COVID-19 and Telemedicine: A Conversation

In an interview with Drug Topics®, Richard Scholz, chief strategy officer of ERxDirect, explained the prominence of telemedicine during the COVID-19 pandemic and the lasting implications of new technologies during unprecedented times.

Drug Topics®: Hi, my name is Gabrielle Ientile with Drug Topics® and today we're talking to Richard Scholz, chief strategy officer of ERxDirect, about telemedicine and how it's been aiding the COVID-19 pandemic. Rich, thanks so much for joining me today.

Scholz: It's my pleasure. Thank you for having me.

Drug Topics®: So I'd like to start with your professional background and how you came into your position with ERxDirect.

Scholz: Fantastic, I'm glad to provide that. It’s somewhat of a long history so bear with me, but my role is to lead strategy for the company's consumer centric product designs, consumer centric implementation strategy, and consumer recognized sustainable value. As all of us in the industry, each of us draws on past experiences to form their foundation for their decisions and the paths that they take. I've had the absolute blessing of being able to view healthcare and, most particularly, pharmacy care, through many unique lenses over 45 years in the industry. And it's through those lenses that I that I that I form the basis for our strategic path. I started out as a practicing pharmacy in the independent small chain and chain environment. I've been a regional chain executive as a pharmacist, and also was an early PBM founder and CEO of an early PBM, which was part of Express script. I was co-creator along with Brian Slusser, who is our current ERxDirect CEO. We were co-founders of Strategic Health Plans. Which is now the PSAO. It's now known as McKesson Health Mart Atlas. I'm an attorney, and I've represented pharmacists and pharmacies in different types of environments. And I'm also a registered lobbyist in Washington DC on health policy, focused primarily on pharmacy. So with that, I say it's a diverse lens. And that's what I enjoy about it. The pharmacy training that I've had, the pharmacy background, has given me the opportunity to apply that lens to every segment of our business. And every business I've ever been in, everything I've done with healthcare, is that the key is the patient, now the patient/consumer; they've got to be central to the strategy or it can't be successful, and it can't be sustainable. Consumers are flexing their muscle in healthcare more than ever before, and I think that's a welcome change. We need consumers to be empowered and to be part of their own health initiatives. With that is, Brian and I have reunited over the last 10 years after our time together at Strategic Health Alliance, and we looked at the technology that was coming into the market and how can we assist providers, pharmacy, and clinical providers to access patients more effectively, more efficiently. That's the initiative of Health in Motion and ERxDirect.

Drug Topics®: So can you give us a little bit of what your current day to day looks like once the outbreak started?

Scholz: Well, we're not a COVID initiative per se. We're a health care initiative and our charge is to bring efficient access to health care, increased quality of health care, increased continuity of care, bring health care to where consumers are and try to decrease the complexity of the process; health care is has grown into a very complicated maze for patients, and part of the beauty of technology is ways to make that maze much more manageable for patients because if the patients - if through frustration, through lack of access, whatever - they abandon their pharmacy therapy or any of their therapy initiatives or care plans for their physicians, then we have a failure for an outcome. And it's not necessarily because we weren't capable of getting a positive outcome, it's just that there was space between the dots that didn't get connected. Part of telehealth, part of our initiative is just connecting those dots. What COVID has been is an accelerant to that, because not only is COVID as a disease state put pressure on healthcare, but it's also brought into the spotlight is the importance of chronic disease management and prevention. And the reality is that our companies were born to make health care more efficient, get it to people more efficiently, where they work, and where they congregate. And that goes for chronic disease management. So COVID, per se, has been a true accelerant to the acceptance of the type of healthcare that we're advocating for.

Drug Topics®: And can you kind of break down how does telemedicine work? Is the nature of telemedicine to replace the maze that you mentioned that health care is or to more supplement what current practice has?

Scholz: First of all, [it is to] clearly supplement, I think that replacement would be a far overreach. I think that there's a lot of things that we can do through telemedicine; within the current practice, first of all, the current practice of health care is professional dependent; professional conditions, professional pharmacists, professional dieticians, professional and behavior health, all these professionals are on the mosaic that that brings us to health care. The key is how do we get them to the people more effectively and more efficiently? So that's truly a supplemental role. We see that as not replacing. Health care providers are the key and empowered patients are the key to health care. So our goal is not to replace, our goal is to enhance. I think it's important that you understand, at least from my perspective, what telemedicine is. All my experience has been in the outpatient world so we're not talking telestroke in the hospital, those kinds of cares: those are different.

Our arena for telehealth is when in a basic sense is there's a clinical encounter. The patient is in 1 location, and the provider is in a different physical location. And then the connectivity in those endpoints has great diversity even within our world. And I'd like to tell you some about that diversity, if I may, is Health in Motion networks, a model of care delivery that focuses on wellness through innovation, improving health management. And we do that through personalized care and that's personalized care with your provider. That's the goal, for you to have that relationship with your provider. Our goal is to enhance that relationship and multiple relationships, and then coordinate them so that maze that we talked about earlier is not so complex.

Our care spaces are hallmark virtual clinic. This is a clinic that is designed to put on employer worksite. It's also used in campus care environments, also used in in our connected health hub clinical sites, which is actually a brick and mortar clinic with dedicated rooms for digital health and for virtual health and telemedicine that allows those brick and mortar sites to now enhance their offering to local patients, so that they can now host an in person practice, but also host a visit for a patient to a specialist that may be at a tertiary care facility 60 miles away. That patient doesn't have to interrupt their day and go to get that additional clinical care through a specialist. What we're looking at really is enhancing portability, but our care spaces is  - what's the hallmark of it is -  that it's synchronous communication of medical data to the provider. So the professional clinician get real time heart and lung sounds, they get real time, detailed, high resolution pictures, there's a nurse at the bedside, at the exam table, helping with the medical devices and working with the physician for hands on care that may be needed or desire for the physician to make the proper diagnosis. So it's a very, very large scope of care. We also have the direct to consumer components, where the physician can do a virtual visit directly to the consumer on a personal device. But again, that has utility, but it doesn't have as robust diagnostic utility, as does the care space. So we see a place for all of that. We see a pharmacist as part of that healthcare team. We see a pharmacist being imported into each of those different environments to bring that pharmacy knowledge to that encounter and to that patient as part of that healthcare team.

Drug Topics®: And where is ERxDirect available currently in the United States? Is it nationally available? Or globally as well yet?

Scholz: Yes, we are rolling out. What prompted our discussion today was rolling out of the ERxDirect telemed, which is the connectivity component for our pharmacists. We're rolling that out through epic pharmacies, and that’s on a national basis. We're also expanding through some other pharmacy groups also on a national basis. All of our initiatives through Health in Motion ERxDirect our national, we don't have any global initiatives at this point, but I would call the attention that if one of our patients was traveling and wanted to reach their pharmacy or their physician back home to do a consult through the web, that would be available.

Drug Topics®: Can you take us through what would the steps be for a pharmacist who is interested in implementing ERxDirect’s telemedicine service? What changes would they have to make to their current practice?

Scholz: Sure. The first piece of ERxDirect telemed that we're rolling out through epic pharmacies is connectivity. They can implement this on various devices depending on their desired workflow. We have some pharmacies right now during COVID, where there's a pharmacist that is actually part of the vulnerable population and chooses not to be able to come to the pharmacy, and appropriately so. So they do all their work on a personal device in their consultations on a personal device for their home, much like you and I are working from offices that are atypical from our normal day. And this enables those practitioners to participate in that market equally as robustly as if they were in their pharmacy.

As far as what they have to adjust, it's really easy because it's a workflow and most significant changes. First of all, they have to have a viable device with a camera, which is quite common now. We have a HIPAA compliant environment, so you wouldn't want to do a consult at a public area, and I think the biggest change from a workflow standpoint, is for pharmacists and community pharmacists is to be able to set aside time in their day to schedule consultations. They're so used to ad hoc consultations and on demand workflow, that schedule consultations is somewhat of a new arena for them from a workflow standpoint.

Drug Topics®: And then going forward after the pandemic ends, hopefully, why do you think it's important to continue to improve telemedicine technologies and what changes will this pandemic create in terms of pharmacy practice?

Scholz: Now, I think that that's a critical question and a good question based upon the fact that yes, this will come to an end and we're hoping for a very quick end to it. I think that what will happen is, what's been spotlighted by this pandemic, is the fact that we have a vulnerable society from health care with comorbidities and some chronic diseases. I believe the spotlight that COVID has shined on those chronic disease states will have a lingering effect as to how we approach and practice population health going forward. That's going to take an implementation of a healthcare team to do that. What we're doing through ERxDirect telemed is making sure that our pharmacists are enabled to fully participate on that team. To give you an example from of how we're using now telemed: urgent care providers actually having a care space or a clinic in a public school. The school nurse becomes the enabler and the care coordinator for the student. It's really fascinating.

I think we'll see a bigger focus on this post-COVID, that 38% of adults reported taking drugs with depression as potential side effect within the past 30 days, and 23% are using drugs that are carried the risk of suicide symptoms. This is an adult population. But also in student population, there are drugs that have side effects that make the school nurse or the teacher, the principal, may be maybe seeing a difference in behavior. Bringing behavior, health, bringing pharmacists bringing all these to the forefront, so you're able to assist the health care team to come to the proper analysis. We’ve seen that, by bringing the team together and facilitating that collaboration, that's where the magic of increasing the access and the quality comes in. So we're seeing that there's going to be a lot more focus on chronic conditions on how the different components of the professions work together for the betterment of that patient.

Drug Topics®: What does ERxDirect hope the future will look like for telemedicine, and can you tell us about any plans for growth?

Scholz: Sure, certainly can. We look at that future as being very bright. Telemedicine has started in a couple different spurts over the last 10 years and as we've been involved in the business, and it had certain hurdles to cross. We do not believe that the telehealth will ever go back to the to the status that it had pre-COVID because of the general acceptability. But to be successful and to be sustainable - and sustainable is the key - that any telemedicine strategies got to focus on the patient experience, the provider experience, and have positive impact on outcomes and return on investment for the healthcare system. That's critically important. We find the patient experience and acceptance of patients has been very, very high. It's never been a problem. And we've been doing this for a long time in the professional space, where providing physician visits to via telehealth provider experience has been, I think the resistance and that is because those providers, they have to make a very critical clinical decision-based upon the information they gather from the encounter. In person, they have an unlimited ability to gather that information remotely in telemedicine, that can be that can be very, very robust gathering information as in our care space, where we have all the digital instrumentations or it could be less of a less of a robust opportunity, much like you and I visiting today on Zoom. So to make that diagnosis and to have the confidence to make complex diagnosis, the key will be the robustness and the credibility of the information that the provider gets. Provider adoption and provider experience becomes critical to the long-term sustainability of telehealth.

We believe the consumer experience has to be welcoming, effortless, adaptable, and continuously refined because consumers are trained to have instant gratification and they're going to demand it from health care, much like they demand it from every other type of consumer experience. We see that as being where we're headed. As far as expansion, we're expanding more naturally through our Health and Motion network. From a clinical side, we have our partnering relationships with the Urgent Care Association of America and their gateway to better network to bring more urgent care providers into our Health in Motion network and our environments. We have local and regional primary care practices, we have university based practices, and we're bringing more and more specialty practices in that want to export their care to more to rural and underserved areas so that those patients don't have to travel as much and can still have access to quality care. We see it as a is a win-win for everybody. And the expansion of it will be purposeful. It's not a matter of putting a lot of connectivity apps out there and hope somebody will use them. It's about purposeful deployment in the marketplace for better health care management.

Drug Topics®: And what's your biggest takeaways that you want our viewers to take from this?

Scholz: The biggest takeaway from my perspective, and this is as a pharmacist and as a health care professional, is that over 45 years in the industry, I've come to 1 really basic conclusion. And everything that I've done and touched in health care is that informed patient, regardless of how they got the credible information through physician connectivity, pharmacy counseling, credible patient-oriented content, health coaching, however they got their credible information that informed patients and empowered patients are the most critical team member in the management of chronic disease. Everything we can do to reach into the lives of these patients and make those lives better, make that maze a little less daunting. That will be for successful management of chronic health care, and hopefully not management but prevention also. So what we see as the tools that we're bringing to market, again, not replacing anyone in healthcare, enhancing what they do every day, and to make it more portable and more viable in the future.

Drug Topics®: Rich, thank you so much for joining us today and for offering your expertise and stay safe.

Scholz: I appreciate it. Thank you so much.

Editor’s note: This interview transcription has been lightly edited for style and clarity.

Check back to drugtopics.com for part 2 of this interview and more expert interviews on COVID-19.