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Season 1, Episode 12: Transcript


Angela Greenwell: Welcome, everyone. Thank you for joining us. You’re listening to Atlanta Business Impact Radio with Veanne Smith and I’m your co-host, Angela Greenwell. Atlanta Business Impact Radio is a podcast that showcases some of Atlanta’s most innovative and forward-thinking business and technology professionals.

In our first season we take a deeper look into the world of healthcare IT. In today’s podcast we cover the topic of specialty telemedicine and the positive impact it is making for rural communities right here in Georgia and the southeast. The stories we share about how telemedicine is saving lives of mothers and their unborn babies are amazing and something you do not want to miss. Both Veanne and I are so excited to welcome as our guest today, Tanya Mack of Women’s Telehealth.

Veanne Smith:      Welcome, everyone. Thanks for joining us. This is Veanne Smith with Atlanta Business Impact Radio. In this episode of our podcast we will be talking about how Telehealth is improving access to specialty medicine care. I am so excited to welcome Tanya Mack as our guest today to talk on this topic.

Tanya Mack, President of Women’s Telehealth, is an operations and business transformation specialist in the healthcare industry. Throughout her 30-year career she has worked with physicians, physician groups, clinics, hospitals and healthcare organizations to help launch new divisions, realign business processes, implement new information technologies systems and facilitate healthcare change management.

Accomplishments at Women’s Telehealth under her leadership are many. I want to share some of them with you, but I warn you it is a long list. Tanya was named as one of three health information technology innovation companies by TAG in 2011 after only seven months in business. She created the first Georgia high-risk obstetrical telemedicine services to rural areas, the results of which were nationally published with American Telemedicine Association in 2015. Tanya was nominated for Atlanta Healthcare Heroes in 2013 and she was featured by NPR in 2015.

Tanya is a member of the American Telemedicine Association, Women Presidents Organization and [Vistage International] and she has also served on the Board of Directors for the Dream House for Medical Fragile Children. For the past four years she has served as the primary sponsor of the Matsiko World Orphan Choir’s annual visit to Atlanta representing over 600 million orphans worldwide. Hello, Tanya and welcome to Atlanta Business Impact Radio.

Tanya Mack:             Well thanks for having me today.

Defining Telehealth and Specialty Medicine

Veanne Smith:      I want to start out by saying that I truly love what you and your organization are doing and how excited for you to be located here in Atlanta, where we lead the nation in providing healthcare via telemedicine. So let’s jump right in. If you could be so kind, define a few terms for us just for listeners that may not be familiar with this topic today. Maybe defined telehealth and can you explain what specialty medicine is?

Tanya Mack:             Yeah. So let’s start with both telehealth and I’ll add telemedicine. So telehealth is really a broader spectrum where we could have anything from long-distance education of providers themselves, like a hub-and-spoke model. Telemedicine is actually the provision of medical care using a telehealth tool network and hardware so there is that whole range of people’s experience probably now with our payers like Teladoc. I have an ear infection, it’s the weekend, my payer now says I don’t have to go to urgent care, and I just sit in front of my laptop like United Healthcare is doing when they show their telemedicine commercial in the last year.

So we all have that experience of whether it’s on our smartphone or whether it’s on our laptop just connecting with the provider. On the other end, telemedicine incorporates a lot of specialty cares. So, people tend to think telemedicine also as a tool that initially was used to bring subspecialty care that is usually only available in the big city to rural areas through distance. So if you were in the Okefenokee Swamp and had a stroke and you had an hour to get that clot buster or not and you couldn’t get to the Emory neurologists you could go in front of telemedicine, you could connect with Emery through their tools and then the local providers could actually go ahead and administer or not.

So telehealth is really the range of everything telemedicine; telemedicine, the provision of services. And specialty care is just any kind of specialty service, not primary care, we’ll talk a little bit later, but 50 percent of our business is now urban, which we tend to think of telemedicine as delivering care in a rural setting but actually it’s kind of become everywhere.

Veanne Smith:      Oh good. We’ll come back to that.

Tanya Mack:             We’ll come back to that.

Introduction To Women’s Telehealth

Veanne Smith:      Good. All right. Very nice. So let’s get specific to what you’re doing now. So you’re now president of a company called Women’s Telehealth. So specifically, what are the services that you are offering?

Tanya Mack:             Right. So we got our start with offering high-risk obstetric care. So just to kind of give you a flavor of numbers. In Georgia, if there is 2000 OBs, if a woman is pregnant and has a problem with either the mom or the baby they’d be referred by their obstetrician off to a subspecialist that would be a high risk provider called maternal fetal specialist. And just to give you a feel for how many there’s about 20 in Georgia so out of 2000 OBs there’s about 20. You can guess…

Veanne Smith:      And those 20, where are they located?

Tanya Mack:             Yeah. Say 16 of the 20 are here in Atlanta. So, in Atlanta, where like a lot of states you have a hub of all the services like Atlanta and then if you are outside of Atlanta there is a couple of other cities, but if you are pregnant in Coffee County, Georgia, and you start bleeding with twins you are going to be driving and hope you make it. So usually a lot of the states are like that. You know, a lot of the states, 70 percent of babies born in America are not born in this city. They’re born in a rural setting.

Veanne Smith:        Seventy percent.

Tanya Mack:             Yes.

Veanne Smith:      Amazing.

Tanya Mack:             But most of our healthcare resources are in the big cities, so telemedicine is a tool that kind of you don’t need a brick-and-mortar and we can deliver the services right there. We can almost do almost everything these days virtually. We’re doing robotic brain surgery by telemedicine. We can do cervical screening by telemedicine now. It used to be thought of as an audiovisual connection, but now that we have smart tools and smartphones and ancillary plug-ins and peripherals we can pretty much do virtual exams for the most part.

Veanne Smith:      So it’s – I’m listing some questions in my mind. To do the things that you do for specialty situations where is the mother or the pregnant woman physically located when you are working with that individual?

Tanya Mack:             Yeah. Great question.

Veanne Smith:      I assume they’re located somewhere besides their home.

Tanya Mack:             Yeah. Well, although, you know we’ll talk about – we just finished our first home monitoring patient where we saw a pregnant woman at home her entire pregnancy up until she delivered by telemedicine for specific reason but we’ll back up. Just in general for telemedicine, I’d say it’s like a three-legged stool. To provide the service you first need a network or a pipeline to transmit all the data, the images, the vital signs, whatever you are gathering on the patient end. Then you need hardware and pretty much it has to mirror wherever the provider is sitting to where the where the patient is. So you bring up a good point about you can’t just scan your own baby at home. You actually have to get to an ER or doctor’s office or government clinic or some setting that is telemedicine enabled with the hardware that that particular specialty needs.

Veanne Smith:      Such as an ultrasound.

Tanya Mack:             Ultrasound for my specialty, but if you were a cardiologists you would need an EKG machine.

Veanne Smith:      Right.

Tanya Mack:             That would plug into telemedicine or PACS system for neurology, there’s probably 6 to 8 regular tools that we plug into a telemedicine cart or system that would enable us to capture real-time data where the patient is. Then we call where the provider sits the host site. So wherever the provider is and where the data is coming back that is where everything is kind of starting port point or housed and then wherever the patient is we call the presenting site. And typically on the presenting site for not just home visit, but actually high-tech telemedicine care you need a healthcare professional there with the patient. So they typically can be a nurse, a mid-level provider, a doctor, an ultrasonographer, just we don’t put the patient in an exam room and say you know it the button when the camera comes on.

Veanne Smith:      Oh right.

Tanya Mack:             There’s always someone with the patient, just like a regular office visit that you would have in a regular doctor’s office or healthcare setting.

What Types Of Cases Does Women’s Telehealth Help?

Veanne Smith:      Well I want to come back to the technology, but I guess before we get there let’s kind to talk about more examples. I like examples. I like stories, you know. Are there specific types of cases in your specific business that you’re treating a lot or are there typical situations or it just – it could be anything.

Tanya Mack:             Yeah. There are, but there’s no different than if you were referred out, whether it’s telemedicine that we connect with you or not. So for example, in my business we have high risk obstetrics, we see diabetic moms, we see multiple gestation moms, we see cardiac defect moms, we see hypertensive. Interestingly enough 45 percent of our patients are obese when they are first – when they are pregnant and that brings a whole range of complications. And then we also see on the fetus side birth defects or chromosome abnormalities or things like that that the regular OB picks up on ultrasound. That doesn’t look right. Let’s take another look. Let’s send them to a specialist and take a look. So we see all of those things in person when we had a brick-and-mortar and we also see most probably the 80/20 rule, see most of them now by telemedicine.

So what we can’t do by telemedicine are hands-on things, like, if you need an amniocentesis obviously the nurse isn’t qualified to perform that where you are you still might have to travel or if you are really sick you still may have to go be admitted to the hospital for a few days, but in general, we can handle 80 percent of the problems right where the woman is in her home community, and she doesn’t have to travel outside of it.

What Are the Benefits of Women’s Telehealth?

Veanne Smith:        That’s awesome. So it seems to me that the benefits are fairly obvious. Like, you know, not having to drive in the traffic or just being able to get to a doctor period but are there other, you know, benefits that we haven’t covered like no time – you don’t have to take time off from work maybe, I don’t know, what are some of the other benefits that you’re seeing?

Tanya Mack:             Yeah. So the three big benefits, certainly one we’ve already talked about is excess and I want to talk a little bit more than urban settings. When we first started our company we’re just having a five-year anniversary this year and we’ve completed almost 15,000 high risk maternal fetal visits, we started with the idea of rural. So we actually went and marketed where our patients traveling that we could bring it right to their community, but in an interesting thing happened after ACA. So after the Affordable Care Act, we now have a lot of healthy pregnant women, childbearing age with $10,000 and $15,000 deductible policies.

So what happens when they get a problem or they’re referred to say the local hospital or the local specialists and they have to go in, they can be charged $800 to $1000 facility fee just for walking in and they haven’t seen anybody yet.

Veanne Smith:      Wow.

Tanya Mack:             And then they are going to be billed at the hospital rate versus an outpatient rate…

Veanne Smith:        Right. 

Tanya Mack:             Which is typically two to three times higher.

Veanne Smith:     They’re in the thousands probably.

Tanya Mack:             So if I might charge for a scan, you know, $500 for an ultrasound scan it might be $1500 in hospital.

Veanne Smith:      In a hospital. Wow.

Tanya Mack:             And so it adds up and they haven’t even been seen yet. So one of our old clients that used to refer us we had an office actually call us up right next to our biggest delivering hospital here in the city.

Veanne Smith:      I wonder where that is.

Tanya Mack:             I said to – and said to us, look, we want to put telemedicine right in our office. They can come here for their OB visit. They walked two exam rooms down to see you. We can connect by telemedicine. They have the convenience of one day off work, no travel, easy access, and they pay their co-pay and so I think a lot…

Veanne Smith:      A huge benefit is money. It’s not just convenient.

Tanya Mack:             Money. And so it’s cost effective. It is cost savings. It is access and its convenience are the top three benefits that we’re seeing with telemedicine.

Veanne Smith:     Very good. I’m glad I asked that. I had no idea the ACA had an impact on your business. So did you anticipate that happening or?

Tanya Mack:             No. It was a surprise.

Veanne Smith:     Or totally a surprise?

Tanya Mack:             Call. However, I will tell you that was about two-and-a-half years ago…

Veanne Smith:     Right.

Tanya Mack:             Since that time 50 percent of our business is now urban. And if you look at a city like Atlanta or Los Angeles. I lived in Los Angeles for 10 years. We could literally live seven miles away and it takes us an hour.

Veanne Smith:     I was just going to say that.

Tanya Mack:             Which we’re used to unless you’re bleeding with a baby.

Veanne Smith:     Totally different.

Tanya Mack:             And then you’re thinking.

Veanne Smith:     I can’t make an hour.

Tanya Mack:             I may not make an hour. I mean that kid may be having a problem. So in obstetrics especially and we’ll talk a little bit about some of the life-saving stories we’ve actually had but minute count a lot when you’re pregnant.

Veanne Smith:     Yeah. Yeah. Absolutely. Very intriguing. I’m so glad I asked about that because I hadn’t thought about that, the ACA impact. Well you’ve alluded to technology a little bit.

Tanya Mack:             Yes.

What Is the Technology Behind Women’s Telehealth?

Veanne Smith:     Can you tell us more about the technology behind your solution?

Tanya Mack:             I can. It’s super cool. Let me tell you that.

Veanne Smith:     It’s my world, so I want to hear about it.

Tanya Mack:             Yeah. So to be able to able to do telemedicine, if we go back to the three-legged stool for our business our specially is really delivering the care. Like I’m not your IT company and I’m not a hardware vendor, and I will never compete with Rubbermaid or Cisco or Polycom. So, how we do it is a series of configurations and connectivity to get from the patient to our clinician, if you would.

So it starts with having hardware. We need to have the same thing. So if I need ultrasound where the patient is, I’ll actually connect an ultrasound…

Veanne Smith:     Right.

Tanya Mack:             And plug it directly into a telemedicine enabled cart or widget.

Veanne Smith:      And so you’ve said that term a few times, an enabled cart. Is it literally a cart?

Tanya Mack:             It literally can be a cart. It’s changing and one of the trends in technology like in your business everything is getting faster, smaller…

Veanne Smith:     Smaller.

Tanya Mack:             Cloud based, that kind of thing. When we first started literally if I can paint for your listeners a visual picture, it would look like a big screen, like maybe a 27-inch screen. On the top of it would be a panoramic camera and just to give you an idea of what that could be I could pan out to include an entire family in the exam room or from remote control I could zoom in on an inch of your skin and count the pores on your skin.

Veanne Smith:      That’s amazing.

Tanya Mack:             From one camera that I can work remote control.

Veanne Smith:     That’s awesome.

Tanya Mack:             So I have a camera, I can split my screen up to four ways. So I can think of a time when we bridge with Children’s healthcare here in Atlanta. We had a lady that had a fetal heart problem down in Thomasville, Georgia, and we were able to connect our doctor, Children’s Hospital Pediatric Cardiologists, a live beating heart of the baby and the mom all in for panes on our screen and each one could see the other and we had a three-way consult, the patient and two specialties from her hometown.

Veanne Smith:     That’s amazing.

Tanya Mack:             So that’s what the screen looks like and then it actually sits on a cart with a computer that we use for electronic medical record integration, digital image storage systems and things like that. And then we have a little box called a Kodak box that is where we plug in all the peripherals. So if I have an EKG machine. We also use Bluetooth technology. So I can put a Bluetooth stethoscope on you in India and here at real-time in my ears here sitting in the Queen Building in Atlanta, or we’ve done an OB clinic from the riverbed of Guatemala through satellites up through my office here at Perimeter.

Veanne Smith:     That’s great.

Tanya Mack:             So the technology is really super cool, but changing fast to be more cloud based, more app based and more device friendly.

What Are The Challenges That Women’s Telehealth Faces?

Veanne Smith:     All right. That’s all so great, right? I’m sure there are challenges. So, what challenges are you seeing around all that technology?

Tanya Mack:             Well actually the technology in telemedicine isn’t our biggest challenge. The biggest challenge is when the platforms change, then getting the platforms all to work so.

Veanne Smith:      Interoperability?

Tanya Mack:             Correct, interoperability. So a good two examples, we are facing within the next month is we are expanding our business to Florida. We are putting telemedicine into a huge OB office in Florida that has seven locations. So typically we use telemedicine either broadband, cellular or satellite and here in the United States we use probably 95 percent is broadband through point-to-point connections where we can really have a big pipeline to move a lot of images in a hurry because we have to make decisions about babies in a hurry.

Veanne Smith:     Quickly.

Tanya Mack:             Yeah. But now we’re going to be working with fiber, and so a lot of people are now working with fiber and so we’re experimenting with how much can I move. Like, I used to have dedicated T-1’s now for the first time we are doing speed checks and we’ll be experimenting with fiber and that will be a whole different configuration. It will be also our first time that we lose the telemedicine cart. So there has been a new, I will call it a widget, because I’m not technology person but a little widget.

Veanne Smith:     You sound pretty technology to me.

Tanya Mack:             Where we can – there you go – we can actually put in from the ultrasound machine to the widget and into a laptop and up to the cloud and totally bypassed the cart and we can use our Bluetooth technology now on a laptop instead of the cart. And what that means for access is where my cart originally for a customer may cost me $30,000, my widget, laptop and ultrasound configurations is more like six.

Veanne Smith:     And you probably already have it.

Tanya Mack:             Right, so it’s like or pieces of it.

Veanne Smith:     Right.

Tanya Mack:             Or components of it is so really the drop in cost and technology is great, but you got to test the configuration so that the technology challenge. In telemedicine, the two big other challenges are reimbursement, because not all states pay for telemedicine. It is very much evolving as we go and typically unfortunately the states that lag are the states that need it the most. So you think of North Dakota, there is no provider in North Dakota for the services that we provide. Literally at one time they had a pilot fly somebody in about once a month, but they lag behind on the reimbursement to pay and the providers can’t afford to provide it for free because they are already not many of them and a big demand for them anyway. So the more states that we get to have reimbursement for the Medicaids because a lot of high risk population is Medicaid, the faster that we grew telemedicine.

Legislation, also there is a thing called Parity Law, and so in telemedicine, we’ve gone from consumers really being I don’t know about that. I’ve always wanted to see my doctor. I want to touch my doctor, to gee I’m in the swamp and had that stroke and doctor or not I don’t want to die so I’m happy to see them by telemedicine. Some third-party payers don’t have to pay as if we’re there so liability wise if you’re pregnant and you have a baby whether you see me in person or by telemedicine, if I give you advice I’m still liable for that. So parity law in telemedicine state-by-state tells us whether or not the carriers, the health insurance carriers, will pay as if we’re there whether we saw you by telemedicine or not. So that sometimes is a barrier legislatively.

And then the third big barrier we have is really licensure because the providers in telemedicine have to be licensed in states where the patients that so the cool thing about technology is I could see easily patients in North Dakota this afternoon or India. We just signed our first deal with Russia. We’re now going to be in June, international.

Veanne Smith:      That’s amazing.

Tanya Mack:             That’s amazing, but if we don’t have the licensure laws, and we have to now have a doctor now licensed in 30 states it’s expensive and licensure can take 90 days or two years and so trying to get.

Veanne Smith:      Is there a test or how do you get, other than the money how do you get licensed?

Tanya Mack:             You apply to each state, and they all as you can imagine for financial reasons and other reasons, have little things that are specific to their state.

Veanne Smith:      Everyone is different.

Tanya Mack:          Yeah.

Veanne Smith:     Like college applications.

Tanya Mack:             Exactly.

Veanne Smith:     There’s a standard form but not everybody follows the same one.

Tanya Mack:             That’s exactly right.

Veanne Smith:     So I am wondering, given everything you’ve said as the president of your organization, are you involved with trying to change legislation – do you spend a lot of your time working on law change and things like that?

Tanya Mack:             I don’t because we belong to an organization called the American Telemedicine Association and they are one of the biggest lobbyist groups.

Veanne Smith:     Okay.

Tanya Mack:             Just to kind of give you a flavor when we have that national meeting here and you can imagine because you do a lot on healthcare IT, there’s about 8,000 attendees that come to that conference once a year. Fifty percent are international, because everybody in the world wants American healthcare technology.

Veanne Smith:     Right.

Tanya Mack:             And so they all come and so but they lobby for changes. Now, they were very successful in the last year in getting Medicare to change a lot of the criteria under which they would pay for telemedicine and typically the carriers follow what the government will pay for.

Veanne Smith:     Right.

Tanya Mack:             And so we – since they got that change through within the last year we’re getting a lot more traction in legislation, a lot faster than Tonya Mack sitting in Atlanta, Georgia would, but thanks for your confidence on that.

Veanne Smith:      That’s good. I could see you, you’re so outgoing and energized I could see you right up there lobbying for change.

Tanya Mack:             Yeah we have. Interestingly enough, if you go to our website we, last year, pulled a T-1 line to the Capital Building in Georgia. On Telemedicine Day we actually have Medicaid patient live down in Albany, Georgia that we piped in both to the Senate and the House during a live session and it was kind of like watching a video. You know when you want to screen people think it’s like TV and in the video a Speaker of the House said, are you having a boy or girl? And the patient said, I am having a boy and hey, guy, in a red shirt in the front row, do you guys know that I can see you? And then every Senator and House Speaker became crystal clear on this is two-way. This is not me watching a video. It’s great.

Veanne Smith:     How fun is that?

Tanya Mack:             So, seeing the legislators actually get a live experience of telemedicine with their own Medicaid dollars on some things we’ve been able has been very valuable. So I shouldn’t say I don’t do anything, but I certainly don’t lobby for it.

Stories Of Saving Lives With Telemedicine

Veanne Smith:     Very fun. All right. Well we’re kind of in a story mode so we all love stories, so I’m sure you’ve seen firsthand how your services and how the technology are putting mother at ease or actually saving lives. Do you have any favorite ones or two stories that you’d like to share?

Tanya Mack:             I do have a favorite too. Of course for us, because we’re in high risk obstetrics, and one of the things we find is there’s a lot of women, especially in rural areas, that when you tell them there’s a problem with you or the baby and you need to go to Atlanta or you need to go to Savanna or somewhere where we have one of the specialists. They don’t have gas money to go across the County so they won’t go. And so we don’t find problems and we have bad outcomes, and that’s how come we have in Georgia, unfortunately, we’re 50 out of 50 or maternal death so.

Veanne Smith:     Say that again.

Tanya Mack:          We’re 50 out of 50 for maternal death.

Veanne Smith:     Wow.

Tanya Mack:             So you don’t think in Georgia, us living in Atlanta, we don’t even think about that because we have great access to care.

Veanne Smith:      Right.

Tanya Mack:             But outside of Atlanta, if you want to die while you are pregnant move to the Georgia. We’re not much better for infant mortality. We’re about 42nd out of 50. And so I always tend to think of the people that would not have had the ability to get care if they were not identified early in a telemedicine kind of setting.

So two stories I always think of kind of extreme, but perfect examples of what’s possible. One I alluded to earlier. We had a lady who was in Thomasville, Georgia. We had a telemedicine cart in her OB office there. She was identified pretty early as having a baby, it had a heart defect. And sometimes you think, well, we’re going to have to manage that kid differently. We’re going to have to measure growth differently. We might have to deliver early. We’re going to have to have routine once a month seeing how that heart and baby are doing and it was a viable pregnancy.

So she was screened early. We put her in telemedicine and this is a patient that would’ve had about a five, four or five hour drive to the closest specialist, once or twice a month and would also have had to have seen a pediatric cardiologist, because at the time of the birth definitely was going to have surgery. Through telemedicine this was our case that we did that stimulated us to build a three-way bridge with Children’s Hospitals so we could actually port in their pediatric cardiologist and not have to have a second visit.

So this lady was actually managed, she was identified about month four. She saved all those visits, all that money, was able to see two specialties in one at remote visits and she only had to come up for Children’s Hospital to delivery once in her pregnancy.

Veanne Smith:      The only time.

Tanya Mack:             Only time. She came up to deliver. She delivered up here and then her baby was immediately put in [CHOA][25:04] and had the surgery, but if she never was identified we couldn’t be assured of the outcome because she was very closely monitored.

Veanne Smith:      Right.

Tanya Mack:             And we got everything ready and coordinated. If we didn’t know about that defect and she would’ve had that baby at Archibald Hospital with not a NICU, not sure of the outcome and she is one that definitely would have never been found if not for telemedicine enabled, which is kind of a baby is here. A good example of technology at use.

Another kind of dramatic story that is one of my favorites is we had another lady. I always think of South Georgia, because south of Macon is kind of our health care no man’s land, you know that Southwest corner we just don’t have a lot of resources in Georgia, and most other states are the same that we see. So we had a lady down there who was pregnant with twins, and about 20 weeks into her pregnancy we discovered by ultrasound, we were monitoring her that she had a twin to twin transfusion. And basically what that is, is there’s a hole in the blood supply from one twin to the other.

So what happens is the bigger twin starts taking the blood supply, and it’s more than its heart can hold and so it dies because the blood volume basically ruptures the heart. And the other twin basically shriveled up and just dies because it’s not getting any blood supply. There is a little window that you can use to treat it and there’s very few fetal surgeons in the country that can close that window through a little laser surgery but it all starts with finding it A.

Veanne Smith:      Right.

Tanya Mack:             And B, you have to identify that little hole that’s moving the blood on ultrasound. So if you just imagine the hole we’re looking for is about the size of the end of your pen.

Veanne Smith:      Right.

Tanya Mack:             It’s about like, I don’t know, a 16th of an inch. So on the remote end we are live scanning with the sonographer that has never seen this in her life. So my doctor up here in Atlanta is actually real time with the patient in South Georgia and the ultrasound tech literally saying, move your hand an inch over here, move it up an inch over here. We’re trying to find this little hole.

Veanne Smith:      And they find it.

Tanya Mack:             They find it. They take a picture. That same day, we electronically passed the picture and call the closest fetal surgeon, which is in Tampa, Florida. And he’s one of the few, we’ve seen him before so we send them down. He goes, oh my gosh, she’s past the window. And so we say, look, we’ve got fabulous images. You’ll know exactly where you’re going. You won’t have to dig around. And he said, okay, let me look.

Well we got her on a plane that night. He stayed and had surgery with her that night. She was in the hospital for four days to make sure that the blood supply was working and about four months later she had two healthy babies.

Veanne Smith:      Wow. That’s great.

Tanya Mack:             And her picture of those babies is on my wall in my office. She is a great story at what’s possible.

Veanne Smith:      I always said I wish I was in a business where I was saving lives.

Tanya Mack:             Yes. Yes. It’s a privilege.

Veanne Smith:      Power boarding.

Tanya Mack:             It’s a privilege.

What Is The Future Of Telemedicine

Veanne Smith:      That’s great. That’s great. Well I’ve known you for so long and I know how passionate you are about healthcare in general and how innovative you’ve also been in this space. I’d love to hear your opinion of where you think we’re headed in telemedicine. Can you predict anything? Any crystal ball?

Tanya Mack:             I wish I could.

Veanne Smith:      Women’s health, any thoughts, comments?

Tanya Mack:             Well, I think you know, for telemedicine I hope that in five or 10 years down the road we’re really not talking about telemedicine. It’s kind of just fallen off as one tool.

Veanne Smith:      It’s just medicine.

Tanya Mack:             We’re all used to and it’s care or medicine. I think right now, when we have United Healthcare and some other people showing what’s possible on TV so consumers…

Veanne Smith:      Awareness.

Tanya Mack:             Are more aware of what’s possible and they’re more comfortable. The nice thing in my specialty, because I don’t deal with a wide range of patients, I deal with women who are pregnant, and they’re mostly young. They were weaned with more chips in their crib than we sent a man to the moon on in my generation so they are very comfortable with telemedicine.

Veanne Smith:      Right. Yeah.

Tanya Mack:             And so they have been early adopters and very very comfortable, but I think we will in five years every doctor’s office will have some station where they man, you know, low acuity, non-acute things to save us time and money. And in Africa, for example, cellular telemedicine is the mode of operation over there because nobody in the village has a T-1 line, but somebody will have a cell phone.

Veanne Smith:      Cell phone.

Tanya Mack:             So they take pictures of the snakebite and they take pictures of the snake and they send it back and we’re able to really do a lot that you know those people would’ve died in the Bush, a little bit earlier before cell phone use. So I think we’ll see a lot more cellular. We right now are going in as a sub in seven countries – we’re bidding on this business now, but it’s quite interesting. There has been 78 medical pods that are being built in California that will be telemedicine enabled that will basically be Bush trucks that will be deployed in the worst countries in Africa and US doctors would be the specialists.

So they’ll have a truck with a primary care provider that will be cellular telemedicine enabled with tools, and if they’re really sick they can get the American specialists in there too by telemedicine, so it will be a lot more available. We, as consumers, will be a lot more comfortable with it. I think the payers are getting on board. I think though about another five year of legislation we probably won’t have a state that doesn’t pay for it.

Veanne Smith:      The payers should be on board. It’s less expensive for them as well.

Tanya Mack:             It is less expensive, yeah. So I think a lot of it on the payers side is when you provide the care you actually have to draw a line on what is appropriate for telemedicine and what is not. And I think the clinical care guidelines are still being evolving in some of the specialties so they don’t want liability. I mean they don’t want – the payers don’t want to be that news story, of hey, we tried it and it was terrible and we should have seen them in person, but I think that the more that we get clear on what is appropriate by specialty and what is not people will be more comfortable. The payer will be more comfortable, the government will be more comfortable. We, as patients, will be more comfortable and again providers have to learn to use these tools.

Veanne Smith:      Right.

Tanya Mack:             We’re talking with Emory. They have a residency program here. We have residency programs here. We are not teaching telemedicine in those residency programs. So we’re talking like, for example, to the Regent’s College down in Augusta, time to start bringing people out and getting them used to and comfortable communicating with patients and prescribing and diagnosing with new tools. So those are some of the things that I think will hopefully change to make it all better for us.

Veanne Smith:      I think that’s quite insightful. Give yourself some credit on that. I think that’s great. Thanks for sharing that. At the end of our show I always like to ask people how they can reach out to you, particularly, I’m intrigued as I’ve been listening to you, how do these folks in remote locations even know you exist? How do they know about you?

Tanya Mack:             Yeah. They mostly know about us because we market to the OBs.

Veanne Smith:      So their primary provider, right?

Tanya Mack:             Yes.

Veanne Smith:      So your job is to make them aware that you.

Tanya Mack:             Yeah. So most pregnant women in my specialty don’t call up and say, gee, I think I’m high-risk and I want to pay a lot more money to see you today. So they’re all going to be referred in.

Veanne Smith:      Just like in the classic brick-and-mortar.

Tanya Mack:             Yeah.

Veanne Smith:      So it’s the same thing.

Tanya Mack:             It’s the same thing.

Veanne Smith:      So your job is to make all those physicians, all those primary folks aware of what you’re doing.

Tanya Mack:             Yes. And we’re having a big push right now trying to get into some of the critical care access hospitals in Georgia and we’re licensed in seven southeast states. So Georgia, both Carolinas, Tennessee, Alabama and Florida and we can provide care in that footprint and there’s still is a lot of critical care access. When you say, you know we can buy CAT scan machine for a million dollars or I can put an $8,000 investment, put telemedicine in here, it gets a lot more affordable, but we still have many, many hospitals in Georgia that don’t have OB units. We are closing labor and delivery unit in Georgia, still.

So, one of our focuses is to make it more cost effective and affordable for patients in urban settings through their doctor’s offices. The State of Georgia Department of Community Health is one of our large clients. They have district health departments. We’re trying to expand into all the District Health Department and then we’re really focusing on the smaller hospitals, like maybe 700 births per year or less, still having technology that if somebody walked in the ER they could be seen by somebody. So that’s kind of how they learned about us and how we’re focusing on that but it’s mostly through healthcare referrals.

Veanne Smith:      Right.

Tanya Mack:             For our business.

How To Contact Women’s Telehealth

Veanne Smith:      Right. For anybody who’s listening, your website, how can they reach you?

Tanya Mack:             Yeah, it’s a website. Please visit. It’s Anybody that’s visiting we’d love to have you come. I would say if you really want to get a flavor for it we actually have a video section. And if you click on the Video tab you can actually see a start to finish visit. You can also see the Capitol Building and what happened at the Capital Building and some other very interesting things over there so visit that. And if you’d like to call our office, you can certainly reach us directly. It’s 404-478-3017. Thanks for asking.


Veanne Smith:      You’re welcome. It’s been such a true pleasure having you. I’ve known you for so many years. You’re always full of energy and ideas. I’ve always admired you. So thanks so much for taking the time to come in and visit.

Tanya Mack:             I appreciate you letting me come in. Thanks so much. A lot of fun.

Veanne Smith:      All right. Thanks.

Angela Greenwell:          You have been listening to an Atlanta Business Impact Radio with Veanne Smith, and I’m your co-host Angela Greenwell. This program is brought to you by SOLTECH. For more information about the podcasts, including other episodes, you can visit our website at or find us on iTunes.

Thank you for listening and we look forward to having you join us again.

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