The Arizona Telemedicine Program Blog

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.

Who are we?

AZCOVIDTXT was created at the start of the COVID-19 pandemic by a few professors at the University of Arizona in order to address the growing need for accurate and up-to-date information about the constantly changing policies and advice around how to deal with the disease. From then until today, the project has provided timely information about the pandemic to over 3700 users around Pima County via sms text messages. In collaboration with the Arizona Center for Rural Health, as a component of the AHEAD AZ grant, AZCOVIDTXT was adapted into AZCOVIDTXT-RH. AZCOVIDTXT-RH is a bilingual,  two-way texting system designed to provide and gather health information to and from users in order to distribute timely, expert-curated information to promote the resilience of our health systems and communities in rural areas of Arizona. The team who founded and implements the program is comprised of staff, faculty, and students across multiple University of Arizona colleges, including the College of Public Health, Communications, Medicine, Linguistics, and more.

The Arizona Telecommunications and Information Council (ATIC) has had an important and impactful vision for over 35 years -that all Arizona citizens, businesses, schools, organizations, and communities have access to high-capacity Internet and the tools, technologies, and skills to participate effectively in the networked world. Telecommunications and telehealth go hand-in-hand, so over the past 25 years I have been a member of and currently serve as an active board member of ATIC.

We read with interest the blog by Paul Sun on June 23, 2022. The blog’s value in acknowledging the upcoming importance of artificial intelligence (AI) in telehealth is high, however, the title and further application to only physicians, requires further thought.

The opening two paragraphs introduce AI as a powerful tool for “physicians” and “the entire” healthcare industry to improve patient care as healthcare turns to telehealth and telemedicine services. This statement appears to include nurse practitioners (NP) (as well as many other types of healthcare providers) as part of “the entire” healthcare industry. Yet, in 2022, there were at least 355,000 NPs with an estimated 1.06 billion patient visits yearly. Eighty-nine percent of NPs are primary care providers. They are required to “make data-driven decisions to improve patient experience and health outcomes”, just like physicians. Professionals with these responsibilities and this degree of outreach are acknowledged as “healthcare providers”. This could be surmised as an error in word choice; however, the blog further discusses how the use of AI in telehealth will support “physicians”.


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