Telehealth Best Practices: Kate Purnell On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Home set up: If the visit involves a physical exam, patients should identify a quiet space in the home and also consider whether a desktop computer, tablet, or smart phone will give them the most maneuverability to show the treating clinician the issue area (e.g. the video camera on a desktop computer may not easily facilitate a foot exam. Additionally, patients should consider clothing that is appropriate for the physical exam, such as shorts for a knee exam.

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 Kate Purnell.

Kate Purnell has worked at the Hospital for Special Surgery for four years, currently serving as Vice President of Service Lines. In her role, she partners with physician leaders and administrators to drive process improvement, strategic initiatives, and growth. Before joining HSS, Kate was an Engagement Manager at the Chartis Group, a healthcare advisory firm. As a child, Kate grew up abroad, living in South Korea, Japan, and England, before moving to the U.S. as a teenager.

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?

My first job was implementing a pilot program that was privately funded by Mayor Bloomberg and other philanthropists. The program attempted to mirror welfare programs seen in Central and South America, and offered low-income families financial incentives around health, work, and education activities. Though I enjoyed the mission-driven work and the day-to-day business operations, I found that I was most interested in the healthcare aspects of the program and the healthcare system more broadly, which was increasingly at the forefront of discussions in the U.S. through the debates and passing of the Affordable Care Act. I decided to go to business school to pursue a career in healthcare.

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

Working with a large multidisciplinary team to rapidly implement telehealth and support our clinicians in the early months of the pandemic was one of the most interesting experiences in my career. Before the pandemic, HSS’s rehabilitation team launched a small but successful telehealth program that supported hip and knee replacement patients in their first three weeks after surgery, before transitioning to outpatient therapy. Later in the year, eight pilot physicians began to incorporate telehealth into their practices.

Due to this foundational infrastructure, HSS was able to get 85% of its medical staff live on telehealth within just three weeks, and ~400 physicians, PAs, and rehabilitation therapists live within five weeks, ensuring that our providers could continue to deliver urgent and ongoing musculoskeletal care to patients. Our accelerated rollout was made possible because of four reasons:

1. Quick decision-making: Decision making was decentralized where possible, and the entire multi-disciplinary team joined a daily planning call with round robin report-outs
2. Starting simple: Customization and additional functionality was offered after all clinicians who wanted access were live with v1.0
3. Ensuring support resources: At-the-elbow IT trainers (onsite and remote) were made available to support clinicians and their administrative support staff, to ensure smooth transition
4. Frequent communication: The team leveraged multiple communication channels to provide updates regarding external changes and internal improvements

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 still in college, trying to figure out what to and where to start, my dad advised, “look for roles and experiences that build skills while you figure out what you like doing, and don’t worry about finding the job with the highest salary or at a specific company.” This advice has guided me through several career moves and also how I approach new professional experiences.

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?

I had incredible mentors who really invested in me while at Chartis, including Pam Damsky, a Director at the firm, who was endlessly thoughtful about tailoring meeting materials to capture the specifics and nuances that were relevant to the client. One time, on a Sunday before a client meeting, she spent hours reviewing every formula in a complex model I had built, found a (huge) mistake, and then took the time to help me see how to do it better next time. And today, I am also incredibly lucky to have a husband who is extremely supportive of my career and does more than his fair share of taking care of our two-year-old son.

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?

One of the benefits of having patients in front of you for a musculoskeletal exam is that clinicians can guide the specific movements of the joint with his or her hands. Therefore, one of the biggest challenges that physicians and therapists have shared with me that is that clinicians have to verbally guide patients to independently complete these physical movements, and also ask patients to verbally describe the outcome of the motion, using words such as instability, locking, clicking, and throbbing. This increased participation in an office visit is new for patients, and so can sometimes take more time.

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.)

1. Technical support: Some patients are not tech savvy. Organizations should ensure that during the visit scheduling process, there is a robust support option for new patients to be guided through registration and hardware set up, including downloading apps
2. Pre-visit instructions: Visits are more likely to be successful if patients know what to expect. For example, what various physical maneuvers or walking will the patient need to do, and what clothes will be most appropriate (e.g. wearing shorts for a knee pain exam). During the visit, patients may benefit from clinicians demonstrating the physical maneuver so that the patient can mimic the action.
3. Home set up: If the visit involves a physical exam, patients should identify a quiet space in the home and also consider whether a desktop computer, tablet, or smart phone will give them the most maneuverability to show the treating clinician the issue area (e.g. the video camera on a desktop computer may not easily facilitate a foot exam. Additionally, patients should consider clothing that is appropriate for the physical exam, such as shorts for a knee exam.
4. 3rd Party Participants: Some video technology easily facilitates 3rd parties, allowing involvement from family members or interpreter services for those patients who benefit from the additional support
5. Selectivity: Telehealth is a powerful tool when used for the right type of visit and the right patient, which comes back to the importance of patient choice.

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?

Convenience to the patient is a huge benefit that cannot be overstated. If patient-centered care is defined as being respectful of, and responsive to, individual patient preferences and needs, telehealth can be an extremely powerful tool that can accommodate patients with mobility issues, patients who have limited ability to take time off work, and also working parents or caregivers of patients who have similar challenges.

In terms of clinical care, for appointments that require review and discussion of x-rays or advanced imaging, patients now benefit from having the physicians share their computer screen with patients, and being guided through the image in detail. I have also heard that some patients express feeling more comfortable in their own home and therefore are able to retain more of the details of the conversation.

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?

Though there are many tools that have enhanced telehealth, such as remote monitoring technology, I believe that most effective thing to drive rapid adoption and permanence of telehealth was the widespread adoption of zoom for professional and social use during the pandemic, especially with those who were not familiar with video conferencing technology. Simple things like realizing that they are on mute, and experiencing major life events with friends and family virtually, have established a comfort level for patients that would have taken a decade without the pandemic.

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?

There are quite a few examples of Augmented Reality and Virtual Reality being incorporated into medical training and staff onboarding, and early uses as a tool in surgeries. Looking forward, I have read some early examples of these technologies being leveraged to improve patient education. I think the opportunities to develop tailored and adaptive patient education, with and without VR and AR, has immense future opportunities to improve outcomes and the patient experience.

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. :-)

To build on the power of telehealth, I hope that state medical boards relax licensure requirements so that patients have more choice in accessing care, and also that CMS includes physical therapists in the group of eligible providers for reimbursable telehealth services.

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