For doctors, familiarize yourself with the technical aspect of the telemedicine platform you are using, because a component of ‘good patient care’ now is being able to help patients navigate the medical appointment. Just like you need to know how to use a stethoscope or reflex hammer, part of our clinical training now is to be 100% familiar with the technology we use.
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 interviewingDr. Angela Fusaro.
Dr. Fusaro is an Emergency Medicine physician and co-founder and CEO of Physician 360™. An on-demand telemedicine platform, Physician 360™ offers rapid tests for ear infections, strep, UTIs, flu, COVID and more so you do not have to visit germ-filled doctor’s offices or urgent care clinics. The tests are done at home, or at your community pharmacy, and if needed, a prescription can be filled via your telemedicine session.
A pioneer in healthcare innovation, Dr. Fusaro recently served as a faculty member at the Emory University School of Medicine, where she designed and implemented two entrepreneurship courses for medical students and led a national workshop. The practicum helps physicians translate clinical insight into marketable products that can save, and improve the quality of, patients’ lives. She also has extensive leadership experience in organized medicine, driving business development for the Emergency Medicine Residents’ Association (EMRA), the second largest emergency medicine organization in the world.
She currently sits on the boards of numerous national organizations, including Hygeia Health and Girls on the Run Atlanta. Dr. Fusaro received an MBA from Goizueta Business School and was a 2017 Poets & Quants recipient.
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 grew up in Connecticut and my friends would have guessed that I’d be a lawyer, but I was good at math and science. In selecting my undergrad school, I drew a 500-mile radius around my hometown and decided to apply outside that boundary because I wanted to explore the world. I went to a large public high school and had never heard of Emory, so that is what I chose. I took pre-med classes, but wasn’t a person who was “destined” to be a doctor. I took time off after college, was a teacher in California, and lived abroad in Central America and volunteered. My mind kept coming back to becoming a physician, so I applied to medical school while on a chicken bus in Guatemala. I got in to New York Medical College. I was the first woman in my family to go to university and first person to go to medical school, so this was a whole new adventure. Yet again, after I got into medical school, I deferred for another year and got a job with the Michael J. Fox Foundation. When I went to med school I chose Emergency Medicine as my specialty because I like tactical interventions where I can be really impactful. In residency (at Carolinas Medical Center in Charlotte, North Carolina) I was involved in health policy and then came back to Emory as a faculty member in the School of Medicine. It was fortuitous that we had a collaboration with the Georgia Tech Biomedical Engineering Department, so I went from a policy focus, what needs to be fixed, to an innovation focus, how to fix it. Real world actionable solutions. I completed my MBA with the intention to start an incubator for doctors to translate healthcare insights into working realities. I saw gaps in healthcare and wanted to fix the gaps. I started a series of workshops, and it was there I met my future business partner for Physician 360™, where we re-imagined the practice of urgent care. We saw so much wasted time, such as a patient waiting for 6 hours to get a throat swab in the ER. I was inspired by the home pregnancy test. Why aren’t there other tests like that? Pre-COVID, testing outside of a traditional healthcare setting was a mind-blowing idea.
There are lots of ways to increase access to care, but we went to pharmacies. The pharmacy footprint touches all communities. We married telemedicine and rapid tests and overlaid that with pharmacies and transformed them into functional urgent cares.
Can you share the most interesting story that happened to you since you began your career?
In Emergency Medicine you see the best and worst of humanity every day. I have had shifts where I was both the first person someone sees after birth, and the last person they see before death. Just the other week, a guy brought in a live bat in a plastic bag. I had to release it outside. That doesn’t happen every day.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Vince Lombardi says, “The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack of will.
I like that quote because I get asked a lot ‘What’s the secret sauce to entrepreneurship?’ What I have learned, there isn’t one. You have to have the ability to just figure it out. Just grit and determination.
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?
I have an awesome community of friends and family that show up for me on the daily in different ways. Whether it’s P360’s first investor or my dog walker, each member of my community (furry friends included) has helped me navigate the reality of building something out of nothing. My life, and the impact I am trying to make on the world, would be a fraction of what it is today without each of them.
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?
There are Intangible cues we learn to look for in patients. You can physically see all of them when you’re in front of a patient. What is their gait like? Are their shoes untied because their feet are swollen? You see a pattern. Telemedicine will become “medicine” so we are going to have to train ourselves to pick up on cues in a new way. It’s easy to overlook in a digital encounter because we haven’t been trained. It will normalize with training and there is now telemedicine education in some med schools and residency programs.
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?
I would again say the challenge is not being trained to see the cues via telemedicine. A lot of medicine is pattern recognition. The inputs are a little different in a digital encounter. We have to learn to know what to ask to see, or what to look for, in this new setting.
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.)
- Thinking through your practice, what are the elements of the physical exam that will be different in a digital encounter? Identify them ahead of time and make a digital check list so no detail is overlooked.
- For doctors, familiarize yourself with the technical aspect of the telemedicine platform you are using, because a component of ‘good patient care’ now is being able to help patients navigate the medical appointment. Just like you need to know how to use a stethoscope or reflex hammer, part of our clinical training now is to be 100% familiar with the technology we use.
- Be proactive and ask your patients to set up their user profiles and access to their patient portal before they need to use it. Do it ahead of time so there is less stress for the patient during the actual appointment.
- Make sure privacy is still protected. The doctor can do that on their end, but advise the patient to be aware of their environment.
- The regulatory landscape is constantly changing. Have a reliable, up-to-date resource for compliance.
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?
Telemedicine provides access to patients and families who have often been marginalized, especially rural communities. Telemedicine can reach patients of all socio-economic levels and makes healthcare more equitable. Also, with telemedicine, your loved ones can participate more in your care. For example, it’s not always achievable for an adult child to miss work and attend medical appointments in person with elderly parents. But now they have access to your healthcare, which allows patients access to an advocate and a second set of ears and eyes which helps with compliance.
COVID has forced us to reanalyze laws around telemedicine. Reimbursement for care was broadened, which greased the wheels for clinicians being more open to try it. Now the questions are: What are we going to take away from the pandemic experience to retain all of the good we learned? How do we re-imagine the reimbursement process long term?
There was a lot of capital infused into the digital health ecosystem. It is great that we are seeing our health innovators, data scientists and all who are building lifesaving solutions being supported.
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?
Our goal with Physician 360™ is for patients to have a comparable virtual experience to a traditional in-person visit. Our way to achieve that is to pair software with testing. If a patient can take a UTI test and interact with the doctor through telemedicine and be treated, we have kept minor ailments out of the ERs and Urgent Cares, which are more expensive care centers. The tools come in many forms, some are software, some are hardware, some are tests, but universally it is the combination of these tools that allow us to create a comprehensive virtual health clinic.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
The tests, tools and features we’re adding now address the ongoing desire to be more inclusive. Inclusivity comes in a variety of forms; that means addressing different disease processes. Some patients are 7 years old; some are 77; it means a user experience that encompasses the tech prowess of both. It also means an accommodating price point for everyone. Insured, uninsured? Ideal is a system that works streamlined to accommodate everyone.
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?
The biggest part is preparedness. Set up beforehand and read instructions carefully. Digital health is still relatively new, so some of the nuances may not be obvious to the patient. Follow directions without deviation.
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?
Technology is going to substantially individualize the practice of medicine. There are some disruptive solutions in the fields of personalized healthcare that I am excited about; specifically, the microbiome will play a big role in new diagnostics that can detect relevant microbe imbalances and new therapies to correct imbalances. We have learned that your gut bacteria may impact everything from obesity to your choice of spouse. I think technology that focuses on mapping the microbiome will play a large role in the next decade of healthcare.
Is there a part of this future vision that concerns you? Can you explain?
For this revolution to continue, we need every stakeholder facilitating the process in the same cadence. If regulatory standards lag, or clinician adoption lags, then you have a bottleneck in the process. We need every stakeholder to evolve as quickly as the others.
We also do not necessarily want to facilitate the robot apocalypse. Tech should be facilitating human connection, not replacing it. Let’s have the best of technology, but not tradeoff the human connection.
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. 🙂
This is a hard one! I would have to say I would start a campaign to instill radical empathy. Until the day when there are no disparities, compassion is the great equalizer. Until we live in a world where there are no external challenges (natural disasters, disease, etc.), we have to turn inward and support each other to find solutions.
Every challenge we have faced as a human race is made more complicated if there is a lack of empathy. So I guess rather trying to solve any one of the triggers, I would try to improve our response.
How can our readers further follow your work online?
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.