Telehealth Best Practices: Christina Chen of Bright-md On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Making sure your internet connection is stable. Audio or visual problems can really detract from the interaction for both the patient and the providers. Optimizing your internet connection, or even having a wired connection will go a long way toward establishing that all-important therapeutic relationship

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Christina Chen, Medical Director of Bright.md

Christina is a board-certified physician trained in family medicine. She began practicing medicine in 2007 and has vast experience delivering care both in-person and virtually. As medical director, she ensures the clinical content inside the Bright.md platform is of the highest quality and adheres to the strictest standards of evidence-based medicine. She oversees the development of new content and monitors the latest guidelines and recommendations to keep clinical modules up to date. Christina also provides insight to product teams and works with our customers to optimize the clinical experience for their providers.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Ever since high school, I’ve had my sights set on a career in medicine. I enjoyed life sciences and was fascinated by everything I learned. Halfway through medical school, I thought I wanted to be a surgeon, but I ultimately chose the family medicine path, and I’ll share more about why later. As I went through my career, I worked in various communities and in all different types of healthcare delivery systems including HMOs, community healthcare clinics, and fee-for-service organizations. I’ve practiced in the traditional brick-and-mortar healthcare clinics as well as in telehealth and virtual care. Through all of those different experiences, I saw the need for something different in the healthcare industry, much like a platform like Bright.md that delivers quality patient care virtually, removes the administrative burden from providers, and helps improve both the patient and the provider experiences.

Can you share the most interesting story that happened to you since you began your career?

A story that comes to mind as I think about my career is when I shifted to seeing patients via video visits back in 2015. Now, this was before it became mainstream and long before health systems were forced to use it due to COVID-19. While seeing patients through video, I was able to experience first-hand how much can be done to help patients through telehealth, and feel like I got a taste of what the future will look like with hybrid care delivery combining in-person visits with telehealth.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I’m not much of a quote person but I do have my own personal ethos on how I approach work and professional challenges: “Put in the effort, learn, and get it done.” It’s nothing flashy but I value hard work, quality, and reliability. I’ve been fortunate in my career to have had a lot of different opportunities and I always approach it with the same mindset. Regardless of the challenge, I know that if I work hard, I can contribute to success.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

It really hasn’t been about one single person for me. I’ve had the honor of being surrounded by a diverse group of peers, teachers, and family members. Throughout my life and career, they’ve been my cheerleaders and support system. I was never told by those close to me that I couldn’t do something because of my gender, race, ethnicity or otherwise. With that support, I knew I was capable of doing whatever I wanted to do and to do it well.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

Obviously the main benefit to having the patient in front of you is the ability to make true eye contact and connect with your patient, and vice versa for the physician. There’s also a lot to be said for the “laying on of hands” not only to examine the patient but also to provide comfort.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Again, not to state the obvious, but technical difficulties are often a real concern when connecting with patients via telehealth. Things such as the internet cutting out or lags in audio or visual can interfere with the patient and provider experience. This also brings up the issue of access — patients who don’t have high-speed internet are often not able to use virtual care options, further exacerbating the health inequities that already exist due to socioeconomic disparities.

Also, there will always be conditions for which virtual care is not appropriate — emergent conditions such as acute chest pain or conditions for which treatment requires a procedure, lab work, or radiology.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You? (Please share a story or example for each.)

Making sure your internet connection is stable. Audio or visual problems can really detract from the interaction for both the patient and the providers. Optimizing your internet connection, or even having a wired connection will go a long way toward establishing that all-important therapeutic relationship

Professional dress: I think this one speaks for itself.

Professional environments: Like the professional dress, making sure that your office is quiet, distraction-free, and that you have an appropriate background, or virtual backdrop.

Leverage access to the patient’s environment: When you are meeting with a patient via telehealth, you can use their environment to not only get insights into the illness context but even to get a more accurate sense of the severity and extent of their symptoms. For example, during my time practicing telehealth, I would often be consulted by parents who were concerned about their child’s symptoms or illness. They wanted to know if their child’s symptoms were part of a more serious condition or if they needed to bring their child into an urgent care clinic or even the emergency room for evaluation. Meanwhile, I could hear and see the child in the background, playing happily, chatting, and running laps around the room. Being able to see the child happy and comfortable in their home environment not only reassured me but allowed me to provide reassurance to the parent as well.

Complete documentation right after the appointment and make your notes clear and concise: Spending that extra 5 minutes to complete your documentation before moving on to the next patient will save you hours of documentation at the end of your day. Making sure that patient follow-up instructions are clear is also important. Many of us are used to going over a printed After-Visit Summary with patients after an in-person visit — circling and highlighting the relevant follow-up instructions. Or even walking the patient from the exam room to the lab or pharmacy waiting area to ensure that they don’t forget to get blood drawn or remember to pick up their medications. Without the ability to provide these cues in a telehealth encounter, it becomes exceedingly important to make sure that the patient is clear on the treatment and follow-up plan at the end of the virtual visit.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Like I touched on earlier, telehealth allows the provider to have insight into the illness context by seeing the patient’s environment at home or wherever they may be seeking care. It provides us, the physician, a new lens into the patient’s life and how that can impact their health. For example, seeing an elderly patient in their home, struggling to find their medication bottles or trying to maneuver around large pieces of furniture gives insight into their daily lives and the factors that influence their health (including the social determinants of health) that a traditional in-person visit never could.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

You’d be surprised by how useful the camera on a computer or smartphone can be. And these days, especially after the pandemic, in the age of FaceTime and Zoom, patients are extremely comfortable using and interacting with their camera phones or webcams. So take advantage of that. I’ve looked in the back of patient’s throats, studied the details of a rash, and evaluated ankle sprains, all via webcams and phone cameras.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

I really think that Bright.md has designed an optimal digital tool for both patients and providers. Patients are guided through a thorough clinical interview that they can take on their tablet or phone, in the comfort of their own home or wherever is most convenient for them. Wait times to receive care for low-acuity conditions are cut down from hours to minutes. Access to care is no longer an issue — we know that in some hospital systems, there is a 2 to 4 week wait to see a primary care physician. On the provider side, automating both the clinical interview and documentation can cut down on the administrative burden by up to 90%. When used in front of a synchronous interaction such as a video visit or in-person visit, it allows the provider to focus on establishing that all-important therapeutic relationship with the patient rather than data-gathering, clerical work, and documentation. None of us went to medical school to spend more time interacting with a computer than with patients. Care automation can help to restore some of the humanity and professional fulfillment to the practice of medicine. And countless studies have shown that engaged clinicians not only provide better care but also contribute to a better overall patient experience.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Interact with their physician the same way they would if they were in person. This might sound simple, but it is incredibly important. Let the physician know as much information as possible about your concerns so that they can provide the best care possible. It’s true that some patients will still prefer that face-to-face interaction, and as I mentioned earlier, some conditions will always require an in-person interaction, but the industry is definitely moving towards a hybrid delivery model. And we’ve seen evidence that virtual care can be just as safe and effective as in-person care.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

I wouldn’t say that there is anything in particular, but I think we definitely need to have an open mind when it comes to technologies like these in the future. What’s important for me is that these future innovations consider both patient experience and convenience, as well as provider experience. Far too many digital tools today have simply moved the site of care rather than really leveraging technology that gets to the roots of the problem in healthcare delivery. Easing the administrative burden on physicians is something close to my heart as there are too many providers leaving the industry because of burnout. The Bright.md platform leverages technology to not only deliver amazing patient experiences that drive loyalty and improve access to quality care, but also decrease the workload on our doctors and let them get back to why they became a doctor in the first place — to help people feel better, faster.

Is there a part of this future vision that concerns you? Can you explain?

Healthcare as an industry is behind when it comes to leveraging technology to really solve the root issues in the system, and not just treat the symptoms. Patients can do many things in their daily lives with the push of a button. They now expect that convenience in every aspect of their lives, and healthcare needs to get to that level. As long as we keep in mind the core goals of providing quality care to patients, increasing both efficiency and professional fulfillment for providers, and lowering costs, I don’t see much that concerns me. One thing I will highlight is how important it is for digital health to embed health equity, and to really ensure we’re designing solutions for everyone that reduce disparities in access and outcomes — rather than exacerbate existing systemic issues.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Leveraging technology, like Bright.md, to automate workflows that will provide career fulfillment for providers will make way for greater patient experience and satisfaction. Provider engagement and professional fulfillment is the foundation for everything else — quality, safety, patient satisfaction, and ultimately, financial success of a healthcare organization.

How can our readers further follow your work online?

You can follow everything I do over at Bright.md on Twitter and LinkedIn

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

Thank you! This was a pleasure to do.