Digital Health Dialogues: Bridging Equity and Access

[00:00:00] Hello there and welcome to the HIT Like a Girl podcast.

[00:00:12] My name is Joy Rios and on this show we talk about how crazy, crazy, crazy complicated

[00:00:17] the world of healthcare is and each one of our guests gets to share their area of expertise

[00:00:23] to help us put the big picture together, the big crazy puzzle.

[00:00:26] So if you don't mind we have two guests today and I would like you both to take a minute

[00:00:31] to introduce yourselves and I'm going to start with you.

[00:00:33] Hi Joy, thank you for having us on your podcast today.

[00:00:37] My name is Dr. Jamie Fernandez.

[00:00:39] I'm the family medicine resident at Harbor UCLA and digital health equity leader.

[00:00:44] Okay.

[00:00:45] And hi my name is Betty Vellante.

[00:00:47] Thank you again so much for I'm honored to being in here.

[00:00:50] Well, my journey is long but let's just cut it short.

[00:00:53] I'm a very non-traditional pre-med.

[00:00:57] I do aspire to become a physician one day in this health equity, digital health equity

[00:01:02] space in mindset and yeah if anything put me as an advocate that'd be more my label.

[00:01:09] Okay and can you guys tell me how you know one another?

[00:01:12] Sure, I'm happy to share a story.

[00:01:14] So just a little bit of background about myself.

[00:01:17] I was born in Los Angeles.

[00:01:19] I'm a Latina American.

[00:01:21] I'm the first one in my family to go to medical school and the path to become a doctor has become

[00:01:25] has been quite challenging to say the least.

[00:01:28] So by the time I got to medical school, I realized how important it is to give back.

[00:01:33] So since then I've been collaborating with organizations like Mime and Thor and the Latino

[00:01:38] Medical Student Associations and hold either webinars or speeches just to talk to other

[00:01:44] non-traditional underrepresented students going into medicine and sharing my path.

[00:01:48] So last year I was sharing my journey on a woman in medicine webinar for Mime and Thor

[00:01:54] and part of my journey I shared that I was interested in health tech and telemedicine

[00:01:58] and Betty was in the audience.

[00:02:02] And usually people reach out to me with questions about how do I study for my MCAT

[00:02:05] or I'm really not nervous about applying to medical school but Betty reached out with

[00:02:10] a different purpose.

[00:02:11] Yeah, so I was in Los Angeles and Charles Drew that's where they were hosting Mime

[00:02:16] and Thor.

[00:02:17] It was actually a hybrid conference so yeah we were very small of us and when you made

[00:02:22] that announcement I was like, oh my word.

[00:02:26] I think I found someone that thinks like me because for such a long time my background

[00:02:32] being biomedical engineering I coming into UC Irvine I didn't even know the word engineering

[00:02:38] because as a child my roles was confused between being an adult translating for my

[00:02:44] parents and my family and then so I had no space to really think about what I really liked

[00:02:51] or what I'm into.

[00:02:52] So when I got into college, knock on wood that everything worked out for me getting

[00:02:58] into a good school but still I had no clue what the term engineering was and yet my

[00:03:03] counselor said you're good in math I can see that maybe you should consider it

[00:03:08] And so he had to break it down for me and so since then moving forward I kind of paved

[00:03:15] the way for myself trying to pretty much you know find answers and I just felt like a lone

[00:03:21] wolf for such a long time and so when Jamie said hey there's this opportunity in a heart

[00:03:28] beat I just I contacted her right away.

[00:03:30] And what was the opportunity?

[00:03:31] So at the time we were hosting a digital health conference and Betty is also a very

[00:03:37] talented videographer and photographer so she joined on board and that was a very successful

[00:03:42] conference where we brought people of color digital health leaders coming in and kind of

[00:03:47] sharing their experience in the space.

[00:03:49] So one thing I did want to you know bring up is that Betty's experience is not is

[00:03:54] it's quite quite unfortunately quite normal in the healthcare field throughout in all

[00:03:58] of medical school pre-med I went to UCLA for undergrad and medical school I wasn't

[00:04:04] taught about digital health equity.

[00:04:05] It wasn't until my fourth year at med school when COVID came that they realized oh we should

[00:04:10] do a really quick course on telemedicine and we did like a two days of like this is how

[00:04:15] you sign in and that's it you're done.

[00:04:17] And then I graduated went to residency and the first couple of years I was doing

[00:04:22] some phone visits and then mainly in person but I noticed that a lot of my patients

[00:04:27] I saw so I work in Harbor UCLA which is Alley County serves 80% Medicaid medical

[00:04:32] patients majority black and brown like Spanish speaking patients and I noticed that

[00:04:39] I out of seven patients I was seeing on my panel I would always have about three or

[00:04:43] four no shows and those were patients that I really needed to see like patients

[00:04:48] with really uncontrolled diabetes patients who I really needed to see me and

[00:04:53] I started digging through their chart and realized that they had a really big

[00:04:56] pattern of no shows and they will be the perfect patients to do telemedicine

[00:04:59] with so the next time I did see them I offered the services to them and it was

[00:05:04] actually quite interesting some of them had never didn't even know we had those

[00:05:08] capabilities this was already two years after the pandemic and for me that

[00:05:12] was just such an eye-opener and really start got me to start thinking about

[00:05:15] telemedicine digital health equity.

[00:05:18] So is that in terms of communication like they weren't communicated to or was

[00:05:23] it a language barrier or was what was it that they like what were the

[00:05:27] reasons behind them not under not knowing what was available to them.

[00:05:31] Yeah that's a really good question so usually a doctor patient interactions

[00:05:36] the patient walks into the room and are just okay I'll see you a follow-up in

[00:05:39] three months so doctors have the option at least at my clinic to offer either

[00:05:42] a video or a phone visit but a lot of times doctors don't offer the other

[00:05:46] options if they don't believe that the patient has the internet capabilities

[00:05:51] or the technological expertise to actually do this so it's easier just

[00:05:54] not to offer it.

[00:05:55] Gotcha.

[00:05:55] So one aspect could be biased from the physician part the other aspect could

[00:05:59] be mistrust from the patient side as well and also the way we communicate it

[00:06:04] so for instance the word portal is medical jargon.

[00:06:07] Okay.

[00:06:07] It does not translate in Spanish.

[00:06:09] What's the right word?

[00:06:10] What would you say?

[00:06:11] I don't know.

[00:06:12] I saw the way I pitch this telemedicine to my patients is I say how do you use

[00:06:17] WhatsApp and they all use WhatsApp.

[00:06:19] Of course they all use WhatsApp.

[00:06:20] Yeah they're on Facebook they're messaging their family and other countries

[00:06:23] and I was like you know what you can message me the way you talk to your

[00:06:26] family on WhatsApp and their eyes open they're like what my doctor's on

[00:06:29] WhatsApp and then I say okay not it's not called WhatsApp but something similar.

[00:06:33] I love it.

[00:06:34] So you utilize it like that and then they're intrigued of it and then

[00:06:37] that's how I get to start the conversation let's continue speaking

[00:06:40] like this so that when you do have those high blood sugar you can

[00:06:42] message me right away.

[00:06:43] And how has that translated as far as usage since you started pitching

[00:06:48] it?

[00:06:48] Yeah a really really big uptake in my class there's three classes

[00:06:53] each class with 12 residents and as a digital health equity lead I get to

[00:06:57] actually bring in students to work with me and shadow me as I do the telemedicine

[00:07:01] visits and the students are the ones helping the patient enroll and getting

[00:07:05] them through the process.

[00:07:06] So I've actually had this project started about two months ago so we've had

[00:07:10] two full two to three full clinic days so that means 12 patients that were

[00:07:13] old video who had never done it before.

[00:07:15] And how have they gone?

[00:07:16] You know Iraqi just say the least but it's been a really great up and

[00:07:22] down because when a patient opens up their home to you in a telemedicine

[00:07:28] visit you learn so much.

[00:07:29] Yeah well once when you're as soon as you said what's up I'm like oh that's

[00:07:35] what we'll click with the Latin community like 100% and I'm sure others

[00:07:40] as well and so once you're able to like put that in their in their mind of

[00:07:44] course they're gonna pick it up that's much more I totally feel you

[00:07:47] that's much more like at home and where people would feel comfortable

[00:07:51] than saying hey log into your patient portal.

[00:07:53] Yes can I add a little bit on that actually because like exactly what

[00:07:57] Jamie said she it was the best way to communicate with the patient of

[00:08:02] explaining what a software is in their language and I think that is the

[00:08:06] biggest thing of educating and communicating and creating that

[00:08:11] initial trust at first impression because some doctors will say oh well

[00:08:16] do you have internet and that internet is a confusing word for some people

[00:08:21] they'd be like oh wi-fi broadband in my home no.

[00:08:24] They're not thinking of their phone.

[00:08:26] Exactly and so that is a big thing and frankly enough like in

[00:08:30] terms of like I can speak a little bit more of like the Latin community

[00:08:33] we're very shy and we fear a lot and we honestly do not become very

[00:08:39] honest even if we are like the same ethnicity practitioner who

[00:08:44] you know is communicating with you you're in the same

[00:08:47] ethnicity but it's still it's a challenge that even till this day

[00:08:51] I even face it I see it every day at community clinics

[00:08:55] and I try to communicate with them what is the best way for them to

[00:08:59] understand me and how can I teach them especially with technology

[00:09:03] so yeah I like that idea with WhatsApp so I'm probably gonna use that too

[00:09:07] yeah. I think it's really smart so as you are creating

[00:09:11] curricula around digital health equity what does that look like

[00:09:15] and as you're trying to teach people because it sounds like it's education

[00:09:19] on the provider side as well as the patient side.

[00:09:22] Yes yes and this this curriculum has designed very intentionally

[00:09:27] so through my path learning about digital health equity

[00:09:31] started really at vibe which was earlier this year in February and

[00:09:34] learning about the TechWidi for the Health Foundation's TechWidi

[00:09:39] for TechWidi Coalition and then I started doing research

[00:09:42] about other medical schools and whether or not they have a digital

[00:09:45] health equity or telemedicine curriculum and I actually found

[00:09:49] that in the year 2000 in Health and Tech published

[00:09:52] did a systematic review of telemedicine curriculum undergraduate

[00:09:55] schools and they only found 28 programs and of those I did a quick search and

[00:10:00] only three of them mentioned the word equity. Wow. Yeah so that opened like

[00:10:04] a huge it was a huge red flag for me and then I started really

[00:10:07] wanting to understand the program the problem a little bit more

[00:10:10] so like I said I like to speak to groups of students

[00:10:13] so I recently gave a speech at the Summer Urban Health Fellowship

[00:10:16] which consisted of 45 underrepresented Black and Brown students

[00:10:21] going into the health fields and I just did a survey how many of you have

[00:10:24] ever heard the term digital health equity?

[00:10:27] Want to guess? Zero maybe one. 10% had heard the term. Okay.

[00:10:30] Yeah yeah 10% had heard the term and then I gave my presentation

[00:10:34] it was very simple of you know the cold digital health equity

[00:10:37] just to be very inclusive build trust in a way that people understand

[00:10:40] it was a very easy concept for Gen X millennials to understand

[00:10:43] and after after the presentation I surveyed the GEM

[00:10:47] and 90% of the students felt a responsibility as future providers to use

[00:10:52] digital health to enable care with their patients.

[00:10:55] That's amazing so one of the things that I have been

[00:10:58] thinking about a lot lately and talking with people that I know is like

[00:11:02] digital health is such a term that we throw around

[00:11:07] but can we speak to ways that has actually made a difference

[00:11:11] and when the theory versus the practice

[00:11:15] of that concept of digital health bringing equity

[00:11:19] do you get to see that in play? Do you have any evidence

[00:11:22] and even in this short amount of time that you've been talking about it

[00:11:25] can you share any stories or experiences around

[00:11:29] how digital health has made a difference or made things more equitable?

[00:11:34] Yeah I have a one patient story particularly comes to mind

[00:11:38] I had a patient to have a patient he's a construction worker 45 year old man

[00:11:43] multiple chronic conditions but we were working on hypertension

[00:11:46] when he sees me he's always really nervous his blood pressure is through the

[00:11:48] roof but he swears at home it's normal so I said okay that's fine

[00:11:53] so let's do a video visit go home take your blood pressure and we'll

[00:11:56] we'll see what you know what it is

[00:11:58] so I had my student work with them connect him he was like wow this is

[00:12:01] great I don't have to miss work I can just like kind of step out and it'll be

[00:12:04] fine so we're like okay so the day of the visit

[00:12:07] he's at home that morning and I was like okay

[00:12:09] it's time to check your blood pressure can you get your machine please and

[00:12:12] show me how you check your blood pressure

[00:12:14] so he's like okay so he's really excited to show me how he is at and I

[00:12:17] see him take the blood pressure machine and put it around his wrist

[00:12:20] oh

[00:12:23] I was like no wonder your blood pressure is low I hope

[00:12:28] so because I was looking through the video I was able to really

[00:12:32] course correct him at the moment and you know really instruct him

[00:12:35] to sit by his side make sure his arm is in 90 degrees and take his blood

[00:12:38] pressure correctly and that was like a really good teaching moment

[00:12:42] and having the students there by my side I just you know turned around and

[00:12:45] looked at them they were like oh my goodness this is so easy

[00:12:47] and if we hadn't had this experience that patient would have been in my

[00:12:51] office and I might have taken out of blood pressure medication right which

[00:12:54] was the wrong course of action right that's incredible yeah can you tell

[00:12:58] me a little bit more about your journey as pre-med I would love to hear just

[00:13:02] like pull out what it is because it's it's a journey that we haven't heard much

[00:13:07] about on the podcast and I would like to bring light to it.

[00:13:09] Yeah of course so actually non-traditional pre-mence is now

[00:13:13] becoming more common than we think especially now this day in age

[00:13:17] I think a lot of medical students do state like oh if I can go back in

[00:13:21] time I wish I've done a gap year to just

[00:13:24] on other things so I took that advice entering into

[00:13:29] this biomedical engineer world when I took a class in coding

[00:13:33] it even in this is a mandatory class

[00:13:37] right it was not an elective it was a requirement for me to graduate

[00:13:41] and it opened up my world once again because I didn't know

[00:13:45] what coding was someone told me okay I just said to my counselor

[00:13:50] whatever that takes me to get into medical school

[00:13:53] and he's like I know just the one biomedical engineering I was like okay

[00:13:57] but no one ever told me like I think as soon as I express it to people they're

[00:14:00] like no that is so tough this is going to be really really tough and

[00:14:04] I switched out from biology out to undeclared because I didn't fit I

[00:14:09] didn't feel that this was just for me I loved math too much and it was just

[00:14:13] my comfort zone it's a universal language

[00:14:16] and I can go back to also like tying it with images

[00:14:20] so yeah so coding I was like okay maybe I want to switch on my major

[00:14:26] but it was I just you know what I'm just going to stick to this course

[00:14:29] and then as I finished I worked as a medical scribe you know and this is

[00:14:34] what in my home country or my parents home country in Peru they call it

[00:14:39] professional years so more I like that better

[00:14:43] I worked at a medical scribe as a medical scribe at breastlink

[00:14:46] and through this experience I was able to learn more of what it is in the clinical

[00:14:52] setting learn a bit about the routine and just saving up for myself as a premed

[00:14:57] to prepare for my applications as I study for the MCAT and everything

[00:15:02] and I took it I I tried I was applying back in 2019

[00:15:06] I realized that I wanted to do a dual program

[00:15:10] that for sure was something I wanted to do and as I was doing my research

[00:15:14] at the time there was no dual programs that involved

[00:15:19] like masters of science with the medical degree

[00:15:23] so it was very you know public health masters of business

[00:15:28] I think Stanford has one for being a Juris Doctor

[00:15:32] but nothing that involved masters of science and I asked myself

[00:15:35] why not like computational biology is is important it's big or maybe someone

[00:15:41] who wants to go and you know I just tapped a little bit but I could only

[00:15:46] imagine the opportunities in what the world we're going to enter into

[00:15:50] right and so I said to myself no I don't feel ready

[00:15:56] there's a big curiosity in me and that's what this gap year is about

[00:16:00] is to answer those curious questions and go with that gut

[00:16:04] so I took the chance and I went to apply I was fortunate enough to study

[00:16:11] in London so University College of London got my masters in biomaterials and

[00:16:15] tissue engineering and for my thesis I said to myself okay

[00:16:19] if we said coding you wanted to almost switch out your major in software

[00:16:24] here we are starting abroad let's knock out two birds one stone see how this is

[00:16:27] going to play out and boy was it challenging

[00:16:31] but exciting at the same time to see the end

[00:16:35] of just finishing it and reflecting on it saying

[00:16:39] wow there is potential now I have this mindset

[00:16:43] and now I could only imagine getting into like medical school

[00:16:47] introducing this and figuring out a way to provide a curriculum

[00:16:52] to provide a chance for medical students that have you know curiosity with

[00:16:58] computational science and software or something because

[00:17:02] AI this that's the buzz in this conference as we all know

[00:17:05] and so why not come and provide that sort of opportunities for a lot of medical

[00:17:13] programs and it has received positive feedback is there anybody

[00:17:17] else that's going to be able to follow in your footsteps I really hope so

[00:17:21] again I think when the more I share I realize like say for example

[00:17:25] I'm volunteering how to free health clinic it's called Orange County

[00:17:29] I project I'm also an AI program manager where

[00:17:32] I'm trying to implement an AI tool to community

[00:17:36] serve clinics but apart from that mainly I'm also utilized as a

[00:17:41] Spanish translator in this space that's a big thing

[00:17:45] and what I realize is that sometimes when I'm explaining and teaching

[00:17:50] students and training them how to translate in Spanish

[00:17:53] with medical terms and then being concise in the intake

[00:17:57] right so that physicians can look and read so that they can do the next

[00:18:01] steps you know sometimes I ask myself like

[00:18:04] what are you into you know like I you know when we have some downtime

[00:18:07] and when I tell them what I'm into everyone seems like

[00:18:11] whoa whoa you're so smart I'm so intimidated yeah

[00:18:15] everyone's intimidated and I was like no don't be like you know how to use

[00:18:19] a computer as well as I I'm sure you took one stats class that made us

[00:18:24] force us to learn this one software called R

[00:18:27] you know like you've done it it's okay I know it was a challenge but

[00:18:31] give yourself that chance again or maybe dabble in other softwares and don't be

[00:18:35] afraid and that that's what I want to do I want to

[00:18:39] be that sort of person to give that support because I understand

[00:18:42] but I don't know what it is about this fear with medical students I think

[00:18:46] they're so caught up with like trying to do all the other things

[00:18:49] patient care and bedside manner which are of course they're so important

[00:18:53] but with AI entering into healthcare space we are noticing right now that

[00:18:57] everyone is trying to create an educated Ginn

[00:19:00] program for physicians where is it for pre-meds

[00:19:04] and how that way how can we make a better net positive forward to making

[00:19:09] the system healthcare better well having just come out of

[00:19:13] your training or even being part of it I think you guys have an interesting

[00:19:17] perspective and if you could wave a magic wand as far as

[00:19:20] wish list of what you wish was included or content or

[00:19:25] curricula that you would like others to learn what would you

[00:19:29] add let's start with Jamie yeah sure yeah so I always say the mission ever

[00:19:35] every student that comes to work with me I start off was like I want to change

[00:19:38] your mindset of what wellness means I think a lot of people in underserved

[00:19:42] communities do think that health only happens when you see a doctor because

[00:19:45] you feel sick but a lot of our community is walking around with

[00:19:48] three or four chronic diseases so they're always sick

[00:19:51] so by doing telemedicine and by a person being able to access a doctor more

[00:19:57] than one having multiple touch points and at the time that they need it

[00:20:00] all of a sudden health becomes a continuous way of life right and I

[00:20:05] think that telemedicine has a really good

[00:20:08] promise to do that and by teaching medical students in the new generation

[00:20:12] of doctors to think in that way then you start

[00:20:15] questioning oh of course I need to talk to them in between visits because that's

[00:20:18] what health is it's all the time there's just so much like even in

[00:20:21] community service like health centers there's always a shortage with

[00:20:26] translators I think that's one of the biggest things that I'm noticing

[00:20:29] and sometimes like if I'm not there and patients come and ask for

[00:20:33] for me I there's so many other Spanish translators that come to

[00:20:37] volunteer as pre-mands but sometimes when all of us are not

[00:20:41] present because of course we're volunteers I feel this is where the

[00:20:44] digital health space comes into play because it's saying well I'm sure there's

[00:20:48] so many other pre-mands in Texas or in rural areas that know how to

[00:20:52] translate they have a big dream to becoming a

[00:20:55] physician they probably don't have as much access to having these

[00:20:58] opportunities why can we bring them much closer to this sort of

[00:21:01] opportunity in those clinical setting space when we need them I love that

[00:21:05] ladies I'm really excited to see and follow your journey

[00:21:09] I mean you've come a long way even in just a short amount of time

[00:21:13] what you're saying is like oh we've got a new idea since February and look where

[00:21:17] we've taken it so I can't wait to check in with you

[00:21:20] a year from now and five years from now and to see where you all have gone

[00:21:24] and so if people if we want to if I would like to connect with you and

[00:21:28] follow you how can I and our listeners do so

[00:21:32] you can connect me on instagram engineer to pre-med

[00:21:36] also on linkedin beddie valante yeah that's like so it's the best two

[00:21:40] ways to contact me and I'll be providing more content I'm hoping to

[00:21:44] provide more of my journey because it took a long time to just

[00:21:48] finish where I'm at and figuring out completing certain things but now

[00:21:52] that I just now feel ready feel ready I just have to take that

[00:21:56] MCAT in which I can share a little bit more at another time but

[00:22:00] if you have any other questions as well with like

[00:22:03] software how do I do this especially now with UCLA that's all Jamie's

[00:22:07] department but I'm hoping to learn more about this so that I can tell

[00:22:10] these two pre-meds saying this is possible for you the you didn't

[00:22:14] you didn't have to go the way I did now because that added a lot of years under

[00:22:17] my belt but I'm glad that it's it's reducing and it's

[00:22:20] making it possible so people can get into the space

[00:22:23] you can always follow me on Jamie Fernandez on

[00:22:27] tiktok or on instagram or on linkedin my first name is Bob Little Funny

[00:22:32] so jh a i m y but you'll find it there

[00:22:37] but yes I'm happy to connect with any pre-health student who's

[00:22:41] listening to this podcast and is interested in digital health like Betty

[00:22:44] will say I'm like really good at message answering DMs and I'm

[00:22:48] always talking to students on the phone and you know referring

[00:22:51] different things so like Joy wanted this this podcast is the

[00:22:54] first thing I refer I love anybody wants to know about

[00:22:57] digital health equity listen to Joy's podcast it's a really good

[00:23:01] introduction of voices that are not represented elsewhere and then after

[00:23:04] that you just become very curious well thank you so much for

[00:23:07] sharing with us and also thank you Cherise for joining in

[00:23:11] I appreciate your insights because you have a really great perspective as well

[00:23:17] and this has been a great conversation so thank you ladies

[00:23:20] we will talk soon yes thank you thank you

[00:23:25] thanks for listening you can learn more about us or this guest by going to

[00:23:29] our website or visiting us on any of the socials with the handle hit like a

[00:23:33] girl pod thanks again see you soon again thank you so much for

[00:23:37] listening to the hit like a girl podcast I am truly grateful for you and I'm

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[00:23:45] subscribe to this podcast or maybe leave us a rating or review or if

[00:23:49] you're feeling extra generous would you share this episode on your

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[00:23:57] so much I'm the show's host Joy Rios and

[00:23:59] I'll see you next time