Transcription:
Physicians on FaceTime: The Future of Medicine

Bill Klaproth (Host): Tuberous sclerosis complex or TSC is a disease that can affect every single organ in the body. When young Maddy Lens was diagnosed with TSC, Dr. John Bissler used telemedicine connecting via computer, smart phone, or tablet to see Maddy at certain times during her treatment plan. So what is the future of telemedicine? Let’s find out with Dr. John Bissler, Chief of Pediatric Nephrology and Director of the Tuberous Sclerosis Center of Excellent at Le Bonheur Children's Hospital.

This is the Peds Pod by Le Bonheur Children’s Hospital where pediatric experts explore topics affecting children’s health including complex cases and innovations on the healthcare horizon. I’m Bill Klaproth. So, Dr. Bissler let’s start with this, what is telemedicine and when and how did doctors start using this?

Dr. John Bissler (Guest): Telemedicine is a – actually I’ll slip and call it telehealth, it’s a little bit broader – is the ability to use secure, encrypted video conferencing for physicians to help patients. So this obviously became very valuable for patients in remote areas when, for example, access to specialty care was limited. So it’s been around for actually quite a while. Initially it was hospital to hospital, but now with the internet and the development of better, more secure communication means, it’s becoming much easier to do so it’s much more widespread.

Host: I can see where this would be very important to a healthcare institution. So why did Le Bonheur choose to implement telemedicine into TSC treatment, and how does it fit into patient treatment for TSC?

Dr. Bissler: Well so this is a really good question, and I’m going to start by telling you a little bit about TSC to help it make a little bit of sense. So the incidence of TSC is about 1 out of 6,000 and the patients that come to the TS Center of Excellence here at Le Bonheur are not just scattered across the country but actually across the globe, and so this is important because it’s very expensive to travel. You know, I love seeing my patients in the clinic and that’s fabulous but there are patients who really can’t afford to come very often if at all just their particular circumstances. So the other thing is maybe they just don’t have good TS nephrology where they are. So it sounds funny but neglecting those patients wasn’t really morally acceptable to me. So, in part of my recruitment, and I have to say Le Bonheur was so fabulous about understanding this and being really onboard right away. Telehealth – TS telehealth was part of my early recruitment discussions and Le Bonheur really helped make sure this went through. What it really does, how does it fit into the care, the second part of your question, is it can greatly reduce the person visit every week and increase the person frequency visit, so I can see them more often but they don’t have to pay – you know you don’t pay for travels, you don’t pay for hotels and things like that. I see patients in their doctor’s office, sometimes we have a joint visit, sometimes it’s with their primary care doctor, and sometimes the patient is really and truly sitting at their kitchen table.

Host: That is amazing, so you see patients all across the country and telehealth as you said allows you to do that. So what are the benefits of telemedicine or telehealth, as you call it, for patients overall, and then how about for you as a doctor?

Dr. Bissler: So the benefits for the patients really is that they can get the help they need that may not otherwise be available to them, and honestly the benefits for me as the doctor are many fold. Really I feel like I can keep much better track of just how my patient’s doing. Actually with this technology, I can go over the imaging with them; I can show them the imaging so they can see what we’re talking about, and being able to demonstrate that for our patient, helps them understand not just the disease process I’m talking about, but also why we need the treatment and what we hope the treatment would do. So that really helps, and me as the physician, and again healthcare has improved because of the frequency of visits, questions are answered. They get to sort of ask for visits when they need them, not when they can afford them, and then I can do a much better job of explaining it then. For example, a phone call from a thousand miles away, I can show them instead of just talk to them.

Host: Yeah, right I can see again why that’s very helpful. So, Dr. Bissler, do you have any examples of cases where telehealth technology changed the way you treated a patient?

Dr. Bissler: Oh yeah, so it’s an interesting thing, the seeing and getting to talk to them at a frequency that’s much more helpful. We’ve adjusted medications, started and stopped medications that otherwise wouldn’t have happened until they could save enough money to come, or if they couldn’t then they may have gone without, so this has really been for the patients that I care for, just a tremendous benefit. It’s almost hard to put into words what it means to family. I’ve had parents that couldn’t come, physically couldn’t bring their family, actually cry because they can’t believe that we would do this – be able to help them at such a distance.

Host: Yeah, technology, this certainly sounds like an advancement in healthcare. So what is the future then of telemedicine for Le Bonheur and what do you think about healthcare as a whole?

Dr. Bissler: Yeah so I think telemedicine, telehealth, the broader aspect is already really helping patients in the greater Memphis area. I know that our emergency room uses it quite a bit and other specialties are starting to. If you think about even the shape of the state of Tennessee, it’s about 2 hours north to south but about 6 hours east to west. I haven’t driven it personally so I’m guessing, but the shape of the state, it would be so good to be able to have a specialist that you might need in an area that doesn’t have it. For example, a cardiologist that specializes in congestive failure, well being able to have this available to the patient population or to the physician’s office there so they can see and talk to the patient and discuss, and even they can listen – there’s a lot of things that can be done. This will really take off. I think it will really help not just Le Bonheur, but I think you’ll see this really take off for the rest of the country in various different aspects, partly because of the ease of use, right?

Host: So when you say take off, how do you see telehealth growing or changing in the future? Might there come a day where connecting via our laptop instead of going to the doctor’s office? And then how do you think this is going to change the way Le Bonheur cares for kids?

Dr. Bissler: I think they’ll always be a role for the hospital based visits and so forth, but I think as an accessory to keep better communication, I think it will greatly improve the physician/patient communication, especially for complex diseases or severely ill patients that live at home, but still have quite medically challenging things – I think that telehealth will greatly relieve family’s fears, but also really improve care because being able to have more frequent communication and visual interactions, and telehealth – the ability to do telehealth is coming such a long way. I think as a whole, the other part of the question, I think there is actually already a ton, there are companies that have employed telehealth physicians so that their workers can get a visit, not a face to face in person visit but a face to face electronic visit with a doctor. For example, they’re not feeling well, they go home from work, and they have a visit the same day. So those things are beginning to happen already and I think Le Bonheur, like other healthcare settings, will move toward this sort of approach.

Host: Yeah, that’s really smart about telehealth and the workplace, I can see where that would really help productivity. So we’ve been talking about TSC, tuberous sclerosis complex. Can you tell us what that is?

Dr. Bissler: I’d be happy to. So tuberous sclerosis complex, or TSC as we abbreviate it, is a disease caused by the loss or dysfunction of one of two genes that sort of controls a program for growth. As a result, there can be developmental abnormalities, parts of the brain that don’t form correctly, and it can also be a tumor predisposition like syndrome. Having said that, sounds sort of nebulous, I’m doing that deliberately because the disease can affect every single organ system, and almost no two patients are exactly alike. They’re all different in their manifestations. In fact, that’s the consensus conference for diagnosis. The clinical diagnosis actually has different criteria, major and minor, that helps make the diagnosis because it can be so varied.

Host: So what does treatment of TSC look like?

Dr. Bissler: So it depends on what the particular manifestations for that particular patient – what that patient needs. So I told you every organ system can be involved, but not every organ system is involved. So for example, if a child has issues with brain formation or brain function, they may have seizures, so you need an epileptologist to help take care of them. They may have a tumor in their retina, so a neural ophthalmologist, kidney tumors – so there are doctors that then follow the different aspects of the disease, and depending on what the manifestation is, there are actually medications that can be used to treat it. So I worked in TSC for about 30 years, and it’s really exciting to see now the different treatments that are so much more effective than when I started.

Host: So speaking of treatments, what are the various parts of the TSC program and what makes Le Bonheur’s TSC program unique?

Dr. Bissler: I think part of our uniqueness is the breadth of different specialists that we have. For example, skin can be involved, and so we really do have a TS dermatologist. I had mentioned the retinal tumors a moment ago, and so we have a neural ophthalmologist that can help with that. We’ve got four neurologists that are specially trained in epilepsy and specialize in tuberous sclerosis. We’ve got a developmental pediatrician that actually specializes in some of the behavior issues that children with TS can have. Some adults can develop a lung disease called lymphangioleiomyomatosis, and we have an adult pulmonologist or lung doctor for that. There are cardiac manifestations, so we have a cardiologist, a gastroenterologist, and neurologist, and we have excellent neurosurgery here that can do seizure surgeries or there can be brain tumors that develop and they are good at removing those, and we have a specialized radiologist that really is excellent in everything TS, and probably the most important, and it’s going to sound funny, but really this is the most important, we have a fabulous nurse coordinator and a scheduler that helps make sure that patients see the physicians they need when they need to and they really keep track of what needs to happen. And so they are probably the most important people for the team.

Host: Right, so you are renowned for your TSC care, in fact you were talking about a mom that was crying because you were able to see their child through telehealth. So in what states do you offer telemedicine?

Dr. Bissler: I offer telehealth where I have a license to be able to do telehealth. That’s the law, and so I can see patients by telehealth in Arkansas, California, Colorado, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Michigan, Ohio, Oklahoma, Tennessee, Washington, Florida, Mississippi, and New York.

Host: Well Dr. Bissler, this has been fascinating. Thank you for your time, and to learn more about Le Bonheur visit lebonheur.org, and if you’re ready to hear more, be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or where ever you listen to your podcasts. You can also check out lebonheur.org/podcasts to view our full podcast library, and if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth, thanks for listening.