Telehealth Best Practices: Dr. Vipin Chengat of MayaMD On How To Best Care For Your Patients When They Are Not Physically In Front Of You

Interview conducted by Dave Philistin, CEO of Candor. Read the original article from Authority Magazine here.

Using checklists — Checklists which might seem trite or even archaic, have proven to be incredibly helpful to make care consistent, efficient and effective. There’s a reason pilots use them every day when flying airplanes and if you look at their history, these checklists have helped to dramatically lessen error. Atul Gawande wrote a fantastic book all about their use in medicine and it documents their history too.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Vipindas Chengat.

Vipindas Chengat, MD, FACP, is a physician, researcher, and technology enthusiast. A winner of the EB1-A “Extraordinary Ability” visa, also known as the “Einstein Visa,” Dr. Chengat is the founder of MayaMD, one of the world’s leading and most advanced personal health assistants. Powered by next-generation AI, Maya can process quadrillion combinations of symptoms, physical signs, and lab results in seconds with a 94 percent accuracy rate to provide a holistic clinical decision support system for doctors and patients.

Dr. Chengat has introduced novel research to the related fields of teaching clinical reasoning and critical thinking to medical students, and top medical schools including the Yale Internal Medicine residency program, the University of Colorado, and the University of Utah have supported his works. He is Board Certified in Internal Medicine (2011) and currently serves as a core teaching faculty member at the Mountain View Internal Medicine residency program in Las Vegas.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Iam a teaching faculty member at the Mountain View Internal Medicine residency program in Las Vegas, Nevada. While doing my residency at Cook County Hospital in Chicago from 2008–2011, I noticed that there were many patients waiting for several hours — and sometimes even a day — to get into their Emergency Room. It dawned on me, if we can predict how many of them would need admission, who can be safely treated as outpatients, who might need MRIs and CTs and who might need specialist consultation before they are seen by the ER doctor; we can significantly improve efficiency, but more importantly patient care. I decided to build an algorithm that can process data like a doctor who has unlimited time and resources to make a decision at a time — be it a combination of symptoms or lab tests or physical signs or chronic disease management.

Can you share the most interesting story that happened to you since you began your career?

As I was building this algorithm with hundreds of thousands of data points, I also started research around understanding human cognitive errors and biases affecting medical decision making. Studies show that 5–15% of all diagnoses are either delayed, missed or wrong. This makes machine learning based decision engines to be highly prone to errors since the electronic health records represent our current practicing methods, which is suboptimal. Plus, EHRs are just modified billing systems and incomplete at best in capturing the patient’s journey. So, I wanted to shift my focus from finding the best next step, to a checklist that allows the clinicians to think through a number of options rather than just one or two. This shift in thinking during my initial learning journey was very compelling.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

The human brain is powerful but subject to limitations. From my learning and research about diagnosis error in my profession and the root causes which relate to human biases or cognitive errors; it is evident that human error exists. In my profession, we train for many years and even the best of the best make mistakes. This appreciation of being ‘human’, helped me to develop a solution that can help to minimize human error.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

Dr. Alan Morris from the University of Utah collaborated with us on several different research projects. His influence was extremely helpful because it really helped us learn about how effective our solution was and could be, but he also mentored us in an invaluable way. He gave us a lot of insight into the US healthcare market and system, the good, the bad and the ugly. We shared some common interests in our research so not only was his help in this area tremendous, but the additional time-tested experiences he shared were monumental.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

The main benefit of telehealth is to quickly address patient health issues in a convenient manner. This can potentially reduce emergency room visits or having to wait for weeks to see a doctor. The problem without seeing the patient in person even though we can treat patients extremely well from afar via telemedicine, is that we simply receive more of the information in person. I think that in is the simplest way to say it and I would bet that 99.9% of doctors would agree. We simply attain more information about each patient in person.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

There are several challenges when the doctor is not seeing the patient directly. Several nonverbal clues might be missing on the diagnostic process. Plus, rates of diagnostic errors could worsen.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)

1. Using checklists — Checklists which might seem trite or even archaic, have proven to be incredibly helpful to make care consistent, efficient and effective. There’s a reason pilots use them every day when flying airplanes and if you look at their history, these checklists have helped to dramatically lessen error. Atul Gawande wrote a fantastic book all about their use in medicine and it documents their history too.
2. Patients partnering in the decision-making process — Having a patient that is an active participant in their own healthcare is such a powerful thing. Active patients will show up to their appointments on time, ready with educated questions, they will adhere to their post-visit instructions, take their daily medications when needed, and be really honest about their life and challenges. Patients like this open up to us and we as doctors are able to really understand them on a whole new level. It’s really enlightening and heartwarming especially when you have a reserved or challenging patient who after time starts to open up and allows themselves to be vulnerable. This is something that I feel is truly special about doing medicine with patients and it’s when we form a real connection.
3. Clinicians forced to think about ‘what else can it be?’ with a diagnostic timeout — Interventions are a common practice used in medicine to pause and take a certain action that has been proven to have a positive impact on care. Doctors unfortunately don’t spend as much time with patients as we would like and we are often under the clock, juggling multiple things and usually tired. In this state, mistakes have a higher chance of happening. Pausing during an evaluation with a patient is a tremendous exercise to help or prevent us from jumping to conclusions too early (premature closure). As the old saying goes, 9 out of 10 times the horse is a horse, but occasionally it is a zebra
4. Patients seeing the clinical documentation in real time — It is critical that the patient is on the same page as the doctor and knows as well as understands the outcome of each visit. This step helps each participant to be accountable as well as perhaps catch something that might be missing.
5. Follow up — Post discharge it is important that there is clear communication with the patient before they leave the clinic or hospital, and then a simple follow up call or text with them to see how they are doing. So many readmissions can be avoided if these simple steps are done properly.

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

Here are a few that come to mind: Non-emergency room visits that might require immediate intervention such as antibiotics, Regular follow ups for chronic disease management, Quick work up for potentially life-threatening diagnoses such as cancer, and Post discharge services where patients might still be learning about the new diagnosis. What these all have in common is speed or the ability to shorten the window for care. These days with these new telemedicine technologies, we can administer care or viral information to patients to help them get the care they need in a timely fashion.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?

In my opinion, the tools that have really transformed care or made virtual care so powerful are RPM (remote patient monitoring), Scheduling and the virtual telemedicine waiting room, and Smart intake solutions. These technologies provide so much information in a very cool and efficient manner. They are impressive and will be used more and more over the next few years for sure. Think about it, doctors can receive patient vitals via Bluetooth or cell technology to help patients get their chronic conditions under control. That’s awesome.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Well, they all offer some great things but if I could design one that has it all, I would include: Intelligent triage using AI and a clinical documentation system to save time, clinical decision support system that is part of the workflow, built in remote monitoring tools, and self-management algorithms. A system that can efficiently and effectively handle the whole patient journey would be very compelling.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

I think that preparing for each visit to see the doctor is an important piece of the puzzle. These days, patients can really do a lot of research prior to their visit to empower themselves and come ready and be an active participant in their healthcare.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

VR does have practical implications in care for medicine and of course medical students. The ability to see inside the body using VR is a tremendous application and offers lots of benefits.

Is there a part of this future vision that concerns you? Can you explain?

The total absence of physical examination. Technology is a wonderful thing, but it simply can’t replace the physical meeting of a doctor and patient. It’s a vital tool not only the doctor patient relationship, but the patient journey too. In my opinion, the physical examination and face to face appointment is invaluable.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

Patients should be empowered to ask the right questions to assist the provider in diagnosis, because patients bear the ultimate harm from diagnostic errors. I sincerely hope that tools like MayaMD provide patients with better information so that they are better informed when meeting with their doctors. We doctors can be a little intimidating sometimes to patients, and I hope that MayaMD can level the playing field a bit so that patients can be more of an active participant in their healthcare. I don’t believe that it should be a one-way street where the doctor is always driving the narrative. I’d like to see more of a shared decision-making process with engaged patients and doctors working together.

How can our readers further follow your work online?

www.mayamd.ai

Our apps

For Patients: MayaMD (iOS and android)

Clinicians: Maya Pro

Medical Education: Maya Edu

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.

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Written by Dave Philistin, CEO of Candor

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