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Telemedicine is Increasingly Important, But Comes With Challenges, Say Route Fifty Panelists

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Photo of Graham Mitchell, city manager of El Cajon, California, courtesy of the City of El Cajon

August 11, 2020 — Telemedicine is crucial for treating patients during the coronavirus pandemics, but carries limitations, agreed participants in two Route Fifty webinars on Tuesday.

Dr. Judd Hollander, associate dean of strategic health initiatives at Thomas Jefferson University, said that there are inherent limitations to telemedicine, and that virtual care is often not what people imagine.

“Telemedicine is not medicine — it’s a care delivery mechanism,” he said. “So if I’m a cardiologist, I’m delivering cardiac care. If I’m a lung specialist, a pulmonologist, I’m delivering pulmonary care… so the medical care is the same, and so it is all about workflows and operations and very little about technology.”

At the beginning of the pandemic, Hollander said, regulatory restrictions were loosened and doctors felt the need to take drastic measures.

“You didn’t need to buy an official telemedicine platform that might cost you six figures,” Hollander said. “You could just use FaceTime or something that doesn’t meet the regular security requirements with the regular consent requirements of telemedicine. But hell, this was a pandemic, this was a crisis, we needed to do something.”

Graham Mitchell, city manager of El Cajon, California, said that barriers to adoption of telemedicine, especially among the elderly, can be difficult to overcome. El Cajon has taken measures to increase use and enable the elderly to get the care they need from a safe distance, he said.

“Even I have to ask my 14-year-old son how to do a lot of things on my phone, and I’m relatively young,” Mitchell said. “We know through experience that the best way to teach a senior how to use technology is hands on… [but] during the pandemic, we can’t do that, so we are working on a series of how-to videos.”

Hollander said that there need to be regulatory guidelines on the technology that doctors can use.

“I don’t think the relaxation and using whatever toy you have around your house to deliver medical care makes sense,” he said. “…It’s better if I use an app where I come in and I sign the terms of use and say I agree with what they say. Some of the big relaxations, I think, probably should go away to keep patients safe and secure and make sure that they know what they’re getting care about.”

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Providers Call for More FCC Telehealth Funding as Demand Grows

‘I think obtaining funding from the Universal Service Fund would go a long way.’

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Photo of FCC Chairwoman Jessica Rosenworcel

WASHINGTON, July 26, 2022 – Health care providers in parts of America say they are struggling to deliver telehealth due to a lack of broadband connectivity in underserved communities, and recommended there be more funding from the Federal Communications Commission.

While the FCC has a $200-million COVID-19 Telehealth program, which emerged from the Coronavirus Aid, Relief and Economic Security (CARES) Act, some providers say more money is needed as demand for telehealth services increases.

“The need for broadband connectivity in underserved communities exceeds current availability,” said Jennifer Stoll from the Oregon Community Health Information Network.

The OCHIN was one of the largest recipients of the FCC’s Rural Health Care Pilot program in 2009. Stoll advocated for the need for more funding with the non-profit SHLB Coalition during the event last week. Panelists didn’t specify how much more funding is needed.

Stoll noted that moving forward, states need sustainable funding in this sector. “I am hoping Congress will be mindful of telehealth,” said Stoll.

“The need for telehealth and other virtual modalities will continue to grow in rural and underserved communities,” she added.

Brian Scarpelli, senior global policy counsel at ACT, the App Association, echoed the call for FCC funding from the Universal Service Fund, which subsidizes basic telecommunications services to rural areas and low-income Americans. “I think obtaining funding from the Universal Service Fund would go a long way.”

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Artificial Intelligence in Healthcare Has Benefits, But Also Challenges That Must Be Rectified: Experts

The technology needs to be examined to ensure it doesn’t create inequities in healthcare, panel hears.

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Screenshot of the Atlantic event in late June

WASHINGTON, July 11, 2022 – While the use of artificial intelligence in healthcare has been lauded by some, experts said at an Atlantic event late last month they are concerned that inaccurate data can also hamper progress in the field.

Artificial intelligence has been used widely across the medical field to analyze relationships between medical providers and patients to improve equality of care, including providing patient risk identification, diagnostics, drug discovery and development, transcribing medical documents, and remotely treating patients.

Carol Horowitz, founder of the Mt. Sinai Institute of Health and Equity Research, argued that while AI plays a substantial role in diagnosing health problems at earlier stages, diagnosing patients more quickly, providing second opinions in diagnoses, enhancing scheduling abilities, stimulating hospital workflow, and finding drug availability for a patient as in dermatology, therapeutics, or population health, it’s not a golden ticket.

She reasoned that it “can reflect and really exaggerate inequities in our system,” negatively affecting healthcare equity among patients.

She stated that AI tools have led to inaccurate measurements in data that have proved harmful to individuals’ health. Horowitz shared the example of faulty AI technology during March 2020 meant to allow individuals to self-monitor their own oxygen levels as a precautionary method to the COVID-19 pandemic but led to inaccurate pulse readings for those with darker skin, and inaccurate data gathering, resulting in delayed treatment for many in need.

Michael Crawford, associate dean for strategy of outreach and innovation at Howard University, added that if these certain mismeasurements and flaws in the technology are not addressed, “AI could increase disparities in health care.”

Alondra Nelson, head of the White House Office of Science and Technology Policy, said when it comes to assessing AI technology innovation for the future, there are both cost and benefits, but we must find “where can we move forward in ways that don’t harm human society but that maximize human benefits.”

As we grapple with how to implement this technology, “we must do science and technology policy that always has equity at the center” for future innovation, said Nelson.

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States Lagging on Bills to Implement 988 Suicide Hotline Mandate as Deadline Approaches

As of June 7, 20 states have passed legislation to implement the 988 suicide hotline mandate, according to FCC data.

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Screenshot from the FCBA event on June 8

WASHINGTON, June 15, 2022 – Only 20 out of the 35 states that have introduced legislation for a new suicide hotline have made the legislation law as of June 7, according to information from the Federal Communications Commission, as the July 16 implementation deadline nears.

States are required to implement the infrastructure and the funding for a 988 number that will go to the National Suicide Hotline, but only four states have passed bills to finance it, Emily Caditz, attorney advisor of the Wireline Competition Bureau under the FCC, said at a Federal Communication Bar Association event last week. Those states – Colorado, Nevada, Virginia, and Washington – fund the implementation from fees on cellphone lines.

James Wright, chief of crisis center operations at the federal Substance Abuse and Mental Health Services Administration, suggested that “key partnerships between state and local governments” will be necessary to help states meet this deadline.

Laura Evans, director of national and state policy at Vibrant Emotional Health, said this funding will “make sure we have robust capacity for the anticipated 9-12 million contacts we expect to come in that first year.”

The commission ordered the adoption of the nationwide line nearly two years ago, on July 16, 2020.

According to the National Suicide Hotline Designation Act of 2020, “988 is designated as the universal telephone number within the United States for the purpose of the national suicide prevention and mental health crisis hotline system operated through the National Suicide Prevention Lifeline.”

“America’s suicide rate is at its highest since World War II,” said former FCC Chairman Ajit Pai at an FCC event in December of 2019. “A simple three-digit code for a suicide hotline can reduce the mental stigma surrounding mental health and ultimately save lives.

Caditz said the implementation of text messaging “is especially popular with groups that are at heightened risk of suicide or mental health crises, including teenagers and young adults and individuals who are deaf, hard of hearing, deafblind, or speech disabled.”

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