Q & A With Dr. Seema Khosla On Telemedicine And Its Future
We spoke with Dr. Khosla, who shared her thoughts on the field of telemedicine
1. What’s your background in sleep medicine and how did you get into telemedicine?
I completed a fellowship in Pulmonary/Critical Care and Sleep Medicine at the Medical College of Georgia. Afterwards, I worked for a hospital system. A few years later, I was asked to join my current company to practice 100 percent Sleep Medicine. At that time, telemedicine was a small part of the clinical practice but one that I enjoyed. The telemedicine component ebbs and flows depending upon patient demand locally and remotely.
2. Would you consider telemedicine to be an integral part of sleep medicine? How has telemedicine’s place in sleep medicine grown the past few years?
For me, it has allowed me to expand our reach into the more rural areas of North Dakota.
We have also performed telemedicine services across state lines and as a result, have been able to diagnose and treat patients who have never even been to Fargo, ND. As a solo practitioner competing with two large health system, it has allowed me to access patients who have chosen to participate in this very patient-centric model.
I believe that sleep telemedicine has grown. I appreciate the investment that the AASM has made in sleep telemedicine as this has not only increased awareness, but has also helped to overcome potential hurdles such as patient acceptance.
3. What excites you the most about telemedicine and working with rural communities that need it?
A few years ago, we sent out a survey to our telemedicine patients.
One of the questions asked them if they ever would have scheduled that first consultation if they had been asked to travel to Fargo rather than being seen in their hometown.
89% of them indicated that they never would have even made that first trip to be seen for an initial consultation.
It took me a while to digest this. My take away from this response is that by simply making that first encounter less cumbersome, we were able to offer sleep medicine care to a number of patients who otherwise would not have been seen at all.
I believe that sleep medicine suffers from a lack of urgency. When patients have chest pain, they go to the ER to be seen. They understand that this is an important, potentially life-threatening issue.
Very few people go to the ER for snoring and yet there are countless studies linking untreated OSA to a multitude of medical ills that can be life-threatening. We need to be able to reach these patients if we expect to make a positive impact in their sleep health and therefore their overall well-being.
4. What are some of the challenges ahead for telemedicine in your opinion?
My greatest challenge has been tackling the inconsistencies with the regulations from state to state. It isn’t as simple as whether or not a service will be covered via telemedicine.
We also have to consider licensure and the regulations regarding establishment of the physician-patient relationship. Some states require that be established in person. Others allow for this to be accomplished remotely but then put limitations on prescribing medications.
CMS coverage of PAP devices often specifies the need for an upper airway and cardiopulmonary examination which cannot be done without utilizing examination extenders. For someone starting out in telemedicine, this may be a steep investment and therefore a deterrent.
Personally, I believe that payor reimbursement is the next largest issue. While there are many states that allow for telemedicine, within the specific guidelines are limitations regarding geography – such as being able to cross state lines. There are also limitations regarding scripting medications.
5. What does the future of telemedicine look like and what’s ahead for you? What are some goals you have as a physician to improve the telemedicine experience for both yourself and your patients?
I am excited by telemedicine. The system we currently utilize is vastly different from the technology we utilized when I first started. It is exciting to have had a hand in shaping our current model.
We re-evaluate this constantly and keep our patients in the forefront – we want this to be as seamless as possible for them. I think that this technology will become more accepted and may become the first-line method of connecting a patient with a health care provider for non-acute issues.
I have experimented with various platforms. My goal is to make this as similar to an in-person visit as possible for both the patient and myself. I like my patients – I don’t want to miss out on the personal connections.
I had a couple that we had seen remotely for years invite me out to see the local sights in their home town. I have another who sends treats back to Fargo with my clinic nurse. This isn’t really a completely different way to practice medicine – it is the same medicine we have practiced for years with a different delivery system.
Telemedicine is just another tool in the tool belt – the patient care is the same.