The growth or use bit in the past couple of months . Dr. Kvedar it has been around some people think since the 1920s. They had a different name for than that chose a family huddled around the radio having a visit with the doctor on the other side. The concept has been around for a while, the late 1960s is when i got going and it puttered along for the next several decades until a couple of months ago when we told everyone, in the u. S. , that they had to stay in their home. And we as clinicians had to take care of them so i blossomed overnight at the point. Host how can it be used today . Guest it can be used in a number of ways. The best uses, Mental Health is the number one probable youths. Probable use. And a growing need, so that is wonderful. A lot of urgent care type things such as sore throat, ear aches. And screening for the coronavirus is handily done using this technology. Virtual urgent care. And chronic illness management followup visits for patients with diseases like hypertension, diabetes, heart fill your, and the like, are handily done. During the pandemic we did everything this way. Im a dermatologist and we did a lot of dermatology this. This way. Where we are headed now is what i would call a hybrid. Most people are confident that we will continue to have telehealth as part of our care Going Forward and there are a lot of reasons for that. Most of those things and even more. I would finish by saying, not everything and that is important. The conversation you need to have is with your doctor. For us as clinicians to think through the information we need to make either a diagnosis or change a care plan and if we can do that without touching the patient, we can do it via telehealth. Host lets bring caverly leonard of Business Insider into the conversation to explore some of those issues. Kimberly leonard. Thank you for being available for this interview. My understanding is that Trump Administration had to make a lot of changes to rules to allow telehealth to be used in more doctors offices. Can you tell us what some of those changes were for those who may not be from there . Dr. Kvedar sure, i was told the other day, i testified in front of a senate panel and was informed there were 31 to be exact but i can only highlight. The biggest one is that the federal government and most private payers came on board with this, are paying physicians and clinicians the same amount for seeingement telehealth patients as they what if someone came in the office. That was a critical one. Us asnd one was allowing clinicians to see our patients wherever they were. Medicare used to limit it to people and rural or Health Profession shortage areas. That went away, so i can beat where i am now, my home, and you can be where you are, and we can have a visit and that would count. And we could bill for that. Of regulatoryr relaxation was in the area of thenology, and hippa, privacy standard rule many know about. It went away overnight. People could use face time, google hangouts, skype to do these calls, a telephone. So we could talk about whether that is a good idea or not. The third area was licensure. 49 of 50 states now have loosened their licensure requirements so you can practice across state lines. I am in the boston area. , lets say visit me you live in new hampshire, a halfhour drive north and came to visit me in the office and we wanted to do a followup while you were in your home. We could not do that before because i was not licensed in new hampshire, but now we can do that because of these relaxations. So it is those three areas i would highlight. Kimberly this week President Trump said he thought a lot of telemedicine changes the Administration Made might become permanent. We heard administrator verma from the center for medicare and Medicaid Services say the same. If you were to look at the landscape, what you think are the most important factors that need to remain in a post pandemic america . Dr. Kvedar thank you for asking. I testified in front of the Senate Health committee. There was strong bipartisan support for this. We are hopeful. , to answer your question, number one is this originating site concept. That i should be able to care for you wherever you are, not just in a Health Profession shortage area or rural area. That is number one on our list at the ata. The second that federally qualified Health Centers and rural Health Centers should be able to get reimbursed for providing the services. That was not the case before. The secretaryhat of health and Human Services should be able to decide which services are reimbursable or not , as part of their mandate. Those are three areas that are very important to us. There are many others but we are trying to be suspect. Kimberly it sounds as though some of these changes might be able to happen through rulemaking, but others will probably require legislation from congress, right . Dr. Kvedar i believe so. The originating site real i mentioned was a statutory role, and that would have to be a new rule. Te to change that host congress usually does not move this quickly. These rule changes are happening fast. Dr. Kvedar this is a new world for me, i have not been directly involved in government before but i was impressed the other day on the hill virtually. I was in this same room testifying in front of them, how committed the senators were at that hearing to move as fast as possible. Called a term we coined a telemedicine cliff. Not anans this is abstract notion. I am back now seeing patients in the office at 40 of our previous volume. And when we get a little more cranked up we will be at 75 . We will knock a higher than that. In order for us we will not go higher than that so in order for us to meet the demand for patient care we have to have teleheath embedded in workflows now. If we cannot do that in a Public Health emergency and there is no way to fix some of these regulatory restrictions, we will be in trouble and our patients will be in more trouble. Host as a dermatologist, how do viagnose the camera camera . Dr. Kvedar it turns out and this is research i did 30 years ago, your Smartphone Camera is quite adequate at taking good quality images. So when we do this we have patients come submit those images over the Patient Portal which is secure and they wind up in my in basket, my electronic record and we can do a video call or phone call with them to go over and review the images. For dermatology, a single lesion bothering you or a rash is a great thing, this is a great thing. There are patients who have had skin cancer and eight a sixmonth or oneyear full body skin check and that has to be done in the office. That is why i said this idea a hybrid environment is the way we are going. It is critical we are able to do both. Kimberly my understanding is many, talking to hospital ceos careoctors, the amount of through telemedicine has increased so drastically the past few months. For a lot of hospitals it was something they wanted to do for a really long time and had planned to roll out in the next two years. Instead they ended up doing it in two weeks or two months. What percent now would you say dr. Visits are happening over teleheath, and what are some of the biggest lessons . Anything unexpected with the volume we have seen in telemedicine visits . Dr. Kvedar thank you for the question. One thing i will say is i am not always proud to be in my profession. Sometimes we miss things as a profession. But this is one where im incredibly proud. Doctors who are predeceased skeptical or thought of this as doctors who were previously skeptical or thought of this as a curiosity, everyone jumped in with both feet. We really have not had a bad patient outcome, it has been extraordinary. Patients have always loved it. Think about it, when you can give patients what i call magical triad of access, quality, and convenience, everyone is happy. Everyone knows it. The patient knows it. The doctor knows it. I would say that is the biggest surprise, it went so well. Where i work in boston, the Delivery System is mass general brigham. We did 1600 virtual encounters in february and we now are now up to 60,000 per week. It has gone pretty smoothly. Everywhere i talk to all the Delivery Systems and other Health Care Providers arson experiencing similar growth. Are experiencing similar growth. We went from only seeing people in the office, overnight, to only seeing people virtually, essentially, except for emergencies. So we know that is not right either. It is too early to tell but most people are thinking 30 50 of their activities will be virtual Going Forward. Some have said 70 and i think that is aggressive. 50 and it does depend on your specialty. My wife is an ophthalmologist and they can do very little this way. You have to go to the office because of the gadgets they need to make the diagnosis of your eye condition. Kimberly one thing im curious about is for people who might be uncomfortable using the technology, maybe because theyre not used to it. Or they might live in a part of the country where there is not good highspeed internet. How do you get around some of those obstacles to make sure this can be something patients can use or try, or have as an option for the . One pleasant surprise from this, and there have been a few, one was health plans and the government started paying us for telephone interactions with patients. Up until the pandemic that was never done. It wasse thought always thought if you call your patient after a visit it is bundled in with the fee for the visit and now that is not the case. The reason i bring that up here is, for our patients in areas where they do not have broadband for four patients that cannot afford a tablet or smartphone, the telephone works. There has been a lot of research to show a lot can be done. Not everything. There are things we missed if we do not have video. Especially as i alluded to, Mental Health. But there is a lot that can be done. In my case, if you send me a few images, i am perfectly comfortable calling you to talk about the results of that. And we can formulate a care plan well on the telephone. So the telephone is an anchor point for solving the problem. As an ata official, we would love it if there were more broadband. We would love it if the government puts stimulus funds into creating more broadband penetration. That would be great for all kinds of things. More broadband would be great. Telephone visits are good. Finally one of the things we own is, making these interactions more patientfriendly. Some of the software is hard. Some people have trouble downloading an app. We have to find ways to make it easy. That is one telemedicine has a workflow that you send the patient a text message when you are ready for the visit. They click on the text and it opened the video and they are chatting with you. We have to find it ways to make it easy by chat. Host at the beginning of the discussion you mentioned hippa has gone out the window. Could you expand on that . Yes, sorry, i do not mean it that way. For the pandemic, the federal government relaxed to the requirements that your video platform had to be hippa compliant. So we can use any number of things. Before to get something and you had to hire an eye to consultant i. T. O an rfp higher and consultant and do an rfp and we made it difficult. It is a great setting because we care so much about patient privacy and take it seriously. But if you are in practice with three doctors and had to go through that before it was an excuse not to get involved. So the federal government was trying to let people overcome that at a time when the only way we could provide care to you was to do this by telehealth. As we see the pandemic start to wane and get back to some level of in person care, i think we will see they will reinstate hippa. And i think that is a good thing. Because for vendors to supply us with videoconferencing and other types of Patient Engagement technologies, they should be willing to hold your information as a patient secure. That should be part of their bargain and they should be able to do that. At they cannot do that we probably should not use their technology. Kimberly how can patients be confident their Health Information, over a Video Conference or over the phone, candy confidential . I think of instances where a physician can be confidential. I think of where a physician might take a call from a patient at a public place like a Grocery Store . Or if the information were to get hacked as a patient is having a conversation. How can we make sure patients can feel comfortable and know that their Health Information is secure and will not be leaked for everyone to see . Dr. Kvedar sure, i am glad you brought it up because everyone is concerned about that and we certainly are concerned at ta. Ata. Number one, it turns out that even though we allow these compliantnhippa platforms, most are secure. Skype is very secure. Whatsapp is very secure. Many are very secure. I think the likelihood, and this is a port for patients, people watching this, the likelihood that you would get your information compromised during a veil call is infinitesimally low, very small. During a video call. It is very unlikely, so that is one thing. And as we move forward we will get back to a state of normalcy where we are demanding those technologies are secure before we use them. So we are headed in that direction again, i am sure. With regard to your question clinician, making sure the clinician is in a private place, we are training people as fast as we can. One of the activities im involved with is the association of american medical colleges, creating training competencies for residences and residencies and medical students to teach them a number of things about me a good teleheath provider. What is being, keeping your video chat private from the point of view of where you have it. So we are getting that word out as fast as we can. Are not too many people foolish enough to take it in the car or publicly. We leave this program now for a statement by joe biden. You are watching live coverage on cspan. Good evening. My fellow americans. We do not have a final declaration of victory yet. But the numbers tell us it is clear, tells a clear and convincing story. We are going to win this race. Just look at what has happened since yesterday. 24 hours, we were behind in georgia, now we are ahead. And we are going to win that state. 24 hours ago, we were behind in pennsylvania, and we are going to win pennsylvania. , winning inre ahead arizona, winning in nevada. In fact, our lead doubled in nevada. We are on track to over 300 Electoral College votes. I look at the national numbers. We are going to win this race with a clear majority of the nation behind us. We have gotten over 74 million votes. Let me repeat that, at 74 million votes, that is more than any president ial ticket has ever gotten in the history of the United States of america. And hour vote total is still growing. We are beating donald trump by 4 million votes, and that is a margin that is still growing as well. One of the things im especially proud of is how well we have done across america. And we are going to be the first democrat to win in arizona in 24 years. We are going to be the first democrat to win georgia in 28 years. And we have rebuilt the blue wall, in the middle of the country, that crumpled just four years ago. Pennsylvania, michigan, wisconsin, the heartland of this nation. I know watching these vote tallies on tv moves very slowly, and as slow as it goes, it can be numbing. Talliesr forget, the are not just numbers. They represent votes and voters. Exercise theirho fundamental right to have their voice heard. Record numbers of americans of all faiths and religions shows change over more of the same. They have given us a mandate for action on covid, the economy, climate change, systemic racism. They made it clear, they want the country to come together, not continue to pull apart. The people spoke. More than 74 million americans. And they spoke loudly for our ticket. But while we are waiting for the final results, i want people to know that we are not waiting to get the work done and start the process. Yesterday senator harris and i held meetings with groups of experts on Public Health and the economic crisis this country is facing. The pandemic, as you also know, is getting more worrisome all across the country. Delhi cases are skyrocketing. And it is daily cases are skyrocketing. It is now believed we could see a spike of 200,000 cases in a single day. The death toll is approaching 240,000 lives lost to this virus. Empty chairs at kitchen tables across america. We will never be able to measure that pain and suffering and loss so many families experienced. We know something about what it feels like to lose someone, and i want them to know they are not alone. Our hearts break with you. We want everyone, everyone to know on day one, we are going to put our plan to control this virus into action. We cannot save any of the lives lost, any of the lies that have been lost, but we can save a lot of lives in the months ahead. Senator harris and i also heard yesterday about how this recovery is slowing, because of the failure to get the pandemic under control. More than 20 Million People are on unemployment. Millions are worried about making rent, and putting food on the table. Our economic plan will put a focus on a path to a strong recovery. Look, we both know tensions are high. They can be high after a tough election, one like we have had. But remember, we have to remain calm, patient. Let the process work out, as we count all the votes. We are proving again what we have proved for 244 years in this country, democracy works. Your vote will be counted. I do not care how hard people try to stop it. I will not let it happen. That people will be heard. Our journey is toward a more perfect union. And it keeps moving on. In america, we hold strong views, we have strong disagreements, and that is ok. Strong disagreements are inevitable in a democracy, and strong discreteness are healthy. They are a sign of a vigorous debate, of