Telehealth Best Practices: Howard Reis of HEALTHePRACTICES On How To Best Care For Your Patients When They Are Not Physically In Front Of You

An Interview With Dave Philistin

The same technology that can be used for the episodic visit can be used to deliver patient education. Good oral health habits can prevent many of the episodic problems. Connecting a patient into a dental home, where the patient regularly goes for dental care like checkups and cleaning, is also a primary objective of the program.

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 Howard Reis.

Howard Reis is the President of HEALTHePRACTICES, a business development and consulting firm focused on various aspects of telehealth and telemedicine. He has 30 years’ experience in the field and is encouraged with the validation of this specialty and see it become widely adopted as one of the few positive outcomes of the recent pandemic. His telemedicine career journey began as a project manager for NYNEX Corp. in a trial with four Boston teaching hospitals in the early 1990s. Career highlights include helping two separate teleradiology companies achieve Inc. 5000 status as the fastest growing private companies (three times each) and serving as CEO of The TeleDentists during the recent pandemic. His expertise is in strategy and business development with a keen focus on helping to develop the future of telehealth.

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?

I come from the “tele” side of telemedicine. In the early 1990s NYNEX Corp. (precursor to Verizon) had bandwidth in the form of T-1 and T-3 data transmission lines and was exploring which vertical markets were the most likely to use them. Medical imaging was a logical choice. We initiated a trial program with four teaching hospitals in Boston including Massachusetts General Hospital, who were interested in receiving and sending medical images worldwide and determining whether their doctors would deem the image quality of the transmitted images to be the equivalent of the film they were used to using. That began my career at the intersection of telecommunications and healthcare which continues to this day.

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

I had met “The TeleDentists” in May of 2017 at the annual meeting of The American Telemedicine Association when our companies exhibited in booths next to each other. Two years later, when I went to visit with my old friends, they told me that their founding CEO had recently left, and asked if I knew anybody that might be interested in the position. Excited at the prospect of leading this innovative company, I said I’d like to throw my hat into the ring. Two weeks later I was hired as the new CEO. It was a great thrill to be in place nine months later when the pandemic broke out and we had the infrastructure in place to respond successfully, provide important dental services and grow our network to provide services for an expanded number of patients in need.

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

“Tell me and I forget. Teach me and I remember. Involve me and I learn.”

While the author of this quote is not verified — it is sometimes attributed to Benjamin Franklin, and other times to ancient Chinese philosophers — the meaning of its is relevant to me both as a lifetime learner and also as a teacher. It reminds me of instructions for a surgeon. “Watch one, do one, teach one.” I am seeing so much innovation from young entrepreneurs. I appreciate the assistance I received early in my career and I can only hope that the new entrepreneurs find my experiences to be helpful to them.

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?

A few come to mind, but I’d like to mention someone who was my boss twice, Bill Shuttleworth. I worked for Bill at NYNEX Science and Technology where we managed an early telemedicine trial with four Boston teaching hospitals. I left NYNEX to become President of a startup telemedicine company which failed after a year. My job search was long and very painful. Bill had left NYNEX and joined Bellcore. He reached out and hired me to begin a program for new entrant telephone companies. It’s not always what you know, it’s also who you know. I’m grateful that I have known Bill Shuttleworth as he provided me initial opportunities in the field and believed in me to work with him on his new venture.

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?

You ask about doctors, but the same goes for dentists who have been able to treat patients remotely.

Benefits of having a patient in front of you include:

• Direct face-to-face contact without staring at a medical record system.
• No need for PPE so the patient can actually see the dentist’s face.
• Opportunity to include other family members into the conversation.
• Ability to immediately connect to a specialist who may be in another location.
• Being able to see the home environment that the patient is in.

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?

• There is an expectation that a problem can be “fixed” with an in-person visit. The teledentists remediate, e-prescribe, and schedule the patient for an on-site visit if necessary. Dentists involved in teledentistry cannot drill the tooth and provide a filling.
• Unlike in-person dental visits, a teledentistry service like the TeleDentists is primarily episodic and not for ongoing relationships or checkups.

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.)

The same technology that can be used for the episodic visit can be used to deliver patient education. Good oral health habits can prevent many of the episodic problems. Connecting a patient into a dental home, where the patient regularly goes for dental care like checkups and cleaning, is also a primary objective of the program.

Five things you need to know:

1. Relevant medical history — Dental issues may just be part of the equation if the patient has conditions such as diabetes or even cancer. I’d like to see a movement toward medical-dental integration where oral health is treated as part of the overall health of the patient.
2. Information about allergies and other prescribed medications — This is very important for e-prescribing as you need to avoid any contra-indications.
3. How long since the last dental visit — This could be a follow-up from a previous procedure, or an indication of poor oral hygiene in general.
4. How long has the problem persisted? Does the patient consider the current situation a real emergency?
5. Do they have insurance, and will they be able to afford a treatment plan if necessary?

Also, it’s important for the doctor to know how to conduct a telehealth visit. Practicing beforehand, and making sure you are familiar with the systems is essential. You need to exude confidence — imagine what a patient may think of your medical abilities if you can’t manage the telehealth system! The doctor needs to be in a professional setting with good lighting and good audio quality. Some doctors may need an alternative bandwidth source in case of emergency, but this has become less of an issue as bandwidth has become more reliable. A lab coat always helps, too!

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?

A virtual visit with a teledentist may be the first positive encounter with dentistry many patients have experienced. The dentist’s role is often that of counselor and motivational interviewer. They can recognize the symptoms of dental anxiety and provide reassurance, empathy, an explanation of why dental care is needed, and a confident, well-executed handoff to a trusted colleague. They also reassure patients that regular visits to the dentist are associated with lower overall cost and lower dental anxiety. Oftentimes, patients only visit the dentist for dental emergencies, which can be expensive, traumatic events.

Telehealth is also an important asset to help patients with mobility issues who can’t easily get to a doctor’s physical office. It can be a great screening tool to help a patient and their physician determine whether an in-office visit is necessary. It is also a great tool for follow-up visits after certain procedures have been performed. Another benefit is that an out-of-town family member can participate in the visit if the patient provides the proper authority. On a global basis, patients in third world countries can get access to expert care that was never before available.

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?

The most important tool is the smartphone which is available and used worldwide. To make these work, high-speed bandwidth is a necessity. Tools which enable Remote Patient Monitoring will become more reliable and more widely available. For instance, TytoCare has developed a device to measure and transmit vital signs which can be purchased at Best Buy. These and other tools which enable image communication will become an increasingly important part of the telehealth experience.

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

Teledentistry is just one sub-specialty of telehealth. The perfect system would provide seamless interconnected access to multiple specialists, all on the same platform. This would include dermatology, ophthalmology, orthopedics, and mental health professionals, and other sub-specialties depending on the needs of the patient- all on the same platform, with access to patient information, and with the ability to easily connect devices to the individual practitioner in the sub-specialty.

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?

First of all, patients need to know that these services are available and where to go to get access to them. They need to know if they are covered by insurance for these services, and if not, where they can find services they can afford. Quality is an issue, and the patient may want to have some information about the credentials and experience of the provider they are working with. Patients also need assurance that their privacy will be protected. Patients must be confident that they are receiving quality care, not just a discounted option.

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 am most excited about Remote Patient Monitoring. Tools will be developed to identify diseases before they become apparent to the patient. For instance, the TeleDentists is working with one company that has developed an illuminated tongue depressor that can take great pictures of the mouth and throat, and when connected to a smartphone or tablet, can be used to transmit photos to be used by the dentist. Another company is working on the ability to test saliva for early indication of decay or gum disease.

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

I am concerned that telemedicine has been used by unscrupulous parties in an attempt to defraud insurance companies. I am also hearing about an increase in medical malpractice cases where a telehealth provider has not used all the tools available to correctly diagnose a patient.

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. :-)

Let’s widely share our success stories. Telemedicine can be lifesaving. It can save patients and the health care system a tremendous amount of money. It can also lead to early diagnoses of issues, which can translate into cost savings. The more we can share and publicize our successes, the more the technology will be used. That leads to more use cases and more positive outcomes.

How can our readers further follow your work online?

www.healthepractices.com, https://www.linkedin.com/in/howardreis/, hreis@healthepractices.com

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