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Blog Feature

By: Kevin Asp on July 7th, 2016

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Q+A with Dr. Barry Fields, An Expert on Telemedicine

Sleep Medicine

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Dr. Barry Fields, an expert on telemedicine does a Q & A with us!

Fields_Photo_1.jpgWho is Dr. Fields?

Dr. Fields completed his undergraduate education at Cornell University in 2003 and obtained his MD at the University of Rochester School of Medicine in 2007.

He trained in Internal Medicine at Yale-New Haven Hospital from 2007-2010, serving an additional year as Chief Resident.

He then moved to the University of Pennsylvania where he completed a clinical sleep medicine fellowship in 2012, a postdoctoral research fellowship in 2014, and earned his Master of Education (MSEd) degree in 2015.

Under the direction of Dr. Samuel Kuna, he trained extensively in sleep telemedicine and researched its application in remote outpatient settings. Dr. Fields became an Assistant Professor of Medicine at Emory University in 2014.

As a core faculty member for the Emory Sleep Medicine fellowship, he enjoys working closely with trainees.  He practices sleep medicine at the Atlanta VA Medical Center where he directs the sleep telemedicine and home sleep testing programs. His research focuses on telemedicine-based strategies to promote sleep health in underserved, rural populations.

Q: Is there anything that wasn’t included in the bio (above) that you think is important for readers to know?

It was included in my bio, but this is something that I wanted to stress.  I trained in telemedicine as a part of my sleep fellowship; I learned telemedicine as part of my sleep training.   That was something that was so unique because there are very few places that do that.   So I was at the university of Pennsylvania and the Philadelphia VA and, it’s not like I picked up telemedicine after training and just did it; I was actually trained in telemedicine by Sam Kuna, who is the groundbreaking leader in sleep telemedicine.

I was able to train with him and get in on the ground floor so to speak, that’s when the field was a growing field in and of itself.   And now telemedicine is expanding, even within sleep, which is a relatively new field.  So I wanted to highlight that I am one of the unique and lucky folks who got formal training in telemedicine.

Q: When you’re on the consumer end of telemedicine, it may seem too easy to be true at times.  What are some of the challenges that remain with telemedicine?

I think one of the problems moving forward with telemedicine and not just sleep telemedicine, but telemedicine in general, is reimbursement.  So how is that doctor getting paid?  Also, if you did not have a good experience and you were allergic to the antibiotic he gave you because he didn’t know and does not have access to your entire medical chart, is he responsible for that?  Did you sign off on some disclaimer?  How does that work?  All of those details have not been worked out with every telemedicine paradigm.  People don’t always do their homework when developing sleep telemedicine programs, and that may affect the consumer.

Q: That’s right, I remember not signing anything in the telemedicine program I’ve had experience with; they did not make me sign a liability waiver of any sort.

Exactly. So in some way, it leaves you open to potentially poor care, but it also exposes him to potential liability.  Because you didn’t sign off basically absolving him of a legal responsibility if he prescribes some medication that you end up being allergic to that’s one of the growing pains.  One of the challenges is that you as a patient are protected and I as a physician am not.  And I stress also to those I talk to about telemedicine, treat these visits as much like regular care as possible.  So you have malpractice insurance coverage - make sure that your malpractice coverage covers telemedicine.  As a patient you want to know that he or she is trained and in a good position to care for your particular issue.  Do your homework as you would with anyone.  Telemedicine is special but not completely special.  We want to find ways to incorporate the paradigm of telemedicine into what we are doing. Telemedicine is just a newer form of healthcare delivery, but it's not a new healthcare system.  It's a tool.  I am pro telemedicine, also pro penicillin, but I wouldn't prescribe penicillin to someone if I didn't think they needed it or had allergies to it.  I wouldn't use telemedicine in an inappropriate situation or in a scenario that could put a patient in danger.  So we just have to be careful. 

Q: Then how do you feel about the idea some people have with telemedicine; that you can do it on your lunch break or even use Starbucks WiFi?

I would say in the beginning do some reality checking.  And reality checking meaning check how you think about telemedicine with how you think about reality.  Would you call your doctor on the phone in the middle of a busy McDonalds and describe your situation?  Probably not.  So as part of your reality testing just think to yourself, telemedicine is just a tool to engage me with a provider.  I could do that in a McDonald's but this is a medical encounter. By law, this is a medical encounter.  Where do I want to have this?   What settings, do I feel comfortable doing this over the telephone legally, economically, and everything else. That formality in  telemedicine for medical care needs to remain to assure quality of care.  As far as not being responsible, you wouldn't not worry about the money.  What is my copay?  Same thing with telemedicine; that's the reality.  You need to think about telemedicine as you think about any form of healthcare. 

Q: So expand upon what we just talked about, some of the concerns about the informality of telemedicine.

What I don't want to see is informality to the point that someone is calling their doctor at 2 am saying I can't sleep.  That is not good, not only from a physician's perspective, but that's not good for the patient either.  Because a lot of what we do in sleep medicine is teaching a patient how to fish. If the patient expects me to deliver a fish at any time, maybe they will know how to eat fish at that time but they won't know how to get it in the future.  In sleep we often train people how to sleep better.  That takes time and can be done using telemedicine as a series of medical encounters that teach a patient how to sleep better.  It's like teaching a patient how to fish, the idea being that in the future they won't need to spend more money to see me because I will have taught them the skills needed to sleep better.  But if they can just text me a problem and I can provide an answer like, here is a pill in the middle of the night, well that can help them but will increase their reliance on the healthcare system overall.  Because you would be giving them a crutch that is not necessarily safe.

Q:  What do you think about the anxiety surrounding telemedicine and how that could ultimately take the jobs of sleep technologists?

From my perspective, it's an interesting thought because the anxiety is already there.  Sleep technologists have been dealing with home sleep apnea testing (HSAT) for years and how it encroaches upon in-lab testing.  HSAT can take away jobs in it of itself so that already creates anxiety.  I see telemedicine as offering technologists new opportunities.  In the telemedicine paradigm that I discussed, I don't see a world in which it takes away technologists jobs.  If anything technologist's roles will change.  A sleep technologist can transition into more daytime work as the treatment model becomes more and more HSAT related.  I don't see telemedicine as a cause for more anxiety. I see it as a response to the anxiety that already exists.  There is an opportunity for technologists to expand into new telemedicine roles!

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