 Welcome, welcome to Think Tech Hawaii. My name is Vikram Acharya. I'm proud to be on the show, happy to be on the show. This is a very special episode today. The subject is telehealth in Hawaii. There's been a lot of talk about telehealth, especially during the COVID-19 pandemic, people wondering, what is telehealth? What does it do? How does it work? And so to answer a lot of these questions today, I'm very happy, very pleased to introduce my coworker, colleague, and friend, Dr. Neil Chauhan. Hi, Vik. Thanks so much for having me on. I'm excited to talk about telehealth. Thank you, Neil. Thank you. When it comes to the subject of telehealth, I cannot think of a better expert on the matter than Dr. Chauhan. And to kick things off, Neil, tell us a little bit about your background. You have an extensive background as a physician, but also in telehealth. Why don't you walk us through it a little bit? Sure. Yeah. So as you can probably tell from my accent, I'm from England. So I did all my training over there. So I'm an amni-medicine physician by training. I had a bit of an unusual course, really. So I started doing urgent care very early, which is a little bit different from the US urgent care, where we really try and keep people at home, rather than them kind of getting into hospital under the National Health Service. And I kind of had my first, well, the beginnings of my kind of telehealth career around that time, we would do a lot of things like remote triage, telephone type consultations. I then did a stint in Canada for a year, year and a half. And then from there, I came to Hawaii. And this was gosh, six, seven years ago to be with my wife. And kind of the telehealth part of things has been serendipitous. So when I moved to Hawaii, was kind of around the same time I was asked to help with a startup telehealth company. And this was, like I said, about six, seven years ago. I'm a very small company. And we were just starting in this kind of telehealth and video consultations. I think I was a second or third clinician to join. And now it's probably the biggest telehealth company in Europe. We see thousands of patients, probably 1,000 patients a day. And it's just a hugely evolved service. And it's just been very interesting to see how things started pre pandemic and how things have been during the pandemic. And that's kind of where we bring Cloudwell. So it was through that experience. And my co-founder, Dr. Cedric Strong, we were neighbors at the time when I moved here. And we were talking about how can we help the local community when it comes to health care? We have certain challenges in a geographical isolation or remote locations. We have a shortage of physicians, long wait times. And with my experience in telehealth and his experience working on all the islands, we thought about creating a telehealth service here. So that's where we began. That's really great. That's really great. Now for the people who may not know, in the simplest form, what is exactly telehealth? There's a lot. Obviously, people are using it more now. But for someone who's thinking about using it for the first time in Hawaii, can you walk somebody through it? Yeah. So I mean, in the simplest form, it's using digital communication to provide health care. And translated, that would be for our services, the ability to do video and telephone consultations from anywhere. As long as you've got the technology, a phone, a tablet, a laptop, you're able to connect with a clinician and get the health care that you need. So it's that convenience factor. It's the access, mitigating or removing some of those barriers that otherwise are present when it comes to bricks and mortar type practice. And it's basically an in-person visit. It's the quality of the visit, making sure that as a physician, you have all the information on the patient. It's essentially the same. Exactly. I'd say about 80% of what you see in person as a primary care physician or as a family medicine doctor is what you can manage using telehealth, vast amounts of stuff that you can manage. And actually, there's clearly benefits. There's not every complaint or issue can be managed with telehealth, but vast majority can. And that easy access, the convenience piece of it and just how quickly you can get an appointment makes a huge difference. Yeah. I would think that, especially with the significant demand for mental health services, something like telehealth and cloud well health, we'll be able to get patients the services they need fairly quickly, right? Exactly. And mental health is a great one to talk about. I think the pandemic has been difficult for most of us. And I think the need for mental health, behavioral health services has significantly risen. I think there's challenges to see someone in person and long wait times and the ability to do it with the convenient stuff, kind of telephone, video consultation at a time that works for you without having to worry about the travel and so forth, means that it's easier and it's more likely that people will follow up with those consultations, which we know is key. Having that ability to see someone or speak to someone regularly is a really important path. Yeah. Yeah. How would the people, residents in the state in Hawaii specifically benefit from something like telehealth? Yeah, I can talk this through my own example. So, I, you know, typical man, I didn't register with a primary care until I really needed one. And in order to see a specialist, I needed to register with a PCP practice. I didn't think it was a big deal. And I didn't realize how difficult it would be. So, you know, it was, I think a two month kind of wait, and it wasn't convenient in terms of location, I think it was like a 30, 40 minute drive. And, you know, having a young kid and juggling just everything, it was just a really difficult process. I just had no idea just how challenging that would be. So, you know, I think for people that kind of need to see or kind of get healthcare conveniently at a time that's appropriate and not having to wait a long time is where we can kind of come in with telehealth, you know, same day appointments often, you know, as soon as within the hour, and a vast array of services. So, you know, adult care, urgent care, primary care services, pediatrics, mental health services, and the ability to kind of see and refer to specialists. So, that's great. That's great. Now, just in a couple clicks, somebody can see a doctor who works and lives in Hawaii, because I know with some other telemedicine companies, I could be in Hawaii, but the doctor that I'm talking to like yourself could be in Florida. With Cloudwell, is it a local service? Yeah, everyone's local here. And that was a really kind of important part of the service for us. You know, very early on, we realized how important it is to have people that understand the lay of the land, kind of work locally in clinics and hospitals. And then we have our clinical coordinators, and they kind of help patients through their kind of journey, booking an appointment, follow-ups, arranging investigations and labs and so on. And, you know, for them to be local, understand how things work here, know what services are where. I think one, it just helps the patients, and two, it helps with the connections so that patients enjoy using the service. It's not a stressful thing. It's a very smooth and easy thing. Yeah, I know when a lot of patients use the service, when they connect with our medical team and our clinical coordinators, you know, they're pleasantly surprised. Like, wow, you know, oh, you work and live in Hawaii, you're from Hawaii, that's great. And I was not expecting that. And so that pleasant surprise, I would think, gets a lot of traction when it comes to getting people to use it. It definitely does. And that's been such a nice thing for us to see that once patients use the service once, you know, the vast, vast majority use it several times after that. And I think having that kind of local presence makes a difference, just makes everything a bit easier for them. Yeah. You know, we, in December, we launched virtual primary care. And there's a lot of primary care shortages in Hawaii. Many people wait months to see a primary care doctor. How is virtual primary care a good alternative to having to wait months? Yeah, I mean, this is something kind of close to my heart in terms of we've evolved our services over time. So when we first started, we were like a pay-as-you-go, pay-for-service model. We then took, you know, all the major insurance providers, waived copays, waived taxes, so that we could increase access so that more and more people that live here can use it. And so the next step for us was to be able to provide kind of ongoing management, not just the urgent care side. So that's where the PCP model has come in. And super excited. I think it's going to make a huge difference to the impact, to the quality of healthcare, not having to wait, you know, those kind of months to kind of see a PCP. And also for the PCPs to be able to have the time to focus on those that they really do need to see in person, so that they've got the time for that. Yeah. You know, we have a telehealth platform. And people have asked me, you know, about how do you track the patients, like the medical records? And because in the traditional hospital setting, you have, you know, medical records departments where all that information is registered, do patients have the same type of high quality electronic medical record in a telehealth setting to know their information is secure, that their information is private, but ultimately delivers good care? Yeah, that's exactly how it is. I mean, it's a very robust, you know, hyper compliant, safe platform with the kind of integrations that allow patients to have, you know, full access to their care, to their notes, their results, and it's completely secure. So it's just a very nice way for patients to be able to access their kind of health information and see their kind of medications and lab results and so on. Yeah. Now, if you were to see me through telehealth and I need to see a cardiologist because you have concerns around, you know, some heart issues I might be having, how do I get to that cardiologist then? What are the next steps with the Cloudwell model and telehealth? How does that exactly work? Yeah. So if a patient has an appointment with us on Cloudwell with one of our practitioners, we would kind of assess, you know, everything that you would do in person. And if it seems like a specialist referral is required, we have a vast network of specialists that we're able to refer to. And amazing clinical coordinators are able to help figure out what's most convenient from a location standpoint, how quickly people can get seen. So they provide that kind of concierge aspect, which kind of helps hold a patient's hand through it. So there's no stress. There's no worry about how long is this going to take? How far away am I going to have to go? And so forth. It's just a very seamless process. And it's nice because, you know, with a network that myself and Cedric have, you know, a lot of these people are coworkers in terms of the specialists. And it's a very nice way of being able to refer patients to clinicians that you work with and trust. I know that probably in the traditional model, if you see a primary care physician and you need to see a cardiologist, they'll probably give you a card or a phone number and you call that number. But it could be another month to two months until you see a cardiologist. So it sounds like there's a nice pathway, you know, through cloud work. Yeah. And that's where we spend a lot of time trying to help see it from the patient's perspective. But what things can we kind of take away that will just make life a bit easier and help increase the access and the timing? And that's where, you know, the team comes in to kind of help help take care of that. Yeah. Now, when it comes to insurance, does this model take all the health plans, all the insurance plans in the state? Or is it only a selective group? How does that typically work? Yeah, we take all the major insurance providers. I think Kaiser being a closed unit system, you know, we can't help with the Kaiser side of things. But even then, I think patients, you know, are provided with information that they can then submit to their insurance to see if they can kind of get that reimbursed. But with all the other major insurance providers, including Medicare and Medicaid, we take them all. And that's pretty unique, you know, because I know that some of the national platforms, it can be more selective in terms of the types of health plans that they'll accept if you're using it as a general consumer. So considering that the vast majority of people in the state of Hawaii about 98% have health insurance, that's a big bonus, isn't it? That outside of Kaiser, we take these plans. Exactly. And that was our mission really was to help improve access to care for everyone here. And I think that's the difference, you know, as being a physician founded company, kind of ensuring patient care is kind of the priority. I think that's made a difference. And that's why we haven't been selective in terms of kind of insurances. We want to make sure everyone has access to kind of good quality care. Yeah. Yeah, I can tell you from working with you that the pride and being part of a company, telehealth organization, that prides itself on health care equity and easy accessibility is really, really great because accessing health care just in general can be really difficult because of all the shortages, not only in Hawaii, but across the country. And you combine that with the fact that you have a team of clinical coordinators that can actually help you get to the next step in your care, call you before the appointment to make sure that you're comfortable even call you after the appointment to make sure you have everything you need. That's that's really great service. And I give a lot of credit to you and Dr. Strong for designing a model with those cornerstones as the foundation. And we've been very fortunate as having worked in kind of multiple health care systems in different kind of countries, we've been able to kind of figure out what are the best elements of each. And I think that's what we've tried to implement here. And they say the two most stressful areas for people in terms of not understanding how things work are mortgages and health care. That's true. That's very true. And so for the health care side of things, we thought, let's figure out from all our knowledge that we have from these different experiences, different countries and different kind of health care systems, let's figure out a way to just make this easy to kind of get rid of some of those question marks and the gray areas. So you don't have to worry about that. It shouldn't just be, I have a health care issue. I want to get it seen to as quickly as possible and I'll get the best care I can. I think that's what it comes down to. Yeah. What would you say is the future of telehealth? So right now, there's a lot of interaction, primary care, mental health, urgent care like you described. Where do you think this is going in the next five to 10 years? Yeah. Great question. I mean, I think telehealth is clearly here to stay. I think it was present, but not as popular an opinion pre-pandemic. And then I think the pandemic really put telehealth on the map. It helped people that were in isolation, people that were concerned about going to practice. It took the pressures off some of the health care services like primary care and so on. And it's grown from there. And what's been interesting is really just getting patients' feedback. Having used the telehealth service, they now understand the convenience and the benefits of it. So I think it's going to continue to grow. I think you're going to what we call bread and butter services. So the urgent care, behavioral health services, primary care, that's just going to continue to evolve in terms of the ease of access, the technology around how to book an appointment, how to access your results and so on. But I think the next real interesting area is going to be wellness. And what I call 360-degree health, where we focus more on preventative health measures and how to help a patient stay healthy, or prevent disease progression. So looking more into chronic disease management, preventative health, and probably the technology. So things like wearables and things that you can use during a consultation. So checking someone's pulse rate and their oxygen levels. I think those are the next things for us as well. It must be really fascinating because Hawaii geographically has a lot of challenges when it comes to accessing care, but also culturally and being one of the most diverse states in the nation. And so how have you gone about designing culturally sensitive care to the residents of this statewide to really connect with them to provide the best level of service that you indicated, but also the highest level of quality? Yeah, I think a lot of that comes to having a great local team. So having kind of clinical coordinators that are all from here, work here, the landscape, and then having clinicians that work in clinics, work in the local hospitals, our colleagues, our fars. I think that helps. I think that really kind of helps patients connect with the clinicians, the coordinators. And then just being very thoughtful about, this isn't a cookie cutter approach. It's not a template that we use in lots of different places. It's very much, how can we help the population here locally? What diseases are prevalent here? What are the burdens of healthcare? Where are the weaknesses in the current system? And what are you trying to focus on those things? Any particular story you want to share of maybe a patient that from one of the remote islands perhaps that we were able to provide great care to? That's a great question. There's lots. So let me think. This was quite a nice one because of just how grateful the patient was. And now looking back, you can kind of see why. So they had, it was a young couple that recently moved to Hawaii. I can't remember which island they were on, but they went quite a remote location. And the lady had a urinary tract infection, which is quite a common problem. But it happened to be, I think on a weekend, it was very far for them to get to a kind of urgent care. They were kind of really concerned because they didn't have healthcare insurance at the time. They just moved and they came across our services online and they were just astounded at how straightforward it was. They were worried about how long this was going to take, how expensive it was going to be, how they were going to figure it all out. I think they happened to have just got married on the honeymoon too. And so being able to sort something so simple out for them in a way that it should be just made a huge difference. And it was so nice for them to be so happy with the services too. Yeah. I know that the big area of feedback we get, positive area, focuses around simplicity that just, hey, wow, I didn't know it was this simple that just in a couple of clicks, I can see a doctor and that doctor provides the care and then the coordinator calls me and everything is just lined up. I mean, it's really that simple, isn't it? Just a couple clicks. Yeah, a couple of clicks and you're kind of scheduled. You then have the consultation with the doctor and then you even get callbacks afterwards to help kind of walk through things like prescriptions and which pharmacy or if you're having kind of tests done like imaging or blood test or you'll walk through it. So there's no ambiguity. There's no question marks. There's no concerns. Who's calling me? Where am I going? It's all answered for you before you even think of the question. Now, hopefully with the decreases in the omicron frequency across the country that hopefully we can get to a post-pandemic norm. Now, in this post-pandemic norm, do you feel that telehealth is here to stay? Now that it was brought into the mainstream, it's still going to be here permanently and it's just going to continue to evolve. What are your thoughts? Yeah, that's definitely an interesting one. What I find, we try and kind of really speak to our patients and get feedback and see what their thoughts are. And what we found is that most people that have used the service during the pandemic are going to continue to use it afterwards. And I think that's true for just telehealth on a large scale. I think it might not have been something people knew about before but now having used it with the conveniences, the efficacy, the safety, I think it's here to stay and I think utilization is going to continue to increase. I'm sure that the medical staff and the therapists probably like it a lot. I know they mentioned it just provides a lot of flexibility that because they live busy lives but they also want to deliver great care and this provides both. Exactly. As you can imagine during the pandemic there's been kind of physician, clinician burnout and having that ability to balance. So most of our clinicians will be working in a clinic hospital setting and this is a nice way for them to still provide care but in the convenience of being at home and being able to do things you know whilst they're not on shift and not being in the hospital. I think it just provides a really nice lifestyle balance for people. And you're in Hawaii and Cedric's in Hawaii and it just must feel good you know to be able to really, I know for me to be part of this and giving really back to residents of the state in a way that's high quality, equitable, socially responsible. I mean it just must feel great you know considering you have so much experience in telehealth now you actually get to really make your mark in the state. Yeah that's the most rewarding part. You know I've done my part and I'm still heavily involved with the UK side and we've seen the impact that's had and now seeing the impact that this is having on you know local people and improving access to health and so on has been super rewarding for us. Yeah, mahalo Neil. Thank you mahalo. Yeah it's always good to talk to you to be part of this organization that's really building something great and taking care of the residents of Hawaii. You know this is something that from a telehealth standpoint providing care it's just very exciting you know and we're going to have a lot more to cover in the world. Yeah I mean it's something it's close to our heart to how can I help improve access to quality of healthcare and to see that it's making an impact that it's just amazing for us. Yeah and we're going to be visiting some other subjects soon you know with you and Dr. Strong and the care team there's going to be a lot of great stories but also using this platform to provide public awareness around telehealth because it is still very new right I mean people are still getting used and this is a great avenue to discuss the subjects discuss the challenges but also how are we going to work to address those challenges. Exactly yeah and you know some people have never used it and they might have reservations but the the beauty of it is once people have used it they realize how easy and simple it is and then they continue to. So how do you keep yourself you know you're a practicing physician you have a young family how do you what do you like to do in your spare time just try and change. There's no spare time sleep. Yeah exactly. Sleep but I can't no no I mean I would have put you know what a wonderful place to be busy right I mean we have amazing weather great people so you know when we can I mean pandemic has been challenging but being able to get out and about and see friends and keep the keep the kid busy that's always a yeah yeah I I understand that completely you know and so thank you for your time. No thank you this is great. We'll continue this subject and telehealth in the weeks to come you know looking forward to it. Sounds good. Mahalo. Thanks Vic. Take care. Thank you.