​1. When did you first hear about telehealth? How did you feel about it then? How do you feel about it now?

Dan and Amy Surdam: We first heard about telemedicine more than a decade ago. Initially, it was very sporadically used. The technology was clunky and expensive. Now, we are happy to see the rapid advancement since 2020! Covid helped advance the technology and patient adoption of this technology when receiving healthcare.

2. When did you begin offering telehealth services? What prompted the need to offer these services?

Dan and Amy: We began offering telemedicine in 2016. We have always thought that there is a great opportunity to advance healthcare through technology. Wyoming is a very rural state and recruiting and retaining providers, and especially specialists, in remote areas can be challenging. We felt that telemedicine could help bridge this gap and provide increased access to health care.

3. What motivates you to continue offering telehealth services?

Dan and Amy: The need for healthcare is never going away. There will always be a need for healthcare, for accessibility, for earlier detection and intervention. We believe that telemedicine will continue to offer more and more solutions for people to become engaged and proactive in their health. As healthcare providers who have spent careers in Emergency Medicine and Urgent Care, we understand the value of keeping people out of the ER by screening, triage, and education. We want to be a part of the bigger picture of shifting healthcare to these strategies rather than a typical reactionary approach to medicine.

4. What is your proudest accomplishment with telehealth?

Dan and Amy: We were offering telemedicine several years before the pandemic started. In the first few weeks of COVID, our telemedicine use went from a handful of patients a day to 30 to 50 visits a day. Additionally, patients began to use our telemedicine services from our parking lots as they waited to be tested. We moved quickly to and deployed providers to answer these calls. We also developed an app that allowed patients to access our telemedicine platform more easily from home and the parking lot. We feel like we were prepared and responded well to the pandemic and the challenges that came with it especially as it pertains to telemedicine. Our proudest accomplishment was offering a safe alternative to traditional office visits at a time when so many people were scared and confused.

5. What advice would you give patients wanting to try telehealth?

Dan and Amy: Just do it! We have always thought the first visit is the hardest, but once you log in once, you will realize it is no different than Facetiming a friend.

6. What advice would you give providers wanting to start offering telehealth?

Dan and Amy: Offering telemedicine may seem intimidating, but it is not that difficult. It’s great for your patients and offers flexibility for everyone. When starting select a platform that is easy to use and costeffective. There is no need to purchase an expensive cart or platform initially. Telemedicine can be conducted by utilizing affordable platforms such as Zoom or Doxy.me at an affordable price.

7. What was the biggest barrier in providing telehealth services? Have you overcome it?

Dan and Amy: Internet capabilities in remote areas are a challenge. We are thankful that the state is prioritizing broadband to help combat this. With regards to fully virtual healthcare practices, we’ve also found that obtaining malpractice is a challenge. With patience and persistence, it is possible to find companies that will provide this. We also have found credentialing a challenge as payers often require a physical clinical address. This requirement and lack of understanding of how virtual healthcare operates prevent an unnecessary barrier to patient care.

8. How do you think implementing telehealth now will affect how things will be done at your organization after the pandemic is over?

Dan and Amy: Telemedicine will continue to be an important service line.

9. Is there anything you learned the hard way in telehealth implementation?

Dan and Amy: Initially, we thought patients and insurance companies would have adopted this healthcare delivery system more readily. That being said, it has been a slow and gratifying journey.

10. Do you have any telehealth hacks or tricks?

​Dan and Amy: “Webside” manners matter. Be sure to engage with the patient as you would in a clinic. Be sure to have an uncluttered work area and good lighting as well. It’s also okay to pivot when there are technology challenges. If there is a poor visual connection, sometimes finishing the visit via a phone call will suffice.

It’s Sunday morning and what used to be one of our favorite days of the week is now just another day of angst. We woke up to an email from a physician colleague, which was a cry for help. She was frustrated that there wasn’t more being done to help physicians, providers and health care workers and that more wasn’t being done to help our patients and our community right now. Last night, we had a similar call from a provider in tears asking for more help. We received that same call four other times this week from different folks on our team.
After 18 months of this pandemic, those who have remained strong and in the fight are breaking. This fourth surge has brought along with it a feeling of defeat. Why? Because many people are refusing to do what we know works, which includes receiving the vaccine, wearing a mask when indoors and observing social distancing when possible. It seems many are focused more on ensuring personal liberty rather than protecting the common good. It is extremely unfortunate that this has become a political issue rather than a matter of health and safety for all of us.
Making masks optional for school children took the wind out of us. We have learned much about this disease during the past year and a half and fortunately the disease has not hit children as hard as adults. With the delta variant, we are now seeing an uptick in children becoming more ill. Hospitals are once again filling up with COVID-19 patients. We know masks prevent the spread of this disease. We know that children can pass the disease to other children and adults, including at-risk individuals. We know saying that COVID-19 is just like the flu or a common cold is absolutely false, and we don’t know what the long-term effects of the virus will be on children or adults. We know in-person education is extremely important to children. We understand how important it is to keep our economy open and thriving. So why are we not doing what we know works to keep moving forward? Saying we will just deal with it and watch people dying from the disease is unacceptable in this day in age, and extremely risky behavior. The disease has passed the point of a pandemic and is now becoming endemic.
We know that by not requiring masks at school while inside, our need for testing will increase, our pediatric population needing urgent and emergency care is going to increase and the risk to the teachers will be drastically increased. Bullying to the children who do wear masks will be a real thing. All of this could have been avoided with a simple mask mandate for another school year until children under the age of 12 can receive the vaccine and herd immunity is reached in the community. Instead, we will see increased COVID-19 cases and massive disruption to classrooms and the economy as parents will have to stay home with their exposed children.
Parents, we encourage you to educate your children to wear masks at school while inside. This education will need to be repeated daily and your children will likely be ridiculed for it, but their efforts will help save lives and decrease the burden on the health-care system. Please have the courage to be a leader in your family and in the community.
Regarding vaccines: The Pfizer vaccine has gained FDA approval, which means the vaccine has been studied extensively and the benefit of the vaccine far outweighs its potential outweighs risks. While these vaccines are new, and were developed quickly, the technology is not new and has been studied for years. The mRNA technology of Pfizer and Moderna prompts our cells to make a protein, for a limited time, that triggers an immune response in our bodies. This immune response produces antibodies and other memory immune cells that are called to action later when you are exposed to COVID-19, protecting you from the virus. Is the vaccine 100-percent effective? No, but it is close. More importantly, those who do contract COVID and are vaccinated are far less likely to require hospitalization or respiratory support once hospitalized.
If you do not receive the vaccine, you will get COVID-19 at some point. Chances are you will be fine, but there will be some, even your loved ones, who will die from COVID-19. COVID-19 is a new disease and we aren’t sure how any one individual will react to it. We do know that those with risk factors such as obesity, hypertension and diabetes are at a higher risk for poor outcomes and even death and that vaccination will give you protection when you are exposed to COVID-19. In Wyoming we have had roughly 70,000 cases of COVID-19 and 809 COVID-19-related deaths thus far. That number of deaths doesn’t sound like a lot but put in context for our state, it is downright scary. That’s the census of many high schools across the state, or more people in many towns across the state. Currently, the vaccination rate of Laramie County is about 35 percent and Albany County is 45 percent. We can do better. We need to do much better.
This is all we have right now for prevention. We know masks and vaccines work, and more importantly are safe. These are the only tools in our toolbox that will shift the burden on health care away from the hospitals and clinics and alleviate some of the massive pressure that healthcare teams are experiencing.
This is a call for action. Please wear a mask in public when you are indoors and please receive the vaccine today. You can easily receive the vaccine by making an appointment at County Health and various other places. If you are unsure of if you need the vaccine, we have made a list of who specifically should receive it.

• 1) If you work in health care, have a family member who works in health care, or have a friend that works in health care you should receive the vaccine.
• 2) If you are immunocompromised or overweight, you should receive the vaccine.
• 3) If you have any comorbidities such as diabetes, hypertension or asthma, you should receive the vaccine.
• 4) If you have a friend or family member who is immunocompromised, overweight or has any comorbidities, you should receive the vaccine.
• 5) If you have a child who is under the age of 12 or you are around any children under the age of 12, you should receive the vaccine.
• 6) If you are over the age of 12, you should receive the vaccine.

And to our health-care colleagues, please be bold in speaking with your patients and friends and families about the vaccine and its importance. Be bold in speaking to the community. We would encourage you to also write an op-ed or letter to the editor that can be published then shared on social media. We need a collaborative effort to educate the public on the value and importance of the vaccine. Vaccination and masks are the only thing that will ease our volumes and lower acuities, and once again flatten the curve. Perhaps the public will listen to their health-care providers. Perhaps if enough of us say the same thing in different ways, they will hear us and help.
Dr. Dan Surdam, MD, is an emergency medicine physician at Cheyenne Regional Medical Center and Amy Surdam, FNP, is the COO of Stitches Acute Care Clinics and Lt. Col. in the Wyoming Army National Guard.