Telehealth Best Practices: Dr. Meeta Shah of Rush University Medical Center On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Access to care has always been an issue. There are patients who have barriers in their social determinants of health that make it very difficult to come in for appointments. For example, they may not have a car or a loved one to bring them to appointments.

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 Dr. Meeta Shah.

Dr. Meeta Shah is an assistant professor at Rush University Medical Center in Chicago, Illinois. She was appointed an Associate Chief Medical Informatics Officer in 2018 and most notably, was integral in the operational launch of the Rush On Demand platform, a virtual urgent care that went live in 2019. She is also an educator for the Rush Medical College and Medical director for the Street Medicine Program partnership with The Night Ministry of Chicago.

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

I get this question all the time but honestly, that’s an impossible question to answer as an Emergency Physician! We see so much of humanity — the best, the worst, funny and tragic all in one shift. There are definitely stories that I feel have molded my career and how I provide care. I have laughed and cried with my patients, been vomited on, bled on — you name it.

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

When I was in University, one of my dorm mates said “Compliments are free, so why not give them.” Of all the quotes we hear, I’m not sure why this one has stuck with me years later. I think it’s just a simple reminder of kindness — it takes nothing from you to recognize someone’s hard work, their effort, their art, their outfit — whatever! So making it a part of our relationships with others (personally and professionally) has so much value and reward to everyone involved.

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 sounds cliché but my husband. He’s also a physician. When we first got married I was burning out despite being a young physician early in my career, was questioning everything and feeling unfulfilled. He knew I was unhappy and would never be happy without making a major change, so he encouraged and pushed me to make that change, even though that meant him working harder to support me advancing my career. He moved to a new city for me and has supported every endeavor I have embarked on, even when it makes his life more painful!

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?

First of all, it’s important to make sure we all understand that telehealth cannot replace all in person care. There are just certain physical exam techniques we just have to do in person, like a gynecological exam. At an in person visit we can use our tools and of course use our hands to perform certain physical examination findings.

The other benefits of in person care of course is human connection — we can use our gestures to display our emotions, shake hands and just sit together and have a conversation. For some patients that aspect is of the utmost importance. It’s personal and private.

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?

When a patient is not in front of us, and instead are on a screen, sometimes the technology can be a struggle. If there’s a poor connection, bad lighting, the user is unfamiliar with technology — those all can be a barrier to completing a successful visit. It’s also hard to maneuver the camera sometimes when the provider needs to focus on a particular part of the body (like when a patient needs to shine a light inside their mouth while at the same time saying “aaaah” for a virtual throat exam!)

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.)

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?

Access to care has always been an issue. There are patients who have barriers in their social determinants of health that make it very difficult to come in for appointments. For example, they may not have a car or a loved one to bring them to appointments. With respect to COVID, if a person was in quarantine due to a high risk exposure, coming to seek care advice was especially difficult without personal transportation. On one hand here we were telling people to quarantine, while at the same time telling them to get care and get tested. How could we expect these folks to come in and see a provider to determine if they needed a test when they couldn’t use public transportation or ride share to go see a doctor?

Perhaps a patient does not have the financial bandwidth to take time off of a much needed job to come and see the doctor. Prioritizing health is a real dilemma for many individuals who are trying to pay the rent and support their families.

On the other hand, a PEW research study in 2019 estimated 85% of Americans now have a smartphone. That means, they can do a visit from where ever they are, at a more convenient time than may have been possible when trying to coordinate in person care. I have seen plenty of patients who have been able to complete their appointments during their lunch breaks at work, or while watching their children at home.

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?

Really the smartphone and the Ipad are the most integral on both sides of the camera right now. Longer term, while still ramping up, remote patient monitoring will be a big opportunity for preventative medicine. Being able to catch a patients abnormal lab values or vital signs remotely before complications occur will be a game changer.

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

My wish list? A universal, muti-purpose virtual kit that patients could own that facilitates a physical examination, and allows us to see what they see. Something every patient could have in their homes. It would include an ipad with the appropriate software, bluetooth stethoscope that allows us to hear their heartbeats and lungs, a otoscope so we can see inside their ears and mouths, an ekg monitor and a virtual blood pressure cuff — all in one kit and better yet affordable., And let’s make it as common as a thermometer!

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?

We have quality metrics for our telemedicine appointments just like we do for our in person visits. As well, preliminary data is showing that patients who have used telehealth are as satisfied with their visits as they are with in person visits, maybe even more so. Some even feel as though their visits are just as good as in person visits.

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?

Honestly this is all so new that it’s still exciting to me. And we haven’t even scraped the surface what telehealth can do. Frankly until now telehealth has been held back by legislative and reimbursement restrictions. Now we are playing catch up.

Already there is technology being developed for virtual scribing. And it’s exciting to think about the day when we might be able to create a virtual examination room using VR so it feels like we are in a physical space together.

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

We have to be very clear on the limitations of virtual care with our patients. I think it’s important we don’t use this technology when inappropriate. As I mentioned earlier, sometimes a human connection is necessary or a hands on physical examination. We have to ensure medical conditions aren’t missed for the sake of convenience.

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. :-)

I want to be part of a movement to use telehealth for good — to expand access to healthcare to those who really need it. I want us to put our money where our mouths are and ensure that telehealth isn’t just an option for those with money. We should have tablets or telehealth stations in public spaces, work with our community health partners to reach patients who otherwise have trouble reaching us. We need to use telehealth not just for medical purposes but for social work, addiction treatment, counselor services and beyond.

How can our readers further follow your work online?

Good question — google my work or follow me on LinkedIn, Twitter or Instagram. I’m on twitter at @msmemesha and on instagram at dr.MsMemeSha. Ironically, despite my life in health IT, I’ve pulled back my social media time to be more present with my family and friends…. But I’ll catch you eventually!

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