UNC Asheville alumnus Dr. Ian Nelligan, a clinical assistant professor in the department of medicine, division of primary care and population health at Stanford, had been working hard on a proposal to roll out video visits for Stanford Health Care’s family medicine clinic over an 18-month period.
Then the COVID-19 pandemic hit.
“We basically did it in a week,” Nelligan said. In that time the primary care clinicians went from just 7 percent of clinic visits taking place over video, to 75 percent.
“We had 26 providers at the time that were doing video visits, and have 168 total providers, so we had to train the rest of the providers very quickly,” Nelligan said. “We had to build out a platform that was integrated into our medical record system that could support this, and we had to train patients on how to access video visits.”
Though the transition to providing medical care through telehealth was much more rapid than Nelligan had anticipated, it was a transition he’s been working towards for years, and a passion rooted in his interest in community health.
After graduating from UNC Asheville with a degree in chemistry with a pre-med focus in 2003, Nelligan attended UNC Chapel Hill with the goal of starting a career in primary care. While there he became involved in various projects focused on working with underserved populations, including a community-based participatory research and community health project in rural Mexico.
While completing his residency at San Francisco General Hospital—a very mission-driven institution, Nelligan said—a project on innovations in primary care brought him to Stanford. With his career now at Stanford, Nelligan splits his time between seeing patients and teaching, with a special interest in getting students out of the classroom and into primary care and underserved clinics, and in working with patients in the digital space.
“Two weeks prior to the escalation of coronavirus cases in our area, I started a new role as the medical director for digital health and primary care,” Nelligan said. “The focus of the role is to leverage technology to better to provide better access to patients and to ensure the safety of patients, staff and providers during the COVID-19 pandemic while maintaining the same quality of care we provide when we are doing in person visits.”
Combining technology, patient care, and community engagement—and making it all work very quickly—was a challenge, but one Nelligan said his liberal arts education helped prepare him for.
“One of the valuable things about a liberal arts education is that you have opportunities to immerse yourself in both scientific and creative scholarly concentrations,” Nelligan said. “You get a very multi-dimensional foundation and I think it cultivates interests in different fields, like medicine, health disparities and technology, that are ultimately synergistic.”
Now that COVID-19 has necessitated the use of telehealth for so many doctors and patients, Nelligan says he believes it’s here to stay.
“Patients lose time, money and valuable productivity to make time for medical appointments,” Nelligan said. “They have to get childcare, or if they’re caregivers for someone else, they have to find support to allow time to take care of their own health.” Being able to “visit” the doctor from home or work can remove those barriers and improve patient access.
“The value of primary care is building long term relationships with patients, and when you already know your patients, a video visit is less intimidating,” Nelligan continued. “Often there are a lot of things that don't require a physical exam, and in fact, we are learning new ways to do physical exams over a video visit.”
Patients can already provide their doctors with a lot of their own data, perhaps by using a smart phone to check their own pulse, or having simple equipment like a blood pressure cuff in the home. With a smart watch, patients can provide information about the heart rhythm. In the future, it may even be possible for doctors to conduct virtual ultrasounds via video while the patient is at home.
Still, there will always be a role for seeing patients in the clinic, and there are still challenges in virtual medicine that need to be addressed, like ensuring that vulnerable populations and patients that aren’t digitally savvy still get the care they need.
“While we still need to overcome these barriers, I think this is the future of medicine,” Nelligan said.
While Nelligan’s career keeps him in Stanford, Asheville and his alma mater remain important places in his heart. UNC Asheville’s undergraduate research program, the mentorship of two of his chemistry professors, Keith Krumpe and Herman Holt, and the long hours spent in his research room in Ramsey Library, stand out in his memories.
“I think one of my fondest memories was studying late into the night at the library and then walking out, and the Quad is empty and it's dark and it's quiet and it's warm at night in the south, especially in the summer,” Nelligan said. When proposing to his now-wife last year, it was the Blue Ridge Parkway Nelligan picked for the setting—though it turned out to be an icy January weekend, instead of a warm summer night. They’re now expecting their first child, and are looking forward to returning to Asheville to visit as a family.
“It’s a place that never leaves your soul,” Nelligan said.
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