Dr. Galia Barkai of Sheba Medical Center: “The clinician needs the proper infrastructure to be a telehealth provider”

The clinician needs the proper infrastructure to be a telehealth provider. Make sure you have the proper setup for telemedicine: a computer with a high-quality screen and sound, good lighting, a neat and welcoming setting and most importantly, that you are using a platform that’s easy to use and reliable. One of the consequences of […]

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The clinician needs the proper infrastructure to be a telehealth provider. Make sure you have the proper setup for telemedicine: a computer with a high-quality screen and sound, good lighting, a neat and welcoming setting and most importantly, that you are using a platform that’s easy to use and reliable.


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 interviewing Galia Barkai, MD MBA.

Galia Barkai, MD MBA is the Director of Sheba BEYOND, Israel’s first virtual hospital. Dr. Barkai serves as the director of the Pediatric Infectious Disease Unit at Sheba Medical Center, as well as the head of Sheba’s telemedicine innovation hub, ARC. Dr. Barkai completed her training in Pediatrics at the Kaplan Medical Center in Rehovot, specialized in Infectious Diseases at the Soroka Medical Center in Be’er Sheva, and holds an MD and MBA (with distinction) with a specialization in health systems management from Tel Aviv University.


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?

If you had asked me five years ago where I would be today, I would never have dreamt that I’d be running a virtual hospital. I was a pediatrician, and the Head of the Pediatric Infectious Disease Department at Sheba Medical Center, when by chance I ended up at a hospital meeting on telehealth in 2017.

Professor Yitshak Kreiss, Director General of Sheba Medical Center, was running the meeting and my manager, Professor Asher Barzilai wasn’t able to attend, so I went in his place. I don’t know what I said in the meeting that got his attention, but Prof. Kreiss decided then and there that I was going to run the new telehealth project he was initiating at Sheba.

I was subsequently appointed head of all telemedicine projects in Sheba, and we managed to develop several telemedicine services — but not until COVID-19 did telemedicine really become medicine, and during the pandemic we took a big leap forward. We realized that Sheba — and the entire world — was ready to go further and open a new virtual hospital, and I was tasked with establishing it. I told Prof. Kreiss that not only will I help develop Sheba’s virtual hospital, but I also want to manage it. And so, Sheba BEYOND was launched in October 2020, and I am privileged to be its director.

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

When an opportunity comes your way, first say yes. First take it and then see how you are able to do it — this is a mantra that’s helped me succeed. Once I have already said yes, I somehow manage to do it, thereby pushing the bar higher every time. I don’t want to let any opportunities slip between my fingers.

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’m really grateful to Prof. Kreiss — he didn’t know me yet chose me to be the lead of telemedicine. At the onset of COVID-19 when Sheba Medical Center received the first patients from the Diamond Princess cruise ship, Prof. Kreiss pointed out to me that I now had the opportunity to use all the telehealth tools I had been learning about. Sheba proceeded to create a technology-based ward for the Diamond Princess patients and appointed me to create a new model for treating COVID patients.

When former Minister of Health Yaakov Litzman came to see the COVID ward, Prof. Kreiss had me present to him all the telehealth technology that we were using. I owe Prof. Kreiss a lot for trusting me, giving me the necessary tools and helping me achieve this goal.

I also am eternally grateful to Hadar Amir, who works with me in business development. Hadar has helped me create the whole Sheba BEYOND concept, and without her I wouldn’t be able to do any of it.

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 is a lot you gain from face-to-face appointments both on the clinical level and the physician-patient relationship level. Being able to put a hand on a patient’s shoulder or offer them a drink are small gestures that can show patients you care, as well as help ease anxieties often accompanied when visiting the doctor.

In addition, when a patient is with you physically, you can see things that are not visible on screen — you can observe how they walk into the room and sit down, you can assess their entire physical appearance and you can notice if they are emitting any odors that may be indicative of medical issues.

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?

As a physician I completely understand the challenges of telemedicine — we were born and raised to practice medicine in the traditional setting and therefore it’s crucial to know our limitations.

On the technical level, sometimes you can’t see or hear the patient well, the internet connection can go out in the middle, etc. In addition, you can’t perform a complete physical exam remotely even though we have available tools to do partial exams. And, as I noted above, physicians observe patients outside of the actual examination, which can be very important.

All these issues aside, there’s just something in the atmosphere when people are in the same physical space and there’s no way to duplicate it.

At Sheba BEYOND, we are aware of these disadvantages and therefore most of our services are hybrid, combining physical examinations and telemedicine. Just like many offices have adjusted to a hybrid work schedule of working some days from home and some from the office, every telehealth provider needs to find the right balance.

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.)

  1. Each clinician should have guidelines for his field to know what is and what is not allowed in a telehealth session. It’s important to determine in advance the limits of telehealth — what can and cannot be done virtually and therefore in which cases you need to see the patient in person.
  2. The clinician needs the proper infrastructure to be a telehealth provider. Make sure you have the proper setup for telemedicine: a computer with a high-quality screen and sound, good lighting, a neat and welcoming setting and most importantly, that you are using a platform that’s easy to use and reliable. Additionally, there should be a system in place to digitalize scheduling and automatically create follow up appointments as necessary.
  3. Beyond the actual set up, the clinician — as well as the patient — needs to be properly prepared for each meeting. The physician should check the patient’s files beforehand, make sure the room is quiet, the door is closed and that the internet connection and everything technical is in order. The patient should be sent a checklist to check before the meeting which should include: sending any requested tests or files to the doctor, checking connectivity, having a quiet room by themselves, preparing any questions for the doctor and a writing tool to take notes. It’s advisable to use a video call platform that allows the patient to test their connection beforehand.
  4. In the beginning of the call, clinicians should make sure that the patient can hear and see them well, and should present a rough framework of the meeting: the goal of the session, approximately how long it will take, what the patient needs to do during the call, etc.
  5. At the end of the call, the clinician should repeat any necessary explanations or directions to ensure they are very clear, make sure the patient has no questions, and if relevant, give the patient exercises to work on at home. It’s also important for the patient to know that they can always physically come into the clinic if they would like (when relevant).

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 allows you to take care of anyone, anywhere. We can help patients that lack proper medical care, or provide otherwise inaccessible specialist for patients in the periphery. Additionally, even for patients that are somewhat near medical facilities, the convenience of it is a huge factor — according to a survey performed by Amwell, telemedicine visits saved patients 100 minutes per appointment. Eliminating transportation costs is also something to be considered.
  • The home setting is the best setting for many kinds of treatments. For example, occupational therapists are there to help you rehabilitate and learn to function in your own setting. When patients come to the hospital for their occupational therapy, they are actually learning to function in the hospital instead — the best place for the therapy is in your home.
  • Another good example is the observation of children in our Child Development Center. When children come to a clinic for an evaluation, they may be shy or intimidated and may not cooperate much. During COVID lockdown, when we had to evaluate children remotely, they were able to play with their own toys in their own homes and seeing them in their natural environment really provided us with extra value.
  • In the home, when there is remote monitoring technology in place, we monitor patients continuously and thereby collect a lot of information in between appointments — which is solid, objective data rather than relying on patient self-report. An added benefit is that having all the data in one digital database allows everything to be synchronized — doctors can view data directly on a cloud rather than having to for example, manually download it from an insulin pump.
  • In addition, when you hospitalize patients at home, it prevents all the complications that can happen in a hospital: secondary infections, delirium, falling and many others. Especially in the case of psychiatric home hospitalization, allowing the patient to be in their own home is part of the healing process.

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?

At Sheba we’re privileged to have many telehealth tools at our disposal, many of which were developed in ARC, our on-campus innovation hub. Some of the main telehealth technologies we use are:

Datos: An encompassing easy-to-use telehealth platform designed to directly connect patients with medical sources of care from the comfort of their own homes.

TytoCare: Atelemedicine technology that allows us to perform physical examinations of the heart, lungs, ears and throat and to remotely communicate by video; it’s a very powerful tool.

Early Sense: A contact-free continuous monitoring device that is placed under a patient’s mattress and monitors respiratory rate, heart rate and motion.

PulsenMore: An ultrasound device that can be operated by pregnant women in their homes, directed remotely by their OB-GYN.

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

I would love to give patients the ability to connect to their physician just by speaking to their phone. Instead of talking to Siri, the patient will have a voice-operated app that through voice command, a screen will open showing them a hologram of the physician and enabling a virtual appointment without having to touch anything. In addition, patients should have a device that will be able to monitor everything — blood levels, vital signs, feelings, etc. There are actually devices like these currently in development.

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?

Iam particularly excited about Well-beat, a comprehensive SaaS patient-engagement solution that utilizes machine learning algorithms and behavioral science to support healthcare organizations.

I’m also really excited about the VRthat we’re starting to use in telehealth at Sheba as well as AR which we’ll be using in the future. We’re already using tools like HoloLens that help us perform virtual training.

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

I’m concerned about losing the human touch. As I mentioned earlier, I believe that there has to be a balance between telehealth and physical face-to-face examinations. In the future we’ll know how to find the exact balance — but it’s important that we don’t get too much into virtual medicine and using computer analysis or decision-making using AI that we lose the contact with human beings. I do believe ultimately the medical community can balance it, but the concern is there.

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. 😊

I would like to promote interconnectivity of data and people from the ecosystem. Connecting different fields between the whole ecosystem throughout the globe will promote high-quality, personalized medicine and transform the way healthcare will be delivered in the future.

How can our readers further follow your work online?

Please follow Sheba Medical Center through our website and corresponding social media platforms:

Facebook

Instagram

LinkedIn

This was very meaningful, thank you so much! We wish you continued success!

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