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The Arizona Telemedicine Program Blog

A storm surge and a tsunami are vastly different entities. A storm surge is an oceanic phenomenon resulting from the piling up of surface water from the sustained pressure of wind in a storm.  Damage, in human terms, is typically limited to structures along the coastline. A tsunami is a very different phenomenon.  Often caused by a natural disaster such as an underwater earthquake or volcanic eruption, the tsunami carries enormous energy in the form of a sheet of water spanning the ocean’s surface down to its floor.  Its devastation can disrupt the fabric of society deep inland.

Drawing of “The Telemedicine Doctor” by a child patient of Sara Gibson, MD. Image courtesy of Health Choice Arizona.

In last week’s blog, I discussed Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances. To summarize the restrictions, the DEA requires that any prescription of a controlled substance must be issued by a practitioner who has conducted at least one in-person medical evaluation of the patient, with a few, very complicated exceptions.

During the COVID-19 Public Health Emergency, the DEA has relaxed these restrictions and is allowing telehealth evaluations to substitute for in-person evaluations. Sara Gibson, MD, a Flagstaff-based telepsychiatrist, last week discussed the impacts of the restrictions and waivers on patients in underserved areas with opioid use disorder. Today, she points out another at-risk population affected by the DEA prescribing restrictions outside of the PHE.

Dr. Gibson demonstrates her telemedicine setup with a staff member, circa 2013. Photo courtesy of Health Choice Arizona

Since the COVID-19 Public Health Emergency (PHE) was declared in January, the use of telehealth has skyrocketed. This is in part because many restrictions on it have been lifted for the duration of the PHE in order to make healthcare services more accessible to patients while maintaining physical safe distance. Some of the temporarily waived restrictions include Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances.

Normally, the DEA requires that any prescription of a controlled substance be issued by a DEA-registered practitioner who has conducted at least one in-person medical evaluation of the patient, with a few exceptions. These include the patient being located in and treated by a DEA-registered hospital or clinic or the patient being in the physical presence of another DEA-registered practitioner during the evaluation.

What is Telemedicine?

In short, telemedicine is the remote treatment or consultation provided by a medical professional via electronic means such as phone call, video conference or online chat. Such communication is carried out in real time when a patient needs medical advice that doesn’t require physical presence of a patient at the doctor’s office.

The goal of telehealth is to make treatment more convenient and more cost-efficient. What is more, it is a lifesaver for patients with chronic diseases like diabetes or high blood pressure who aren’t in need of emergency treatment, but need regular medical advice on lifestyle regime, or medicine dosage.

Hushabye Nursery will provide compassionate, non-stigmatizing care to at-risk mom’s and babies during their stay and address their psychosocial needs after discharge.

Tara Sundem, RN, NNP-BC, MS, used to think the best place for babies going through withdrawal was not with their parents. Sundem admits that she, like many of her colleagues, used to judge parents when newborns in her neonatal ICU were going through withdrawal.

Sundem now believes she was wrong after studying Opiate Use Disorder (OUD) and says the best place for these newborns almost always is with their parents, even if those parents are not yet drug free. We should be able to ‘think out of the box’ to ensure the biological parents are able to ‘parent’. As long as it is safe, babies should be with their parents. She learned that the entire family needs to be involved to improve outcomes.

What we call telemedicine nowadays actually started in the 1950s, when a few hospitals and university medical facilities started to look for methods and techniques that would allow them to share images and information via telephone. In one of the first instances of the successful usage of telemedicine, two healthcare facilities in Pennsylvania, U.S. transferred radiological images over the telephone. In the initial days, telemedicine was majorly used for connecting doctors working in one location to specialists somewhere far away.

This method was hugely beneficial to patients or populations in rural areas, where specialists were not easily available. As the systems and equipment used for connecting healthcare practitioners across different regions became more expensive and complex over the next few years, especially with the development of technologically advanced devices, the use of the approach started becoming limited. However, the advent of the internet and the subsequent emergence of video transmission and smart devices completely transformed the practice of telemedicine and made this technique affordable and convenient.

Amid the COVID-19 pandemic, the Children's Postinfectious Autoimmune Encephalopathy (CPAE) multispecialty team at the University of Arizona Steele Children’s Research Center was challenged with the undertaking of how to safely continue clinical care.  The team responded quickly with a telemedicine model of care that did not compromise the quality of clinical care, while adding additional benefits to family members and the center. 

The CPAE Center was developed in partnership with Banner – University Medicine. The CPAE Center of Excellence is the first of its kind in the world to integrate clinical care, education and research.  We treat disorders such as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) and Sydenham chorea.

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