I'd like to start off this segment by reading to you from the glossary section of this 1988, publication from the World Health Organization, and it's titled Informatics and Telematics in Health Present and Potential uses. Recognize the floppy disk right here. In the glossary I think it's always great to look back at things that were published decades ago. They have on page 101. The definition of telemedicine is listed as The use of telematics to transmit medical data. On the previous page, we have the definition of telematics. The use of computer based information processing in telecommunications and the use of telecommunications to allow computers to transfer programs and data to one another. It's amazing to see how certain documents have a particular definition. Now telemedicine is everywhere, just the other day I received this envelope in the mail and it's from a vendor, and our particular health insurance is now offering the benefit of having these remote video visits. So, for a certain co-pay of $15 a visit. We can have a general medicine on telemedicine visit, with a 10 minute median response time it says. For dermatology evaluation we can upload images of skin issues, and we'll get a reply in less than two days. So, it looks like this is an asynchronous form of telemedicine and that's $15 a visit. It says right here, you can have access to a doctor at your fingertips. What's amazing is in 1988, telemedicine and telematics were being defined here in a certain way. Now, there's telemedicine vendors e-mailing us advertisements, and putting them in our snail mail every single day. Yet we're in this trans-formative time where there are so many projects going on in the space and some successful, some more challenging. There's a lot of barriers to telemedicine adoption not just in the United States but abroad. In this next clip, you're going to hear me speak to Rebecca Camino. Who is the Administrative Director of the Office of telemedicine here at Johns Hopkins, as well as Dr. Ingrid Zimmer Geller, who's an ophthalmologist and is the executive Clinical Director of the Office of telemedicine. You'll hear from them some of the various projects that are underway here at Hopkins in this field of telemedicine. As we're talking about project management think about some of the success criteria that you hear from Rebecca and Ingrid. Think about the great team that they make a clinical and non-clinical partner. Think about the part where we refer to the importance of having that executive support and how valuable that is. You will also hear them refer to whether they are doing pilots anymore and the reasoning behind that. I think it's a great way to get a good overview of what's going on in telemedicine and to connect the dots between some of the concepts we're talking about. I'd like to introduce you to Rebecca Camino, who is the administrative director of Johns Hopkins telemedicine. We're also joined by Dr. Ingrid Zimmer Geller, who's the executive clinical director of Johns Hopkins telemedicine. Ladies, thanks so much for taking time to speak with me. Yes, thank you. So, tell us a little bit about the state of telemedicine. Today this is an exciting time for you to be significantly leading change through the enterprise. We are actually very excited to be a part of the new technology that we're using. The office of telemedicine is now two years old here at Hopkins and our role really is to coordinate all the telemedicine activities across Johns Hopkins Medicine, Johns Hopkins International and beyond. We've spent the first two years really building out our infrastructure, so that we can coordinate all of our telemedicine activities within our electronic medical record. Really, our overarching goals are to increase patient access to reduce the cost of care and to provide connected care. Right. Now, Ingrid, you're an ophthalmologist? I am. What brought you to this particular role? That's actually an interesting question. One of the first areas of interests that I had from a research standpoint when I finished my retina fellowship, was to address the problem of diabetic retinopathy. We have great treatments for diabetic retinopathy, but it's still the most common reason for a vision loss in working age adults in the US, primarily because patients aren't going in for the recommended screening. So, about now, 18, 19 years ago we started a telemedicine diabetic retinopathy screening project, where patients with diabetes were offered an opportunity to have images taken up their retina of the back of the eye, when they were seeing their primary care physician. Patients with diabetes do regularly see their primary care doctors. But if they, especially if they have no vision problems they often will neglect the recommended eye evaluation for diabetic retinopathy. By capturing them in the primary care setting, taking the photographs and then sending those photographs to a reading center, we're able to capture a significant number of patients with vision threatening disease. Even though they still had good vision and were completely unaware of that. So, that project ultimately resulted in almost 200,000 patient encounters. That got me involved with the American Telemedicine Association and that kind of snowballed into the opportunity that I was very fortunate to be given to run the Office of telemedicine. That's wonderful. Rebecca, it's just always so interesting I think for students to hear about the different pathways, that individuals take where their career in clinical informatics and health IT. You get to work and interact with a variety of different providers and you see individuals with varying degrees of comfort, with change and with health IT. What is that like? To really helping providers, become more familiar with these tools to get them to gain acceptance. Yeah. Well, it's very exciting. It's very exciting to be part of the leading edge of change in this area. Right. I think the important part for us is to link the passion that the providers already have. They already want to reach their patients. They're already thinking of new ways. So, our goal is really just to give them the tools to do that. I think it's very important for our office. We don't take over these projects. These projects are housed with the divisions, with the departments, with the providers that are running them. It is theirs, it is their way to reach their patients. So, we're here to facilitate to cheer lead to connect those dots to educate ourselves right altogether as a group to really come to the point where we can reach the patient and really have that easy simple best way to reach the patient. You know that's really interesting because Dr. Peter Green, often talks about the push and pull approach. It can be very difficult when you're pushing change. Yes. Upon a health system. So, that's really interesting that I think that's a smart approach that you're taking, where the projects are being housed within the division. Then you have your champions already. Already! They're already fighting for them. They've already been working. We're just coming alongside. I think what's interesting in the Johns Hopkins medicine approach is that it is supported and funded from the top. But it's the boots on the ground that are developing the programs and carrying it forward. So, we're just really in the middle there saying here we are with support. Here we are with knowledge. How do we do this, and then how do we take your fantastic idea to reach our patients and scale it across the health system. So, that we're reaching a large amount of people really impacting population health. Right, you know to that point I wanted to ask you. You talked about how you are getting the support from the top? Can you speak a bit to how important it is to have that organization leadership having your back? Huge. So, yes very important. When the office was established, really it was recognizing that across Johns Hopkins Medicine, there were a number of different telemedicine projects that we're doing things kind of on their own. The concerns there were when you have different pockets of people doing different things. Sometimes you're reinventing the wheel. Sometimes, not every provider's familiar with all the rules and regulations, you're not able to necessarily capture optimal reimbursement strategies. So, having the office of Telemedicine and having the support, really, from the top down, has made it possible for us to really flourish in our first two years. I think we are now a very well known entity. I think when providers, when they have an idea, I think they now know where to turn. Again, as Rebecca mentioned, we really provide them with all the necessary tools from the integration with the electronic medical record, through the legal channels, the compliance channels. That way, we really can ensure that we are providing first-class healthcare even through our Telemedicine platforms. Right. Going from this disparate approach to this centralized approach, it has to be just such a huge improvement and the time was right for it. Yes. I think that's a huge piece of it, because really these efforts started a decade ago. Right, yeah. Ahead of our time, a lot of the stroke programs across the country are built on a program that was built here at Hopkins, right? So, it's all about timing and adoption and culture change, and we're just really, I think blessed and inspired to be right at that edge. Now, one question I have for you, is when you are going live, we talk to students about this phased approach, the small pilot versus this big bang, can you speak a little bit to your philosophy? Yeah. We have a real philosophy at this point. Okay. Yeah. So, I think a lot of- Good lessons learned. Yeah. Good lessons learned, I think, definitely, we don't use the word pilot anymore. Okay. Okay. So, this is their initial step into the big pool. So, when we do a project, we want to make sure it's either reaching a small amount of people in a very significant way or it's reaching a large amount of people to get that significance. So, when we take projects, we're looking at scalability right from the beginning. So, when folks start a project, it's not going to be we're going to do this for three months then stop and consider. It's going to be, we have already considered, were confident in this approach, we're going to build it and then expand it. We see redesigns often, right? Yeah. So, you deploy, you have a month or two and then you come back to the table, you redesign your workflow, you tweak it, you add another location and really expand on the foundation you built, but we're not putting our efforts into pilots that are going to end. Right. What we're also doing as interested persons come to us with ideas, we're now able to say these are the various offerings that we have, this is what would work well for the program that you'd like to build. Yeah. Then, we work on expanding what we already have in place, we don't have to rebuild it every time. So, we have our tool box and we can really customize that for the individual programs. Yeah. Now that you have these years under new wings, right? Yes. Those building blocks are there and it's really interesting when you start off, you're wanting to get some engagement, gets him adoption and then, as an entity, you get to a point where, okay, we have plenty of interests. We need to be efficient with our resources. Yes. Thoughtful. Yeah. I think getting the stakeholders in a room, collecting your interested parties, showing them what's available and really refining your use cases. So, it meets the maximum amount of people, right? I think this is really the direction that we're working with. We're finding those stakeholders can be on the inpatient side, can be on outpatient side, could be population or precision, but they all have similar goals, the same product can work for all of them. It's just really getting people to the table and designing together. Right. Now, one thing I want to ask you is strategic planning, can you speak a little bit to the importance of that? Clearly, lessons have been learned, but having a vision for where you're going and how important that is to your group as a whole. So, our strategic plan for the Telemedicine office really aligns very well with the Johns Hopkins Medicine Strategic Plan. There are, of course, those six pillars, those six areas of priority for Johns Hopkins Medicine. We fit under the integration pillar or fit into the integration pillar. So, some of the pieces of that are, again, to increase access, lower the cost of care, provide efficient healthcare, connect communities, so much of what we do really fits beautifully into the Strategic Plan, The Innovation 2023, a plan for Johns Hopkins Medicine. I think you can get stuck on your strategic plan, right? So, having the patient at the core for us, that is the passion point, that's the guiding point that everyone is coming together on. Then, we're actually moving on various fronts which affects our strategic plan. So, we have to move on the legislative front and change our regulations, work with payers on laws, looking at national movements. So, that really, if you're stuck to, we're going do this and this. Then you can take those opportunities when they present themselves and you could stagnate waiting for those next steps. So, really being able to have the patient at our core, know where we want to go with lowering the cost of care, keeping value, having connected care, allows us, as things change, because we're really in a fast-paced environment here, technologies leaping forward, what we consider healthcare and how we roll it out, is changing. So, really being able to keep that flexibility within your strategic plan and keeping patients at the core. Also what patients expect this change. Yes. Right? And what they want, that core. Yeah. So, maintaining a lot of flexibility while staying true to the vision, I think is something that we're always swimming with, you're in the tide of it all. Very well said. You have to have that road map, you have to have the strategic plan, but you're saying that you need to be nimble enough to pivot as well. Yes. Which can be a challenge but, you know. It's a challenge we love. Yes. A challenge that you deal with every day, you love. Yes. Great. Thank you so much for your time ladies. Thank you. Thank you very much, thank you.
