Healthcare at Home: The Rise of Telemedicine

Dr. Angela Fusaro

Co-founder / CEO of Physician360

Healthcare at Home: The Rise of Telemedicine

How have advancements in technology transformed healthcare? In this episode, Dr. Angela Fusaro, Cofounder and CEO of Physician360, discusses the various applications for telehealth and its role in the modern healthcare system. How has the pandemic accelerated remote healthcare in rural communities? See why the modern medicine cabinet won't look like your parents'.

Consumers are very used to getting everything they need, um, with the touch of a button from their smartphone. So their healthcare is no different. So when you think about telemedicine from a patient's perspective, it's now the ability to interact with their doctors and other healthcare professionals, uh, right from their phones.

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I can sit on my couch now and my doctor can treat me at home. You know, there's a lot more, in some ways the, the concierge vibe of having one available to you, whenever you need them having literally an urgent care in your pocket. Like we're, we're kind of recreating that again, but just through technology. 

There is so much health tech enablement with your smartphone. It is just, it's limitless, right? So there are, there are now ultrasound probes that can function off of your smartphone. Um, I mean, not only is that an amazing technology, but when we talk about things like access to care, you know, and, and practicing healthcare in places where they might not be able to afford a $10,000 or more ultrasound machine, there's now versions of these technologies that again require just a simple smartphone and are so much more affordable. There are EKG monitoring telemetry monitoring really that can hook up to your smartphone. And so, you know, being able to know about your heart rhythms on a regular basis obviously provides the doctor with so much more, so much more data, right? It's not just the snapshot in time. When you go to the hospital and you get an EKG for those few seconds, you can now say, what does your heart rhythm look like for the last two weeks? And that's obviously more meaningful.  You can deduce more [meaning] from the information because there's so many more inputs. 

On the other end, we tremendously value convenience in our society. So you could almost make the counter argument, which is, you just got something done for me in a fraction of the time at a fraction of the cost. I didn't have to miss work. I didn't have to sit in your germ-infested waiting room. In theory, I should be motivated to pay more because that was such a better user experience. But I think you're right. Sometimes we say, well, that looked easier. So I shouldn't have to pay as much as I was paying back when it sucked. 

There are still approximately 19 million Americans who don't have access to high-speed internet. And so when we start talking about how to close the digital divide part of that is building the infrastructure that's necessary to get them the tools they need so they can access telemedicine. During COVID, for example, there were over 500 million in federal grants to build infrastructure, especially in rural communities where oftentimes that's where, [broadband] internet is not found. Part of, again, addressing the digital divide though, is it's providing patients with tools, on their terms. So even though we have these millions of Americans who don't have access to high speed internet we also have 86% of Medicaid that have a smartphone. So, you know, I think it's about saying to ourselves, well, how do we get them access to care? Even if it's through their phone, and not necessarily through something that needs broadband. 

We will start to see a shift in what patients consider to be normal to have at home. The modern-day medicine cabinet is gonna look very different than it did 20 years ago. Whereas before no parent would've been in a house where there wasn't Tylenol and a thermometer in their medicine cabinet. Now, they're not gonna be found without their digital otoscope in case their kid is one of the 3 million ear infections this year. So, I just think the tools that we're gonna start to see as normal as everyday as common place is gonna have totally shifted away from non-smart to smart all-tech enabled. That will be this movement on all fronts of care into the home. 

So imagine if everyone was able to just kind of have standard operating procedure. You have your little emergency box in your house, and it has things like a defibrillator and a few other tools that are used in the setting of common emergencies and those tools are all telehealth enabled. So the information from those tools, they're user friendly, the prudent layperson can, can use them. And the information that's gathered from them is sent instantaneously to an expert, right? And take it even a step further. Imagine your, your everyday cable provider is now telehealth. Your provider is now a telemedicine provider. And so you literally are just sitting there in your living room, take out your emergency kit, put on your little [your] power pack and off the information goes and up on your television screen pops the doctor who tells you to take an aspirin and to do X, Y, or Z. I 100% anticipate that we will have emergency care at home and not to say it'll make the concept of EMS or pre-hospital care obsolete. But we will start to see a lot of that move into the home.

Digital Health in the Home

Is there underlying relief in the “big brother” of telehealth? Dr. Angela Fusaro discusses the future of hospital care at home.

Remote patient monitoring is pretty interesting in the sense that, again, it's like big brother, but in the best possible way, right? It's a little bit of a relief. I think for patients to be like, “I don't have to pay so much attention to this. I actually can have an expert who is paying attention to it for me.” So I think our ability to, to monitor patients remotely in an ongoing way is pretty amazing. Just the hospital at home concept I think is, is tremendous. So we're seeing more and more care being practiced at home. It started again with COVID testing. The concept of doing a rapid test on your own at home was almost nonexistent before COVID and that seems impossible to remember, cause it was just so recent, but really before the pandemic, the idea of consumers being in the driver's seat of their healthcare hadn't happened yet. So we now have really flipped the switch and we're saying, yeah, do your COVID test at home. You know what, maybe you can also be using all of these other types of tests at home and maybe we can actually start putting more digital tools in your home to not only test you when you need to be, but to treat you also. And so I think we'll get to the point where in the home setting, we have enough digital health tools that in some ways the hospital becomes obsolete.

Adoption, Infrastructure & Digital Literacy

How does the digital divide affect telemedicine and its reach? Access, digital illiteracy, and more all play their part in the digital divide.

The adoption piece, just like with anything, it's complicated from a patient perspective because when you talk about the adoption of anything there's cultural elements, there's socioeconomic elements, there's access elements. And so I think although patients for the most part were very eager to use telemedicine and have really embraced it, there's obviously disparities within that usage. And a lot of that comes down to access. Is the proper infrastructure in place for all people to access telemedicine? And then do they have the digital literacy to do that? Are they living in a community, for example, that doesn't have broadband internet? You can't expect someone who doesn't have access to telemedicine to access it in this at the same level. And if they do have the infrastructure in place, they still have to understand how that data is collected at the value in collecting the data and kind of what interpretation to make from it in order for them to participate in the same way. So digital literacy is a big component of the digital divide and why we're seeing some communities adopt telemedicine so much more than others.

Access in Rural Communities

Pharmacies in many communities are the frontline healthcare workers available. Telemedicine resources and tools help elevate this, making comprehensive care more accessible.

You know, when we start talking about models for access to care, especially in rural communities, there is a community pharmacy, for example, within a few miles of over 90% of Americans. And so, in places where there isn't a hospital, there isn't a doctor's office, there is almost always a community pharmacy. That becomes the frontline healthcare worker. And so the fact that we've been able to take telemedicine and telehealth tools, and now put them in a community pharmacy setting, we're really able to elevate those pharmacies to a place that can actually provide comprehensive care. And that has been transformative for a lot of communities that historically didn’t have access.

Growing Pains

The telemedicine boom did not come without growing pains. Listen in as Dr. Angela Fusaro discusses the vetting and growth of these at-home tools.

With every innovation, with every transformational change that we see in healthcare, any industry, there are growing pains. And what’s so consequential about growing pains? When you start talking about healthcare, [you're] talking about people's lives. And so, just like we've done with testing and other diagnostic tools to this point, they obviously have to be extremely well-vetted before they're brought to scale. But I think the fact that the consequence in healthcare is always patient lives, the biggest risk is liability. And not even just liability from like doctors [who] don't want to be sued perspective, but nobody wants to have a patient not have a perfect outcome. That's the trepidation, which is how do we get it to the point where it is game-time ready so that we can trust it? Because when we can get it to that level it can really work for us.

Expert insights

In the home setting, we have enough digital health tools that, in some ways, the hospital becomes obsolete."

Dr. Angela Fusaro

Co-founder / CEO of Physician360


How will digital tools at home improve the quality of healthcare?

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Thanks to significant advances in technology and progressive healthcare practices, patients have access to life-saving applications from the comfort of their smartphones. From ultrasound probes to telemetry monitoring and more, the possibilities are right in the palm of our hands. 

Thanks to smartphone applications, we now have the ability to not only offer healthcare to those who couldn’t afford it before, but we are also drastically improving the quality of health-centric data. Doctors are able to collect and analyze more comprehensive data sets and identify long-term patterns, leading to more accurate diagnoses and more preventative care.


How do we close the digital divide in telemedicine?

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Today, there are approximately 19 million Americans who don’t have access to high-speed internet. Even as millions of dollars in federal funding are raised and deployed to build infrastructure in these communities, a major aspect of closing the digital divide involves providing relevant, accessible tools for the people who live there. 

As telemedicine progresses over the next decade, providers will face the critical challenge of distributing and humanizing telehealth in a way that isn’t dependent on things like broadband internet or costly equipment. Digital literacy, among other issues, plays a significant role in the adoption of modern telehealth practices, and will be a critical component in its advancement.


What are the next steps for the ‘Hospital at Home” concept?

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In the post-pandemic world, we’re seeing a rise in the practice of healthcare taking place in the home. Now that we’ve proven as a society that we can do things like at-home testing fairly reliably, the doors are now open for other types of testing and regular monitoring. We’re now able to access a variety of new tools and equipment to capture and analyze health data without entering a physical building.

As more and more patients become comfortable being in the driver’s seat and healthcare companies adopt new, more user-friendly technology, we will continue to see an increase in at-home healthcare and the many benefits that telehealth entails.


What is the role of community pharmacies in modern healthcare?

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When it comes to access to healthcare, telehealth creates a wealth of opportunities for rural communities, even those without access to high-speed internet. Did you know there is a community pharmacy within a few miles of more than 90% of U.S. residents, even where hospitals and doctors’ offices are not? 

Due to their proximity to such a large number of patients, these community pharmacies act as extensions of healthcare providers. By arming them with telehealth and telemedicine tools, we’re providing more options to communities that historically lacked access to quality healthcare.

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