The Q&A: Kristi Henderson

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Kristi Henderson is the vice president for virtual care and innovation at Seton Healthcare Family in Austin. Prior to this role, she served as chief telehealth and innovation officer for the University of Mississippi Medical Center where she led the development of a statewide telehealth program. 

Editor's note: This interview has been edited for length and clarity.

Trib+Health: First of all, can you talk to me fairly generally about what virtual care and medicine actually are and what patients they help the most?

Kristi Henderson: Let me start by saying that virtual care is a terminology that many use interchangeably with other words that can sometimes confuse not only the public but the health care sector as well. Virtual care, telehealth tend to be the terms used in the broad sense to really represent the use of technology for healthcare delivery in a broad sense. That could be education that could be actual medical delivery of care and it could be collaboration. So it is a broader term where telemedicine ends up being the specific delivery of medical care.

So when you talk about these terms and using them in the healthcare system, what it means is that we're delivering the same type of care that we normally did in person but we're using technology to reach people so that either people or the healthcare team don't have to travel to get that care. That makes it about access and about convenience overall. When it started, it really was about reaching people that didn't have access and it started in the military and then has grown mostly in rural areas where they were underserved. But what we found was that even people in urban areas have challenges with access and need healthcare to be more convenient so that we have adherence to treatment plans and we can really get people healthier. 

So while it started around underserved areas, it has quickly migrated to be an enhancement tool. We all know that our $3 trillion healthcare system in the U.S. has not got a corresponding good health outcome rating. It's disproportionate to the efforts we're putting into it. So the efforts now are about using the technology not only to provide access and convenience, but to really enhance quality and outcomes. So we're able to do more and reach people more frequently than before using the technology.  

Trib+Health: So how does it actually work when it comes to an area? Is this something where a certain town or city reaches out and identifies this as a need or is it something on the other side where someone like you at a larger hospital identifies a need in a particular area?

Henderson: Traditionally, and in the majority of cases here today, there is some health system or some company that provides telemedicine or telehealth services. They reach out and say, "Hey, we'd like to help you." And they deliver that healthcare and they will contract for those services.

I would say in the last five years, we've seen a flip of that to where people in underserved areas have seen others that are similar to them have positive outcomes and they said, "Wait a minute. If this city in North Carolina or Mississippi or Alaska can have these outcomes, why can't I have it as well?"

And they seek it out and they are starting to reach out to these private companies and even health systems to say, "We don't have a cardiologist" or "We don't have a psychiatrist. Can you provide that service through telemedicine?" So it's happening bi-directionally.  

Trib+Health: Can you walk me through an example of what it might look like to actually deliver this telemedicine, maybe a generic case and how it would work?

Henderson: I'll give you a generic one, and then I'll tell you the caveats around how it may be different depending on the specialty. So you would have maybe a critical access or a small community hospital in a town and they don't have a neurologist. This is a pretty common scenario.

So right now what happens if they don't have telemedicine is, a patient may come to the hospital and they have symptoms of a stroke. They will have to call to get that patient transferred to what we call a "higher level of care," to where there is a neurologist. So what would typically happen is that they'd be put in an ambulance and then shipped and hopefully get there in enough time to where they can still have live-saving intervention delivered. 

With telemedicine, there is typically what we call a telemedicine cart in the ER or in the hospital somewhere. Instead of calling the neurologist to come run down, the neurologist just appears at the bedside through this telemedicine cart, yet they may be hundreds of miles away. And through this equipment they can see and assess the patient.

So it has the ability to not only do two-way audio, video interaction, but they have devices they can attach to it where that physician can listen to heart and lungs, can look at pupils to see their reaction. So it really is a use of technology to replicate what would happen if that neurologist had actually driven in to that hospital to see the patient but it's done all through Bluetooth devices.

So that physician is sitting wherever they may be, their office, another clinic or even in their home, and are logging into a secure network, talking to the patient, assessing and talking with the healthcare team and then giving orders for that patient. And so that's a typical scenario of how that would look. 

The nuances around other specialties is that not every specialty needs all those devices. A psychiatrist would be able to talk and look at a patient, but doesn't need to have the stethoscopes and otoscopes and all the other devices. So the technology might look different depending on the specialty, but the interaction is the same. It's to replicate whatever they would do in person. So the technology is created or developed in the sense of that specialty. So it can look a different way, but it always is a goal to replicate what would happen in person just through the technology.

That is the typical setting in a hospital, but when you start talking about it in workplaces and in schools and homes and all the ways we can do telemedicine, it can look a lot of different ways, from your smartphone being the device where you interact with your physician, all the way to a home monitoring kit that allows a team to monitor vital signs. So there's a broad spectrum of services that can be offered through the technology to advance care. 

Trib+Health: So do you think this is the future of medical care? Or when it appears in these underserved areas, is it more of a placeholder until more legitimate, in-person services can be brought in?

Henderson: I think we are way past a pilot or proof of concept of telemedicine. I think that it is absolutely here to stay. It will not replace in-person care, but what it will allow us to do is deliver care in the right, most appropriate place at the right time. It's really about trying to enhance and change the outcomes of our country as far as health outcomes. And so I would say that it's definitely here to stay.

I think what will continue to evolve is how we utilize it and what the balance of in-person care and telemedicine care needs to be. And how do we balance the two to optimize the delivery system but have the best results possible? The goal is to be really high tech, but to be high touch as well so we really get the outcomes we want and need and are adopted by patients as well as the healthcare team. 

Trib+Health: Now what are some of the drawbacks to this, other than the fact that you're physically not in the same room as your patient? 

Henderson: I think that part of it is really just around comfort level with this. So there's still a lot of people that are skeptical and think that they won't be able to do the same level of care as they do in person. And I think that's probably the biggest concern that I hear from providers, that "I can't touch the patient."

Touch is important in healthcare, so it's really important to find that right balance. There may be somebody that is still with the patient and touching the patient and saying, "They're tender when I touch here," or, "I feel a mass over on this side." So it just becomes a different way to deliver healthcare ... so we're using all the different healthcare team members that we can to really still get that optimal outcome.

I think the main thing I hear from people is just, "That's not how I was taught." So they might feel a little bit out of control when they can't grab something or do something themselves. But I think that we've now had enough years behind us on this. The outcomes are showing that not only are we able to do good care, in many ways we're enhancing it and delivering care that was once not afforded to certain people.

I think a lot of that skepticism and concern of a potential downfall has been abated to some degree. We've just got more studies and more volume to be able to really identify where it fits into the healthcare system perfectly.  

Trib+Health: Can you tell me about the program you're looking to unveil in Central Texas?

Henderson: I came here in December to develop a virtual care network throughout Central Texas. The goal first was to really identify where the gaps were and where we had challenges. What's needed in one state may not be needed in another around the needs of a population and the resources that are available.

My goal is to connect all of our locations to be able to use the resources that we have better so we can intervene earlier and improve the health of the people that we serve. So it's really around enhancing services like mental health services, neurology — even urgent care services. We have delays for people to get in and see their specialist. We want to enhance that and allow people to be seen sooner before small problems become big problems and hopefully keep people out of the ER and out of the hospital. 

So we'll use technology a lot of ways, so it will be in the typical scenario like I described to you in emergency departments, but it will also be in chronic disease management. So we'll bring in technology in a lot of different settings, not just hospitals and clinics but in homes and schools because we know people aren't getting the care that they need. It will still be the familiar faces that people see when they come into our facilities, but it will just be delivered using technology, so it will be more convenient and accessible.