Tag Archive for: PEN-Powered

Green Monster Frittata Bites

Green Monster Frittata Bites from Patient Empowerment Network on Vimeo.

Best-selling cookbook author and chef Ryan Scott is a juvenile colorectal cancer survivor whose father and grandfather also battled cancer. Ryan won an Emmy Award for his TV show Food Rush and was on Top Chef in 2007. Watch as he shares some of his cancer story as he demonstrates a healthy frittata recipe along with helpful cooking tips.


  • 1 cup shredded russet potato (frozen or fresh)
  • 2 tablespoons butter
  • ½ cup diced onion
  • 1 clove garlic, minced (about 1 teaspoon)
  • 3 large handfuls finely chopped swiss chard
  • 7 large eggs
  • ¾ cup plain Greek yogurt
  • 1 tablespoon flaxseed
  • ¼ teaspoon salt
  • 3 or 4 large fresh basil leaves
  • ½ teaspoon chopped fresh rosemary leaves
  • ½ cup loosely packed fresh parsley leaves
  • 1 tablespoon chopped fresh chives
  • 2 tablespoons vegetable oil
  • 1 cup shredded swiss cheese

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Hail to Kale: Spicy Sausage, Kale, and Goat Cheese Pizza

Hail to Kale: Spicy Sausage, Kale, and Goat Cheese Pizza from Patient Empowerment Network on Vimeo.

Recipe: Spicy Sausage, Kale, and Goat Cheese Pizza

  • 1 lb. pizza dough
  • 4 tsp. extra virgin olive oil, plus more for drizzling
  • 2 large leaves Tuscan kale, ribs removed, leaves torn into 1-inch pieces
  • 1 clove garlic, minced
  • 2 tbsp. chicken broth
  • Kosher salt
  • 2 links spicy sausage, casings removed
  • 1 ripe tomato, seeded and coarsely chopped
  • 5 fresh basil leaves
  • 2 tbsp. crumbled goat cheese

History of Kale

Enjoying a resurgence in popularity in recent years, kale has some controversy between scientists about its exact origins. Kale is said to have originated in Asia Minor and Europe where it has been eaten for almost 4,000 years. But others claim that kale was grown in Europe, especially in Greek and Roman lands, over 2,000 years ago. Some claim that up until the Middle Ages, kale was the most popular vegetable that was eaten. No matter its origins, kale arrived in the United States in the 1600s.

Medical Properties of Kale

Kale boasts a standing as one of the most nutrient-dense vegetables around. Exceptionally high in vitamin K, vitamin A, and vitamin C, kale also supplies nutrients like manganese, potassium, copper, calcium, vitamin B6, and magnesium. Kale is a source of antioxidants that help fight cancer. And zeaxanthin and lutein along with vitamin A in kale help fight degeneration of eyesight and against the formation of cataracts. Kale contains the flavonoids kaempferol and quercetin that studies have shown to be helpful in lowering blood pressure, fighting inflammation, protecting the heart, combatting depression, and in fighting viruses and cancer. Studies have also shown that cholesterol can be lowered by substances in kale that bind to bile acids and then prevent their reabsorption by the body. With its high water content and low amount of calories, kale can be a helpful addition to aid in losing weight.

Surprising Facts About Kale

As a winter vegetable, kale grows well while withstanding cold temperatures and even frost. Encountering frost during its growing process is actually known to improve the flavor of kale. Farmers try to harvest kale after the first frost that converts some of the starches into sugars for better flavor. Previously known as pheasant’s cabbage, kale was used by Greeks in ancient times to sober up and to fight hangovers. As a member of the cruciferous vegetable family, kale is related to collard greens, Brussels sprouts, and cabbage.

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Power-Packed Pumpkin Hummus

Power-Packed Pumpkin Hummus from Patient Empowerment Network on Vimeo.

Recipe: Delicious Pumpkin Hummus

  • 1 c. pumpkin purée
  • 1 (15-oz.) can chickpeas, drained and rinsed
  • 1/2 c. tahini
  • 1/4 c. apple cider vinegar
  • 2 tbsp. extra-virgin olive oil
  • 1 chipotle pepper in adobo sauce
  • 1/2 tsp. ground cinnamon, plus more for garnish
  • 1/2 tsp. paprika, plus more for garnish
  • Kosher salt
  • 1 tsp. toasted sesame seeds, for garnish
  • Pita chips, for serving

History of Pumpkin

Known in the U.S. for their uses as jack-o-lanterns and in pumpkin pies for holidays, domesticated pumpkin seeds were first found by archaeologists in the Oaxaca Highlands in Mexico. Though the original variety was different with a bitter flavor and smaller size, historians believe that pumpkins originated over 7,500 years ago in Central America. In North America, pumpkins were among some of the first crops grown for people to eat. The thick flesh of pumpkins was prized for its ease of storage during cold weather when other food sources were scarce. One of the earliest American recipes for pumpkin was for a side dish recipe in the early 1670s, and it later came into use in sweetened holiday dishes in the 1800s.

Medical Properties of Pumpkin

Pumpkin supplies vitamin A, vitamin C, potassium, and fiber that help support healthy blood pressure and healthy cholesterol levels. The liver can also be protected by eating pumpkin, and the fiber in pumpkin aids in health digestion and in maintaining a healthy weight. Vitamin A, vitamin C, and zinc consumed from pumpkin helps to boost the immune system against colds and other viruses. Antioxidants in pumpkin also fight against free radicals to help in aging healthily, and protein and zinc in pumpkin seeds help with recovery when consumed after a workout.

Surprising Facts About Pumpkin

Pumpkin helps protect the liver by removing harmful substances from the bloodstream. Along with their many health benefits, pumpkins can grow to become massive in size. A pumpkin that weighed in at 2,624.6 pounds was recorded in Belgium in 2016. Indigenous people of North America have grown pumpkins as a crop for thousands of years, even before corn and beans were grown as crops. Members of the gourd family, including pumpkins, watermelons, cucumbers, zucchinis, cantaloupes, and others, grow on all the continents of the world except for Antarctica.

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Zesty Lemon Parmesan Brussels Sprouts

Zesty Lemon Parmesan Brussels Sprouts from Patient Empowerment Network on Vimeo.

Recipe: Lemon Parmesan Brussels Sprouts


  • 1 TBS olive oil
  • Salt and pepper
  • Juice of 2 lemons
  • 1/4 cup shaved Parmesan cheese
  • 2 to 3 cloves of garlic (minced or pressed)
  • 1TBS fresh thyme leaves
  • 1TBS fresh chopped parsley leaves
  • Pinch of red pepper flakes


  1. Preheat oven to 400°F
  2. Toss Brussels sprouts in olive oil & sprinkle salt and pepper
  3. Transfer to a parchment lined baking sheet
  4. Place cut side facing down Bake for 30 minutes
  5. Toss half way through
  6. Serve warm spritzed with more lemon juice and top with parmesan cheese

History of Brussels Sprouts

Brussels sprouts, also known as Brussel sprouts, are named after the city in Belgium. Historians believe that they were first grown there in the 16th century and then were introduced to North America by French settlers in Louisiana in the 18th century. Though the flavor of Brussels sprouts is disliked by some – most likely due to a bitter flavor from overcooking – they have a nutty sweet flavor when roasted. With their resemblance to cabbages, Brussels sprouts are also referred to as mini cabbages and remain a favorite among top chefs like Jacques Pepin and many others.

Medical Properties of Brussels Sprouts

Brussels sprouts are rich in several important nutrients for the body including folate, vitamin C, vitamin K, and the carotenoids of beta-carotene, lutein, and zeaxanthin. They are also very good sources of manganese, vitamin B6, dietary fiber, choline, copper, vitamin B1, potassium, phosphorus, and omega-3 fatty acids. Brussels sprouts belong to the cruciferous vegetable family that includes broccoli, cauliflower, collard greens, kale, and cabbage. The processes of cooking and digestion break down to a phytochemical called isothiocyanate that researchers have discovered to have anti-cancer effects in fighting against DNA damage and against growth within tumor cells. Medical experts tout Brussels sprouts for their role in helping with bone and skin health, lowering cholesterol, balancing hormone levels, improving digestion, reducing oxidative stress, decreasing the risk of obesity and diabetes, protecting the heart, reducing inflammation, aiding the immune system, and increasing circulation. Though Brussels sprouts may help fight cancer, experts recommend limiting dietary intake to once a week and to rotate other vegetables into your diet as well.

Surprising Facts About Brussels Sprouts

Brussels sprouts are packed with vitamin C, and one serving of them delivers four times more than an orange. Researchers have found that Brussels sprouts contain Indole-3-carbinol that is a libido booster in men but can have the opposite effect in women. Shoppers can sometimes find Brussels sprouts at grocery stores and farmers markets attached to the stalks that they grow on. Keeping the sprouts on their stalks helps to retain moisture and to nourish the sprouts after harvesting.


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Uncovering the Hidden Health Benefits of Garlic

Uncovering the Hidden Health Benefits of Garlic from Patient Empowerment Network on Vimeo.

Recipe: Hidden Garlic Broccoli and Beef

• 1 1/4 lbs flank steak sliced thin
• 1 TBS vegetable oil
• 2 cups broccoli florets
• 2 TBS minced fresh ginger
• 1/4 cup oyster sauce
• 1/4 cup beef broth or water
• 1 TBS brown sugar
• 2 tsp toasted sesame oil
• 1 tsp soy sauce
• 1 tsp cornstarch
• Salt and pepper to taste

History of Garlic

Though the exact origin of garlic is unknown, historians generally agree that it came from Middle Asia. It most likely means that garlic came from West China around the region of the Tien Shen Mountains to Kazakhstan and Kyrgyzstan. Ancient Sumerians from the time of 2600 to 2100 BC used garlic for its healing properties, and some believe that they brought the bulb to China. There’s also evidence that garlic was used as a health remedy for its heating and stimulating properties in China as far back as 2700 BC. In the Chinese principles of yin and yang (or that in good there is bad and in bad there is good), garlic falls into the yang category. Also known as the stinking rose, garlic was used in numerous other ancient civilizations including Indian, Egyptian, Tibetan, Greek, Roman, and others.

Medical Properties of Garlic

Has anyone ever told you to eat some garlic when you’re fighting off a cold? Well, it turns out they’re not wrong in giving you that advice after all. Garlic contains the important substances of sulphur and quercetin that help the body in numerous and unexpected ways. It’s been shown to work as an antibiotic, antioxidant, antibacterial, antifungal, and antihistamine medical agent. And what do all those things mean exactly? They translate to fighting a variety of ailments like the common cold, fungal infections, allergies, and cancer among other things.

Surprising Facts About Garlic

Did you think that was all? No, garlic is touted as a cure-all by many, and the benefits of garlic don’t stop there. Along with these benefits, garlic has also been shown to improve cardiovascular health by turning sulphur into hydrogen sulfide that expands blood vessels and improves the regulation of blood pressure. And if you have skin and hair troubles, garlic can even improve the appearance of your skin and hair. Simply slice a clove of raw garlic and rub it over the affected area of your skin, and the antibacterial properties of garlic help to clear up pimples. Garlic can also help kill bacteria on food like E.coli and salmonella that cause food poisoning, and it is even effective against infections that are resistant to antibiotics like MRSA.



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Welcome to Digitally Empowered™!

A New Patient Empowerment Course from PEN

Empowered patients who are well-informed and take an active role in their care tend to have better health outcomes. With telehealth, patient portals, and research and treatment information all online, access to the internet has become critical to receiving quality care. However, the ability to access technology is one of the biggest hurdles to learning about health and making healthcare decisions. This hurdle creates a digital divide in healthcare where patients with access to the internet are more likely to have better treatment outcomes than patients who don’t have the skills or ability to use technology to their benefit. That’s a problem, but Patient Empowerment Network (PEN) has created a solution.

Digitally Empowered is a free and easy-to-complete, video-based course, created by PEN and made possible with the support and collaboration of Pfizer Oncology, that provides an opportunity for everyone to have equal access to healthcare resources on the internet. The course helps patients, and those who care for them, develop the skills necessary to access and use online health and support tools.

There is a clear need for programs like Digitally Empowered. Only 12 percent of adults in the United States are able to obtain and understand the basic health information and services needed to make informed decisions about their care. Older patients are particularly vulnerable when it comes to health literacy because many patients age 65 and older don’t have digital technology skills. Digitally Empowered is specifically tailored to help older cancer patients, and those caring for them, to be more tech-savvy, but the course has beneficial information to anyone who needs help managing their healthcare online, or who would like to better use online resources to improve treatment outcomes.

Research shows that patients make the best decisions about their care when they are armed with credible information. Patients who are able to access reliable and up-to-date information about cancer treatments can work with their care teams to receive the most personalized care and the best possible outcomes. The Digitally Empowered course teaches patients how to get the latest credible information, research their conditions, ask pertinent questions, and take an active role in their care and treatment. The course teaches patients how to use the internet, social media, and mobile applications to help them search for information and to connect with other patients. No matter where they are in their cancer journey, the course will help cancer patients and care partners gain access to better cancer care.

To enroll in the Digitally Empowered course, patients will need an email address. After a few simple steps to create login information there are clear instructions to guide patients through the program. Available in English and Spanish, the course is easy-to-follow, and is divided into ten parts, called modules. In each module, patients watch a short video, review a resource guide, and take a simple quiz to reinforce what was learned. While it’s not necessary to complete the course all in one sitting, the modules are meant to be completed in chronological order and take about ten minutes or less to complete. The entire course takes less than 90 minutes and automatically saves your progress along the way. If you need to leave the course at any time, you will pick up where you left off when you log back in.

In the first module, an animated version of PEN Director of Digital Communications and Engagement, Kara Rayburn, provides an introduction to the course and an overview of PEN’s mission to empower cancer patients and their care partners. She also introduces Carmen and Quincy, the program’s digital tutors. Carmen guides the course through each module and Quincy explains all the technical processes taught. The subsequent lessons take you through the rest of the course objectives which include learning how to access the internet, identifying credible resources and websites, learning the benefits of patient portals, using social media to connect and learn, navigating healthcare with mobile devices, using applications (apps) for convenience and fun, learning how to use telemedicine, and accessing and joining online support communities.

After completing all three steps of each module, participants earn a badge, and after completing all ten modules, they get a certificate of completion. Patients also receive emails of encouragement after the completion of each module. In the end patients will have gained the skills they need to use the internet to empower their cancer journey, but they will also be able to get continued support. Course participants are encouraged to join the Digitally Empowered Facebook group and to sign up for the Digitally Empowered newsletter. In addition, course participants can return to the modules to watch the videos and access, or download, the review guides at any time. There is also a Frequently Asked Questions page should anyone get stuck or need help along the way.

The course equips patients with the ability to research their diagnosis, navigate telehealth, and forge beneficial connections to others in the cancer community, all of which could lead to life-changing outcomes. Digitally Empowered was created to help all patients become knowledgeable about their diseases, because where there is knowledge there are choices, and where there are choices there is hope.

Hope for better health outcomes and the Digitally Empowered course are both available at iamdigitallyempowered.org, and additional support provided by Pfizer can be found at thisislivingwithcancer.com.

The Value of PEN: Community and Connection

Community and Connection from Patient Empowerment Network on Vimeo.

 You are not alone. The Patient Empowerment Network (PEN) community understands the anxiety and uncertainty that comes with a cancer diagnosis. PEN helps patients through every step of their cancer journey and offers meaningful and valuable patient-to-patient connections. Video four, in a five-part series about the Value of PEN, focuses on the ways in which PEN helps patients connect with people who have a similar experience. Through social media channels, patient chats, and blog posts, PEN helps patients and caregivers feel empowered, informed, and less alone as they navigate the life-changing experience of a cancer diagnosis.

Nancy Gatschat is a PEN board member and a cancer survivor who emphasizes the need for patient-to-patient connection. She explains how important it is to have support from people who understand what you’re going through. She says, through PEN, patients can talk to each other and share experiences and that anyone anywhere can connect. The programs and resources offered through PEN are free and are available all hours of the day, every day.

When members of the PEN community connect, they find hope, says Board Member Scott Riccio. He describes the patient-to-patient connections as fantastic because through the community at PEN patients learn that they really are not alone and that there are other people who have been through what they are going through.

The chats on Twitter were particularly helpful to PEN Network Manager Carly Flumer, who is also a cancer survivor. She found that she was comfortable in the Twitter chats knowing that she could ask questions of other people with similar experiences who would understand her without judgement. Patients can follow the chats, called Tweet Chats, through the hashtag #patientchat.

 Getting connected and feeling less alone leads to patient empowerment, and the best cancer care happens when you’re empowered. Watch the video and find out how you can get involved and get connected through PEN.

The Value of PEN – Free Resources For Cancer Patients

Free Resources for Cancer Patients from Patient Empowerment Network on Vimeo.

The best cancer care comes when a patient is empowered with knowledge and the resources to know what questions to ask and when to ask them. Video three, in a five-part series about the Value of Patient Empowerment Network (PEN), highlights the free resources PEN offers for patients and their loved ones. Featured in the video are ways in which patients can easily engage with their doctors and other members of their care and support teams. From the comprehensive activity guide designed to make patients feel more relaxed and less overwhelmed during their cancer journey, to the scripted questions patients can use when meeting with their doctors, PEN is here to help.

PEN Board Member Nancy Gatschat is a cancer survivor, and she speaks from experience when she says that PEN is a tool to empowerment. She emphasizes that through the resources provided by PEN, cancer patients become comfortable communicating needs and feelings with doctors, friends, and other members of their support network. She says it’s important for cancer patients to speak up for themselves and that PEN helps patients do just that. Part of the free resources available through PEN 24 hours a day, seven days a week are questions and scripts that patients can use to prepare themselves to speak with their doctors. PEN helps patients identify the critical questions they need to ask and offers suggestions about how to ask them.

PEN encourages all patients to be empowered, but for many people a cancer diagnosis can be overwhelming. Board Member Asalia Goldberg says that there are so many unknowns that patients face when they are about to enter treatment, but if they are equipped with not only answers, but also the critical questions they need to ask, they become their own voice and their own advocate, and they become empowered through their cancer journey.

Through resources like the scripts and activity guide provided by PEN, patients can have more productive doctor appointments. There’s even a checklist for patients to use to make sure they didn’t forget anything. Learn more about the many free resources available through PEN’s website, workshops, webinars, social media channels, and network managers. Watch the video and find out how you can get involved.

Take Care of Yourself and Your Family’s Health

Building Resilience and Boosting Immunity

At a time when health is top of mind for everyone, despite the stressors, how can we ensure to emerge emotionally, physically and mentally resilient? Patient Empowerment Network Care Partner Manager, Sherea Cary sits down with distinguished guests, Sara Goldberger and Dr. Shivdev Rao to discuss building resilience and boosting immunity. Both experts define resilience, provide tips for boosting heart-lung health and provide useful tools for cultivating resilience.

Defining Resilience

Defining Resilience from Patient Empowerment Network on Vimeo.

Tips for Boosting Heart and Lung Health

Tips for Boosting Heart and Lung Health from Patient Empowerment Network on Vimeo.

Community Resources & Tools for Cultivating Resilience

Community Resources and Tools for Cultivating Resilience from Patient Empowerment Network on Vimeo.

Oncology Social Worker Checklist

Resiliency Checklist During the Time of COVID-19

Sara Goldberger, MSSW, LCSW-R, has been an oncology social worker for 30 years. Currently she is the Senior Director, Program for the Cancer Support Community Headquarters. She has also worked in hospitals and community NFP settings. She is a member of several Advisory Boards is a frequent presenter and author. As AOSW strives to continue to advance excellence in psychosocial oncology, Sara hopes to play a part in efforts to educate, advocate, develop resources, expand on research initiatives, and create networking opportunities so that AOSW can improve the care of people impacted by a cancer diagnosis.

Turning Your Home Into a Sanctuary

In Five Simple Steps

These days, whether you’re spending more time there or you need a place to unwind after a long day, you need to feel like your home is your happy place. With the help of a few simple tips you can turn your home into your very own sanctuary.

1. Define your sanctuary

Think about where and when you feel the most comfortable and happy; then bring elements of that into your space. Whether you feel your best reading under a cozy blanket and low lighting, or painting in a sunlit room, consider your needs for the space. It doesn’t have to be complicated, says Professional Organizer Kristy Potgieter at KLP Organizing, LLC. Her philosophy is: simple is better.

2. Appeal to the senses

Sound, smell, and color can all evoke emotions. Play music that soothes you or makes you happy, use candles, oils, or incense to fill your space with your favorite scents, and paint your walls with neutral or calming colors. Even changing out your light bulbs can make a difference. Pink light bulbs give a warm, calm glow to your space.

3. Ditch the clutter

Clutter causes anxiety and stress so your best bet is to get rid of it. While clutter looks different to everyone, a good rule of thumb is to remove anything that doesn’t serve a purpose or make you happy. For the things you use on a regular basis, Potgieter recommends storing them in baskets and bins, which can be both decorative and functional. She also says keeping your kitchen counters clear is a simple way to make your home appear clutter-free.

4. Bring nature inside

You can place a vase of fresh-cut flowers on your table or bring in some house plants. If you don’t have a green thumb, a photo of the ocean, a wall painted green, a water fountain, some seashells, or a piece of wood are all okay ways to incorporate nature into your home. It can be as simple as opening a window and letting in the sunlight, which is a known mood booster.

5. Unplug from technology

You don’t have to ban technology altogether, but pick times, such as during meals and the hour before bed, to not use technology at all. Spend less time on social media platforms by deleting the apps on your phone and only using your computer to log onto those sites. You can also use the “do not disturb” settings on your devices to allow yourself some down time.


Whatever you do, remember Potgieter’s philosophy and keep it simple. Address the things that are most important to you and let the other stuff go. “The first thing I think of when making a home a sanctuary is really taking a look around and making sure all the things you see are things you love,” she says.

Daily Practices for Cultivating Awareness and Anchoring Yourself in Resilience

Resilience is our capacity to bounce back from the inevitable challenges of being alive. When challenges arise, our meandering minds can take us into various worrisome directions, leading to a host of negative emotional states and their subsequent adverse effects on our well-being.

Although we may not have control over the external factors in our lives or needless to say our genetic predispositions, we do have the capacity to cultivate inner psychological faculties that enable us to weather the storms of life with relative calm. For most of us, these internal resources are underdeveloped. They require intentional cultivation through the regular practice of actions that support their development. Among these inner resources are self-awareness, self-acceptance, and a secure inner base to fall back on.

What is Resilience?

What is Resilience? from Patient Empowerment Network on Vimeo.

Anchoring the Mind

Anchoring the Mind from Patient Empowerment Network on Vimeo.

Focusing the attention on the natural breathing process and body cultivates self-awareness and tends to have a calming effect on the mind. By doing so non-judgmentally, we accept the process as it is truly experienced. This is not an advocation of apathy towards our lives. To the contrary, by shining the light of awareness on our experience and accepting it as it truly is, we are given a clarity from which to make any necessary course corrections in our lives.

Awareness of Breath

Awareness of Breath from Patient Empowerment Network on Vimeo.

Awareness of Body

Awareness of Body from Patient Empowerment Network on Vimeo.

A secure base is supported by continually returning our attention to our breath and body when distracted by the meandering nature of the mind. By regularly practicing the activities here offered you can enhance your capacity to bounce back and calmly weather the fluctuating trials of life.

Broderick Rodell has a PhD in chemical engineering from the Georgia Institute of Technology and a Doctorate of Naturopathic Medicine from Bastyr University. His search for self-betterment led to his passion for mindfulness. He considers himself a dedicated student and practitioner of yoga including contemplation, meditation, breath work, and mindful movement. Broderick believes that through individual evolution we can all tap into greater possibilities within ourselves.

A Complete Breakdown of Telemedicine

Interview with Joe Kvedar, MD, President, American Telemedicine Association (ATA) Professor of Dermatology, Harvard Medical School Physician Scientist, Author. As the only organization completely focused on advancing telehealth, the ATA is committed to ensuring that everyone has access to safe, affordable, and appropriate care when and where they need it, enabling the system to do more good for more people.

Honora Miller:

Dr. Kvedar, thank you for joining us.

Dr. Kvedar:

I’m delighted to be with you.

Honora Miller:

Can you tell us what telemedicine is?

Dr. Kvedar:

Well, it’s not a new concept, but since the late 1960s, people have been talking and working towards this idea that care doesn’t necessarily have to be two people in the same room at the same time — that we can use technology to connect people. Like we’re doing now with this video interview, that’s the most common type of telehealth visit, but we can also connect with patients via telephone calls.

There are various remote monitoring devices that are able to monitor an individual’s vital signs or other health measures in their homes.

Finally, in the same way we exchange emails and text messages, we can do that securely with patients, what we call e-visits, which can be very helpful, as well. So there are a variety of forms, but it’s really all about care where the patient is, when the patient needs it, and not having an individual travel to visit a doctor in person.

Honora Miller:

Can you break down the differences between the terms telehealth, virtual visits, e-visits, and virtual health?

Dr. Kvedar:

I’ll go back to the beginning when there were visionary clinicians who believed medicine could be delivered this way and were doing this kind of work. They called it telemedicine. A few years into that journey, there were a number of clinicians who felt that the same technologies could be used in other ways, including education, and so they started using the term telehealth to make it broader and more inclusive. To this day, telehealth the term that everyone is mostly comfortable with.

A few years ago, some people started to say that we needed to be able distinguish between real-time and asynchronous interactions, the same way that we have video or phone calls and emails, and that we also needed to distinguish between direct-to-patient interactions and interactions between clinicians

If it is an interaction between patient and doctor, it’s a virtual visit; if it’s between clinicians, it’s a virtual consult. For example, if a physician is caring for a stroke patient in another hospital, we call that a virtual consult. An e-visit is considered an asynchronous interaction. For instance, I’m a dermatologist, so if my patient takes a picture of a rash or skin disorder, and sends it to me via a secure portal, I could respond with a message back to the patient. That would be an e-visit.

Likewise, if the primary care doctor caring for a patient decided that she wanted a picture of something looked at and sent it to me electronically, then we call that an e-consult.

Telehealth generally encompasses four areas: virtual visits, virtual consults, e-visits and e-consults. Digital Health has become a term of art because that includes everything from robotic process automation, to artificial intelligence, and so on.

Honora Miller:

What is telemedicine remote monitoring?

Dr. Kvedar:

Well, remote monitoring is best suited for certain conditions, mostly chronic illness — conditions like congestive heart failure or high blood pressure or diabetes, particularly type 2 diabetes, when it’s helpful to have more data from the patient about their condition.

For example, if you were starting out on blood pressure medication, we could give you a blood pressure cuff to take home, so that you could take your blood pressure for a week. The cuff, connected by Bluetooth, would automatically share your BP readings with your healthcare provider.

That would be an example of home-monitoring. For people with heart failure, we might give them a wireless blood pressure cuff, weight scale and a device to measure oxygen levels in the blood, so that we can remotely monitor their vital signs.

There are a variety of opportunities to monitor all types of health measures using wearable devices like an Apple Watch, and sensors, that can remotely monitor things like an EKG, sleep patterns, daily activity and other functions.

Honora Miller:

Is the monitoring done in real-time? Or do patients supply the data as it becomes available by entering it into a portal?

Dr. Kvedar:

A lot of remote monitor is done in an asynchronous way. For example, you might step on a scale every morning, take your blood pressure and heart rate, and that personal health data is securely transmitted to your healthcare provider and winds up in your electronic health record. Then a nurse or other provider could look at your data and put in a call to you if something was not quite right, and you’d have a dialogue. Again, it could be a video call or an audio call, but you’d have a dialogue with your provider about what was going on — maybe your diet was off, or maybe you need to increase your medicine dose, but that’s typically how it’s done. It’s not usually done with real-time readings.

Honora Miller:

Can you speak to what telemedicine care looks like in the era of COVID-19?

Dr. Kvedar:

I’ll start with statistics from my own large delivery system in Boston to give you a flavor, and by the way, our numbers are not unique. February of 2020, across two academic hospitals, we did about 1600 virtual encounters. In March, we did 89,000 and in April we did 242,000. We are not unique because I’ve been talking to my colleagues around the country and everyone’s having that kind of accelerated demand for telehealth services, what we would call hockey stick growth, partly because, to help stop the spread of the virus, people need to stay at home, yet we still have to take care of our patients. The technology that you and I are using for this interview is common now, whether it be Zoom or Skype or FaceTime.

People are, for the most part, comfortable with video calls, and likewise, patients have really taken to it. Patients generally have been very, very positive. Doctors are warming to it. Many doctors are saying Gosh, there’s so many things I can do this way that I hadn’t thought about, and I’m going to continue to practice this way. So telehealth services have grown a like wildfire. Before the pandemic, mental health was the biggest user and for sure now mental health providers are still the biggest users of telehealth. In mental health care, providers are talking to the patient, so it’s very easy to make that transition. And then we mentioned chronic illness before, but it turns out that the screening questions used to decide if someone needs a COVID test can easily be asked via telehealth.

if someone is sick at home with only mild symptoms, that individual can be monitored quite well using this kind of virtual care tool set because it’s all about asking questions.

Honora Miller:

So those are the main things that we’re seeing — the use of telehealth for follow-up visits for all kinds of conditions and health concerns, mental health, as well as respiratory symptom questions to determine if individuals need additional testing for coronavirus.

I’m wondering if you can speak to whether or not health insurance coverage has kept up with the pace of change in this arena?

Dr. Kvedar:

So great question and any time you ask about insurance coverage, it is always a long answer with a lot of caveats. I’ll start with Medicare, the Centers for Medicare and Medicaid Services, the biggest payer in the country for the elderly and disabled, and they said very early on they would pay for telehealth at the same level they would pay us for seeing you in the office, so that was a big boom. They’ve since refined that to pay for telephone calls at that rate, as well. That, by the way, is really a nod to addressing disparities because there are people who can’t afford a smartphone or have broadband and we want to make sure that we get to them.

I credit the Medicare folks for seeing that. Medicare is doing very well. Medicaid is state-by-state. Reimbursement will depend upon where you live. But most states, most governors, during this State of Emergency, said that they should pay and most private payers are paying for telehealth as well, so it’s pretty rosy right now, in terms of reimbursement.

One of the things that we’re doing at the ATA is trying to make sure that enough of that reimbursement culture sticks when we move out of this health crisis so that people can continue to enjoy the benefits of this type of care delivery.

Honora Miller:

Do you think that there will be legislation required in order to have that level of coverage continue or is there going to be another mechanism to advocate for that to be the case?

Dr. Kvedar:

Again, great question. I would say that if we look at history as a guide, when Medicare decides to pay for something, private payers typically follow, and there was no need for legislation because it was something that just rippled through the medical economy. So that’s what we’re hoping will happen again. In every state Medicaid is a little bit different. Patients have found that they can get care and there’s this what I call the magic of access, quality and convenience. And when you get that kind of care delivery, everyone feels great about it.

Patients have experienced that and doctors have experienced that. I would just suggest that you listeners and readers talk to their company’s human resources person, and tell them how much they’ve enjoyed their telehealth benefit; if you are insured by the government, take the time to write your senator or representative, and tell them that you don’t want to go back to in-person only care. I think we will have to advocate some but there’s such an overwhelming positive response that I’m quite optimistic that it will stick.

Honora Miller:

Having recently experienced four or five different medical professionals interacting with me through telemedicine, I’ve noticed that there’s a different cadence to each of the visits depending on the person’s communication style and their comfort level with the medium.

How patients can prepare themselves in order to get the best possible experience out of telemedicine?

Dr. Kvedar:

Sure, but before I get to that, I would just quickly say that we’re working on doctors, too, on what we’re calling “website manner.” It used to be something that we sort of said with a chuckle, but we’re very serious about it now. And it’s things like looking directly at the camera, and dressing up so that your patient takes you seriously.

But back to your question about how patients can prepare for a telehealth visit. I’d suggest everyone think about being more conscious of the information that your doctor needs to help you, either in making a diagnosis or by helping you with a care plan. For example, when we were able to have office visits back in the day — that was only several weeks ago — the doctor was asking questions, they listened to your lungs, your heart, even indicators such as your speech pattern or if you look your doctor in the eye. They were collecting information constantly during that office visit. So, let’s say, you’re a patient with diabetes. You should make sure you have your blood sugar readings handy.

Let’s say you’ve been following your blood pressure, make sure you have your blood pressure readings handy.

For me, as a dermatologist, it’s so important that we have good images of whatever it is on your skin that you need looked at. So it’s really thinking through what information your provider needs, and sometimes a doctor will help you. In our case, in advance of a telehealth interaction, we send patients information about how to take good quality pictures of their skin condition. So we’re learning, too.

Also, make sure you have your questions ready in advance, which is always good advice, both for an in-person or virtual visit, so that you get all your questions answered.

Make sure you have all the information about your condition that you can gather and make sure you have your questions prepared.

Honora Miller:

In relation to lab tests that a patient may need to get, how does that work in the telemedicine context?

Dr. Kvedar:

Well, that’s a wonderful question. Notwithstanding home pregnancy tests and the like, there are a number of companies making great strides towards taking a drop or two of blood and having a test done in the home, so we can look forward to that in the future.

In the meantime, the answer is, you need to go to a lab, hospital or clinic for testing, which is in most cases what happens currently. Things like genetic tests can be done with saliva, so some samples can be packaged from the home and shipped to a lab to be evaluated.

So it depends on the test, but unfortunately, for a lot of these tests, we still have to send people to a lab to get a blood specimen drawn or to leave a urine or stool specimen.

Honora Miller:

How can patients best identify whether their doctors provide a telemedicine option?

Dr. Kvedar:

Well, these days, I think most doctors are being very proactive, because we have this dilemma, where we want to take care of you but we’re discouraging you from coming to healthcare facilities because of the risk of contracting the virus.

If your doctor hasn’t reached out to you and you feel like you need a consultation or some care, reach out to your doctor and ask them what telehealth platform they’re using.

The government also said in the middle of March, when they relaxed the reimbursement rules, that providers could use any technology right now that we wanted during this crisis, including FaceTime, Skype, Google Hangouts, Zoom et cetera.

I’ve been telling patients, if you’re comfortable, there’s no harm in asking your doctor’s office if they will talk with you via FaceTime or another platform. I would say the first step is to ask your provider. Most people can also get access to basic telehealth services through large pharmacy chains. If you happen to have a CVS app on your phone or a Walgreens app, you can get a telehealth visit that way as well.

Most health plans, even before this health crisis, would offer an option for you to get a telehealth visit. I hope your doctor is responsive and he/she should be, but in the event that your provider isn’t offering telehealth visits, other options exist.

Honora Miller:

Can you speak to what tools a patient will need to adequately engage with patient portals?

Dr. Kvedar:

Patient portals have been around for a long time. However, I would give us a bit of a black eye on making them user-friendly. I don’t think we’ve done a very good job of that. And again, this is a patient empowerment conversation, and I don’t know that we’ve done a very good job of empowering people to interact with us through those tools.

That said, all of a sudden now patient portals have become a primary way you’re interacting with your healthcare providers, so we’re upping our game. It’s too bad it takes a crisis but there it is, and I think we’ll get much, much better.

I often say, every service you consume other than healthcare has a digital front end that has a way of interacting with software to get things done easily. For example, you take a picture of your check and deposit in your bank account with just a few taps on your smartphone. There’s millions of examples now, and health care is just getting going in that regard.

The patient portal story is really mostly about security, that is to say, it’s a very secure electronic environment for you to interact with your healthcare provider. The basic things that you can do there, apart from doing a virtual visit, is to do billing information, usually there’s a way to get a list of your medications, ask for prescription refills, schedule appointments, get letters for things like school physicals, and that the like. Nowadays, those things can be handled electronically.

There’s a little bit of, I would say, activation energy for some people, because signing up can be complicated.

It is so secure you are sometimes required to submit a letter or do something extra than you would to sign up for a normal website, all in good intent. I would urge people to put up with whatever barrier hits you in the beginning. Once you get involved with a patient portal, and we’re working very hard now to make it a really a good experience for you, patients will be able to not only interact with us as providers, but you will be able to access all kinds of information and services offered by your healthcare system, access lots of information from your record and so forth.

Honora Miller:

As a cancer patient, and for others living with chronic conditions, how might telemedicine impact the future of survivorship?

Dr. Kvedar:

It’s a great question. One aspect of survivorship is things like living wills which, if it isn’t done electronically, we will have to move in that direction, to enable that. There is a lot of interest in interactivity with palliative care and hospice around how to better care for patients, particularly around medication management. Patients can be afraid of opiates and sometimes they’re in terrible pain, so we need to get this right. So those are a couple of examples.

Honora Miller:

Is a potential for telemedicine to be used in lieu of in-person visits to such an extent that the medical provider doesn’t get to see the patient enough to pick up on subtleties that are crucial? Can you share any insights about this concern?

Dr. Kvedar:

I think that’s wonderful insight and we are definitely grappling with that for sure, especially now that telehealth use has surged. Before this pandemic hit, we had only one channel healthcare delivery to come to the hospital or doctor’s office. Now of course the answer is, let’s do a telehealth visit.

But the truth is somewhere in the middle, and I trust clinicians to have good instincts about that.

For instance, patients that we’re treating for a chronic illness, maybe we do every other visit in the office so that we can have that face time and actual interactivity. There’s something about in-person interactions with patients that’s very special. I take care of patients with acne, for example, and arguably that can be done online. But I would say we’ll probably end up doing every other visit in the office, because you want to get to know the patient, their family, etcetera. It’s just that right now where we don’t really have a choice.

Honora Miller:

Can you speak to privacy concerns around telemedicine?

Dr. Kvedar:

Forty-eight states have temporarily loosened their licensure restrictions in response to the pandemic. As, a patient, that may or may not hit your radar, depending upon where you live. Here in Eastern Massachusetts, I have a medical license in Massachusetts, but regularly take care of patients who live in New Hampshire and Rhode Island, because they often had come in for office visits. So now if we’re doing follow-up care, there’s a mechanism where I can still take care of them, even though I don’t have a medical license in those two other states.

Waiving restrictions on state licensure is important to point out because it’s really enabling us to again deliver better care to more people. The question then becomes, after this crisis is over, will we have to go back to the very old-fashioned, state-by-state geographic border-based care delivery model? This is something that the ATA is working on, as well as the need to maintain patient privacy, especially for providers using telehealth for the first time, who may not be familiar with these new procedures.

I would also point out that the biggest part of health data security is how we record that visit in the medical record, and that hasn’t changed. We do that in a very secure way. It’s something we take very seriously. And I don’t mean to say that you’d never get hacked. It’s part of reality that anyone can get hacked any time, but I don’t believe it’s something that should get in the way of delivering care.

Honora Miller:

Thank you, these are interesting times and we are moving at an amazing speed, and just the incredible growth that you described it really is a testament to how there can be interesting unintended consequences of a pandemic. Thank you very much for joining us and for you sharing your expertise.

Dr. Kvedar:

It’s been a real honor and pleasure.

How to Make the Most of a Virtual Visit

“Well, we need to check your titer,” the doctor explained as he went over my lab results via a recent Zoom call. “Titer?” I thought. I know I’ve heard that term before, but I wasn’t really sure what it meant. The doctor reappeared the word a few more times, exacerbating my confusion. I was too embarrassed to ask what he meant; he was talking quickly. When he eventually said, “The titer is the strength of the antibodies in your blood,” I finally understood and felt more at ease.

As we face this pandemic, chronic and/or rare disease patients like myself are facing an extension of the “new normal” that everyone is experiencing firsthand. Our doctor’s appointments are critical times when we’re able to explain how we’re feeling, how our medication may or may not be working, and what the next steps are. But our visits become different when our face to face sessions turn virtual. I believe we become more vulnerable, as we invite the doctors into our home lives.

While healthcare has certainly come a long way and telemedicine has been on the horizon, virtual visits are now the norm. We have been placed, both as patient and healthcare professionals, in a position that allows us to take advantage of the technology we have and still provide and receive great care. In my opinion, these visits should not be considered a hassle, but rather an encounter that continues to focus on patient education as we face unprecedented times.

A part of patient education is health literacy. Health literacy can be defined in many ways, but the short, paraphrased version is that health literacy is the ability of patients to understand health information (verbal, visual, etc.) in order to make the best decisions about their health. This includes understanding the messages that are being conveyed to them by health professionals, including symptoms to look for and how to take medication. The case remains the same whether visits are in-person or virtual, perhaps with greater emphasis on the latter, in my opinion.

Below, I will highlight things that patients can do to make the most of their health appointment, with a focus on health literacy.

Tips for Patients

  1. Discuss any information you have questions about during your appointment, especially if it has jargon you don’t understand
  2. If a doctor speaks too quickly, tell them to slow down or repeat what they said
  3. Take notes during your appointment if having something visual helps you remember
  4. If your doctor mentions a word you’ve never heard of, ask them to define it
  5. Share your understanding of how a certain medication or treatment is helping you and/or if you think something could work better
  6. If you’re unsure of how to take a medication, show the label to your doctor to have them explain
  7. If you are provided with test results, ask your doctor to review them carefully with clear language

Tips for Patients on Staying Connected Despite Physical Distancing

We are in a crazy time right now, and no one has experienced anything like it…except for cancer patients. As high-risk patients, we know what it’s like to distance ourselves from others and practice good hygiene. I know I do.

As a thyroid cancer patient, I underwent radioactive iodine treatment, where I became radioactive. I was living with my family at the time, and I had to have my own room and bathroom. No family member could come within a certain distance from me. Not even my dog. I remember them leaving meals outside my door, and texting a parent or sibling when I needed something. It was strange, yes, but I knew it was what I had to do to keep myself and my family safe.

The same thing is happening right now. We’re told to stay at least 6 feet apart from people at all times. Performing normal tasks such as going to the grocery store, a friend’s house, and even work are no longer possible. It creates a sense of grief in all of us, as we feel lost without our normalcy. Instead, we are living a “new normal,” something that cancer patients have already been long accustomed to. It’s as if the rest of the world gets to see how we live, how we feel.

We may have to physically distance ourselves, but staying connected is still possible. And it is in these moments that we can learn how to cultivate strong relationships. We live in a world with an abundance of technology. We have the ability to call, text, email, video chat, Tweet, etc. Had this pandemic happened a long time ago, none of this would’ve been possible. Social distancing would be real.

To take advantage of the opportunities that are currently presented to us, I’d like to highlight the ways in which we can stay connected:

(NEW!) Virtual Empowered #PatientChat | Friday, May 15 @ 1PM EDT

The Virtual Empowered #PatientChat is a moderated conversation conducted online via Zoom and Facebook Live. This support group will feature an expert moderator, a panel of passionate patient advocates and care partners, and other people seeking a consistent friendly community. Learn more and register!

 Support groups via Zoom

  • Our Odyssey
  • Smith Center – for AYA patients (located in the Washington, D.C. area but is open to patients all over)
  • Look for ones from specific cancer orgs (ex. Thyca, Inc.)

Facebook support groups

These can be found for cancers from the general (ex. breast cancer) to the specific (ex. breast cancer with BRCA1 mutation)

Tweet chats

Search for these using the hashtag as seen below. A few of my favorites include:

  • #patientchat
  • #ThyCaTalk
  • #bcsm
  • #HealtheVoicesChat
  • #medtwitter
  • #HCLDR