Aluna representative Charvi Shetty sat down with Dr. Kensho Iwanaga, a pediatric pulmonologist, to discuss the role of remote patient monitoring and digital health solutions and how they can impact pediatrics and pulmonology. Dr. Iwanaga attended medical school at the University of California Irvine and completed his residency in pediatrics at  UCSF Benioff Children’s Hospital in Oakland. He then went on to complete a fellowship in pediatric pulmonology at Seattle Children’s Hospital. During that time he also earned his master’s degree in epidemiology from the University of Washington school of public health. Dr. Iwanaga has board certifications from the American Board of Pediatrics. 

Q: “What inspired you to become a medical doctor, and why did you decide to specialize in pediatric pulmonology?”

I quickly learned as I was going through my rotations, which all of us do during our second and third years of medical school, that I really enjoyed working with children. So it was a fairly easy choice for me to go into pediatrics because it spans from age 0 all the way to the mid-20s. So lots of tremendous changes as the child is growing physically, mentally, behaviorally, developmentally, all these kinds of things. And of course, working with their parents and their other caregivers was a big plus for me. And then when I was a pediatric resident I really enjoyed asthma. Of course, that’ll play into other questions later on today, but I really really enjoyed taking care of patients with asthma

Q: In your opinion, what patient demographics are best suited for using digital health solutions?” 

I think it’ll matter in terms of what goal you’re trying to achieve. I think, on the one hand, there’s a subset of patients who are truly motivated and understanding and really trying to take control of their disease, not letting it define them. So of course in speaking with asthma, there are patients, children and adults alike, who are sick and tired of being breathless or coughing and having it impacting their school, their work, their home lives, and those kinds of things. So I think there is certainly one element where you have a population who really has a great set of motivation to say, “I really want to take control of this, because I don’t want it to take control of me”. But I think about how we’re having this conversation on Zoom rather than in person because of the COVID pandemic and all these kinds of things, it also brings up an issue of access. 

So when I am talking about demographics, I think there’s also that element of improving access to patients who may not otherwise have access to a type of service like lung function monitoring. In general, this is one of the reasons why we’ve been working together for so long. It’s the fact that doing spirometry traditionally has always taken place in the hospital or in a clinic setting. The patient had to drive over to our clinics or to our testing facilities and get the breathing test done, and through several iterations, we now have a product where that’s not necessary anymore. We actually can have a patient living in the next town, or even further off, who may not be living close to a testing facility. We take it for granted because I can order it anytime I want, but imagine someone who lives hundreds of miles away. So to enable them and provide them that access to an important tool to help them again take charge of their conditions, they may not initially have that intrinsic desire to say “I’m going to take over this instead of letting it take over me” but at the very least we’re giving them the option now to have a tool that wasn’t otherwise going to be available to them.

Q: “What advice would you offer a physician that wants to start implementing digital health solutions into their practice?”

I think again, it all depends on what the goals of that practice may be. My first bit of advice would be to probably start with a finite goal, or at least starting small. Have a predefined goal in terms of who you are trying to target whether you’re trying to say, “within my practice, I might be covering a geographic area, and either this population or this patient population living in this general area within my catchment area”. 

Let’s take your patients with severe asthma, and you’re looking back at your practice model and saying, “what is it that makes them severe?” It’s a fact that we’re having trouble titrating the medications because we don’t have all the information available to us. So even if they live down the street or whether they live 200 miles away you can then say well all right we’re going to focus on incorporating digital health and remote patient monitoring for this population. 

So I think at the very least these practice managers are going to have to start thinking about who we want to start off with first, and establishing feasibility. Then from there, you’ll find that you can quickly expand to other areas to say all right well now we’ve demonstrated that it works for this population. Now, who’s gonna be the next group of people? Or find a logical expansion from there to say now we can increase the access and you can utilize it more whatever it works for in the practice. So I would say start small and be specific, and then from there, it’s gonna be much easier to expand.

Q: “What do you think the use of digital health solutions will evolve within the respiratory healthcare space over the next five years?”

The irony with healthcare is that when it comes to technology and innovations, healthcare practices are the slowest adopters of technology. We still utilize pagers and those kinds of things. That being said, whether you want to look at it as a positive or negative, the COVID pandemic has truly forced and changed healthcare in general in terms of how we’re going to do it. And that’s happening even in the workplace where we may never go back to the “good-old-days” or whatever you want to call them, to the pre-pandemic days where everyone just goes back to the office, everyone goes back to the clinic in terms of in-person visits. 

Telehealth, telework, whatever you want to say, but the virtual platform is here to stay. So again, I think in terms of improving access for those who are geographically far away, but even for whatever reason those who may not be far away, they may be unwilling or unable to come in. Regardless of how this pandemic plays out, there’s going to be some bit of a hybrid model where we doctors are still going to have to reopen our clinics. And we already have some patients being seen in person. And we will utilize our input, or our in-person base testing facility infrastructure, and those who may not come in as frequently we can’t just go on and allow these big gaps in missing data in terms of their lung function and their symptoms and their medications. 

Medicine still needs to continue, and so if we’re going to be continuous on a virtual platform then we also want to augment that right with objective data lung function data to help us with our patient decision making. So if you’re working from home it’s going to be the same thing where this is going to be a regular part of a routine.

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