 and welcome to the latest episode of Tell Health in Hawaii. I'm Vikram Acharya. I'm the Chief Executive Officer of Cloudwell Health in all virtual position founded telemedicine platform born and raised in Hawaii. We got a great show for you today. On the show is our position assistant, superior physician assistant, Lauren Cunningham. How are you, Lauren? Hey, guys. It's great to be here. I'm doing great today. How are you, Vik? I'm doing well. I'm doing well. It's nice to have you on the show. Thanks for joining. Yes. It's great to be here. I'm happy to talk to people about what we're doing here in Hawaii. Awesome. Awesome. To get things started, Lauren, you're a physician assistant. You take care of patients in Hawaii. Tell us a little bit about your background, where you're from, and what brought you to the great state of Hawaii. So I'm actually originally from Texas. I did all my schooling out there. I went to University of Texas for my undergrad. I went to UT Southwestern for my medical training. I initially started out there doing internal medicine at a massive community hospital, trying to help the lower fortunate and get some people staying through there. After that, I went and specialized in leukemia at MB Anderson Medical Center in Houston. We had a great team there, but I did come out to Hawaii for a medical conference to learn more about internal medicine as well as leukemia. I fell in love with the patient population out here. I actually had people begging me to come and move here to provide more medical care when I'd be out walking around in my scrubs. People would literally come up to me and say, we need your help, please move. And so I actually started looking into opportunities out here and wages, lifestyle, cost of living. And I really thought this was a good move for myself and decided to come out and treat the patient population here in Hawaii. So you're treating patients both in-person as well as virtually through telemedicine. How's that experience been for you? So the in-person is bread and butter, definitely very similar to what I was practicing in Houston and Dallas. When it comes to telemedicine, it has been a revolutionary opportunity for both patients and providers. I think since the pandemic has come around, we've seen a shift away from in-person care and more to an important aspect of non-contact telemedicine care to provide a safer aspect in the atmosphere for a lot of our patients. So I very much enjoyed learning and shifting my practice from a tele... in-person to a telehealth focus as well. Yeah. Now, people often will probably ask you, you know, especially patients, is telehealth the same as an in-person visit? Is this just as effective? What are some of the things that you tell them to put them at ease during their appointments? I would say yes. This would be just as effective as an in-person visit. The limitations are going to be the physical exam. A lot of the times physical exams are technically quite brief in-person anyways. To do an effective physical exam, it takes you about 30 minutes of time. And what we can do via telehealth is do a slew of lab work in order to take place of that in-depth physical exam. A lot of the times and almost every time when you see a primary care, you're getting a slew of lab work anyways. Many of the times your treatment plans are going to be based on the lab work itself and not so much the physical exam. There's other ways to learning on what's going on physically, including imaging and lab work. And so physically being in touch with the person has been less important these days. And so I am able to effectively come up with treatment plans by lab work and imaging alone to treat these patients effectively. Oh, yes. So if you see me and I need to see, let's say a cardiologist, because you have concerns about my heart and maybe we need to get to the next step. What would be the next steps in that type of process? So in that type of process, you would likely be my family physician patient. We would like to bring you on as a primary care patient so that I can effectively refer you via insurance to the proper place that could treat you more effectively. How family medicine works anyways is really doing a screening process where if we do find something that's important for a specialist to address, we then refer you on to a specialist who has a lot of knowledge about a limited area of medicine, while family providers have a lot of knowledge over a sliver of medicine and then we refer you out to the proper place. And so the telehealth PCP platform allows me to effectively already refer you quickly to someone who you might need after my screening pulls from the visit. I'm sure you encounter a lot of patients who really like this service not only because of the great patient care you provide but also they can see somebody like yourself within a day. Whereas with the traditional model at times it can take months to see a physician assistant. It can see months to see a family practice physician, I would think. Yes, that's right. And that's one of the best things about being a PA and having a dance practice providers, APPs, nurse practitioners, entering into the medical field is that we've allowed patients to be seen quite quickly in comparison to waiting for your family physician while giving also the quality of care you would get from a physician. Then you enter telehealth which can get you even quicker into a physician or a PA and being able to address your problems faster. For example, we had a man that had a DVT he called our telehealth services and if you wouldn't have done that it would have taken him two weeks to get into a primary care physician or a vascular specialty. If he wouldn't have called us it would have been two weeks without anticoagulants, two weeks without imaging, two weeks of potentially a dangerous situation and this telehealth platform has given him treatment immediately and extremely improved his risk profile. Wow, that's really impressive. Without the on-demand same-day telehealth the patient would have been in a tough spot, sounds like. That's right, it would have taken him almost two to three weeks just to get treatment before so and he had no idea what was going on. We were able to order everything we needed to do in order to figure out what was going on and get him on that appropriate blood then are to really improve his risk profile to actually save his life. Wow, that's very impressive. That's very impressive. Have you seen a lot of, you know I'm sure many patients have gone maybe one possibly two years or more without really seeing a clinical provider in large part because of COVID. Are you seeing a lot of patients who haven't seen anybody in a long time and then when you assess them you find that they're at higher risk for diabetes, high cholesterol and high blood pressure chronic conditions? Almost every day. So we definitely have patients growing two, three, four years even without pandemic reasons to not see a provider and when I get these lab works on patients I'm seeing cholesterol issues, diabetes that they didn't know about. A lot of issues that could be causing some of the things they're complaining about and not really sure what's going on. Fatigue, frequent urination, frequent thirst, a lot of different issues that can be caused by thyroid, cholesterol, diabetes, heart issues, liver issues, kidney issues that they didn't know was where it was even happening in the beginning. So we were able to tease that out and start really referring them to the right people and getting them on the right treatment and medication whether that be lifestyle choices and changes up front or getting them on a medication because they're already past the threshold that's appropriate for that. That's very concerning. Now if I wanted to improve my diet for example, diet is a big part of physical wellness. What types of diets do you recommend for your patients when you talk to them especially those who live in Hawaii? It definitely depends on what their risk profile looks like what their cholesterol looks like but a Mediterranean diet with the healthy olive oils are definitely going to be one of the ones that I promote the most here in Hawaii. A lower carb, higher safe fat diet is going to be something that we prefer especially for the Polynesian population. Here we're seeing a lot of carbohydrate intake especially with things like taro and poi, rice, a lot of other foods here that are popular are high in the carbohydrate and fat but we try to move towards those for soluble fats, the liquid fats, the olive oils to cook with and away from the margarine and butters. We try to focus on the healthy vegetables and the low carb aspect here. I see, I see. Now being well physically also plays a role in being well mentally. Now do you find that the two are pretty that at times be very linked that the healthier I am the better my mental health is because it is mental health awareness month and part of also there's the physical aspects to health but also mental. So I think being physically active whether that's even walking doing the activities that you love whether that's fishing, swimming, kayaking, paddle boarding, surfing getting out and being physically active with that heart rate up for at least 30 minutes a day as well as eating a healthy diet 75% of the time is important with mental health. We've seen during this pandemic a lot of the issues that we're having with mental health is inability to go out and do those things that they love inability to go out and be active. The Hawaiian population is not so much heavily like my Texas population where you have people going to the gym. You have more people going to the beaches fishing and doing activities with families family and friends that are increasing their heart rate and keeping them healthy and through the pandemic this was quite limited. And so the mental health aspect that I have seen correlate with that has been pretty strong. People are having a hard time not being able to get out be as physically active as they want to be. So there's a direct correlation between physical health and mental health and it's strongly been exhibited during the pandemic time definitely. Yeah. Now you see patients of all ages but I'm sure that regardless of the age they're probably pretty pleasantly surprised as to how easy it is to actually see a provider how easy it is to book an appointment just a couple clicks. I mean it's not very complicated so that when they see you they're like wow I didn't first of all this is my first time using telemedicine I didn't know it was this easy. Right. No yeah so that's one of their that's one of my favorite things about this service is that patients are so happy when they get on because they can actually see someone within a short amount of time instead of stressing to try to drive to the doctor to get an appointment wait weeks out of the time sit in traffic or have cost of gas which we all know is an issue right now. They love the ability if they're having an issue and it's on their mind they get on the service and they make that appointment and they're able to discuss those things the same day and you know what I think that does a great deal with mental health as well being able to actually address what is what is problematic with you especially not having to work around work or other things that are going on in your life whether you have kids or school as well being able to quickly address physical problems is extremely important to mental health and continuing to stay healthy a lot of people prevent bettering themselves because they don't even want to physically go to the doctor. And having something available almost 24 hours a day where you could see get a examination at 11 o'clock at night that's not always the case a lot of in-person doctor's offices are closed during you know during off hours but with telehealth you can access this that's around your schedule. That's exactly right so that's why the accessibility to medicine is so improved with this service accessibility to medicine is one of the biggest barriers of people staying healthy and getting care for what they need and telemed is one of the most key aspects and areas in medicine that's going to curb that issue and that's exhibited right there just being able to work around your own schedule without having to call an office to make your own appointment it's huge the convenience factor is massive for people and being able to stay healthy the convenience factor is so important. Yeah and you know Hawaii has a lot of multi-generational households a largest percentage in the country so I'm sure that when you're working with a patient whether they're very young or potentially older you also are not only empowering them but you're also empowering the family so if the daughter or the son is there or the granddaughter or the grandson can also be part of making sure that the patient is better the whole household becomes vested it seems like. That's right so one of the most important things with especially with our older or younger population is having family involvement being able to say we are all involved we know what the plan is we hear from the provider directly it's not a playing telephone with the one relative that came to the appointment it makes sure that the family is invested in the care of that person because they're all looking and communicating and involved in the meeting as well this allows patients to have a better quality of care for life just because their family members know what also is going on what also is needed it really it drives commitment from those family members to keeping that person healthy and it's an interesting situation because on some of the more remote islands there's significant shortages of providers like yourself but residents of those islands have smartphones and they but so they can still connect with you and you might be on a different island simply through the phone that's exactly right so that's the beautiful thing here and why is there a lot of remote patients that need to be seen and a lot of them are not getting the care that they need the medical care the prescriptions the lap work the ultrasounds the imaging the screening because they're not able to make it to a provider many of them are hours away from even a medical center or even a store and so having an iPhone having a way to communicate outside of physically going somewhere is so important with reaching the most remote aspects of these islands yeah what's the best part of your day you know you're seeing a lot of patients you see you know multiple a day from all over the state what part do you enjoy the most one of my favorite parts is just seeing the patients and getting them on a video I love just talking to them and schmoozing and communicating and seeing how they're doing and I feel like trust in a provider feeling like they're almost like your friend more than some kind of professional or someone above you or I feel like really getting deep down and creating a relationship is important with people and so I just love getting my patients on and talking how are you doing today what's going on how can I help you I want to do what I can to make your day better or make you feel better and helping people feel better especially in the moment is one of my favorite things and showing people that someone really actually cares about how they're doing and getting them to an improved state they just are so appreciative and that's what makes my day that is my day yeah you mentioned the great story about the patient with the DVT are there other stories that you can recall in particular where it's like wow thank you so much Lauren for for helping me I didn't know about telemedicine but now I do and I'm going to come back and I want to see you again specifically I do have a lot of primary care patients that do request that because I do like to keep my meetings upbeat I do like to make sure that you the patient are also appreciated and that you're doing a great job and I'm here to support you there's a number of stories that I could probably drum up in order to prove that for you guys but there are especially in the pediatric population with the parents how appreciative they are to be seen when their kid is either nauseous vomiting not taking fluids they're worried just to have someone to triage stuff with there was a child that I was having intractable nausea and vomiting they were not making tears which is one of the warning signs for us as providers that they're too dehydrated and may need an IV and so I sent them on quickly onto the ER and they were so appreciative that they were able to be seen and triaged by a provider without maybe needlessly going to an ER maybe needlessly taking time out of the day or just being able to heal at home and so they were they were so appreciative of the peace of mind that their treatment plan going to the ER that was the right move they liked the confidence from the provider and they were able to get that in 30 minutes wow so that's an interesting one so it's a child who needs care and in this situation if they pursue the let's call it the in-person model the parent would have to take time away from work would have to take the child to the emergency room get seen by a provider and by the time that whole process is complete you could be looking at a day oh boy and people cannot afford to do that right yes likely more than that and so especially with kiddos I are very serious about getting those kids the treatment that they need as quickly as possible and you know what in-person providers here are so overwhelmed in Hawaii we do not have enough providers we are underserved in almost every county if not every county and so it's no fault of those in-person providers or physicians they are overwhelmed they're slammed every day and so they're trying their best to get through those emergent patients but sometimes it's just too hard to address everybody and that's where we come in yeah now you're obviously very busy but in your spare time I know that you also had to do a lot of fun activities what kind of activities do you like to do so I'm a huge surfer I love surfing I'm also actually pregnant at the time so I cannot go surfing right now oh my belly is starting to get in the way I also have thank you I also have a one-year-old that we take care of and we're huge kayakers so we opened our own adventure company boom kanani and shore adventure club here on Maui we take out private group kayaking charters and so we pour our heart and soul into the to the locals and the tourists that come here to show them the best time so that's that's a huge huge commitment and one of my passions is being able to grow and start something for myself and so surfing small businesses taking care of family that's kind of my that's my big three here on Maui no doubt no doubt so you fully embedded yourself and just the the wonderful luxuries of the state huh absolutely and we we purchased a house here and I'm very committed to the locals of the state and and treating this population I very much care about everyone here and I absolutely love love the population here yeah and the fact that especially cloudwell has a strong focus on what I consider like high touch really local providers who understand the population so you know you know if a person lives in a certain part of the state you in particular know exactly where they are exactly what they need which is much better than if you were to pursue some of the larger companies now the patient could be in Maui but they could be seeing a provider in Florida which is very hard to build that personal connection right and they don't understand the nuances of Hawaii it is actually there's a lot of specifics about the population and I feel like a lot of I'd like to say Southern's respect too because I'm from Texas but the aloha here is is is deep ingrained and having that family spirit and understanding again the nuances of Hawaii inability to get to medical centers which isn't something that's very common on the mainland not being able to see your provider get to provider within 20 minutes is kind of rare on the mainland here that is actually very common and so understanding that they don't have a pharmacy within 50 miles they don't have a provider within that this amount of space or time and and being able to work around those and really being able to address the population based on what they eat if you live here you understand how the culture is it's very important to understand culture to treating the population that's why cloud well is so specifically important to the Hawaiian population because our providers are here and we know what's going on we know the nuances we know the cultural aspect and we I think we really care about addressing the population specifically yeah yeah because there's a lot of details and nuances that in order to develop culturally sensitive care specific to the state someone like yourself is well equipped because you're you're there and you know it in and out right and I I did practice in person for three years prior to starting a telehealth position and so I am very well and great especially with the population here on Maui yeah what's it like the population on Maui oh I love my Friday patients they're all very high energy I let it from the young ones to the old ones always acted like I was staying the surfing the paddle boarding I've got my eight year olds going out there doing the kayaking and the canoeing I just love the spirit of the islands this is one of the reasons I moved out here is because happiness and health go hand in hand and to be healthy you're active out in beauty out on the beach out in nature and that is the main thing about Hawaii it's all interconnected physical wellness mental wellness being active helps your out just your outlook on life I mean it just makes you much more positive much more energetic and that's a good thing that's right that's right being able to really see the positivity in your surroundings keeps you positive as well and so that's why getting out and being healthy and really focusing on physical health is so important yeah yeah Lauren I want to take a moment to really thank you all the care providers especially during the pandemic have been on the front lines taking care of patients and it's not an easy thing to do there's a lot of work involved and you're just doing a great service to the state and we really really appreciate you very much I can't say enough about the great work you do and just the great compassionate care you provide to everyone in Hawaii oh thank you so much I'm pretty sure I was born to do this I just love helping people and I do I love helping people so I mean I was blessed with the knowledge and I just want to give it to everybody here and be able to get them to a better place so I am lucky myself to be able to fulfill this role absolutely absolutely we're very grateful to have you thank you for being on the show thank you for everything that you're doing in Hawaii and Mahalo look thank you so much for having me on Vic I was so happy to be able to communicate about telehealth and how we're able to reach a bigger population and hopefully get Hawaii to a better health standard oh definitely definitely we'll see you soon thank you thank you Vic bye bye thank you so much for watching Think Tech Hawaii if you like what we do please like us and click the subscribe button on youtube and the follow button on Vimeo you can also follow us on facebook instagram twitter and linked in and donate to us at thinktechhawaii.com Mahalo