think one of the things that’s really interesting to me is—we’ve been talking about this whole time—there’s been a long-standing interest in all these different technologies. People are still very actively using all these solutions, and starting to really fully incorporate them into the core parts of their practices. And that leaves me wondering how healthcare organizations can build on this momentum, and carry forward to make improvements in patient care, in the workflow for the care providers, to bring costs down, to bring a better experience. So, what do you see as the next biggest steps for the healthcare sector?

Yulun Wang: Well, I think, in terms of the healthcare sector’s usage of these new tools, I think they can all think about how to use virtual-care and digital-health tools for their members and patients for each of the different workflows. What do I mean by that? Let’s go to the health-system side, and let’s take a patient who’s got, perhaps, a bad hip. Without virtual care, that patient goes in; sees a primary care doc; gets referred to an orthopedist. Waits several weeks to get that to happen; goes in to see the orthopedist; maybe has surgery scheduled; goes in; has a surgical procedure; maybe goes to one or two or three follow-up meetings in person. So, how might that change?

Well, a patient who has a bad hip might see a virtual–primary care doc first. That virtual–primary care doc: okay—the patient’s really got a bad hip. Goes in physically to see the orthopedic physician: the orthopedic physician manipulates the hip and appreciates that the hip needs to be replaced. But let’s say for a second the patient’s overweight. So the orthopedist might put that patient on some kind of a digital app which is to help that patient reduce weight to the acceptable weight for the surgery. So now the patient is using the digital app, and slowly but surely getting to the right weight.

The orthopedist and the primary care doctor are perhaps getting updates of what’s going on with that patient—not needing to see the patient in real life and using that time and energy, but just seeing how that patient’s come along. Patient hits the desired weight. A schedule for surgery is put in place. Patient goes in to have the surgery. And then, virtually perhaps, the primary care doc might make a visit. The orthopedist comes in afterwards, after the patient goes home, and there might be a bunch of virtual follow-ups, and there might be a digital app which is making sure the patient does the right exercises for physical therapy and recovery. But I walk you through that whole example to show how digital interactions, virtual interactions, and in-person interactions can be all integrated into a flow where each capability is used at the right time.

Kenton Williston: That’s really exciting. And it’s easy to imagine all kinds of ways in which everybody benefits from this. The patient has a better experience. The doctors have way more data to work with. So it’s kind of a win-win situation across the board.

Yulun Wang: Yeah. One thing which is important to also consider, thinking about these new technologies, is that we’re not just doing it for the benefit of the patient and the members, but we’re doing it for the benefit of the providers as well—the healthcare professionals. I think you don’t have to look very far to see that burnout among healthcare professionals is at an all-time high.

Kenton Williston: Yeah. So, I’m sure when you talk to healthcare providers they’re very excited about spending more time with patients, and less time on paperwork.

Yulun Wang: Every single healthcare professional I’ve ever talked to—this is over several decades—they always say the best part of their job is taking care of the patients. And then the worst part of their job is all the administrative overhead they need to go through in order to take care of their patients. And so if we can eliminate a lot of that administrative burden, we’ve done a lot to improve the quality of life and quality of work of our healthcare professionals, which then actually translates to improved quality of care for our members and patients.

Kenton Williston: Yeah, absolutely. And the other big thing that comes to mind is, we’ve largely been talking about these technologies in the context of improving care in existing relationships. But I think the other thing that’s really exciting about telehealth is it opens up opportunities to get access in areas that previously didn’t have access to the full spectrum of healthcare services.

Yulun Wang: In the US it’s roughly 25% of the population lives in rural locations. And in rural locations oftentimes there’s not even a doctor, let alone a specialist. And so telehealth can get expertise into anywhere where there’s internet, which is pretty much everywhere in the world now. Taking that a step further, another thing that I’m involved in is a nonprofit called World Telehealth Initiative. And World Telehealth Initiative is an NGO where Teladoc Health donates its technology for free to World Telehealth Initiative.

Then World Telehealth Initiative identifies underresourced communities in the world—which is basically half of the world’s population—and then finds volunteer physicians who want to help take care of these underresourced communities to help train the clinicians in these underresourced communities to improve the capacity that they have, in order to help take care of themselves. And we’ve been doing this for four years now. We’re in 22 different locations around the world, and it’s actually proving to be a model which is very effective. At first we were wondering how difficult it was going to be to get volunteer physicians. Well, it turns out it’s not difficult at all. We have actually hundreds and thousands of physicians who are asking to volunteer for these efforts.

Kenton Williston: Wow, that’s really great. I think it speaks, again, to the point you were making about physicians being really excited about providing the care—it’s all the other hassle that can make their lives miserable. And if we can enable them to focus on what they do best, not only can they, like I said, help existing patients, but spread out that care to other parts of the world and people who might not be able to afford it right now, and all those sorts of things. And that’s really great.

Yulun Wang: Yeah. It’s actually telehealth could be a key part of the solution to global healthcare.

Kenton Williston: Yeah. Absolutely. And that’s really exciting to hear. So, one thing that we haven’t really talked about that I wanted to touch on before we wrap things up is about your relationship with Intel^®. And so, in the interest of full disclosure, insight.tech is an Intel publication. So, of course we’ve got a bit of an agenda here. But I do know that you’re using Intel technology for a lot of your solutions. So I’d be interested in hearing about how you work with Intel, and what the value of that partnership has been to you.

Yulun Wang: Our efforts with Intel have been fantastic. First of all, our telehealth cloud—which is how Teladoc services our health-system partners—that cloud is all powered by Intel chips. We have many servers out there distributed around the world, and those are all based on servers which are running off of Intel processors in Intel software and boards. We also have built a number of different telehealth-specific devices. Devices like a robot which can round on patients in the ICU; to a wall-mounted head which can manipulate and turn around—look all around a room in a patient’s room, and provide interactions with the patient. And these devices are all Intel based as well. But also Intel has helped us with the NGO I was talking about a second ago—the World Telehealth Initiative. Intel provide us a grant to help us stand up the World Telehealth Initiative in order to bring healthcare to the less privileged in the world.

Kenton Williston: Wow. That’s really great. And I’m also interested in hearing—looking forward to what you see as some of the key technological advancements. So, for example, one of the things that comes to mind is what the role of AI will be in the future of telehealth.

Yulun Wang: So, I’m a big believer that AI will be a big part of the future of telehealth. Why is that? Just the concept of telehealth requires the digitization of the interaction between the clinician and the patient. Because the clinician and the patient are, say, at different locations, everything’s digitized and then transmitted back and forth. By virtue of the fact that it’s digitized, you can now run algorithms like AI algorithms on it to improve capability. So, what are the kinds of things which you can use AI for? Well, one is if you’re interacting with a person on a virtual screen, using AI I can actually automatically measure their heart rate. I can automatically measure their respiration rate. I can do that through the video image—in the subtle changes of motion or color in that video image.

I can also even measure sentiment. So, whether or not the person’s feeling angry or happy or sad or frustrated. These are the types of things which AI algorithms can do. So they can actually do it faster and better than a human, but they might provide feedback to the clinician in order to help that clinician render a good diagnosis of the patient. Another capability could be in the whole area of natural language processing. Where, instead of having a human scribe, you have an AI scribe which is able to listen to the entire interaction between the clinician and the patient to automatically generate a transcript and a note, and perhaps even bill for the encounter. That would completely take the load and burden off the clinician, which would be a huge benefit to clinicians everywhere in the world.

So, those are a couple of different categories where AI and telehealth can intersect and really improve the ability to deliver care and to administrate care. It’s an exciting time. And I think we are at an inflection point, and I think it was accelerated by COVID, and that acceleration is going to get us to a better place quicker than we might have otherwise got. An area I’m thinking a lot about these days, which I find very exciting, is actually using telehealth for even surgery. And so you might think, “Wow, it’s never going to hit surgery.” Well, I wouldn’t be so sure. Where telehealth may go, nobody knows exactly yet. But I don’t think we should sell it short, as it’s just only usable in this area or that area. I think it can be pretty pervasive throughout the healthcare-delivery system.

An analogy I often fall back on is the banking system. When I was younger, I went into the bank every time I had to withdraw or deposit money. Now you never do, basically. You only have to go in the bank sometimes when you have to, say, sign some loan documents or something like that. Healthcare is going to be the same way, where the health centers—whether they’re hospitals or clinics—they really become hubs of knowledge, but then they can deliver their expertise out into the communities around the world. But then occasionally people do have to come in. They might have to come in to get an MRI or CT scan or something like that, but they don’t have to always come in in the way they do today. So that’s how I think the evolution is going to happen.

Kenton Williston: Absolutely. So with that, let me just thank you so much for joining us today.

Yulun Wang: It’s my pleasure. Thanks for having me.

Kenton Williston: And thanks to our listeners for joining us. To keep up with the latest from Teladoc, follow them on Twitter @Teladoc, and on LinkedIn @Teladoc Health. If you enjoyed listening, please support us by subscribing and rating us on your favorite podcast app. This has been the IoT Chat. We’ll be back next time with more ideas from industry leaders at the forefront of IoT design.

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