In a recent episode of Agent of Influence, I talked with Anubhav Kaul, Chief Medical Officer at Mattapan Community Health Center near Boston about not only some of the medical challenges they are facing during COVID-19, but also some of the software and security challenges. I wanted to share some of his insights in a blog post, but you can also listen to our interview here, on Spotify, Apple Music, or wherever you listen to podcasts.
COVID-19 Impacts on Telemedicine
Telemedicine has been available and used for multiple years and takes many different forms. For example, your doctor calling you on the phone and updating you on your results is telemedicine, receiving results through an electronic portal is telemedicine, or receiving feedback from your provider over a text message platform is telemedicine.
However, COVID-19 has drastically changed many doctors’ reliance on telemedicine to be the primary platform for how they provide care to their patients. According to Kaul, 90 percent of care being delivered by Mattapan is currently being delivered via telemedicine, including treatment of chronic conditions and urgent concerns. This has been made possible largely because the payers, both public and private, recognized the essential need of working in the current climate and have been able to help Mattapan receive reimbursement for providing telemedicine-based care.
The challenges Mattapan is currently experiencing are mostly around adoption of video and phone technology enabling remote treatment, since many clinicians have never had training on how to conduct effective telemedicine appointments.
In addition, while there is a tremendous amount of care that can be provided to patients without physically seeing them, the ability to be in the presence of patients and evaluate them in person is sometimes irreplaceable. In part to combat this challenge, Mattapan is leveraging medical devices to help manage certain conditions by patients from home, many of which automatically send data directly to doctors as it’s collected, including devices to measure blood pressure, glucose, weight, and more.
Kaul has also noticed that doctor-patient relationships, like so many relationships, are struggling with the lack of social connection, one of the most gratifying parts of providing care in person. With new technological developments, people are in general more distracted by their technology from the person right in front of them, including doctors when seeing patients. This may even be exacerbated as doctors leverage telemedicine to provide treatment and try to connect with patients over video and phone.
Staying Secure While Providing Remote Treatment
Providers have always had to focus on ensuring their communications with patients are secure and HIPAA compliant. Many clinicians want to provide the best care to their patients, which may sometimes mean giving out their cell phone numbers to patients or texting their patients to allow for accessibility of care. While they have every intention of doing the right thing for the patient, these are not necessarily considered safe modes of communicating with patients. They may be easy and accessible, but there is a level of risk when it comes to using unofficial platforms.
Using encrypted emails and online patient portals to send text messages are more secure options, even if they may not be as convenient for clinicians and patients.
Even outside of a pandemic situation, doctors and clinics will always face this security challenge that sometimes stands in conflict: trying to protect the patient’s information and trying to protect the patient’s health by providing accessible care. And at the same time, not putting themselves or their clinic at risk when using unsecure modes of communication.
Mattapan uses Epic, an Electronic Medical Record (EMR) system that is integrated with Zoom technology to provide telemedicine via video and which allows patients to send pictures that are then uploaded into their patient portal and medical record. However, most visits will continue to be phone-based, primarily because of accessibility. While getting people to adopt new technology is always a challenge, Mattapan is working to increase video adoption to give all their patients the full functionality that that medium provides.
As Mattapan and clinics around the world leverage new technology and medical devices to treat patients remotely, they don’t necessarily know the security threats these technology solutions pose because they’ve never used them before, especially to this extent. While hospital IT and security teams are working to quickly test and set up these systems, there are risks associated.
As a clinician, Kaul is not necessarily constantly thinking about security risks, but more about the most accessible way to provide care to Mattapan’s patients. He sees this time as presenting an opportunity in the market for telemedicine software solutions and medical devices, so that doctors can continue to treat patients remotely – and even offer broader and improved treatments.
I’ve completed a fair number of security assessments for electronic medical devices and organizations that build hardware leveraged by doctors, and in my experience, doctors hate security because it interferes with their ability to conduct the job at hand. And in certain cases, the job at hand takes significantly higher priority than the potential security risks. For example, I don’t think any doctor wants to have to enter a password before they can use a surgical device, because sometimes every second matters when it comes to the life of a patient.
Increasing Challenges of Patient Authentication
Another challenge when it comes to treating patients remotely is that of patient authentication. For example, you may be trying to monitor the blood pressure of your patient and you send them home with a device that’s continually sending data back, but how do you know that data is for your patient and not their child, sibling or someone else? Kaul acknowledges that there’s no easy way to authenticate this and it’s very easy for patients to cheat the system if they want to. These are challenges that need more focus and attention, of which they’re probably not getting right now because usability is taking a much higher priority than security.
Mattapan is focused on making sure any patient interactions they’re having are as reliable as possible, especially during this time. However, there are unique challenges. For example, sometimes they rely on talking with family members of people who can’t speak English, but maybe that family member doesn’t have full jurisdiction about their health care information and making decisions about their health care. These types of scenarios are opportunities for software and medical device companies to fill, but they may not be given the highest priority at this time.
Prescribing Prescriptions Virtually
Doctors have long been able to electronically prescribe most medications, but during the COVID-19 pandemic, they are also allowed to prescribe other medications that previously required a paper prescription, including controlled substance pain medications, certain psychiatric medications, and medications meant to treat addictions.
Being able to prescribe controlled substances electronically has made the process more accessible, especially in these current times, but it has also added security challenges. These challenges include making sure that the patient is properly identified, and they are receiving the prescriptions in a secure manner from the pharmacy. This level of accessibility is great for the patient and for the provider, but certain guidelines have been adopted to make sure this is done in a standardized fashion and to make sure that doctors are still connecting with these patients over the phone or video to see how their care is going, whether it’s for pain management or treating them for addiction-based disorders.
During these uncertain times, doctors and hospitals are working to increase accessibility of care, but with accessibility comes the responsibility of making sure that parameters of appropriately treating patients are in place – along with the appropriate security measures.
To listen to the full podcast, click here, or you can find Agent of Influence on Spotify, Apple Music, or wherever you listen to podcasts.