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

Elijah Labby

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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.”

Elijah Labby was a Reporter with Broadband Breakfast. He was born in Pittsburgh, Pennsylvania and now resides in Orlando, Florida. He studies political science at Seminole State College, and enjoys reading and writing fiction (but not for Broadband Breakfast).

Health

Pandemic Creating Long-Term City Solutions to Technology Challenges: Route Fifty Town Hall

Derek Shumway

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Screenshot taken from Route Fifty town hall

March 24, 2021 – Partnerships between cities and tech companies have not only allowed municipalities to acquire technology to get online quickly during the pandemic, but it’s also helped city staff absorb technological training to address challenges in the future, a virtual town hall heard Tuesday.

“Government too, can be adaptable and flexible,” said Heidi Norman, acting director of innovation and performance for the City of Pittsburgh, Pennsylvania. Asked by Dell innovation officer Tony Encinias what allowed Norman to embrace remote working during the past year, she said having relationships with tech companies like Dell helped keep Pittsburgh connected with computers, hotspots, and Wi-Fi routers when in-person work was not an option.

The town hall, which heard about experiences during the first full year with Covid, was hosted by Route Fifty, a digital news publication from Government Executive Media Group, which also publishes Government Executive magazine, GovExec, Nextgov and Defense One.

Pittsburgh had to adapt and move fast and focus on getting eligible people to work remotely and, with that, more digital software was a priority. The city had to ensure its plans were executed and communicated clearly between its staff and city residents. And to accomplish that, proper videoconferencing technology was needed. 200 city employees were able to work from home in less than 2 weeks on new Dell laptops.

Pittsburgh’s government was able to prove it can do things in new and better ways, Norman said, as it had no other choice but to increase its remote working ability. As the pandemic was emerging, much of the city staff had not worked with many of the technologies needed to work remotely, she added. Staff needed to be trained on new videoconferencing technology and learn how to set up home offices as they began working from home.

Ed Zuercher, city manager of Phoenix, Arizona, said during the event that the pandemic should create long-term “systems” to address its effects rather than bring about temporary “responses.” The city has since been able to maintain its pandemic-driven response by partnering with Dell and turned it into a system that now has plans to keep its staff with the right skills to continue being able to serve its residents.

Pittsburgh also plans to stabilize its foundational IT structure into the cloud and to establish a new wide area fiber network called NetPGH, Norman said.

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Health

With Security And Cost Concerns, Telehealth Is A Double-Edged Sword: Harvard Professor

Samuel Triginelli

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Photo of Ateev Mehrotra from Harvard Medical School

March 4, 2021 – The benefits of telehealth, especially during the pandemic, is being offset by the enhanced security requirements and the increased costs to adapt, a professor of Harvard’s medical school said at a House hearing Tuesday.

Ateev Mehrotra said at the House Energy and Commerce Committee studying the future of telehealth that new technologies have allowed many Americans to get healthcare from home. But with its expansion, and its growing popularity, health care policies will also need to keep pace – and there may be significant adaptation costs and security enhancements that will need be made, he said.

One security concern is evident in existing telephone scams, which are increasing. If a prospective patient doesn’t have adequate internet at home to video chat with their physician and require a phone, they are opening themselves up to potentially being scammed or worse, being given bad medical advice.

Similarly, other witnesses present at the hearing addressed health care providers’ concerns about pricing, security, and lack of universal access to adequate broadband as the limiting factors of telehealth, especially to rural communities and underserved intercity areas.

The increasing popularity of seeing a doctor virtually on your device, compared to in person, has elevated these concerns. Now, private insurers and governments are concerned about the sustainability of the required increase in health care spending.

Mehrotra outlined that health plans would also need to be updated to reflect the technological differences, including having audio-only appointments, and align with existing plans that see patients go in person.

The long-term solution is for health care providers to invest in access to video visits to all Americans for good. Mehrotra said he advocates for telemedicine visits to be charged at a lower rate than in-person visits. In the longer-term, telemedicine visits have a lower overhead per visit, he said. The payment should reflect those lower costs, which may open up competition for customers and even lower costs.

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Expert Opinion

Debra Berlyn: Telehealth is Here Today and Here to Stay

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The author of this Expert Opinion is Debra Berlyn, president of Consumer Policy Solutions

The COVD-19 pandemic has been an extremely difficult time for everyone and has led to the implementation of major changes in our daily behaviors. In order to overcome this adversity and adapt to living in a new age, great innovations have been advanced.

New tech devices and programs have offered many solutions to help solve some of our struggles during this pandemic and raise our spirts.

The pandemic has also highlighted how technology supports consumers who are homebound or living distant from essential services.  In a post-pandemic environment, we can already predict that many consumers, particularly older adults, will continue to rely on many tech services they have adopted during COVID-19.  Services such as online shopping and telehealth have been particularly indispensable during this era of stay-at-home orders, social distancing and quarantine.

The benefits of telehealth options for all consumers have been demonstrated during this pandemic. Telehealth has replaced many routine doctor’s visits, has been used for setting-up COVID testing appointments, and conducting all too critical mental health sessions during periods of isolation. It has also served to keep medical workers safe during the pandemic.

According to a Center for Disease Control report, there was a “154 percent increase in telehealth visits during the last week of March 2020, compared with the same period in 2019….”

During the emergence of COVID-19, both a majority of doctor’s offices were closed, and their patients were staying in their homes.  Options for medical appointments were limited to a telehealth visit only, and while most medical offices reopened with safety protocols in place, many consumers opted to continue with telehealth medical appointments.

The reduction of red tape and the number of doctors who quickly adapted to virtual services was one of the greatest developments of 2020; however, only those who have adequate access to broadband internet are able to take advantage of this tool, leaving out the unconnected population.

As we contemplate permanent integration of virtual care into our medical health system, we must acknowledge that consumer demand for telehealth requires access to ubiquitous high-speed broadband. In 2021, policymakers need to take aggressive steps to deliver broadband to those who do not have access, or who are unable to afford the service.

The $900 billion-dollar COVID Relief package approved by Congress in the final days of 2020 provides $7 billion to increase access to broadband. In addition, Telehealth expansion is included within the broadband funding priorities. The package more broadly includes overall support for these initiatives, with funding for:

  • Expanding telehealth access to mental health services for Medicare patients
  • Closing rural telehealth gaps to provide increased funding to the Health and Human Services agency’s Health Resources and Service Administrations pilot project for Telehealth Centers of Excellence, to access broadband capacity available to rural health providers and patient communities
  • The Federal Communications Commission to support the efforts of health care providers to address coronavirus by providing telecommunications services, information services, and devices necessary to enable the provision of telehealth services.

The FCC has made a broad commitment to telehealth programs, initially under the leadership of Chairman Ajit Pai, and now in the most capable hands of Acting Chairwoman Jessica Rosenworcel. The Chairwoman recently visited the Washington, D.C., Whitman-Walker Clinic, which provides community-based health and wellness services specializing in LGBTQ and HIV care.

Rosenworcel said: “Through expanded and affordable access to broadband for all, organizations like Whitman-Walker and clinics around the country can continue to grow their telehealth efforts to support their communities.”

The Acting Chair is committed to closing the digital divide and sees access to telehealth care services—especially for underserved and marginalized communities—as a top priority. The FCC has initiated a number of COVID-19 Telehealth Programs and the Connected Care Pilot Program to focus on implementing innovative telehealth initiatives.

Telehealth has met the demand of health care management during the pandemic and has become particularly essential for older adults unable to leave their homes for medical visits.  It is vital that programs and policies supporting this technology continue to be a significant priority. In addition, access and affordability of high-speed broadband must be ubiquitous and affordable for all.

Debra Berlyn is executive director of the Project to Get Older Adults onLine (Project GOAL), and president of Consumer Policy Solutions, a firm centered on developing public policies addressing the interests of consumers and the marketplace. This piece is exclusive to Broadband Breakfast.

Broadband Breakfast accepts commentary from informed observers of the broadband scene. Please send pieces to [email protected]. The views reflected in Expert Opinion pieces do not necessarily reflect the views of Broadband Breakfast and Breakfast Media LLC. 

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