Telehealth Best Practices: Tomer Shussman of OneStep On How To Best Care For Your Patients When They Are Not Physically In Front Of You

An Interview With Dave Philistin

… Implement platforms that offer data-driven monitoring and analysis. Work with technology that can accurately track as much health information as possible so that even when chatting with a patient from afar, the practitioner gets the bigger picture concerning the patient’s medical condition and progress.

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 Tomer Shussman.

Tomer Shussman is the Co-Founder & CEO of OneStep, a digital physical therapy platform harnessing the power of motion sensor technology in smartphones and the empathy, professionalism, and human touch of experienced physical therapists to provide remote physical therapy that is convenient, innovative, and exceptionally effective.

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 am a physicist in training and spent many years working on sensor technology. My co-founders and I are good friends and were educated in the Talpiot program, an elite high-tech division of the Israel Defense Forces, where we worked together for many years. I also served as the chief instructor of the program and managed the 150 cadets and 10 staff members, which was a fascinating leadership experience for me. After being released from military service, my co-founders and I wanted to use our scientific and technical experience to create something revolutionary that would benefit the well-being of others, and we had a strong hunch that everyday sensors could be used to improve people’s health.

Initially, we set out to create an app that can detect strokes by measuring how people walk. Many people don’t know this, but no two people walk the same way. Several parameters such as speed, step rate, stride length, and more, are taken into account when analyzing how we walk, or our ‘gait.’ For years, gait has been a subject of interest for researchers, psychologists, sociologists, and physical therapists. More recently, gait has been studied scientifically and is now used as an indicator to assess and treat individuals with conditions affecting their mobility and other functions.

We developed a technology that turns any smartphone into a 24/7 motion analysis lab, and then realized that there is a huge need for accurate feedback in many areas of medicine, the most significant one being physical therapy. Motion is a skill — one that requires continued practice — and meaningful feedback. Regaining it after an accident or an injury is particularly difficult, and unfortunately, most patients are alone in their recovery. Sure, they get a weekly hour at the clinic with a therapist, but what do they do back at home? This is how OneStep came to be. Our approach (and name) emerged from the belief that continued practice should fit seamlessly into your life — small, consistent, daily actions result in big outcomes. We use our technology to provide patients with ongoing feedback that puts them in control over their recovery and equips their therapists with around-the-clock clinical evidence that allows them to not only make better decisions, but also be there for their patients all the time, very efficiently.

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

Wow, I’ve had so many… I think that the most interesting, intense, and funny stories of my career happened when we just “got out there” and tested our efforts in real world situations. When the rubber meets the road, you learn so much. For example, when we just started OneStep, we decided to launch an informal study to help us understand our target audience. We picked the location — a small clinic in Israel; we built a very ‘lean’ app that periodically collected motion data from the smartphone; we built a sales pitch on how to convince people to try it for free; we had a whole protocol that explained how to install it, how to operate it, and more; in theory, we were as prepared as one could be.

When we kicked off, it turned out to be a disaster. We had initially started off as a team of 3 with clear areas of responsibility, but suddenly there was a huge influx of people applying, too many for us to handle. Each of us was so occupied with our predefined ‘responsibility’ that we weren’t available to do our part, and we found ourselves improvising. A large majority of the prospects had trouble downloading our ‘lean’ app, the rest didn’t understand how to use it. It was as hectic as it could be, and within just a few days we all felt like we had run a marathon. We went to a nearby bar, sat there silently for what seemed like hours, and just drank our beer. Today, this is one of our funniest memories. But this also taught us so many things about what could go wrong, what’s not working, and how to better prepare and improve. We thought we knew everything, and then everything went wrong.

It is so easy to fear putting things to the test, but I think those are the best learning experiences, and in retrospect also the funniest moments of my career.

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

It is not a quote per se, but one of my favorite mantras is to ask myself “who’s actually in charge?” I had a cadet once in Talpiot who was so independent, determined and intelligent that he would actually manage me. He’d come to our weekly meetings with a clear agenda, he’d tell me exactly what our plan was, and exactly what I needed to do to help. I loved that he worked that way, but at first it seemed a bit odd — wasn’t I supposed to be “in charge?” Was I not doing my job by letting him set the plan all by himself? It took me a while to realize that this is exactly how things are supposed to work.

Relationships are a lot less hierarchical than we think they are. Take even the most hierarchical relationship that most human beings experience in their day-to-day life — parents and children. Who’s actually in charge? So many parents joke that their kids are their true bosses, and it’s somewhat true. It’s complicated. I think that the best parents know how to set boundaries but also allow their children (especially as they grow) to set their own boundaries, and sometimes even set boundaries for their parents (they do anyway, so let’s acknowledge it). Eventually, our kids need to grow up and become independent adults. (My wife and I are about to have our first child, so check back in with me to see how I’m doing with this, ‘when the rubber meets the road.’)

Too many managers micromanage on many different levels, even when they fully trust their employees! It’s hard not to — you want to stay involved, you want to set your tone, and many times you actually know best because you see the wider picture. But when managing ambitious, talented people (which is the holy grail) I think we have to change our approach: Make suggestions rather than giving orders. Ask “how can I help” rather than tell what you’d like to do. Great employees know how to do their job, and many times they know what they need from us. More often than not, all they need is some guidance.

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’ve been blessed to be surrounded by amazing people. I’m learning so much from so many people that it’s hard to name one person. My family is filled with brilliant people, my co-founders are the most interesting people I know, and actually, I can’t think of one person that is active in my life and that I don’t appreciate. So naming one is very difficult.

If you put a gun to my head, the person that probably influenced my early life the most is Tal Greenfeld. He was my teacher during middle school and high school and helped me develop my learning skills. Tal’s class was one of a kind — he would teach abstract, college-level math in one lesson, read to us from Freud’s notebook in the other, and have us read poetry in the third. Tal taught us to doubt, to refer to multiple sources, to go directly to the source (actually read Freud instead of analyzing Freud), to trust our gut instinct, and more. As luck would have it, Tal works with us at OneStep today — he is an active musician and teaching was his part-time job, mostly out of inspiration. Recently he decided to make a career change and a natural direction was building workshops for the Israeli high-tech industry. I suggested that he spend some time at our office to learn more about Israeli startups, and eventually, we were able to find a very unique position for him. Even after 20 years, he’s still teaching me today.

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 who 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?

There are many benefits of having a patient right in front of you. From a clinical perspective, you can run numerous tests and if you need to form a new diagnosis or if you want to examine a different limb or body part, you can. Most importantly, in-person interactions involve a personalized touch and provide an opportunity to perform a holistic physical assessment of their condition. Eye contact, undivided attention, and compassion all foster a patient’s trust in their practitioner. Up until recently, these factors were irreplicable in the digital space. However, with innovative technology, many treatments and diagnoses can be done remotely without compromising on quality or the personal touch on the clinical side. In fact, transitioning to the digital space has many advantages and can oftentimes improve outcomes both in the short and long term.

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?

Building a trusting relationship between doctor and patient becomes trickier when done via telehealth. Nobody wants to feel like they’ve called a Dial-A-Doctor hotline — they want to be able to speak comfortably and frankly with a physician who knows their history and has taken time to fully understand their medical condition and challenges. Patients are looking for a partner in recovery who will consider and plan a course of treatment that suits their needs and continue to follow up with them afterwards and monitor their progress. However, this issue can also be mitigated if telehealth platforms provide a dedicated healthcare professional who accompanies the patient throughout their experience.

Another significant challenge is providing an accurate diagnosis from afar. Many companies in the telehealth space resolve this by providing wearable solutions — using these is oftentimes accompanied by a separate set of challenges, from delivery times (which can be impacted by the pandemic) and distribution, and ensuring the patients remember to wear them and use them, among others. The same applies to monitoring progress. When a patient doesn’t consistently show up at the clinic or use wearables, it is hard to gauge progress and modify the treatment accordingly. At OneStep, we took these concerns into consideration as we developed our technology and addressed them to provide a highly personalized physical therapy solution to our clients.

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.)

1. Implement platforms that offer data-driven monitoring and analysis. Work with technology that can accurately track as much health information as possible so that even when chatting with a patient from afar, the practitioner gets the bigger picture concerning the patient’s medical condition and progress.
2. Use simple, accessible tech. Enough patients have difficulty with technology and connectivity, which can be exacerbated by the plethora of sensors and wearables often used for telehealth. By using familiar technology, such as a smartphone, a lot of the burden and concerns associated with telehealth can be mitigated.
3. It is easier to become dissociated when you don’t see patients in person. Go the extra mile to establish a meaningful connection when treating patients remotely, check-in periodically and make sure your patients feel heard and seen.
4. Create a long-term plan with your patient. Then check-in consistently and modify it as needed. Take advantage of the fact that you can monitor your patient remotely and don’t have to base decisions on infrequent visits.
5. Treat each appointment like you are meeting in person. If you have a habit that you tend to do in person, add it or adapt it to your telehealth appointment so that there is a real and perceptible personal aspect of each meeting.

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?

Today’s consumers are seldom without a phone on-hand or in their pocket. Telehealth platforms like OneStep’s have the benefit of providing value 24/7, not just once or twice a week at a clinic. They do this by consistently monitoring the patient in the background and using this data to improve the patient experience and optimize their recovery plan by providing feedback and clinically-relevant insights into aspects of their daily life. For example, measuring their motor abilities when they wake up in the morning compared to later in the day.

This aspect of telehealth also helps motivate patients. Think of someone on a weight loss journey — they weigh themselves often and when they see they’ve lost a pound or two, it empowers them to continue their plan in order to reach their goals one step at a time. This is one of the reasons why 72% of OneStep’s patients finish their full course of care — much higher than the national average.

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?

This is a double-edged sword. Technology can replicate many of the benefits of an in-person visit between patient and physician. However, the more add-ons, wearables, and sensors that are used, the more complicated treatment becomes for the patient, and eventually, only the most tech-savvy of patients will be able to benefit.

In my experience, keeping it simple is the best method of creating a patient experience that is beneficial for everyone. By eliminating a lot of the noise around treatment, healthcare professionals can focus on the patient, like they do when they are in the same room.

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

I don’t believe there is a perfect system. It’s all about the patient and every patient has a different preference — some want more personalized attention, some less. The key to a system that works for everyone is to make it accessible, adaptable, and easy to use while also utilizing innovative technology to make the clinical side of treatment as advanced, personalized, and efficient as possible.

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?

If we want our patients to know they can reach out any time with any questions or concerns, it is important that they not only understand this, but that they are empowered to do just that. If there is data that will help them improve their journey to recovery, this data should not only be available to the healthcare professional but to the patient as well. At OneStep we have taken this to heart by enabling patients 24/7 access to physical therapists and by providing quantifiable results and feedback directly to them, ensuring they are getting the best results from their treatment, and making them aware of their progress at all times, no matter where they are.

Another equally important element is understanding that when it comes to recovery, small but consistent daily efforts often translate into longer lasting results when compared to dispersed, concentrated efforts. That’s why our recovery program is flexible and offered as bite-sized exercise regimens which patients can easily integrate into their day-to-day.

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?

Evolving technologies such as AR and VR are exciting. From a healthcare perspective, they can provide benefits that improve the patient experience. We may reach a point in time when we can schedule appointments in the metaverse where providers feel like they are in the very same room as a patient while being miles away or even in different countries.

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

As digital technology continues to permeate more and more areas of our life, it’s vital that we remind ourselves that there is no replacement for the personalized touch of a healthcare professional. As the lines between what is real and what is virtual become more and more blurred, we need to take extra care in ensuring that we provide empathy and compassion to our patients and that these don’t get lost in the digital world. Physicians — as well as leaders in other digital spaces — need to focus on retaining a human connection and fostering strong interpersonal relationships, no matter the space.

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. :-)

In a perfect world, everyone would have access to exceptional care no matter who they are, where they come from, or where they’re going. Physical therapy is a field that has traditionally been viewed as a solution for those with physical injuries or for those recovering from surgery. However, physical therapy has proven to be beneficial for all adults and can be utilized not only to treat current challenges but to prevent future injuries and illnesses as well. As the world becomes more and more sedentary, musculoskeletal issues are becoming more common: About 8% of all adults or 16 million people in the US suffer from chronic back pain and are therefore limited in certain everyday activities. No one should have to suffer from unnecessary pain. We hope that by making physical therapy easy, effective, accessible, and affordable, more and more people will be empowered to live healthier, pain-free lives.

How can our readers further follow your work online?

Our website, Facebook, LinkedIn, Instagram, and Twitter.

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