The Arizona Telemedicine Program Blog

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”.

As more and more people turn to telehealth services for care, it is becoming increasingly important for physicians and the entire healthcare industry to have access to technology that can help improve patient care. Luckily, artificial intelligence (AI) is quickly emerging as a powerful tool that can do just that.

Artificial Intelligence (AI) is being increasingly used in telemedicine to allow doctors to make more data-driven, real-time decisions that may improve the patient experience and health outcomes by allowing them to work more toward virtual care alternatives throughout the care continuum.

According to a study from MIT, 75% of healthcare facilities that utilized AI reported improved capacity to manage illnesses, and 4/5 said it aided in reducing employee fatigue. AI in healthcare is a promising strategy for the future of medical delivery, given that Covid-19 places a strain on both industries--the amount of patient data analysis, and the number of people who need medical attention.

Before the pandemic, Amy Hu, MD, a psychiatrist with Banner Health and a UArizona College of Medicine Clinical Assistant Professor of Psychiatry, had not utilized telemedicine to see her patients. She says she viewed it as more of a niche application for other healthcare providers.

“I did have some misconceptions about what telehealth was like. I thought that patients may not feel as engaged or connected, or that it might feel a little unnatural compared to meeting in-person.”

However, with the COVID-19 shutdowns in March 2020, the shift to telemedicine was swift. “Our clinic went from seeing all patients in-person to exclusively telehealth almost overnight. Everyone had to adapt pretty quickly.”


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