In this next segment, you'll hear from Benjamin Seo, who was a Senior Business Development Associate with Johns Hopkins International. He's spearheading the Medical Second Opinion program that connects physicians from around the globe with specialists here at Hopkins. I have with me here a listing of a variety of different programs, and initiatives, and pilots, and projects that are underway with Johns Hopkins Telemedicine. So you're going to hear about the medical second opinion program, but other ones include teledermatology, ED, an inpatient and outpatient consults. In this list, I see a program for minded home care managers, visiting dementia patients at home, and providing an assessment and then facilitating a video visit with the remote physiatrist. There's a telescreening program. We have the fetal echo consult, where real-time and immediate video consoles are used to discuss treatment options for high-risk expectant mothers. Now, when we're talking about all of these programs, there's a few terms in telemedicine that you should be familiar with if not already. So, when we talk about the modes of transmission, there's asynchronous, which is not in real time. So, asynchronous or store and forward is an approach that can be used, let's say by dermatologists or radiologists. Picture might be taken of a patient's lesion, and the dermatologist can view that picture in a secure manner at a later point in time, or radiologists might use asynchronous communications to review a imaging at another time. Synchronous is real-time communications. What people generally traditionally think of when they hear telemedicine, sort of a face-to-face, real-time video consult, but synchronous communications, real-time. Asynchronous, not in real time. Then, of course, there's remote patient monitoring, which is becoming more and more ubiquitous these days with RPM. It can be asynchronous or synchronous, a patient's vital signs, their blood glucose, their blood pressure values. They're not having to record them in a chart, and go to a provider three months later to have their insulin titrated based on what was written on paper, right? With smart glucometers, remote patient monitoring that data's being transmitted, and a care manager, a certified diabetes educator, and endocrinologist, might be able to keep track of that patient's glycaemic control on an ongoing basis. So remember, there's synchronous, asynchronous remote patient monitoring. As you hear me talk in this next clip with Benjamin Seo about the medical second opinion program, think about the following: when you traditionally think of face-to-face video visits telemedicine, we're talking about a provider who is at a distant site seeing a patient who's at the originating site. So, those are important terms, distant site, originating site, because it can really impact legal, reimbursement issues et cetera. The patient is at the originating site, you'll also hear that sometimes referred to as the primary site, the rural site, the spoke site, okay? But in the Medical Second Opinion program, we're not talking about a provider to patient communication, What Benjamin Seo is referring to, what they're spearheading is a provider to provider consultation program. So, allowing providers from abroad who might have a complicated patient with scleroderma, who's having pain and inflammation in the lungs and difficult to control on a variety of different agents. They might be able to connect with the rheumatologists, who works at a tertiary academic medical center like ours, and who has seen a handful of cases, which is a handful more than people might have seen elsewhere. Being able to connect provider to provider, very exciting, but there are some barriers, right? As we're talking about strategic planning, we've talked about steep factors, social technological, think about some of the economic and the political barriers to successfully implementing a medical second opinion program across international lines. You'll hear me talk to Benjamin Seo about some of the cultural barriers that can occur, some of the issues with this not being a reimbursed service. Some of the challenges in making the business case. So, in connecting the dots during this particular module, I also want you to think about how it's so important to make that business case. What's the ROI here? How do we demonstrate that there's a return on investment? When the services and the current state internationally might not be getting reimbursed. So, use this as a good example as we listen to the story of what's going on currently in driving this Medical Second Opinion program using telemedicine. I'm here today with Benjamin Seo, who's a Senior Business Development Associate with Johns Hopkins International. Benjamin, thank you for talking to me a little bit. It's really exciting the work that you're doing, it's spearheading the second opinion. Yes. Electronic second opinion internationally with Hopkins, can you talk a bit about that? Yeah. So, this program actually stems out of Johns Hopkins Medicine International. Okay. We've been around for 20 years, and the main charge of it is twofold. We take care of patients here locally. We're traveling overseas, internationally or from out of states. But on the other hand, we also have a consultancy management arm that deals with delivering consultancy and management services to health systems to governments around the world, to kind of build our local capacity. Yeah. So, what we're finding often time is that, to really deliver the right care to the right patient the right time, there needs to be kind of efforts to really ramp up the healthcare capabilities overseas. So as this progresses, and I think it has this kind of, I held some other trainings all around the world. Yeah. What we're finding is that, services like this Mexican Athenians, would empower local physicians there to kind of deliver that more of specialty access, and deliver that right cares for every patient. Right. It's interesting because a lot of times when we're leading change through health IT, there can be a clinical argument, there can be the quality of care argument, but really making that business case, that financial argument is really important. It is. How does your group meet the financial cases? Who is responsible for that? So, this program is set up to be a physician to physician consultative service, remote service. I think a lot of the insurers and a lot of the payers right now, are now kind of reimbursing for these e-visits, for these patient-physician interactions that are synchronous in nature. Right. However, our program is structured more to be provided to provider. Okay. It's more educational in nature. So, it's a specialists delivering a console to a care provider who's from another country like Turkey or in UAE. Right. So the reimbursements are not really stemming there and then I really have to bring it there. So I think there's a lot of importance that has to be placed on how do you compensate the physician's time here for rendering those services when it's not being reimbursed at this time, so it's a really critical factor. I think right now, there's pretty a lot. There's a lot of room to kind of, I guess develop innovative business models that would address exactly getting that specialty care access. Right. Being part of the business development group, I'm sure that's something that weighs on your mind. One of the things that we impress upon the students is you can have a great idea. You can have a wonderful innovation, a great need, but sometimes the regulatory policy framework might not support that, so advocating for it or making the arguments somehow. We talked about total cost of ownership. We talked about the importance of return on investment. I'm sure those are things that are on your mind. Especially with a lot of the legal considerations that are now come to the forefront around telemedicine, telehealth in general, I think it's still the world's best. Yes. I think there's a lot of questions about reimbursements. Well, seeing a patient virtually versus a single patient in person, there's a lot of differences there. Sometimes, might take a longer to do a virtual consult. Yeah. So I think those are lack of research definitely have to be considered. Yeah. Now, one other thing Benjamin, a lot of our course focuses on the US healthcare system but, of course, we have students from all over the world, internationally. Tell me though in your role as you're taking something that has the IT infrastructure, and the healthcare infrastructure rooted in the United States, as you're trying to implement that abroad or connect folks from abroad, what are some of the challenges that you end up facing? Well, I think governments have their own priorities. I think data privacy is a huge element. Yeah. Having a data leave from a particular country to another country, I think that's a huge consideration that lot of governments have on their minds. Another pieces is just a nature of telemedicine, you could basically set up a shop in China, and take away business from those local providers as well. So, if you look at a lot of the policy's violations are being built by these governments, it's mainly to really protect their own ecosystems and their own common economy. Yeah. So I think as people begin to think about global compensation and go into the international arena,- Yeah. -that those considerations definitely have to be in place. Those are significant infrastructure considerations. Thanks so much for your time Benjamin, really appreciate it. Thank you.
