Danielle speaks with Sarah Swank, a nationally noted healthcare and health equity attorney and policy advisor with Nixon Peabody LLP. In this episode, we discuss the legal and ethical complications that come with telehealth, artificial intelligence, and the future of healthcare.

to a Virtual View, a telehealth podcast, brought to you by the Upper

Midwest Telehealth Resource Center.

Today I'm joined by Sarah Swank, health attorney of

Nixon Peabody in Washington DC.

Sarah, thanks for taking the time to join us today.

Yeah.

Thank you for having me today.

Yeah, and this isn't your first podcast, is it?

It isn't I guess I didn't mean to be the podcast queen, but

just like you, I've somehow am out speaking more and more on.

Thank you for adding ours to your list.

Could you introduce yourself to our audience?

A.

Yeah.

So I am Sarah Swank.

I'm a healthcare attorney.

I've been a healthcare attorney for 23 something years in there.

And I have I would say I'm of a traditional healthcare attorney in that

I do regulatory and corporate work, but I would say I'm not a traditional

healthcare attorney because I am driven.

A lot by what I think are innovations, changes and improvements in healthcare.

And not that I think I'm the only one, I think a lot of people are but

when we talk about where my interests lie and where I go you'll see that

the clients and the people that I'm working with are really trying to push

where healthcare delivery is going.

So I have to admit, looking at health and healthcare from a

more legal perspective that's not something that I've really done before.

It's not my first thought when I think of healthcare, so what does

being a health attorney entail?

Yeah.

So for a health attorney it's funny cuz it's one of those things, like what

attorneys do is you're, let's say you're at an event and someone asks you what

you do and you say, I'm in healthcare.

And then you say what do you do?

And then you say, Are you a nurse?

No.

Are you doctor?

No.

Are you a pharmacist?

No.

And then you say, I'm an attorney.

And they say, Oh, are you a malpractice lawyer?

And they're like, No, , I'm not that either.

So what do we do?

There's a lot of regulations.

If this was easy.

You wouldn't need me.

And honestly and with every like advice you give, there could be thousands

of pages of like regulations and law and that sit behind, behind that.

And, but what I think, so there's that part of it.

Healthcares are healthcare is has corporations, a lot of it, some of

it's public, but a lot of it's private.

And so we have those regulations overlapping with a private

industry in our country.

And then we.

Federal dollars that come in.

And so we've got Medicare and Medicaid laws.

We are United States, we've got, in these federal laws, but we also have state laws.

So it's it gets complicated really fast.

But I think what I think what do I do?

I try to help.

Understand what people's visions are.

Try to navigate all that's going on.

Maybe sometimes even get out ahead of it with health policy and try to make

sure that care's being delivered in the United States in the way it should.

And, for clients, what I'm I say is, I'm, I, my favorite things

to do are to build things, right?

Like I love sitting and helping to build.

But the other thing I do with like compliance and otherwise is to help

people do the right thing, right?

Like to complying with the laws is the right thing to do right?

And if there's times where it's in the gray, which happens a lot,

especially in telehealth, right?

As it's changing so fast, is to figure out, what can we mitigate?

Where's the risk on this?

What does the program look like?

What are the details that make it go into compliance?

Cause it's, if you're on the cutting edge of healthcare, If you're not

trying to go out and break the laws, but there's some of the laws might have not

caught up where you're trying to head.

And so that, those are my favorite projects to work on are with people

that are really, have a passion and a drive towards changing healthcare and

healthcare delivery, especially using technology and people in a innovative way.

And then helping them navigate it.

And those are my favorite.

So that's what healthy is.

I think a really good health care lawyer also becomes an advisor, has

business knowledge and ment hopefully, and seen enough deals, seen enough

of this or that to say, Hey, by the way do you wanna do it that way?

Like you could.

And I think those are also some of my favorite moments when we're

having these really great strategy talk talks and trying to figure

out, how do we do things best or.

Very cool.

So you talked that you're involved with telehealth.

How's that something you became interested in?

Was that deliberate?

S

Yeah, it's so interesting.

So I tripped into health law.

I didn't know what kind of attorney I wanted to be.

There's a lot of us that came out that timeframe.

There wasn't as many laws back then to even comply with.

So you tripped into the health law and then, I was, government

and psych major, if anyone out there is fascinated by my majors.

But I was obviously drawn towards healthcare in that I was thinking

I'd be a clinician myself, right?

Like I was thinking about going and becoming a psychologist and and just

left that behind and thought I'd be an attorney and then here, Health law.

So where did Telehealth come into it?

I think some of my first projects where I was drawn and I was interested in

them was watching some of the first technology go into like manage care in

New York and watching the change of people trying to get data out of these really

archaic systems and things, really being on paper and trying to figure out how

do we care better for these patients?

And I.

Gravitated to that.

And then I think my first real exposure to telehealth as we think of it today

was I was in house at a hospital that was really trying to figure out how do

we get like a specialist to see a patient or something when there's like a lot of

traffic in dc for example Or it could be the office in the rural IT community.

It could be, how do I.

Do I drive two and a half hours?

Like it could be two and a half hours in traffic or no traffic.

It's still difficult if you have to try to get to somebody and how do we solve that?

Or if you have a very specialized, like in the hospital visit, like

with a pediatrician, how do we get the doctor across the traffic?

Maybe that's not gonna make sense or the big long distance to get to the patient.

And so that's how I got involved.

And I just joked that things were rolling down hallways like . It

was not the same as it is now.

And really what I would say is, I've always this, but it's

the technology that's changed.

And now we can say the laws have changed, the reimbursement's changed.

But the concept hasn't.

And that's how I got involved and then why I stayed passionate in it and

really gravitated again to trying to work with people that are trying to do

this was because personally I saw it as so many opportunities in it, even

when there was no money in it, right?

Like some point there wasn't a lot of payment in it, and people were trying

to figure out, do I go to employers?

Do I just do this because it's actually keeping costs down and

admissions outta hospitals down.

Like, why am I doing it?

I still thought, Gosh, look at the benefit of this.

And I even remember going to the American telemedicine association and

it was one of the first speakers that said, I'm seeing all the, there's

lots of legal barriers, right?

That was a lot of the things you're talking about, telehealth.

And I said, But look at what's happening with the Affordable

Care Act ACOs population.

And yet at the same time, isn't that like telehealth that kinda helps

with some of this work And just came out and said, I don't think you

should be scared of the laws as much.

Don't use that as an excuse, right?

Like it's an opportunity and a barrier, but let's see what we can do.

And so that, that's where, how I got involved and why I've stayed involved.

Now it's so exciting.

I don't even, there's so much going on in this space.

So we talked a little bit about the fact that there's legal challenges

associated with telehealth specifically.

What are some of those specific legal challenges?

I think the first, I think I, I said this, but I really hit it home.

The first one was there was no reimbursement for a lot of this,

so it's like, where do you get funded for or why are you doing it?

Where and not to say that the money drive is, drives everything, but at some

point you have to say, it, it's a cost.

And honestly, if not enough people are doing it, it's hard to get the

data to show it's effective even.

I think the other barrier that you hear a lot is around licensure, right?

Like the idea of if I wanna do this in 50 states, which we get this a

lot, like in my firm at Nixon, like I wanna do this in 50 states, but

I can't be like, how are we gonna, what's the licensing strategy or what?

And that got even more wild during.

Covid in the pandemic in the public health emergency cuz all the states

were doing different licensing.

They were changing their licensing as we were going.

And even if you're not saying I wanna do 50 states, your patients

may be in a tri-state area cuz you're on the edge of a state somewhere.

Your patients might have decided that they wanted to go visit a family

during this public health emergency.

Maybe they needed to go stay with family, or maybe they said, Hey, I

just wanna go on vacation for two weeks and just go to somewhere warm.

I, you don't know.

And so there you are, like, and are you properly licensed to talk to that

person as they're moving, or honestly, Again, we'll go back to not just

the patient's, move, the people, the providers move, the physicians that

now it's even bigger social work.

Tell us psychiatry.

They can move too.

They might decide they wanna take a two week vacation and half of

that will work remotely out of.

You all their visiting family in a confidential space.

And can they do that?

Are they licensed to do that?

And licensure becomes a huge, can become a huge barrier.

We figured out how to do it.

It's a lot of work.

There's a lot of people that say, Why don't we have a compact on

this, like the nursing compact or some like national standards.

But we're not there yet.

I We've been saying that for 10 years.

. Those were like the two biggest ones that you hear a lot.

There's other ones too, because we've got now, which is really

exciting, like the opportunity to have other people besides physicians.

It used to be telemedicine that meant doctors.

It's not.

It's all kinds of clinicians, which is really great.

They all have their own scope of their license and what they can and can't do.

And so now we have to think about and who can supervise them, Who

needs to be watching their work, who needs to be overseeing them?

And each of those are state by state.

So you may be able to have a nurse do something here or a, like an LPN or some.

other category and you have to go, Huh, the right people.

Could they say that?

Or do they need to be scripted?

Are they a health coach?

Are they a nurse?

Are they a doctor?

And so even that concept of telehealth is so exciting, but a big legal

barrier where we're really having to think through things are, corporate

practice of medicine, scope of license.

And scope of supervision requirements within the state.

And some again, though, some of those got waved during the pandemic, but

those waivers are coming in and out and some of those things have stuck.

Some things are not gonna change.

I A lot of these laws were set up like in a traditional brick and mortar sense.

They weren't set up for telehealth necessarily.

Yeah.

So an emerging field in telehealth and really technology in general is

artificial intelligence, and I understand, is that an area of interest for you?

It is.

Absolutely.

Yeah.

I would assume that AI is something that, for a whole host

of reasons, might come with some very interesting legal questions.

Yeah.

AI's very interesting because.

There's not a lot of regulation around it if you look at it from a national

level and that or even a global level.

And we're seeing the regulations of it in other countries, like in Europe.

But what I think is interesting about it is, artificial intelligence

is not that regulated, and yet we're looking at if you look at.

We say about where we need to be with it as a country, like as our like economics

of our country, which includes healthcare as one of those economic factors.

It's a priority.

So it's and obviously healthcare's something that's a huge part of

our budget in the United States.

It's a huge part of our economy.

And so it naturally makes sense that like we're gonna wanna promote some

level of artificial intelligence.

And so that's, it's interesting, some people say how did you get

involved in artificial intelligence?

It's not like I knew 10 years ago that I was gonna be thinking about

artificial intelligence necessarily.

Or maybe I could have predicted some of it.

There's some of it that's in there.

But what I think is interesting, it's the natural flow of the use

of data and technology to care for patients or to transform processes

in healthcare just as it could infor, it could transform processes in any

industry or even our daily lives.

A good example of this is, Bots.

So bots, a lot of people say bots aren't artificial intelligence.

But if we're gonna use this broadest definition, cuz the definition is all

over the place of how we think about it.

If you said, When I get healthcare, a little text message is gonna show up

and then it's gonna talk to me and then I'm gonna go do something, we would

all say, Gosh, that's like inhumane.

I might not feel cared about.

I'm gonna like it.

Now go look at covid testing.

And how we got bots.

I said, Do you have this system?

Do you have that da?

And then it directed you to something to do.

Maybe it was a telehealth visit, maybe it was to go to your doctor,

maybe it was to go to testing.

And we were not offended by that.

So we can see how when that starts getting integrated into care delivery or

even the backend processes in EHRs and getting realtime data out there's some

real opportunities there, but legally, We have to look at the laws that kind

of, that exist now and frame this new technology over it, which sounds a lot

like the, like telehealth or telemedicine.

A long time ago, a lot of laws weren't out there, and so we have to take

this technology and say, what is the framework and how does that framework

of our laws, is it working or not working based on this technology?

I think where artificial intelligence a little bit different than telehealth is.

It's got such widespread use outside of even healthcare, like that, that it's

not just a healthcare, thing, it is something that would be transformative

to a lot of different parts of our lives.

Yeah, it's the next big horizon in technology.

But you talked about bots and stuff, and I was reminded, like two days ago, I got

a message from my dentist reminding me to come in with one of those like AI systems.

And then I got one from my GP as well, and I'm like, Wow.

Five or 10 years ago, I wouldn't even have thought that this was possible, but

it's just become so commonplace recently that we don't even think twice about it.

But something else you mentioned that I wanted to talk about was, you mentioned

how healthcare is a huge part of the sort of market or the economic landscape of

the United States, and I think that's very true because it's one of those things that

you, , you really can't get away from.

Everybody engages in.

Health to some extent during their life, obviously.

So I know this is a very broad question, but with the development of other new

technologies, even aside from ai do you think there are any legal or ethical

issues that might stand out to you as things we're going to need to confront

as we continue to have this huge development of new health technologies?

Is.

I think for me, what, and I'll use artificial intelligence as a place

to think about this cuz it could.

It could be a lot of places but really what is, when I first started going out

and talking about artificial intelligence as an attorney, there weren't a lot of

lawyers out there talking about it because there wasn't a lot of laws out there.

And so you're trying to talk about navigating certain laws, but what I, one

of the things I would hit home is the ethics behind it, the morals behind it.

And when you look at the ethics and morals of artificial

intelligence, you're looking at data.

And even if.

Whether it's data that's a pixel and how many pixels there are to be able to look

at, a breast cancer scan to see whether it's breast cancer and the computer's

looking at it and or whether they're like looking at o other processes.

You're taking data out of our healthcare system and even, know, if you look

at the, there's a NIST report and I S N I S T, but people in telehealth

probably already know who they are but They, they said we think there's bias.

Where does this bias come from?

They come from healthcare's part of our society.

It's part of systems and who comes and access healthcare.

That's the data that's in the system.

How we track it is how it's in the system, how we ask about it.

It's in the system.

And having talked to data scientists who think about the word way

differently than I do as an attorney say, there's information in there.

We could be doing all these great things.

Of course we have laws and things that say maybe you can, maybe you can't.

We also have the way our system's structured, which is system by system.

It's not like a big national system where all this data's

getting pulled into it, right?

So we've got that and then we've got again, like our biases.

And a really good example of that is if we look at clinical research,

clinical research, Is done.

It gives us evidence-based medicine.

It proves our drugs and devices.

It's like a process we get through.

And at the end of it, we've got, some product that can be used under the market.

It could be a drug or it could be, a new way to care for

patients, whatever that research.

But if you don't have people of different diverse backgrounds, in every way

of that underserved communities in every way we can think about that.

Do we really know if that science is correct?

And so I would say, artificial intelligence, you could say,

Okay, we've seen it really work well in clinical research.

Where did it work?

There it can be helpful in being able to identify patients that

might meet a criteria for a study.

It might be really good at screening only for those patients

that are actually in ther.

If you are somebody who did not want to go.

To the emergency room or go to a doctor because of the systematic biases that

may exist in our world, then you're not in there . Or if you're in a

location, maybe it's a rural location, maybe it's an underserved community.

In an urban location.

Maybe you don't even get clinical research near you and so you're

not in the system to be looked at.

Then we have, so then that data is in naturally inherently biased

towards the, what's in there and the research can, could be then biased.

And there's re researchers that are trying to think about this.

The FDA has put out for the last year saying, you need to

have equity in your clinical.

can throw all the AI you want over it and it won't necessarily fix that problem.

But there, I do think there's hope in ai.

If we understand that when AI gets built, we can build it with bias, that

we can understand the systems and try to figure out if we can break the bias.

And build that in.

But if we now take this moment and build the AI based off of, the people that

are gonna end up coding it, the people that are putting the input in the data

that we have, we may actually bake our biases into the future generations.

And that's the part that I think is the biggest barrier.

And that's, that goes beyond legal, that goes beyond ethics.

That goes beyond what, where do we want, What do we want our

country to look like in the future?

And what do we want healthcare to.

I think that's such an important point because I feel like

a lot of people do look down at data and be like it's just data.

And don't take into account that there are like biases.

And what have you like involved in putting that data together?

One of the things that I do find most exciting about telehealth, aside from the

fact that , I can go to the doctor in my pajamas is the potential utility in the

field of health equity, like you said.

So I know you have an interest in health equity as well.

Do you think that Telehealth can have a role in promoting future health?

I think it does because you, if it can provide more access, right?

In that way, like when we look at health equity and even just defining what

health equity means, we're looking at.

What we underserved community.

So if you look at CMSs health Equity plan, you'll see a lot of the laws around

access are in there and they still sit on the books, but clearly they haven't

completely eliminated some of the issues.

Just cuz those laws are sitting there.

So it's, it is a reframing of that.

And when we, and defining what underserved.

Helps too.

So it's, it is, it can be race, it can be gender, it could be rural, it could

be, it can be a lot of different areas.

And it's, what's interesting is is there a solution that can solve that?

Fact that those are all underserved communities.

I Telehealth could be one of those that serves just to, to cut across

what we are defining as underserved communities, which may have some

things in common and may not.

So like here, but where a barrier would sit and where

the health equity also sits is.

We don't always have digital health equity, so we say yes, it's gonna help

us, but if we don't have digital health equity in that, we mean that we have

these really cool, fancy things we're doing like telehealth or fem tech where

you've got like a phone and you can have a device and you can track thing.

There's all these really cool innovations happening.

But if they.

If you don't have access to them, we're actually creating

what they call a digital divide.

We're actually making it worse for everybody or some people.

And so we look at broadband, right?

There was a, this administration's putting out grants for states to look at, like

what they call the internet for all.

And they have specifically called out healthcare as one of those areas.

And education is surprisingly not another one in the,

economics just general economics.

So that's really important.

If you can't actually get to it.

Like you, you don't actually have access to it.

If you are somebody who has a hard time using the technology, then you don't

have meaningful access and I think.

We saw that with signing up for vaccines.

There's just some people that like, and this wasn't even telehealth.

Were like, I can't use this system.

I will tell you, I had a hard time using this.

It was not always user friendly, no offense.

I know people had to throw them up quickly, but it wasn't use.

So some people just called, I'm just gonna make fun a phone call, because

I, every time I tried to do something, someone else has taken my appointment

and I, I'm having a hard time doing this.

So it's digital health equity isn't just, It is BroadB.

it's digital literacy.

It's and it's also like cultural competency.

Am I somebody who would want to use it or not?

Just say it's absolutely a good thing for everybody.

It might be like yeah, it's a good thing, but we need to be culturally

competent to know certain people are going to wanna access it in

this situation versus another.

And we can't just assume with our biases that whatever we wanna do to

access it is gonna be the right answer.

So there.

There's a lot of equity that comes into this, but there's so much opportunity too.

We shouldn't just say not everyone can have it, so we're not gonna do it.

No, I think it's the opposite.

Like how do we knock down the barriers that are around the access to it so that

we can get those other, Because it like, it's not just healthcare too, right?

If it's an internet thing, it literally might be school, it literally might

be able to start a business, or do you know, And that's not right.

Yeah, I think there's just a, there's a ton of opportunity in it and just

so people know, like, why does a lawyer care about health equity?

I care personally.

But Right.

That's a passion of mine.

But legally, we're watching this, It's gonna get baked into how we get paid.

It's gonna get baked into quality measures that we don't have right now.

It's gonna get baked into transparency laws and things that go on to like

Ford facing websites about this is how much you cost, this is your quality,

and and if your quality scores include health equity scores and access score.

It's gonna be apparent to everybody.

So I, I think, and then honestly like access laws still are out there and

whether they're used or not used, there's a lot of potential for enforcement

around some of the things they're already sitting on the books, nevermind

them getting picked back up and looked at in a digital way, not just look at

it like, Oh, I walk into a building and I can't get into the building.

That's not good, but how about I can't walk into my platform and I can't see.

So how am I supposed to navigate my telehealth visit when I can't?

I can't see it.

And that's just as much of a buried access.

And so looking at these A platforms access and saying, Can I really do this?

Do an access audit on it in the way.

Now if you really think you have problems, do it with lawyer, but do it, go look

at it, say, do I really, Am I really.

These requirements, Yes, it could be the right thing to do, but honestly

you could you will need to do it.

Yeah, but I really like the point.

Telehealth is not the way we fix health equity.

It is one tool and a lot of different tools we're going to

have to use to improve that.

Because I have read studies about the utilization rates of telehealth,

particularly during the pandemic, and I was very surprised at how much they.

It's compared to just rates of traditional healthcare utilization

and how close they were.

I expected folks in rural populations or other disadvantaged populations

to be taking more advantage of it.

But a lot of times, like you said, the tools just aren't there.

It's I think you're absolutely right.

It's like it.

We have big, we have issues that are bigger than this.

Like someone was getting interviewed for an article around modern healthcare,

around like behavioral health and telehealth and hospitals vetting

behavioral health startups, right?

Cause there's a lot of people going into the market and, at

the end I just, I couldn't leave it there, but all I could think.

You need to vet 'em.

You need to like, we need to have more behavioral health access in

every way, addiction, mental health.

But at the end of the day, one hospital system's not gonna solve this problem.

Even 20 hospital systems, even 20 startups.

This is so big of a issue around access and care that we need

to think about it as a country.

We can think about it at a state level too.

I'm not saying you can't like, focus on a state, like a governor

could say this isn't a state emergency and we need to look at it.

That too.

But it's just the idea that we're gonna one off it and that's

gonna solve the behavioral health problem by using telehealth.

or we shouldn't trust the people in the behavioral health

industry going into health.

I don't think either of those are true.

I think that you need to vet it and do due diligence, but I also think it's gonna

solve the entire problem of it because we are looking at the continuum of care and

yeah, you can try to solve some things for people to be at home, but sometimes you

actually do need to go into a facility.

Sometimes you need to, cuz that is actually.

Heal you better, like both mentally, physically, in whatever way.

And I don't think we've figured out that quite right.

What's that ratio?

What does that look like?

And what does that look like for each specialty or each care

setting or each care protocol.

And so I think you're right.

I think people needed their healthcare.

There was definitely delay care.

I People.

Using telehealth right now to patch that d delay care because they can't

get everyone back into the office.

They really literally can't.

But people are trying.

So I think the utilization might have looked the same, but we know that

there's delayed care, especially when we look at like screenings and other

testing and our wellness visits and so yeah, I think it's quite interesting.

Yeah, I don't think it's just it's not gonna.

Our healthcare problems, but it is a tool and our toolkit to, to

start working on it because we do have, we've got a lot of work to do.

And then I guess unfortunately, or fortunately, the pandemic put a lot

of things to light that was really good about our healthcare system, like

science, innovation and use of technology and our actual healthcare workforce

out there and doing amazing things.

but it also gave delight.

Like the systematic biases we have the problems the people falling

out of, how easy it's to fall out of our system and get lost.

So I, but telehealth, I don't think, I don't think we should lose sight of it.

If we are gonna have gone through something really not great as a country,

let's figure out what we learned from it and what we found out was great.

And if Telehealth is there I hope, I don't think we'll lose

sight of it but I hope we.

Yeah.

I do think it is important to keep it in perspective, like you said, where

we're not saying that telehealth.

The entire solution, like it feels a lot like someone's telling you to

build a house and then giving you telehealth and it's like a screwdriver.

It's I need other tools too.

This is an important one, but it can't be the only one.

Yeah.

Yeah, I think it's, it's interesting because even looking through this,

Tell of that is certainly we had the, these different definitions,

like I'm a lawyer, we love words, or at least I do, and definitions.

And so we look at like the evolving definition and I love language,

so our language has to evolve too.

Like the word health is a new.

Health justice and it in some ways it empowers some people and it puts off

other people, which is very interesting.

But when you tell them like, What does that mean?

I've never had somebody say, Gosh, that doesn't seem right.

We shouldn't, you're right.

Why wouldn't somebody have access to telehealth?

Or if I say to somebody, Gosh, there's times you just, you

actually need to be in a hospital.

Or you need to be in a setting like, like in a surgery center or I, When

you explain it like that, people will go, Oh, yeah, that makes sense.

So some of this is we have this great wording and we have these great words

that are changing in it, even telehealth.

But sometimes that we just.

Get away from these academic words and just talk about what it really is.

Cuz it's is a day to day thing in our lives.

We have to, either we or somebody, we in our lives is usually engaging in some kind

of healthcare interaction at some point.

It's not, and.

And we like sometimes in healthcare, overcomplicate it with all our terminology

and including telehealth or bots or ai.

What does that really mean?

So maybe even telehealth will get involved cuz we got virtual visits now and this

and it's just all these different phrases.

But the idea is you don't get lost in the shovel and you don't get sick without

somebody knowing about it, hopefully.

And that you're, hopefully you're getting care and hopefully you're

not using the emergency room as your.

Care source, that you're getting the right place.

Yeah, I agree with that.

I really do.

I know we touched on a lot of this already, but one question

I like to ask is, what do you think the future of telehealth looks like?

Yeah.

I've always like worked on telehealth, so I always saw the potential of it.

I've said, gosh, it got, some people say it got pushed

five years in the future, 10.

To me it felt like 20 because the reimbursement changed, right?

The licensure hasn't, but the reimbursement changed.

So I think I will say wherever the technology.

Whether that's ai, all that.

I think that's where telehealth looks.

So when I would first go out and do telehealth speeches, I had to explain

what telemedicine was and telehealth was a new concept cuz it was more than doctors.

And I would have to define it and try to explain it and people would look

at me and go, That's so interesting.

Wow.

That's low cutting edge.

And then give it a couple years later, I was saying, Yeah.

And you could do it on your.

It Cause there was an iPad.

We didn't have iPad so far.

Then we had, because it was webcams before, it was like I didn't, like

I didn't have a camera in my laptop before, but now I need it every day.

I don't know a hundred percent what it will look like in that way, but I do know

it will evolve as technology evolves.

What I'm seeing out in the market is it being what we call like a virtual

care integration is happening where people are trying to marry what we

call like bricks and mortar, going into a building to not going into a

building and doing it some other way.

And whether that's a text reminder appointment reminder, whether that's

a coach call cuz they can tell your glucose got to a certain thing

and someone calls, whatever that.

I think that's where we're, that's where we're headed.

So I don't think telehealth will be the simple telehealth.

I think it will be integrated in and we'll have to figure out how that looks,

if that changes the care protocols and if it changes reimbursement.

But I don't, given the federal laws are gonna stick, then in

reimbursement's gonna stay around.

If those things are all true then it looks, Yeah, it looks it.

like it becomes part of our care delivery.

Mm-hmm.

, , which I think is very exciting.

It, it is.

And again, we just don't lose sight of the leaving people behind part of it.

We don't get so excited that we go, we forget that there are

other people out there that we're might be, we might be missing.

And I think one more other thing to add out there that I'm, we see a lot

is the, you know what we talked about data and is like the value of data.

Our laws around not being able to sell data, but yet the value of

it and the compliance around that.

And whether there ultimately we will be, there's was talk about an agency

around AI or an agency around data privacy that was agnostic to healthcare.

And so those things will impact those bigger national policy issues.

Will.

ends up being a day to day interaction on telehealth.

So keep an eye on that.

Even if you look at the Department of Health and Human Services they have a

group looking at artificial intelligence, so it's not even for themselves.

If you look at like the office.

For Inspector General that does the audits of healthcare payments, they are

using AI algorithms to ch detect fraud.

So just know that, like the future of telehealth, I think it does look bright,

we still have the laws out there.

We still have national policy and other items, so it's, it, it may be regulated

in a different way than I can even anticipate sitting here right now as well.

But I do think, I don't see it going away and honestly, I didn't see it going away.

Even in 2020, because it's once you roll something out to somebody, it's really

hard in healthcare to take it away.

Yeah.

Particularly when people like how convenient.

Yes.

All right, we're coming up on time here.

So is there anything else you want to touch on before I log us off, as it were

yes.

First of all, I wanna thank you so much for having me, because as you

can, I very much care about this topic.

And and I really hate to be the doom and gloom lawyer.

Type on, on, on these, like sometimes people take the power if they ever

have a PowerPoint and then there's like a slide with someone in jail

and they're like, Don't do this.

And then you're like, See jail.

There aren't laws that actually could put you in jail, in healthcare,

yes, they do exist but I don't want people to feel stunted by it.

It's if you really are feeling that stunted by it, it's make sure you have a

good attorney or make sure you have good.

In house or do you know don't get stalled out by it cuz there,

there are things that you can, do and then do it in compliant ways.

There's models out there, and also at the others say time.

I would say don't go out there and just do whatever you want because.

You're, and it's a, it's on the OIG work plan to audit these, there's

gonna be enforcement around it.

But also don't not do it because you're worried about being, and

you just do it the right way.

People are doing it the right way.

It's possible to do it.

And and I think that's the message I wanted to say to everybody because

when I go to conferences where there's not a lot of lawyers, I

just get the are we gonna get sued?

Are we gonna get in trouble?

I just hear that people literally say that on stages, and I just

wanna say, you can figure this out.

It's not, I'm not saying it's easy, I'm just saying it is absolutely doable.

and in, in, in the right way.

And and also just to get out and talk to, if you have a, to have a voice in

this, because I think the more we get out and talk about it, the more normalize

it gets, whether about health equity or whatever you're passionate about, care,

virtual care, telehealth, Because the more we talk about it, the more the policy

makers hear us and the more normalize it gets because that's how policy changes.

And if you have an opportunity, Through your attorney or an advocate,

an association, wherever you have a voice, get out there and talk and say it

because that really will make a change.

If we sit quiet about these things, the change won't happen.

So use your resources out there.

I can't sit here with our fingers crossed

Not gonna just happen.

I wish that's the way it worked, but it doesn't.

Certainly be easier.

Thank you so much for joining us today.

I don't typically get to discuss health and healthcare from a legal perspective,

so I really appreciate you coming on and touching on those topics with me today.

Great.

Thank you.

Thank you for having me.