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The Arizona Telemedicine Program Blog

The Arizona Telemedicine Program’s T-Health Institute (Institute for Advanced Telemedicine and Telehealth) is charged with developing innovative medical science curriculum throughout the education continuum in Arizona and throughout the Unites States.  Since its creation in 2004 by the Arizona State Legislature, and initially supported by targeted funding in the federal budget, the T-Health Institute has facilitated over 100 webinars and helped publish over 200 blogs articles.  It has supported innovative education research for STEM training, K-12 medical science education, early college curriculum development, and interprofessional education.  T-Health is currently engaged in developing telemedicine curriculum for medical students.

There is a glaring shortage of healthcare providers across the world as is, and with the novel coronavirus epidemic taking over the world, hospitals are stretched too thin. It is envisaged by Inside Higher Ed that there will be a shortage of almost 120,000 doctors in the United States alone by the year 2030. The extremely lopsided doctor to patient ratio in some clinical specialties and geographic locations highlights the difficulty healthcare providers have in providing care to patients in a satisfactory manner. At present, there are around 40 doctors for 100,000 patients in the rural areas and around 53 doctors for 100,000 patients in the urban areas, as stated by Rural Health Web. This stark gap is one of the key driving forces for the adoption of digital applications and mechanisms by healthcare institutions.

Since July of 2019, a unique collaborative team approach has been employed to optimize HIV and general infectious diseases telemedicine services delivered to correctional facilities throughout Arizona. The program builds on a program to provide telemedicine services to the Arizona Correctional system since 1998, with infectious diseases services being provided since 2009.
 
This team in the University of Arizona (UA) Petersen HIV clinics (PHC) includes an infectious diseases physician and a clinical pharmacist along with administrative, scheduling, and technological support.  This model was adapted from a process already in place at PHC in Banner University Medical Center (Tucson, AZ) in which a physician, pharmacist, and clinical coordinator all see the patient simultaneously.  This model was implemented in direct response to the numerous issues and barriers faced by individuals living with HIV, not only in affording costly antiretroviral HIV medications but in addressing social barriers that are just as likely to contribute to treatment failure.  By the conclusion of the brief visits, all issues have been addressed relating to HIV care, including medication usage and acquisition as well as insurance coverage and follow-up plans.

Imagine delivering a baby at 24 weeks gestation, or three months early. You deliver at the hospital closest to your house or the one that your OB/GYN recommends.  Exploring the quality of care outcomes in that facility are not at the forefront of your mind. Wanting a healthy baby, or even a baby that simply survives, free of life-altering complications, becomes your goal. Quickly after this baby is born, he is whisked away to the neonatal intensive care unit (NICU), and it may be hours or sometimes even days before you see him again. The clinicians in that unit are trying their very best and they are providing excellent care: or are they? How do you know? Without questioning the intent or skill of clinicians, the data show that the quality of NICU care varies from unit to unit, and one complication in particular can vary widely: necrotizing enterocolitis (NEC). For this condition, there is a core of evidence-based prevention interventions that are essential to reduce the risk of contracting NEC. Perhaps most importantly among these tactics is giving baby the mom’s own milk, using a feeding protocol, limiting antibiotic and antacid exposure, and considering strategies for timely recognition. NEC-Zero is a prevention bundle for NEC and our team has made a concerted effort to share it freely so any unit in any location can deliver excellent care to any baby. However, improving quality is a difficult task, and it requires a committed team to implement the best evidence in the NICU.

Telemedicine involves monitoring patients, exchanging medical information and analyzing the results of various clinical exams. These exams are examined and handed digitally, giving invaluable support to traditional medicine. Telemedicine is already used worldwide, in a very safe and legal manner, complying with medical legislation and standards. With the utilization of data technologies that add quality and speed within the exchange of information, doctors can make decisions with greater agility and precision. Through telemedicine, specialists can access exams from anywhere within their practice jurisdiction, using platforms such as computers and mobile devices, like smartphones and tablets. This article provides an overview of 6 essential telemedicine books that are useful to help those interested in telemedicine improve their understanding of the field.

The long-awaited promise of telemedicine may finally be realized as a response to Covid-19.

For decades, advocates hailed telemedicine as the way forward to improve access and reduce cost, while maintaining high-quality care. There have been steady gains in investment and growth across the country, and an increasing number of studies suggest that for certain services, namely chronic care management and mental health services, telemedicine may be superior to in-person care. Specifically, studies showed better health outcomes through improved medication adherence, integration of medical tests, and reduced hospital readmissions. However, even with these positive steps, it would be a stretch to claim that telemedicine had transformed the US healthcare system and, in large part, that is because of legal barriers that were in place prior to Covid-19.

Depiction of doctor conducting telehealth video visit with patient

The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law by President Trump on March 27, 2020 in response to the COVID-19 public health emergency. The CARES Act provided $200 million to the FCC to support healthcare providers in the fight against the COVID-19 pandemic. On April 2, 2020 the FCC announced its COVID-19 Telehealth Program which provides funding of up to $1 million per applicant to “purchase telecommunications, information services, and connected devices to provide connected care services in response to the coronavirus pandemic.” As of April 29, 2020, the FCC has already awarded 30 applicants from 15 states funding totaling $13,700,581.  The average amount awarded is $456,686, with individual funding awards ranging from $26,180 to the maximum of $1,000,000.  Per the FCC order, “this funding opportunity will remain available until the funding is expended or the COVID-19 pandemic has ended,” and “applicants that have exhausted initially awarded funding may request additional support.”

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