By Eric Wicklund, mHealth Intelligence | June 14, 2019
The National Consortium of Telehealth Resource Centers, consisting of 12 designated regional TRCs and two national centers, acts as a clearinghouse for telehealth and telemedicine providers and programs. These centers offer healthcare providers and others in the connected health industry both national and regional guidance and information.
Many also host their own events, amd send representatives to other digital health events and conferences. An example of both takes place on June 17-18 in Portland, ME, when the Northeast Telehealth Resource Center hosts its annual conference.
Among those speaking at this event is Doris T. Barta, director of the National Telehealth Technology Assessment Center (NTTAC), based out of the Alaska Native Tribal Health Consortium (ANTHC) in Anchorage, AK. She’s also a principal investigator for the Salt Lake City-based Northwest Telehealth Resource Center, and prior to that was director of telehealth services for St. Vincent Healthcare in Billings, MT.
mHealthIntelligence recently talked to Barta about the TTAC and the role it and the TRC network play in advancing telehealth and telemedicine adoption.
Q. What does the National Telehealth Technology Assessment Center do?
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A. “The TTAC is an expert source of telehealth technology knowledge. It strives to create better-informed customers of telehealth technology by offering a variety of services in the area of technology assessment. It aims to become the place for answers to questions about selecting appropriate technologies for telehealth programs. Through the use of toolkits developed by telehealth experts, It provides interactive elements that allow users to learn the fundamentals of how various technologies work, as well as how to assess them for use in telehealth programs.”
Q. How does it help healthcare providers adopt new telehealth programs?
A. “We help healthcare providers through several means. We provide feedback to individuals seeking information about telehealth through one-on-one conversations; by sending them to our website, where we have multiple toolkits designed to help an individual or organization research the use of telehealth for clinical services; and by referring an individual or organization to the regional TRC in their state or area who can help further develop their cause.
We also provide the Technology Showcase at regional conferences, which offers an opportunity for conference attendees or people interested in telehealth technology to be able to review and assess similar medical peripherals side by side in a vendor neutral environment. The opportunity to provide this technical overview at regional conferences allows TTAC to reach individuals throughout the nation who have an interest in telehealth technology assessment.
TTAC displays and demonstrates a range of current and up and coming telehealth technologies through the showcase. It features a range of medical peripheral devices, including innovative watch equipment that is new to the market or soon to be released. It’s designed for participant interaction. Program staff answer questions about the technology present, as well as technology options for those organizations new to telehealth, or who are planning an expansion of their telehealth program.”
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Q. What are the telehealth trends – good and bad – that you’re seeing now?
A. “We are seeing movement toward web-based video platforms and USB plug-and-play videoconferencing systems. We are also seeing telemedicine platforms being offered through the electronic health record as part of the EHR platform for direct-to-consumer and video conferencing. We are also seeing an increase in remote patient monitoring (RPM) platforms, particularly with cellular connectivity.
This is all good, as the technology and types of service are evolving. The bad in this is that there are many telehealth solutions out there that organizations have already purchased, and they need to find a way to merge the old (legacy) systems with new and more mobile technology. This can be a complicated process. Although the cost of providing telehealth has come down extensively, it is still costly to provide telehealth to a large rural population when medical peripheral equipment remains somewhat expensive.”
Q. What are the biggest challenges that you’re seeing now in telehealth adoption – what’s keeping hospitals and health systems from launching new programs?
A. “One of the biggest challenges continues to be provider buy-in. If a provider already has a busy practice, they do not see the value in providing telehealth, which can increase their workload. Another reason for lack of provider buy-in is the lack of equipment and platforms that seamlessly integrate with EHRs. People have to work with different solutions to provide telemedicine, when they only want to use one electronic system.
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From the equipment side of things, there can still be a prohibitive cost to providing telehealth, including expensive platforms and licensing fees that make it too expensive to do telemedicine. Another factor is staff turnover, both professionally and through site coordination. When there is staff turnover, it can be costly in retraining staff to conduct telehealth clinical visits.”
Q. You’re part of a national network of resource centers aimed at helping healthcare providers move forward with telehealth. What could this network do to improve adoption? Does it need more federal support or resources?
A. “The network will do what it is very good at doing, and that is to continue to be a resource for individuals seeking information about telehealth. Through the 12 regional TRCs and the two national TRCs, we have the capacity to serve the needs of individuals and organizations both on site and over videoconference systems, providing education, training and technical assistance. Since we are connected through the National Consortium of Telehealth Resource Centers, we seek answers to questions we get from all of the TRCs, so that we can insure that the individual and/or organization receives the most current and appropriate responses to their questions.
With regard to federal support or resources, the TRCs have been in existence for more than 14 years, yet we have not received any cost-of-living increases. If we were to look at cost-of-living increase analysis, we would be receiving approximately $90 more a year today than we were 14 years ago. Additionally, we are continuing to be asked to do more and more, yet the finances we receive to do this work remain static.”
Q. Is there a new technology out there on the horizon that will have a big effect on telehealth in the future? Is there a trend or technology out there that you expect to die out?
A. “There are several new technologies that will have an effect. For example, broadband Internet will change telemedicine, both in quality of transmission and cost of providing this service. Broadband Internet speed will make it more feasible to provide services to rural communities, a challenge we face today due to the cost of providing this service to rural areas, as well as the quality of internet services in many rural communities. We will be able to use broadband Internet speed to provide services because everyone will be able to access it.
Another technology that will change telehealth is the direct-to-consumer model – caring for patients in their homes. With the explosion of direct-to-consumer care, it is already changing how we do healthcare in general, as well as telemedicine services. As direct-to-consumer healthcare services become more and more commonplace, it will change how we do healthcare in general.
Although the large legacy systems still have their place, we are seeing less and less need for a pre-built all-in-one telehealth cart. People are seeking cost savings by streamlining their telehealth services and only purchasing what is necessary. For example, many telehealth systems are now using an iPad or other type of tablet providing services over the internet, rather than a dedicated system using dedicated T1 solutions.”
Q. Montana offers an ideal environment for telehealth – large, rural, with population centers spread far apart. How is your state applying telehealth to address patient care and provider workflows? How could it serve as a model for other states?
A. “Montana was an early adopter of telemedicine, beginning in the early 1990s. We have been doing telehealth in Montana for almost 30 years. We began with large telehealth platforms, and found out that we needed to make it as easy as possible for the clinician to provide telehealth services. We are now creating clinical workflows that are as similar as possible to a face-to-face visit; the difference is when the provider walks into the room, the patient is virtual.
With the advent of cloud-based systems, we are not tied to “telehealth networks” like we were when we first started. We can now provide telehealth to any patient, in any community, at any time – if that clinic has the capacity to do telehealth. Because we have been active for many years, just about every critical access hospital and associated clinic in Montana has the ability to do telehealth. Many organizations in many other states have come to Montana to examine our telehealth services, and have replicated the type of programs that we provide.”
Q. In your opinion, what state or government agency is doing telehealth right, and why?
A. “Simply because of the need for better access to healthcare services in rural communities, Montana and Alaska are both states that have a great deal of experience in telehealth. Alaska started out with store-and-forward solutions, mainly because of broadband capacity. However, through the years access to the internet has improved, so they are also very engaged in video solutions for telehealth applications. Due to their large geographic regions and small population centers, they have been very innovative in developing telehealth solutions that provide access to specialty services in their very rural communities.
Georgia also has a good model – they have implemented a statewide network. This decreases competition, because everyone is on the same network and they use it to provide telehealth services throughout the state. This also creates economies of scale since everyone is using the same network, and all of the telemedicine encounters are scheduled by the same organization.”
Q. Likewise for hospitals and health systems – is there one out there that really strikes you as knowing how to do telehealth, and why?
A. “Mercy Virtual Health is a very impressive and innovative model. They are a hospital without walls, pushing telehealth to the forefront of their delivery model. They are using telehealth for direct-to-consumer, as well as remote patient monitoring, prescription services and all clinical encounters. They started out providing it within their own network of hospitals, but are now expanding it to include other systems of care. This model can definitely be the wave of the future of healthcare services.”
Barta will be participating in the pre-conference telebehavioral health workshop, taking place from 9 a.m. to noon on Monday, June 17.
The two-day conference opens at noon on June 17 with an opening keynote from Kathy Hsu Wibberly, PhD, director of the Mid-Atlantic Telehealth Resource Center. The second-day keynote will be given by Chris Gibbons, MD, MPH, Chief Health Innovation Adviser for the Federal Communications Commission and founder and CEO of The Greystone Group.
The conference will feature two telehealth technology labs and sessions that explore topics like legal, regulatory and credentialing issues, quality management, teleopthalmology, asynchronous telehealth, virtual visits, community teleparamedicine, provider-payer collaboration and telehealth in nursing homes and skilled nursing facilities.