Leading Care, Earning Trust with guest Dr. Kelly Rhone

What does it really take to lead care in a way that earns trust—from clinicians, partners, and patients alike?

In this episode of Virtual Health Connections, Dr. Kelly Rhone, Chief Medical Officer at Avel eCare, shares her perspective on clinical leadership in today’s evolving healthcare landscape. With a background in emergency medicine and more than a decade in telehealth, Dr. Rhone brings a grounded, frontline view of what it means to deliver high-quality care through a virtual health system.

She dives into how Avel is designed to support—not replace—bedside teams, extending expertise across the full continuum of care. From emergency response and ICU support to behavioral health and rural hospital partnerships, Dr. Rhone highlights how virtual care creates stronger teams, improves outcomes, and ensures patients receive the right care, wherever they are.

You’ll also hear how trust is built in high-pressure moments, why quality and consistency matter more than ever, and how Avel continues to innovate while staying rooted in one simple belief: care should never depend on a patient’s zip code.

If you’re a healthcare leader navigating workforce challenges, access gaps, or the future of care delivery, this conversation offers both clarity and inspiration.

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Virtual Health Connections is a podcast by Avel eCare, the nation’s largest and most comprehensive telemedicine network. It explores telemedicine networks, virtual integration, and what it takes to redefine healthcare delivery.

Each episode features leaders and clinicians from across Avel’s Virtual Health System, exploring the real challenges facing healthcare today and how innovative solutions are making a difference. From the care challenges rural and underserved communities face to the frontline perspectives of those delivering care every day, these conversations highlight how telemedicine is creating new possibilities.

Along the way, listeners gain insight into the advantages of virtual integration, the realities of today’s healthcare workforce, and the leadership decisions driving meaningful change, all while looking ahead to what the future of care can and should be.

Founded in 1993 as the nation’s first virtual hospital, Avel eCare continues to lead the way in virtual health services. This podcast extends that mission, connecting people, ideas, and innovation to improve outcomes and expand access to care across the U.S.

Thank you for listening to Avel eCare: Virtual Health Connections. To learn more about how Avel is expanding access to care and supporting healthcare teams nationwide, visit www.avelecare.com .

Be sure to subscribe, share this episode, and join us next time as we continue redefining healthcare delivery.

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Transcript

SPEAKER_00 0:05

Welcome to Avel Ecare Virtual Health Connections. I'm Jessica Gaikowski, and this is a podcast where we explore telemedicine in the future of healthcare delivery. At Avel, we often describe ourselves as a technology-enabled healthcare company, but at the core of everything we do is clinical leadership and our clinical expertise who support care teams every day. Today's conversation is intentionally geared toward medical directors, clinical leaders, and physicians who are navigating telemedicine, quality expectations, and workforce strain, and want to understand what good virtual care actually looks like. I'm joined today by Dr. Kelly Rohn, Chief Medical Officer at Avel ECare. Dr. Rohn is a board-certified emergency physician and leads physician engagement, retention, program development, and clinical education across Avel's telemedicine services. Dr. Rohn, thanks for being here today. It's good to have you. Thank you so much for inviting me. I'm really excited for the conversation. Me too. So to begin, can you just give us a little bit of background about your role at Avel ECare and what being a chief medical officer at a virtual health system really means? Sure. Yeah.

SPEAKER_03 1:16

So I've been with Avel since 2011. Um, and I started out um doing clinical shifts as an emergency physician and multiple leadership roles, medical director, et cetera. And today I'm chief medical officer, which means that I am over all of the clinical services that we have at Avel. And so all of the medical directors report to me, and I get to be involved in all sorts of wonderful things like innovation and um, you know, thinking about how we can always improve and quality. So I think we're gonna talk about a lot of fun things today.

SPEAKER_00 1:54

Absolutely. And before we even do that, I would love to hear your experience of how you went from, I mean, you still are practicing at the bedside, but how did you make that adjustment or that shift or what made you lead to being like, oh, I can do both and be at the bedside, but also help through telemedicine?

SPEAKER_03 2:11

I think when I started doing telemedicine, because I've always been an emergency physician who's worked in a large center, like a level one, level two trauma center. So big places, right? And I am from South Dakota. Um, I grew up in a rural area. And so I always loved rural healthcare. I started out as an EMT um in volunteer EMT in a little town, right? And so when I started doing this work, um, and we serve a lot of rural communities, right? It was such a uh, you know, kind of cup filler for me that I was not only helping patients and bringing that same type of care that we're doing in these huge centers, right? To the care where that patient is and at the right time. We always say the right care at the right time, right? Where the patient is.

SPEAKER_01 3:08

Yeah.

SPEAKER_03 3:08

So um I felt like I kind of had the best of both worlds, really, that I could do this work and that work.

SPEAKER_00 3:16

That's amazing. So being able to see both sides of things, you've gotten to see challenges from those rural health care facilities in the communities, and then also being on the opposite side, we're seeing those every day. Can you talk about from your perspective what are the biggest clinical challenges we are seeing today?

SPEAKER_03 3:34

So I think that we have a lot of challenges in healthcare, right? Um, I think our patients are getting even more complex. Um, there's a lot of people that just don't have great access to care, whether it's because of geography or it could be because they don't have insurance, right? And so um I think the patients we're seeing sometimes are sicker, more complex patients than maybe we did at the beginning of my career.

SPEAKER_01 4:00

Yeah.

SPEAKER_03 4:00

But I think one of the other challenges that we're really seeing is um uh a real lack of beds um in our tertiary facility.

SPEAKER_00 4:10

Right.

SPEAKER_03 4:10

Yeah. And I think that hospitals are keeping more patients. And I think sometimes it's harder for them to get the patients out, right? So the patients are staying maybe longer, those complex patients.

SPEAKER_02 4:23

Yes.

SPEAKER_03 4:23

And so we we have the throughput problem. Yeah, but that doesn't help our rural facilities who kind of need those patients to move to a higher level of care. And those rural hospitals are keeping sicker patients than they used to. I mean, and and I think what's kind of neat is COVID taught them they could, right? Yeah, yeah, because they had to.

SPEAKER_02 4:44

Yeah.

SPEAKER_03 4:44

And um, so what they're asking for is support so they can keep those sicker patients in rural hospitals. And so I think that's what we bring to the table. Um, you know, when you look at rural health care, you know, 20% of our population lives in a rural community, but only 10% of our physicians practice in a rural community and much less so specialists, right? And so it's a lot of primary care, and man, they do a great job. Yeah, right. But we need to support them.

SPEAKER_00 5:18

And yes, and they can't know everything and be an expert about everything.

SPEAKER_03 5:22

Right. And some of these really small areas that we help with, you know, they may have one or two physicians on their entire medical staff. Yeah. So you can imagine the load that they have to do, right? So I think, you know, trying to figure out how we can partner with them to help them carry the load while still giving them the autonomy of being that physician leader in their own community.

SPEAKER_00 5:47

Yeah. For those that don't understand, you know, keeping higher complex patients being a good or bad thing, how do we explain that to people to really understand, or even clinical years, be like it's good to keep what you can keep and how we can support you. But then there's also a level where we can help you transfer where that's needed too. Can you talk a little bit about, you know, how you kind of differentiate the two, or how do you how do you make that seem like a good thing that they're able to keep more patients? Right.

SPEAKER_02 6:15

Yeah.

SPEAKER_03 6:16

Well, I think when they can keep more patients, obviously those for the patient, they're closer to their family. They have a lot of support for the family, they don't have to travel, hotel, all of those things. Um, for the hospital, obviously it's increased revenue. But I think um one of the things that I want to make sure that people understand is we're trying to keep the right patient in that hospital, right? If that patient needs to go somewhere and have, you know, a heart catheterization, right? Or if they need to go and have surgery and there's no surgeon, those aren't the kind of patients that we're trying to keep there. No. In fact, you know, on those patients, we're actually showing that we can move those patients out to tertiary care faster, right? Because what's, you know, when you have that really, really sick patient and you're one physician and two nurses, right? And you still have to make all the phone calls, we can kind of take that off their plate and get that accepting physician, find the bed for them, all of those things. But there's a lot of patients that you can care for that don't necessarily need a procedure that we can care for and even bring in our intensive care team to talk about, you know, blood pressure support or antibiotic choice, um, um, and even sometimes ventilator support, bipap, right? Uh, I think COVID taught people that and gave them the tools, you know, a lot of these hospitals didn't have BiPAP, didn't have a ventilator or had a ventilator that was, you know, from 1947.

SPEAKER_00 7:52

And so it doesn't work anymore. It doesn't work anymore.

SPEAKER_03 7:54

So they have great new equipment, you know, and um, so we're working with them so that they can keep those patients local. But again, if those patients need to move out, we're there to partner with them to get them to that higher level of care. So we've been doing this a long time, over 30 years. It's helped us to really differentiate who can stay and who can go. And I would say too, if you've been to one hospital, you've been to one hospital. So it's really about knowing what that one hospital can keep. Exactly. And the resources they have to do so. Exactly. Yeah. So I think sometimes it's talking to them about do they need to get more resources if that's the kind of patient that they want to keep in their facility.

SPEAKER_02 8:39

Yeah.

SPEAKER_03 8:40

Um, but other times it's really saying, well, here's the reasons why this is the kind of patient you could keep, maybe this one isn't. Because, you know, maybe they need an MRI, you don't have an MRI type thing.

SPEAKER_00 8:51

Yeah. Oh, that makes sense. Yeah. So you touched a little bit about this, but when you're looking at these challenges compared to these rural, saying that, you know, that's where this all kind of stemmed from. And now going into more of these urban settings, are you seeing a lot of the same challenges, or does it look completely different from these two different outlooks of life?

SPEAKER_03 9:11

Yeah, sure. I think it's the same, but different. Yeah. I think urban areas may have different challenges in the workforce that they're seeking. I think we see a lot of needs in the behavioral health area. Yeah. Right. Yeah. In in every place, right? I mean, there's not enough um behavioral health clinicians for the patients that need them. Um, you know, I think now we're seeing as many behavioral health patients as we are primary care patients in our country. It's amazing, right?

SPEAKER_02 9:42

Yeah.

SPEAKER_03 9:43

And um, and so what we're seeing is even urban areas are really looking for that workforce to come in virtually to help kind of share the load and take the load off of their teams. Yeah. So I think that's one thing that we're really seeing there. Of course, ICU, you know, they have large ICUs. So um, so it's those programs just make a whole lot of sense in larger facilities.

SPEAKER_00 10:07

Yeah. So from all of your experience, is there an example that kind of stands out from your early days or even more so recently that you're like, wow, this was an instant that we helped with one of these challenges that we're seeing today? Um, so I can give a lot of different ones, but maybe we'll do one or two if you'd like.

SPEAKER_03 10:28

Um I think really early on when I was doing this work, um, I had a case of a small hospital and they had a pretty large explosion in that town. And so this facility was gonna get five severe burn patients all at once, which that would tax a large travel. Or the city, yeah, right. Yes. And and burn is, you know, such a specialized um situation anyway, right? And so uh and the the physician who was working there was actually a traveling physician, you know, it wasn't where she normally works, type thing.

SPEAKER_00 11:09

Yeah.

SPEAKER_03 11:09

And so we were able to, you know, send multiple aircraft there because we knew we were gonna have to move those patients out. We knew we were gonna have to move them to a burn center. Um, we knew that they probably had trauma underneath that, right? Yeah. And um, and so I just said to her over the camera, like, I'm not leaving you. Yeah, right. I'm gonna be here as long as you need me. Yeah. And it was, you know, kind of this marathon session of you know, taking care of the patients as they came and figuring out who needs intubation, you know, an airway, who needs, you know, what do they all need? Do some of can some of them be cared for locally? Yeah. Right. And I think just the coolest thing that I found out later was that this physician that was her hometown that she happened to be doing a shift in.

SPEAKER_02 11:58

Wow.

SPEAKER_03 11:59

And after that, she signed in that facility and she's been practicing there for over a decade.

SPEAKER_00 12:04

Oh my gosh.

SPEAKER_03 12:05

So, like, think about the change that that brought.

SPEAKER_00 12:08

Well, and now they have an amazing physician that's local and knows the community and maybe would never have stayed there.

SPEAKER_03 12:15

Yeah, she said that I mean, she worked in in a large facility and um and ended up saying, you know, I think if I have this backup, like those are the kind of cases that made me nervous about having to cover the emergency department, right? I'm I'm primary care, I'm not emergency medicine, you know, board certified. And um it, you know, she does OB, you know, she's able to deliver babies in that community. It's just a huge change for that facility. And so that just completely changed how I felt about the care that I was doing because I wasn't just caring for the patient, I was caring for the provider on the other side.

SPEAKER_00 12:57

Wow, that's amazing. Well, and you think that if she's feeling that way, multiple different physicians that are doing, whether it's traveling or whether they're doing a rotation or whatever it may be, they might feel a little isolated or on their own. And this is a way to be like, you have a whole team right here with you.

SPEAKER_03 13:13

Yes, absolutely. You know, last week we um put on our difficult airway course. So we had uh 88 frontline practitioners, physicians, nurse practitioners, PAs who came and worked with us on site. We we did a lot of hands-on work with them. Yeah, and it was so fun. It's always so fun to get to talk to them. Yes, you know, and half the time they're saying, like, you are a real person. Like, yeah, I'm a real person, you know. You're not a robot on the camera.

SPEAKER_00 13:43

Yes, that's funny.

SPEAKER_03 13:45

But one of them um, you know, came up to me and he said, you know, he he named one of my physicians and he said, you know, he's helped me through so many really hard cases. Wow. And today I got to meet him. Oh, that's cool. And so they got to connect, you know. And so um, you know, we feel like colleagues, but there is still something about getting to meet people in person and and having um just that real connection. Um, but we hear that all the time that you know, thank you for being the calm voice on the other side when things are really scary on this side. Yes. Um, and and kind of helping me to to carry the load.

SPEAKER_00 14:26

Yeah. Well, and since you brought up the airway course, then we might as well talk a little bit about that. So, why is that so important and why doing this training in person to bring the team here to kind of show them how to intubate and how to do the pig tracheas and all that fun stuff. Tell me a little bit more about why that's so important to do.

SPEAKER_03 14:44

Yeah, I think, you know, when we very first started emergency, um, you know, I never thought that I would do this kind of work. It wasn't a thing, right? When I trained. And um, and I think one of the things that is scary about being on this side of the camera, right, is that I I literally can't reach through the camera, right? And so I have to be able to tell people how to do things with my voice. Yes. And um, there are certain things that I think really getting hands-on training for our teams across the miles um makes a huge difference. Yeah. And so um and and all sorts of different airway techniques from bagging a patient, and really the best way to do it, we bring in the airway expert from the United States, um, and we do a ton of training. Um, we use video laryngoscopes, um, so and we can actually now see through our camera into the airway. So we're just fantastic. It is because a lot of times, you know, we would say things like, tell me what you see, right? Yeah, yeah. And I remember when I was training, that's what my attendings would say because we didn't have video scopes back then, right? So I'm aging myself a bit, but um, but you know, so I'd say, tell me what you see. But I think if I can see what they can see, then I can get them a better view and I can help them to kind of get there.

SPEAKER_02 16:14

Yeah.

SPEAKER_03 16:15

And so um another story here, just about two weeks ago, um, I was helping um uh uh physician assistant actually um to intubate and they had a new video scope. Oh and so she had just practiced on it the day before. So it was brand new scope for them.

SPEAKER_02 16:37

Yeah.

SPEAKER_03 16:37

And um, and so we talked about the intubation, you know, what's our backup, yeah, what's our plan, you know. So we're always kind of, you know, what are we gonna do if things don't go well or whatever? And so we first try, intubated, no problem, you know. So I'm doing the, you know, like virtual high fives on the camera. And and we're really um, you know, celebrating what a great job their team did. Yeah. And um, and then later she called me and she said, Could you see how much my hand was shaking? And I said, No, you did fantastic. I mean, you just did fantastic. So it is like really about kind of cheering each other on when things go well and then supporting them, you know, maybe when um things aren't going uh the way we want it to.

SPEAKER_00 17:21

Yeah, well, and you know, all of these unique situations that rural facilities don't see every day. Just give us a little bit of, you know, we talk about reps and sets, and the more times you do it, the better you become. But when you're a rural facility, you don't see intubations every day, you don't see delivering a baby every day. Can you tell us a little bit about what we see at a Vell and the frequency that we see compared to maybe what they would see? Right. Yeah, right.

SPEAKER_03 17:48

Well, so I mentioned that I've always worked at level one and level two trauma centers, right? I see higher acuity in one day when I do a shift in our emergency program than I do in weeks or months sometimes. You know, I mean, we see three to four cardiac arrests every day. We do intubations every day, um, traumas, of course, um, acute MIs, heart attacks, strokes. I mean, the acuity that we see through our departments, um not just in our ER, but in patient, right? Throughout our ICU program. Um, you know, we see incredibly sick patients and we see a lot of them. So you talked about rep rep reps and sets, right? Yeah. Um, it's about that. And so I think that's why, you know, our everyday is we always say our everyday is somebody's worst day, right? For our patients, but I think the more that you do it, um, you can be that kind of eye in the sky and you know what to anticipate. And we're trying to anticipate those problems before they even come.

SPEAKER_00 18:58

Yeah.

SPEAKER_03 18:59

So we can help that that um practitioner um if if those things would occur. Yeah. That's awesome.

SPEAKER_00 19:07

So you work closely with a lot of medical directors across the country. When it comes to telemedicine, what do you want the clinical leaders to really understand from that perspective?

SPEAKER_03 19:19

I think what I like to let them know is maybe telehealth today and telemedicine today isn't what it was five years ago, yeah, 10 years ago. Well, if you think about it, it's changed a lot. It's changed a lot. Think about COVID, right? Yes. I mean, I think pre-COVID we were kind of trying to tell people that this could work, right? That that they could trust it. I think COVID really told people that they they could do telehealth, they could be part of telehealth, so it became really, you know, a household word. Yeah, um, more or less. But I do think that there's still this thought that telehealth is urgent care or or maybe a visit, and it absolutely is that. Yeah. But it's so much more. Yes. Right? Yes. And um, and so I think that's what our innovation brings. And um, and our partner is really asking us if we can help with things, and then we look at it and we say, you know, like I think that is something that we can do. And it's kind of why we've always been on this leading edge, right? Of, I mean, nobody else is helping someone intubate over a thousand miles away. No, right? Yes. Um, and so, but otherwise they're there by themselves, right? So um, you know, we're gonna be there with that. Absolutely.

SPEAKER_00 20:42

So we talked a little bit about all the licensing and credentialing that our physicians have to do, and just even the background of all of our clinical expertise from the nurses, paramedics, et cetera. What role does that engagement from our clinical teams really play into maintaining that high quality virtual care with our partner sites?

SPEAKER_03 21:01

Yeah, I think um I would take this in a couple different directions. I think that being licensed, credentialed, and privileged really tells them that we are on their team, right? And and we bring a team to help do that. So not only does that take the load off of our physicians because it's a lot of work, right? We still have to we take our part in it, but we have a whole team that helps with some of that paperwork in bringing that together. Um but their administrative staff then doesn't have to do all of that load. So I think that's part of it. But I think even more so we've taken that step of being joint commission accredited. And we were one of the very first telehealth companies to take that step. And I think, you know, we were born from a health system, we came from that as our background, and so our our whole um clinical. Team is set up like a hospital, right? And um, and our clinician leaders pair in a dyad with administrators, which has been proven to be a great way um to lead high quality teams. Yeah. And then we go through joint commission accreditation, which um is stringent, right? And so we want to show people that quality matters to us and we are bringing a quality product to them when they partner with us.

SPEAKER_00 22:29

Absolutely. And if those people or if those listening do not understand what joint commission accreditation means, what what is the importance of that?

SPEAKER_03 22:37

Yeah, so when we say we're joint commission accredited, it goes into a lot of different areas. Um so the joint commission um comes to us as an accreditation council and they accreditate, they accreditate accredit, they accredit um hospitals, um uh clinics, et cetera, right? And so they're looking for, you know, are we doing all of our paperwork? I mean, some of it's all back office stuff, you know, is our is our HR all uh in line, things of that nature. But also, you know, are we doing those appropriate background checks on our physicians? Are we doing making sure that they came from accredited training? You know, um, have they had malpractice suits? I mean, all of that, right? We need to know all of that. Um, but also it goes further into that we have to have quality projects and make sure that every year we are showing that we are doing a quality project and that we have all of the the kind of right tools um available to the point where they even check to make sure that we have generators because if the power goes out, we still have to care for patients, right? And we care for patients um using technology. So we have to have those kind of backups in order to care for our patients. So it's really a kind of a global look at our company and how we care for patients and what kind of clinicians we're bringing um to our partner facilities.

SPEAKER_00 24:12

Yeah, absolutely. You talked a little bit about this when we were talking through the technology just being kind of in the background, but we always say we're a technology-enabled platform or a company, a virtual health system, but we're very clear that the clinical expertise is really the foundation and the differentiator of what Avel does compared to others. Can you talk about why this distinction is so important or why it's different?

SPEAKER_03 24:38

I think, you know, we've done some things that have set us up for success, I think. Um we really thought about how can the platform not only help us to kind of manage our patients because we're getting patients from different hospitals all at one time, right? And so kind of triaging those patients and knowing what our workload is for our clinicians, but also giving us tools for working in and out of different electronic medical records and then understanding each hospital and what they have, right? Because every hospital is a little bit different in even like the medications that they carry, um, the equipment that they use, you know, they may all have, you know, whatever a ventilator, but it may not all be the same. Yes. And so understanding where those where that equipment is, what the equipment is, what they have for medications, um what kind of um, you know, do they have ultrasound available, or is it only like every Thursday? You know, so having some of that at your fingertips um not only helps just so that you're it's easier to work, but I think that our colleagues on the other side of the camera really appreciate that when you can be like, oh, I, you know, probably needs an ultrasound, but that's not available till Thursday. And they're like, wow, really? You can you know all of that, right?

SPEAKER_00 26:06

Yes, yes. So sometimes you probably know it better than they do.

SPEAKER_03 26:10

Sometimes, sometimes, yeah, like you know, like, hey, and I I need you to get this equipment and it's in drawer three, you know, type thing. So so I think um those are the things that we've really worked with our developers, yes, um, to be able to make our workflows um easier um because we do a lot of complex things and we don't we want that to just really support us and not be complex.

SPEAKER_00 26:36

Yeah. So diving in a little bit more to that, how do we know when we're partnering with a site that we're actually making a positive impact rather than being just another thing on the wall that's in their way? Yeah. Yeah, how do we kind of work through that?

SPEAKER_03 26:49

So I think we look at that in a couple of different ways. Um, we survey our customers, uh, our partners really commonly, right? So pretty often. And we want to know, and we're also asking them like, please call us if things didn't go the way you wanted it to. Yes. Um, please tell us what we're doing well, right? We'd love to hear that. But make sure we know when something doesn't go well, right? Um, and we are um we have account executives who go out and visit the sites. Um, you know, a lot of us, one of my favorite things is to go out and visit sites. Oh, yeah. You know, it's just the best. Um, and so really driving that engagement. And then I think it's who we put in front of the customer too, right? Um, so our frontline staff, um, you know, customer service is a big piece of this. Absolutely. Yeah, and it's not just the patient, it is absolutely the patient, right? But it's also the bedside nurse there, it's the bedside clinician, it's you know, it's really partnering with them and and and that collaborative work that I think um makes it more of a team.

SPEAKER_00 28:02

Yes. And with collaboration, you we talked about workforce a little bit, but how how does virtual care really support those bedside teams rather than strain them? Can you just elaborate a little bit more on that?

SPEAKER_03 28:14

Yeah, so I think um we support it in different ways, depending on the service line, right? And I think, you know, if you look at emergency or our ICU product, it's really helping them with those really uh critically ill patients in that time of need. Um, but it I think if you look at our pharmacy services, I think it's a great way to look at it. Many of these areas that we work with maybe lost a pharmacist, right? Or they only have one pharmacist that works in their facility. And so they're a kind of a Monday through Friday person. Yeah. And in many of our service lines, we take kind of those hours that people don't always love to work. Yes. As someone who's worked a lot of night shifts, right, in their life. I think, you know, we work a lot of nights, a lot of weekends, a lot of holidays. And I think if you think about pharmacy services, you know, they'll even, if their pharmacist needs to take a vacation, they'll just fill in, right? And so otherwise they would have had to bring in a traveling pharmacist at a really high rate. Yeah, you know, but we're able to just fill that gap for them. Um, and then they don't have to have that worry, you know. We hear from administrators like, I don't even have to worry about that anymore because I know that if I have a gap, you know, that that you'll fill it.

SPEAKER_00 29:38

Yeah.

SPEAKER_03 29:39

And so, but yeah, nights, weekends, holidays, um, you know, I think if you look at pain points, um we fill them. That's awesome.

SPEAKER_00 29:48

So a lot of what we do is invisible because we try to be, you know, just part of the solution or part of their workflow. Can you talk about what physicians don't always see but absolutely rely on when these processes take place?

SPEAKER_03 30:02

Yeah, I think that there's um several things. We already talked about licensing and credentialing, right? Um, all of that work that's done. Um, but I think part of it is too our implementation process, right? So once we partner and have that contract, then um we have a whole team that works with your team, right? That hospital's team to bring us to go live. So it is um all of the equipment. It's, you know, right? Making sure the connectivity is is there, you know. In those early days, man, we were like waiting for wires to be buried, right? So we don't have that anymore, but we still have to make sure, right, that they have the right technology, the right um connectivity um for our services. Um, and then it's it's the tech, right? And then um it's getting everybody up and ready on their electronic medical record, it's training our physicians, and then um it's continuing to have those quality programs and and making sure that we're continuing to look at if they have quality programs that we need to be part of, or um, even just within, we're constantly looking at how can we be better, how can we make this better, and then how can we quantify it so that we can share that story with our customers. Yeah, absolutely.

SPEAKER_00 31:31

So, in the world of TV and soap operas, there's lots that are trying to convey from the hospital or the medical setting. So you got Gray's Anatomy, you got, you know, all these other ones, but one of the most recent is the pit. And what you see in there is all of these urban facilities and the chaos that's going on within the hospital walls, whether the beds are filled, the hospital um hallways are covered with patient beds being filled as well. Is that the typical what we're seeing today when we're talking about, you know, these hospitals are being full to max capacity right now or the staff are stretched all the way thin? Is it giving a good sense of reality?

SPEAKER_03 32:09

You know, unfortunately, it really is. You know, we're seeing um that, you know, we're putting on our EMRs hallway bed number one, hallway bed number two, you know, and so um hospitals are full, you can't get patients upstairs. There's um boarding of patients, and so they take up rooms, and so you're still, you know, in the especially in the ER, right? We're not taking appointments, people come when they come. And so um you can't help if there's two patients that show up or 20 in the same hour, and you still are responsible for all those patients. And I think, you know, one of the things that is kind of neat that they're trying to portray, I think, especially on the pit, is the stress that it causes on our healthcare workers. Yes. Right. Um, I think our healthcare workers have gone through a lot um in the last couple of years. I mean, COVID was very stressful for our teams. And then, you know, uh like we didn't get a break. It just has continued with um with hallway beds, with uh, you know, throughput problems.

SPEAKER_00 33:18

Yeah.

SPEAKER_03 33:18

And um, and I think too, you know, we do see a lot of the worst of the worst. And so it does um kind of weigh on teams. And so, you know, one of the things I just heard um last week from one of our members was you know, you guys see so much. Yes, you know, doesn't that bother you, you know? And I think um, of course, you know, I think the answer is of course. We wouldn't be human, but right? Um, I think, you know, the day that I take care or pronounce a child deceased, I think is the day I gotta hang out my stethoscope, right? And so I think that um one of the things that we offer is walking people through those really difficult times. And so um, you know, we don't always get to decide the end result, but we just have to show up and do our best work on every patient that that comes in the door and know that, you know, it's not always up to us, you know, what happens in the end. Um, but what we hear from a lot of our partners on the other side was you know, being able to talk through with you and and saying, you know, you did everything that you could have done. There's nothing else I would have done to change this outcome. Um, you know, I've had people tell me like that's the first time I've ever slept after a situation like that. Yeah. That I knew that I had done everything that I could. And so um one of the things too that we bring to the table is you know, we do stress debriefings on some of these really, really difficult cases and help their teams to kind of talk through it. Um, because what we want is for the people who are going through this and and to come back the next day.

SPEAKER_00 35:11

Yes.

SPEAKER_03 35:12

Right. And I think that's portrayed pretty nicely in some of these shows, right? Is that you know, people sometimes they don't want to come back. It's hard to sometimes come back, or you know, sometimes the places that we work are somewhat dangerous, you know. And so we're that second set of eyes and and kind of a protection in some way, and and then just offering support. Um, and so I think it makes a difference. Um and um hopefully we're keeping people in the workforce longer um and and helping them to kind of carry that load. Yeah.

SPEAKER_00 35:49

Well, let's go back to the bedside. And if I'm a physician or a nurse or anyone that's at the bedside of our facilities, we support, what should their experience look like when they tap the button or they give us the phone call? What should that experience look like for them?

SPEAKER_03 36:04

So I think it should look like how it looks when you work with another colleague at the bedside. That's a great way to say it. Yeah. Like we're really trying to replicate that, but virtual. So if I'm working at a large facility, there's usually more than one physician on at a time, right? And we're seeing different patients. Um, but we may be discussing um cases, you know, there may even be difficult cases where I might bring my partner in for a second opinion type thing. Yeah. And then also you have consultants, right? Um, so you so you have um someone kind of a phone, a friend, right? Yeah. And so um we're trying to replicate that and having them have someone that they can reach out to.

SPEAKER_00 36:52

And that's a great way to put it. How do you ensure that like our clinical decisions that we're helping support them if they're asking for advice on something is truly at the best interest of the patient since we can't have our hands on them? How do we make sure that we're helping guide them in the best way possible?

SPEAKER_03 37:11

I think it comes back to those reps and sets that we talked about, right? I think that we um we see a lot of bad stuff, right? We see a lot of really critical patients. And I think the more that you do that, um, you really get good at walking someone through that on the other side in a way that's calm. Um, you know, I was talking to one of the people who came and took our airway course last week.

SPEAKER_02 37:39

Yeah.

SPEAKER_03 37:39

And she said, like, how do you guys stay so calm? Yes. When things are crazy, right?

SPEAKER_00 37:46

You're seeing all of the chaos on the screen. Yeah.

SPEAKER_03 37:49

Yeah. And I think, you know, I would say when I first started doing this kind of work when things got crazy, probably my face got bigger and bigger in there in closer to trying to get in there to help them. But I think then, you know, like you get good at um helping them to know what is the next thing that they need to work on. Or, or sometimes we're saying things like, Have you ever thought about trying this? You know, if it's not a critical time, but just discussing the case in a way that's either educational or um really just collegial, right? Yeah. You know, like how there's in medicine, there's not always just one way to do the same thing or to get the same outcome, to be honest. And so sometimes it's, you know, should we use this medication or this medication? Which one is probably best for this patient? Or um, you know, you may really like to use this class of blood pressure medicines, I may like to use this one. And that's okay. And I think um our teams are really flexible in that um because you know it's it's more important that they're using what they are comfortable with as long as it's safe and the right tool.

SPEAKER_00 38:59

Yes.

SPEAKER_03 39:00

Um can I tell another story? Yes, I love another story. Okay, you can um put this wherever you want. Um so I was traveling, this is several years ago, but I was traveling um to a really, really small town um in uh in the United States. And um it was one of these counties where they had one physician and one nurse practitioner. That was the entirety of their staff, besides their nursing staff, of course, right? Yes. And so we're talking to them about our services and kind of, you know, just having that discussion. Yeah. Um, and a lot of times when you go to that small, like everybody, everybody's there, right? Like all the nurses are there. Yes. The paramedic is there, the board is there, you know, and like the banker's there, like everybody's there. Everybody's at the table, everybody's, yes, everybody's in the room. And so we're talking about it. And the paramedic in the room said, you know, I think this is all great for other people, right? Um, but our physician always sees everything in black and white and always knows exactly what to do. And so, like, I don't know why we would ever need this.

SPEAKER_01 40:11

Yeah.

SPEAKER_03 40:11

And he's always here, right? Like, he's always on. So he's always here to help us. And and and so I I don't think we need this type thing. And I was like, Well, that's awesome, you know, like great. And um and we But are you sure? Yeah, and so we just kind of went on talking, and then the physician actually stood up and turned to that paramedic and said, you know, I'm so glad that you do think that I always know what to do.

SPEAKER_02 40:41

Wow.

SPEAKER_03 40:42

Um, and I I I want you to, yes. Um, but sometimes I don't in here. And I need to reach out to someone for a second opinion. Wow. And the whole room changed because I think him being vulnerable in that spot, because nobody knows everything about everything in any situation, right? Like in in any um profession, right? Um, and so we should always be learning, we should always be changing, and um immediately they saw the value. Right? Wow, yeah, and he said, I can't go on vacation, I can't go to my kids' ball game. Yeah, right. Like this could change my life. Wow. Yeah. And so like those are the moments I think for me that I just think like that's gonna keep that physician in that town. Um, so it's it's retention, right? It's so it's about recruitment and retention and keeping rural hospitals open.

SPEAKER_00 41:49

Yes. That's what it's about. End of story.

unknown 41:52

Yeah.

SPEAKER_00 41:52

Well, that's cool that I feel like we've talked a lot about skepticalism on the clinical side, but it's fun to hear, not that it's fun, but it was a cool story to hear it from the other side. Because I feel like that's you get a and I was gonna ask you that if you had another example from the clinical perspective of their skepticism, and then finally getting to see how we can support them in real life and that difference that it makes. But fun to hear it from the admin side of things too, being like, no, my team's great. We got this. Yep. That's amazing. Yeah. Do you want to say another story about a clinical side? I feel like you have tons of skepticism that you've overcome.

SPEAKER_03 42:29

Yeah. So in my bedside practice, um, even though it's a large facility, right, we still have we have the cameras there. Um, and uh I have used them, we use them very commonly in any sick patient that we have, any critical patient that we um see. So anytime we're doing a code, anytime we're doing an airway, anytime we're using, you know, having an MI, things like that, we are um utilizing the cameras um even in our trauma center, right? And so I had an extremely sick, one of the sickest patients I've ever cared for um ever. And I was at the head of the bed and having to intubate very quickly on this patient, and I had to put in a central line. I mean, I had a lot of things I needed to do to try to resuscitate this patient.

SPEAKER_02 43:18

Yeah.

SPEAKER_03 43:18

And um I also needed to call a specialized surgeon. Okay. And so having that partner on in there virtually in the room with me, um, so often I'm the person on the other side of the camera making those phone calls, right? Yes. Um, but I was like, I can't leave. You know, like I I can't keep my hands off. I've got to keep them in. But I also can't wait to call the surgeon because I need them to get here, right? Yes. And so um, you know, I was able to say, here's what's going on. This is what's, you know, this is what's occurring, this is what I need. Can you do this for me? And to To this day, I know that that saved that patient's life, right? Because um, we were able to partner in order to take care of that just really sick patient.

SPEAKER_00 44:09

Well, and how cool to see it from the other side. Yeah. Because you talk about it all the time, but really now you getting to experience it as well and supporting you.

SPEAKER_03 44:16

Yeah. I think all of my physicians who work, it doesn't matter what service line, right? It can be our senior care services and the care that they bring to our long-term care centers. It can be our pharmacists, our intensive care physicians. It doesn't matter. We're all huge believers in it because we see the difference that it makes. And it's, you know, like we're just all believers. And I think that drives engagement.

SPEAKER_00 44:46

Yes, absolutely. Absolutely.

SPEAKER_03 44:47

And then, you know, then when we practice at the bedside, um, it becomes just a natural part of the way that we practice there as well.

SPEAKER_00 44:56

Very cool. So looking ahead, you know, since adoption has become more and more, I guess the blinders have come off really of how telemedicine is being adopted. We have rural health transformation initiatives coming through where telemedicine has weaved its way in there and multiple facets. What does the future really look like for telemedicine or and for clinical leaders, I guess, too, looking at virtual care? What does that look like now when they enable or adopt this being a part of their process and solution?

SPEAKER_03 45:26

Yeah. I think I think rural health transformation is going to drive a ton of innovation. Yes. I'm so excited about it. I mean I think that rural health has needed this uh support for a really long time, right? Yes. And it is a unique uh um, it's a unique opportunity to uh change healthcare and not just in the rural space. I think that there will be innovation that happens in the rural space that will then go to the urban space. Yes. And um, and I think that uh if we figure out what the challenges are and try to figure out then how can we solve for those challenges using technology, using our tools, right? And maybe tools that we haven't even used yet. Yes, like all sorts of exciting things, right? So we're gonna use those tools, yeah, and then we have to drive sustainability. Um, and so that's all part of rural health transformation, yeah, where we really need to not only think, you know, this is the innovation, but how do I then after the those grant dollars are done, yeah, how do I continue to make that sustainable? And then I think in my mind, it's going to drive innovation in all levels of healthcare. I I believe that. Yeah. It just makes you optimistic about what's to come.

SPEAKER_02 46:59

Yeah.

SPEAKER_03 47:00

Yeah. And I think if we focus on the challenges that we have, that will help us to find solutions that are meaningful.

SPEAKER_00 47:06

Yes.

SPEAKER_03 47:06

Yeah.

SPEAKER_00 47:07

Wow, that's a great way to look at it. What's one misconception physicians have about telemedicine?

SPEAKER_03 47:14

I think that a lot of physicians still think it's just urgent care. Yep. And um, I think they don't really realize all the tools that can come with it and all the different things that we can do to care for patients and different areas, you know, it's not just in the clinic, it's not just in the hospital, yeah, but it can be out in our communities as well. So um kind of thinking about that patient throughout their um healthcare continuum.

SPEAKER_00 47:39

Yeah. So if you were in a room full of medical directors, yeah, what is kind of the one to two lines that you would describe a VEL as to this group?

SPEAKER_03 47:49

A Vell is a virtual health system and we have a lot of different products or um service lines, right, that can help to support them with their challenges. You know, so um we can come to them and they can kind of pick and choose what is their biggest challenge and and how can we um partner to bring them help.

SPEAKER_00 48:16

Yeah. What's one thing medical directors should insist on when evaluating a virtual care partner?

SPEAKER_03 48:24

I think they really need to look at quality and consistency.

SPEAKER_00 48:29

Yes.

SPEAKER_03 48:30

They need to see kind of what's behind the curtain, right? Um, you know, I think there's a lot of programs that um, you know, are are early in development, but maybe just don't have the support on the back end um and aren't necessarily committed to that quality and going the extra mile. And I think they really need to look at um someone that can maybe be their partner in different avenues as well. So maybe not just in one thing, but in multiple um areas of their challenges. Yeah.

SPEAKER_00 49:06

You've given us a lot to think about, and we've covered a lot of important topics, just from you know, the technology enablement piece, but our clinical expertise and what that really means at a Vell. If there's one takeaway you hope for clinical leaders to remember from this conversation today, what would it be?

SPEAKER_03 49:24

I think I would want them to understand that our programs are clinician and physician-led. You know, we we lead with excellent quality physicians who bring on more excellent quality physicians, and that is who are who's helping to build these programs and and bring them out. And then the other thing I would say is this is collaborative, right? We're not trying to take over, we're not big brother. This is um, this is about good clinicians helping good clinicians. Yeah, absolutely.

SPEAKER_00 49:59

Well, it's been so great talking with you today and just learning your scope of things and all of your experience throughout the Avell journey, going from innovation and quality and being a medical director yourself to now the CMO. You have a lot of fun experience to learn from, and I look forward to having you back again. Thanks. It's been a joy. Yes, thank you. And thank you for joining us on Avel Ecare Virtual Health Connections. If you found this conversation helpful, we would love for you to subscribe, share it with your colleagues, and stay connected with us as we continue exploring telemedicine in the future of healthcare delivery. To learn more about Avel Ecare and how we're supporting care teams across the country, visit Avelecare.com. Thanks again for listening. Until next time, stay connected.