The Arizona Telemedicine Program Blog

To almost anyone passing by the latest star at Benson Hospital, the room looks like a typical workout spot with a treadmill, an exercise bike, and a set of free weights, but to 12 patients living near this rural community hospital, it represents saving time and critical steps needed to making their cardiac health a priority.

During a recent tour, Velma Cooper, Director of Nursing, excitedly pointed out construction taking place—a soon-to-be new entrance, check-in area, administrative offices and more, which will hopefully be done by the end of March. Past the hospital’s new radiology department and further past the ER, sits the new cardiac telemedicine rehabilitation room.

As Dr. Eladio Pereira recalls the challenges he and other medical professionals experienced during Covid, an easy broad smile spreads across his face thinking about his friend the late Dr. Ron Weinstein and the crew at the Arizona Telemedicine Program.

Pereira, chief medical officer at the Mariposa Community Health Center that serves the U.S.-Mexico border communities of Santa Cruz County in Southern Arizona, said Mariposa’s Nogales clinic was one of ATP’s first telemedicine projects outside Tucson in 1997.

“We were learning together. They wanted us to participate and were extremely generous with us,” Pereira said.

Five Key Telehealth Takeaways from the Consolidated Appropriations Act of 2023  

On Thursday, December 29, President Biden signed into law H.R. 2716, the Consolidated Appropriations Act (CAA) for Fiscal Year 2023. This legislation provides more than $1.7 trillion to fund various aspects of the federal government, including a 2-year extension of the major telehealth waivers that were initiated during the federal public health emergency (PHE). 

The full text of the legislation, is available here. The most pertinent section of the new law that relates to telehealth is under:

A young version of the author at the view box looking at chest “films” (chest radiographs), circa 1975.

In the Beginning: Going from Analog to Digital

I am now a retired radiologist. I actively practiced radiology from 1971 at the start of my residency until 2014 when I retired as a professor of medical imaging (radiology). A lot certainly changed during that time. When I first started my radiology career, there was no CT or MRI, and ultrasound was very primitive with no real-time imaging. Nuclear medicine did not offer the wide range of studies now available. There was no PET scanning. In fact, radiologists read films on view boxes, actual films, anywhere from 8 x 10 inches to 14 x 17 inches in size.

The standard x-ray equipment was similar today with the same images and routines being used for everyday chest, abdominal, spine, skull, and bone radiographs. The films were enclosed in a metal cassette, exposed, and then taken out of the cassette in a darkroom and placed into a developing machine coming out the other end of the machine developed and dried, ready for viewing on a view box. The films for an individual patient were placed in a large envelope, the film jacket, which was stored in the departmental film library, a large complex of rooms with multiple shelves for holding thousands of film jackets.

As a telehealth expert, it is essential to note that telehealth has four significant perspectives: healthcare, policy, technology, and business. Of course, all perspectives must intersect to build a successful telehealth program. Still, healthcare can be seen as the overarching connection because, it has ties to all the perspectives.

For physical therapist Tony Kottoor, telehealth was cool long before the Covid pandemic made his peers and other health providers rush to find options for patients when face-to-face was no longer possible.

“I’m probably a bit of an anomaly and kind of unique in that I became fascinated with telehealth in 2017 when I did my capstone research for my physical therapy doctorate program,” Kottoor said.

The research, which focused on using telehealth in physical therapy and rehabilitation, took him to India and Colombia where he saw the difference it made, especially in rural communities, improving health outcomes for patients with great difficulty traveling to specialists and other doctors.

As the COVID-19 pandemic unfolded, I’ve watched with great interest how older adults with limited English proficiency (LEP) are encountering telehealth. My own grandmother speaks and understands very limited English and must rely on others for translation services and transportation to doctors’ appointments.

Telehealth is poised to be a significant tool in increasing healthcare access for older adult LEP patients, especially those who live rurally. It eliminates travel obstacles, which are made increasingly difficult for patients of advanced age and could allow for greater compliance with healthcare plans, better continuity of care, and access to specialists that may not reside in a patient’s area. However, there are legal, structural, and practical obstacles that make the reality of telehealth a far cry from its intention.


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