Dear Doctor: Sylvia Romm

The telemedicine pediatrician on the future of medicine and connecting with patients digitally.

Dr. Sylvia Romm, Vice President of Medical Affairs for the national telemedicine company American Well and herself a telemedicine pediatrician, brings expansive insight into how the field has evolved from a largely practitioner-to-practitioner landscape to also include the direct-to-consumer framework that now exists. Her own experience reveals that not only does tech facilitate the practitioner experience, it actually facilitates connections between doctor and patient in unforeseen ways. Here, we chat with her what has changed the most in the last 10 years, both for the consumer and for practitioners.

How long has telemedicine been around?

That’s an interesting question. The federal government is actually one of the earliest adopters of telemedicine. They started using it around 50 years ago, doing psychiatric evaluations using interactive TV. People have been using inventive ways to talk to one another to transmit medical information for much longer than we realize. The way it is happening right now is new, but the tech idea is actually quite old, and is simply based on the concept of trying to get help when you don’t have the right people right next to you to provide it. The methods are changing much more quickly contemporarily than they used to though.

You first utilized telemedicine yourself not that long ago as a pediatrician. What was that experience like?

My first encounter with it was when I was in residency around 2010. Massachusetts General Hospital had a couple of different telemedicine initiatives specifically to address needs on the islands off the coast of Massachusetts, in places like Martha’s Vineyard, for example. The derm dept had a video program that allowed for examinations without the patients having to travel in several hours for a 20 minute visit, which was particularly useful for dermatological problems that often require regular checkups.

The pediatric intensive care unit also had a video cart robot that let them bring the attending in during the evening as necessary when only a fellow was there in person. I started using it regularly myself about four years ago, when the technology had evolved to include what we now call direct-to-consumer, where the patient usually is at home at the time of the visit and calling in with their phone or computer. And this, of course, has all been facilitated because the devices people have at home have evolved enough to support adequate connections that make this kind of communication possible.

What is telemedicine good at right now? What can it be used for, and what can it not be used for?

Right now, telemedicine is still being used mostly for urgent care, though that is changing. Urgent care was an easy first step; one of my friends helps run an urgent care chain and she was telling me the other day that an estimated 40% of people coming in could be seen through telemedicine. In this case, there are a few different situations for which it’s particularly good. One is if your personal doctor isn’t available because they’re on vacation or it’s after hours. Another case is when you’re not sure whether or not you need to go into an urgent care center, and it would be easier for everyone to opt for staying home.

Parenting alone offers a good example of why checking with a doctor before you leave home can be particularly useful. Going to the ER involves dragging the entire family in the middle of the night, not to mention the eventual cost to the patient of being seen through the emergency department for a case that could have waited until the next morning. I never fault the families for those kinds of decisions. I went to four years of medical school and three years of pediatrics training to be able to tell you your child was sick or not — but gosh I’d rather do that in a way that doesn’t cost so much money. There are, of course, things we don’t do, like order labs or imaging, though many of the hospitals we work with make it easy to schedule those as follow-ups to the call.

How have you seen telemedicine change in the time that you’ve been at American Well?

The sheer number of people that have used telemedicine is impressive — about 18% of consumers at the moment. It gets easier and easier to use as people’s phones get better and better. The biggest change on the consumer side is what we call UX — user experience, or, how easy and natural it is to use the technology. To cite an old adage, good design looks nice, great design is something you don’t even notice. So the epitome of perfect design in this context is being able to have a deep relationship with another person because the tech falls away completely.

On the provider side, in our particular platform, the ease of finding and collecting information is what has changed the most. So while an urgent care visit with American Well typically only lasts 10 minutes, that slot represents just a part of the visit on the practitioner’s end. Before you come to them, they go through your chart. While you’re in the visit, they’re recording, and the template on their end has to be set up in a way that isn’t distracting from the visit, so we incorporate a lot of prefills for common conditions, and even predictive text features to cut down on typing time. It’s all about trying to keep the actual interaction between doctor and patient as whole as possible. After the visit is finished, the physician still has to make sure the notes are set up and that the correct information is sent to the insurance company, the prescription is sent off. So that brings the actual time of each visit for the practitioner up to about 15 to 17 minutes.

What do you think is next in telemedicine?

I think that telemedicine is going to become a common part of the practice in two-to-five years. There have been some recent well-publicized uses, the most famous being when Montel Williams last month had a stroke diagnosed through telemedicine at New York Presbyterian. We actually run their platform. In my own practice, a couple of weeks ago a mom called in about her three-month-old baby who had gotten down to the 1st percentile in weight. She had been seeing the family doctor she’d been seeing since she herself was a child. She called in while on her lunch break and was overwhelmed and worried. I reassured her that she was being a good mom, that her doctor was doing the right thing, and cited a couple of extra things she could bring up with the pediatrician. It’s funny how people say you can’t connect through tech — you really can.

Are you high tech in other ways? What pieces of tech are in your own home?

I actually am pretty high tech in my life. I travel a lot for work; my husband is the CEO of a start-up, and we have a six-year-old and a four-year-old, so we’re often hustling to keep things together. For example, a few months ago I was leaving for a flight, and as I was headed out the door, my four-year-old yelled, “Don’t forget to order bananas on Amazon!” And I thought, “Yeah, I’m THAT mom.” And, sure enough, I was in the Uber on the way to the airport, ordering groceries to show up at our door while I was away. It’s how we make things work.

How do you unplug?

Unsurprisingly, I use tech to help me unplug! I actually got an Apple Watch that I set to only buzz if I get a text message. That way, I can put my phone and computer away every evening until the kids go to bed, knowing that I can be reached if it’s really important. I found that I used to check my phone for messages from my husband or my friends, and then I would get sucked into email or social media. Now that it’s just on my watch, I find it much easier to stay away from the electronic black hole of always being on.

If you weren’t practicing medicine, what else would you be doing?

I would be sailing around the world with my family! That may still happen though…

Favorite movie or book recently?

I just saw Three Identical Strangers and was just blown away by the intersection and conflict of science, research, and humanity.

Favorite restaurant close to the office?

When I’m not traveling I work from home, so my favorite spot is Gotan in Williamsburg, Brooklyn. It’s a great coffee shop and there are a few other health entrepreneurs that work from there as well!

You can learn more about Dr. Sylvia Romm and American Well here.

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