The Month in Telemedicine: The Future of Telehealth

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In November, I had the pleasure of joining a group from my institution down to Washington, D.C. to discuss telehealth including regulatory issues, appropriations, research and its future.

It was a week after the elections so both the new and old guard were around in what was an exciting atmosphere. We had the pleasure to speaking to both ways and means and the administrator of HRSA, who has recently commented on wanting to expand telehealth, which is relevant to their mission of access to the ‘geographically isolated, economically or medically vulnerable.’

Aside from our personal visit to government agencies and being able to discuss why telehealth is necessary for future efficient healthcare, telehealth has gotten attention by a number of government agencies to combat the opioid crisis. For example, HHS recently awarded close to $400 million in order to combat the epidemic and has outlined five points to help the crisis:

  • better access
  • better data
  • more pain management
  • more availability of opioid reversing meds
  • improved research.

HHS has outlined and given materials on how to expand buprenorphine-based MAT (medication assisted treatment) under DEA regulations to aid those in rural areas to assist with recovery and decrease transmission of HIV and HCV. MAT combines use of medications and psychosocial and behavioral health support and this policy can help increase access to it by allowing remote prescribers that are licensed to treat those geographically remote.

IHS (Indian Health Service) has most recently released a policy in November called “Internet Eligible Controlled Substance Provider Designation Policy” designed to increase access to treatments for opioid use disorders to help American Indians and Alaska Natives living in rural or remote areas.

How it helps:

  • Greater access to patients to treat their disorder as well as decrease transmission
  • Normally, providers have to see a patient in person prior to prescribing opioids, this gives access to a larger group of patients, both for treatment and follow-up.

Barriers:

  • The reality is that few providers are aware of this program, prompting the HHS to try to educate widely in September.
  • The other possible issue is that there may not be enough providers to prescribe this over telemedicine. As the opioid crisis has been widely publicized, physicians have started to decrease their prescriptions in person, either opting for few pills or referring to pain specialists. There would need to be a push to both train and decrease the demonization of medications used for treatment as many practitioners have become less comfortable with prescribing them, not more.
  • There are not enough telemedicine programs that can access the patients even if there are providers willing to train and treat.

While I’m hopeful that this is a step in the right direction to increase access to a group of patients vulnerable to morbidity and mortality, we will still have to change the culture and dynamic that has made physicians gun shy of prescribing these meds.

Changing the narrative, training physicians and making sure they feel comfortably treating these patients safely and expanding telehealth access will all help.

 

ABOUT THE AUTHOR

Dr. Aditi Joshi is an Emergency Medicine Physician who has worked in Telemedicine for over five years, beginning at a startup and moving onto an academic institution. She is the current Medical Director of JeffConnect, part of Thomas Jefferson University Hospital's Telehealth program. She is particularly interested in the issues of patient access and engagement, provider education and fostering international collaboration.

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