Ash Shehata: “Telehealth needs to deliver value”

Telehealth providers need to focus on improving the patient experience. Healthcare providers, health plans, and tech companies are looking to telehealth as a patient access program and a growth vehicle. If the delays are long and the level of care is inadequate, the sector has matured enough where competition is a click or swipe away. […]

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Telehealth providers need to focus on improving the patient experience. Healthcare providers, health plans, and tech companies are looking to telehealth as a patient access program and a growth vehicle. If the delays are long and the level of care is inadequate, the sector has matured enough where competition is a click or swipe away. It is important to build that loyalty and connection with customers.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewingAsh Shehata.

Ash is a highly experienced healthcare professional at the cutting edge of information technology (IT) advances in the sector. In a career spanning over 35 years, he has worked for some of the world’s leading IT and consulting firms, using technology to drive improvements such as telemedicine, e-commerce, membership systems, customer service and healthcare management. As KPMG’s national sector leader for healthcare & life sciences, Ash has a proven record in leading teams to develop innovative, compelling, and transformational solutions for an array of healthcare organizations.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I’m KPMG’s National Sector Leader for Healthcare & Life Sciences and served on the firm’s Global Healthcare Center of Excellence panel to address some of the major issues health systems around the world are facing. In the United States, I have advised healthcare providers and health systems for the firm since I joined in 2012. I have worked at technology companies, health plans and hospital systems before joining KPMG. I led Cisco System’s healthcare practice for the Americas for nearly seven years in my prior role.

Can you share the most interesting story that happened to you since you began your career?

When I was at Cisco, I appeared in segment on the Discovery Channel program called “Future World” that was shown around the world about a decade ago featured the company’s HealthPresence platform. We were imagining what the world would be like with connected medical devices, video consults and electronic health records, but now it’s real. I was included in the segment, which was shown around the world. The platform was used for Cisco employee clinics, as well as by medical professionals in the U.S. It was an exciting time to be part of the tech industry to help the economy, which was suffering during the financial crisis, but helping to drive innovation in industries like healthcare.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“The world is not getting better by itself. Making the world a better place demands more and better leaders.” — Rosabeth Moss Kanter, author of Think Outside the Building: How Advanced Leaders Change the World One Smart Innovation at a Time.

This was especially relevant to me in graduate school and early in my career.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

When I was at grad school at Xavier University, my internship was with Terry White, who was the CEO of the University of Cincinnati’s health system. He gave me an assignment: Spend the next six months getting to know the organization. I visited nurses, spent time in the operating suite, going to central supply. I had to report to him once a week with my observations and it was a rewarding opportunity to learn about the organization. We would ride the elevators together. We saw interactions of employees and patients. After that six months, the assignment was then changed to solving the organization’s problems and that is how I started my executive management career.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

We need to make the patient experience and that clinical relationship much more accessible. A patient-doctor relationship is normally a bit resistant. Improving the patient experience would entail taking technology to help ease that resistance and make the patient much more likely to engage the medical profession. For many younger individuals or people who are home-bound, telehealth is a great way to reduce the barrier to care.

Telehealth provides convenience to patients and sometimes equivalent care to an in-person visit. In the current pandemic or even during a bad flu season, it can have a role in mitigating infection risk and expanding access to non-emergency, urgent care. In the case of dermatology, the use of telemedicine combined with AI can be very powerful in cancer screening. Behavioral healthcare has also gained a significant foothold in the world of telehealth. We see a lot of opportunities around follow-up care, wellness, and nutrition.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

Clinicians are used to knowing patients. The initial telehealth consults are sometimes not easy to start. The challenge will be building data & analytics platforms for a foundation to make the initial consult less awkward. To make a parallel with the consumer digital world, had to adapt its dating service in the pandemic with the notion of virtual dates. Now what could have been an electronic barrier has become an electronic enabler. Healthcare needs to consider a similar approach for telehealth.

There are an abundance of situations where in-person care has advantages over telehealth in care delivery. For example, doctors and clinicians need to sometimes listen to lung sounds to strengthen a diagnosis and that is something that should not be trusted to poor-quality Internet connections. In-person medical appointments have an advantage particularly with injuries. Telehealth can have a role in EMS and is sometimes necessary for a doctor to guide care, but you still need a trained EMT to provide hands on treatment. Also, orthopedists can get a better diagnosis when testing the range of motion for an injury. This goes without saying that bloodwork and certain imaging scans also need to be done in person.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You? (Please share a story or example for each.)

I’m not a physician, but I’ve worked with clinicians across the country to create a digital front door for hospitals and health systems. Payers and providers have been positioning their telehealth platforms for use as the healthcare system returns to a “new normal” as more people get vaccinated. We have the following suggestions to get the most value from a telehealth program.

  1. Telehealth providers need to focus on improving the patient experience. Healthcare providers, health plans, and tech companies are looking to telehealth as a patient access program and a growth vehicle. If the delays are long and the level of care is inadequate, the sector has matured enough where competition is a click or swipe away. It is important to build that loyalty and connection with customers.
  2. Barriers between telehealth and in-person care need to be reduced. A telehealth consult cannot be an isolated Skype or Facetime call and these visits need to be integrated with a patient’s broader electronic health record. A telehealth consult may be a red flag for a chronic health issue, so it is important to have a 360-degree view of the patient so clinicians can make more informed treatment decisions.
  3. Telehealth needs to deliver value. Telehealth can offer convenience to patients and potentially improve productivity of providers. There is also something to be said where telehealth providers start specializing in certain disease categories, such as diabetes or heart failure. Some disease management programs have been engaged in a variation telehealth for decades, but the technology — especially video — has become more sophisticated and allows for more meaningful engagement with patients. If a telehealth visit can identify a potential problem and lead into an intervention before it becomes an emergency, it really shows its value.
  4. To amplify beyond that point, some health insurers are making telehealth part of their offerings to consumers. This can reduce friction about the coordination of benefits and access to care. The telehealth provider has claims information that can be used to identify patterns of treatment, prescriptions and when a patient is seeking care. The information can inform the clinical decisions being made. The health plan’s telehealth platform can offer treatment and steer the patient to the most clinically appropriate and lowest cost option. For example, a telehealth consult might steer a patient to an urgent care clinic for non-emergency care that cannot be handled remotely rather than an ER, which is more expensive for both the health plan and patient.
  5. Telehealth started to take root in response to the worst health emergency in the U.S. in more than a century. It should be refined for future emergencies and embedded into routine care. I think the foundation that we’ve built to mitigate infection risk will serve America’s health system very well, if there is another major health emergency. It doesn’t have to only apply to a pandemic. Telehealth can be deployed in more localized emergencies, such as chemical, radiological or biological contamination or other situations that impede the use of an area hospital. In remote settings, telehealth is often the norm. We helped create a virtual care system that served ships and oil rigs in the North Sea because you cannot always get helicopters to treat patients in the stormy weather.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Access to care or medical specialties is an area where there is a clear advantage. Some regions have shortages of professionals. Telehealth is an important part of the continuum of care, where patients need to get treatment at the most appropriate source. We’ve had telemedicine — clinician-to-clinician consultations — for decades, which has been helpful where medical specialists aided with care being delivered in remote locations or areas where specialists may be in short supply. The U.S. Navy was a pioneer in the use of telemedicine decades ago.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

This is an emerging field of care, but more and more tools are being developed to aid in remote monitoring for patients with chronic conditions. Blood pressure cuffs, pulse-ox readers and other tools can be connected to the platform and give the provider real-time readings. 5G capabilities will also enhance the potential for a more connected healthcare delivery system.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

The ideal platform would provide high resolution images and integrate with both an electronic health record and benefits platform to make the function as seamless as possible. What is most important in the mix is a healthcare provider asking the patient the right questions to get the correct diagnosis and treatment plan, while showing compassion and concern.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

Patients have more information at their fingertips than ever before. That is both a good and bad thing. The quality of health information is abundant but widely varying in quality. Patients can be their own best advocate from the right sources. They can be their own worst enemy if the information is incorrect or taken out of context from the range of symptoms being displayed. Patients need to have an effective dialogue with to make sure the doctor/nurse practitioner/physician assistant can make the best-informed decisions.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

We started to see omni-channel systems emerge with different technologies and call centers, using voice, video and text to help with scheduling and patient triage. The excitement about AR, VR and mixed reality will be that it will come from a combination of medical devices, telecommunications, diagnostics, healthcare providers and tech firms to create medical diagnosis tools that will have a multi-channel technology. We’re starting to see VR introduced for pain management and for simulations in Parkinson’s and migraine therapies. These technologies will also be helpful in ambulances, mental health and medical education. 5G technology will have a hand in connecting the technologies together and there will be some big changes, since phones and devices will be incorporating the expanded bandwidth across multiple modalities. If you think about older video game systems that used exclusive cartridges or CD/DVD programs have now evolved to become broadly available via the cloud on any mobile device. We’ll see telehealth undergo a similar transformation.

Competition from these new technologies will show that you cannot rest your laurels in telehealth and that you need to keep pace with what’s new. Some of these technologies will need to be proved in academic environments, but there is a great deal of excitement about the possibilities.

Is there a part of this future vision that concerns you? Can you explain?

Technology is merely a tool. We should not forget that. The use of telehealth with AI and electronic health records can not only be prescriptive but predictive when it comes to health. No matter how much technology you draw into the delivery of care, our humanity makes us unique and sometimes we are not easily pigeon-holed into an algorithm. Sometimes social and environmental factors change the trajectory of how a patient responds to treatment. So virtual care is important in improving access to care, but ultimately the caring element is more important than the technology.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Never underestimate the power of America’s consumers and they can be a force to improve healthcare, which is on its way to absorbing one of every five dollars spent in the economy. We pay more for healthcare than other nations and our outcomes — despite pockets of excellence — are middling. There is a big opportunity to engage consumers in healthcare and make it as accessible as how we shop, travel, entertain, and conduct financial transactions. Right now, there is too much disintermediation between how healthcare is paid for and the service being delivered, which creates a lot of waste and dissatisfaction. As an industry, healthcare has lagged other sectors when it comes to engaging consumers. With emerging technologies such as artificial intelligence, cloud computing, and telehealth, a more connected healthcare system can improve access, engage consumers better, prevent gaps in care, and lead to better medical outcomes.

How can our readers further follow your work online?

You can follow me on LinkedIn or see the KPMG’s Healthcare & Life Sciences Institute page.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

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