Pacific Telemedicine Newsletter #6

September 2019

Welcome to the Pacific Telemedicine Network American Samoa Newsletter. PTN is a Telemedicine and Education Program funded through USDA providing care where and when it is needed.  This month we look at the use of secure, HIPAA compliant Video for conferencing and diagnostics in Telemedicine.

• To view the Behavioral Health discussion video go to:  https://youtu.be/B0dR2DM12Ek
• To view the Genera Examination Camera Training video go to: http://rain.org/trainingvideo/general%20exam%20camera%20training%208-22-2019.mp4

===================================

Telemedicine Video Basics:

Use of secure Telemedicine video expands access for patients in significant ways. With telemedicine, doctors and patients can use two-way video, email, smartphones, and Internet-based secure email to exchange information and keep the Doctor in touch with the Patient.  Video conferencing technology is ideal for live, interactive, Doctor to Patient communication, medication adherence monitoring,  behavioral health support, and exchange of diagnostic images.

Telemedicine is changing the current paradigm of care, establishing an exchange between primary care and behavioral health care, allowing for better access and better health outcomes and providing a new health care environment to support social determinants of health. Telemedicine expands access to healthcare patients, allowing them to receive care when and where it is needed, without costly travel. Using Telemedicine, Rural hospitals can expand emergency and intensive services and bring Specialists in to assist in care through the use of secure video.

Telemedicine video conferencing uses we will learn about and practice are:

• Primary and Follow-up care.
• Remote consultations and patient monitoring.
• Triage and Urgent Care/EMS.
• Multidisciplinary meetings for training and education.
• Behavioral Health.
• Specialists Consultation,
• Infectious Disease Management.
• Assisted Living Care.
• School-based Healthcare.

Reasons to integrate telemedicine enabled video conferencing into your care routine:

1.  Better Patient Access:
2. A primary benefit of video conferencing is both expanded care access and improved Doctor communication with the patient.  Telemedicine enabled Video conferencing is also essential in disaster areas, allowing health care providers and emergency services personnel to reach those affected by fires, earthquakes, hurricanes, and when treating overdose due to opioid use disorder or substance use disorder.

2. Connecting physicians to specialists regardless of location.

Video conferencing can connect physicians with colleagues, health facilities and specialists who are in distant locations from the care site allowing for an unprecedented level of collaboration and knowledge-sharing between Doctors resulting in better outcomes and improved community health.

3. Providing medical education.

In American Samoa, we will use HIPAA compliant video conferencing to provide education for Nurses and Doctors.  The use of video conferencing will increase understanding of Telemedicine procedures, use of Telemedicine for treating SUD/OUD, Behavioral Health care, and Community Wellness.

4. Enabling more effective critical care.

Patients with chronic care needs have difficulty traveling long distances to see their doctor. Handicapped, elderly and patients in late stages of pregnancy significantly benefit from video access to their Doctor. Telemedicine is also vital for pediatrics. Many children’s ailments are straightforward enough to be diagnosed remotely – without requiring parents to bring sick children to the clinic.

5. Making Behavioral Health care more accessible.

With a focus on doctor-patient interaction, Behavioral Health services are ideal for telemedicine through video conferencing. Doctors can connect with patients using video, hold individual and group therapy sessions, and be available when the patient needs to talk.

6. Specialist referral services.

Video conferencing can expedite the specialist referral process. Using video, a primary care doctor can consult with a patient and specialist, helping with diagnosis and referrals.

==================================

Project Notes:

Do you know a school, church, or community organization that should also take part in the telemedicine project? Send an email with your suggestion to timothy@rain2.org , and we will contact them.

The Next video conference call is Thursday, Oct.  17,  9 a.m. Invitations will be sent out by email.  We will review the secure video conferencing system we will be using for the Pacific Telemedicine Project.

Questions on Clinical Issues?  Send an email to the Project Medical Director, Dr. Chris Landon at chris.landon@ventura.org .

Pacific Telemedicine Newsletter #5

August 2019

Welcome to the Pacific Telemedicine Network American Samoa Newsletter. PTN is a Telemedicine and Education Program funded through USDA providing care where and when it is needed.  Congratulations to the PTN program for a second USDA Telemedicine award which will provide Olympus Digital Microscopes and CellSens Imaging software and Intraoral Dental Cameras for both the LBJ Medical Center and Department of Health.  This will allow us to begin integrating Telepathology and Teledentistry into the services PTN can provide in American Samoa.  Special thanks to Dr. Akapusi Ledua and Dr. Anaise Uso for their help in planning for the new equipment.

New CMS rules impacting Telemedicine based OUD/SUD treatment:

Medicare is proposing to provide reimbursement for Healthcare providers who use telehealth in substance abuse treatment.  CMS has recommended creating new codes for bundled episodes of care for treatment of opioid use disorders, adding connected health services, including a payment option for Medication-Assisted Treatment (MAT) therapy and services for the treatment of OUD including overall management, care coordination, individual and group psychotherapy.

CMS is proposing that the individual psychotherapy, group psychotherapy, and substance use counseling included in these codes could be furnished as Medicare telehealth services using communication technology as clinically appropriate.

CMS is also seeking comment on bundles describing services for other SUDs and on the use of MAT in the emergency department setting, including initiation of MAT and the potential for either referral or follow-up care, as well as the potential for administration of long-acting MAT agents in this setting, to help inform whether they should consider proposing to make separate payment for such services in future rule making.

Infectious Disease Society of America Releases Position Statement in Favor of Telehealth:

The Infectious Disease Society of America (ISDA) has published a position statement on the use of telehealth in infectious disease practice. The statement, published in the journal Clinical Infectious Diseases, is in favor of the appropriate and evidence-based use of telehealth. The ISDA announced its support for telehealth in areas including HIV care, directly observed treatment for tuberculosis management, antimicrobial stewardship programs, and infection prevention and control. The ISDA lists these as established use cases that demonstrate the ability of telehealth to improve access to care, patient satisfaction, outcomes, and reduce costs. 

Evidence-based Telemedicine Healthcare:

An Evidence-based approach to telemedicine delivers the best treatment outcomes. Telehealth provides a unique opportunity to provide evidence-based care to patients in the most remote sites and the case of Behavioral Health, allows the patient to remain in a familiar location. Once a patient has entered data such as symptoms and personal health history, use of video conferencing software can bring Doctor and Patient together and help determine a diagnosis that will lead to the creation and delivery of an evidence-based treatment plan that optimizes patient outcomes. As we begin to establish regular diagnostic exchanges between Pago Pago and Dr. Landon’s team of specialists in California, we should look at the opportunity to educate the community about this new resource.  Letting community groups, as well as patients, know about the Pacific Telemedicine Network availability to provide Primary Care and Behavioral Health Care assistance working with the LBJ Medical Center and Department of Health Clinics will lead to increased use. Let the community know that telehealth delivers quality, evidence-based care, and the treatment received through telemedicine and telepsychiatry involves the most up-to-date technology.

Telemedicine and Dental Care

Teledentistry can improve access to comprehensive oral health care through community health center oral health care integration.  If community clinics have intraoral dental cameras and are connected to a Telemedicine Network Providers can focus on the importance of preventive oral health care during regular clinic visits, and as a result, the community will see a reduction in visits to the emergency department (ED) for dental emergencies.  Teledentistry expanded to the schools has the potential to bring oral health education and regular check ups to the most rural communities.

    Telemedicine and Asthma Treatment:

For patients with Asthma, access to Specialists is often a problem which telemedicine can solve.  Telemedicine is cost-effective, eliminates travel, and provides doctors with the opportunity to bring in Specialist assistance as needed.   In many cases, the patient only needs a refill on their rescue inhaler or inhaled corticosteroids. Rather than taking time off from work and traveling to the clinic, telemedicine provides a way for a patient to see their doctor and refill prescriptions.

Telemedicine in Asthma treatment has proven to maintain quality of care, increase access to specialists, and provide patients a way to see their doctor, receive the proper medicine for their symptoms and have reliable follow up.   For Asthma treatment, Telemedicine is often classified into five categories: tele-case management, teleconsultation, tele-education, telemonitoring, and tele-reminder services.  Utilization of all five categories for asthma follow-up potentially results in improved clinical outcomes such as the Asthma Control Test (ACT) scores, lung function, and medication adherence.

==================================================

Project Notes:

Do you know a school that should also take part in the telemedicine project? Send an email with your suggestion to rain@rain.org, and we will contact them.

The Next video conference call is Thursday, Aug.  22,   9 a.m. Invitations will be sent out by email.  Dan Kurywchak will provide training in the use of the new General Exam Cameras during this call.

Questions on Clinical Issues?  Send an email to the Project Medical Director, Dr. Chris Landon at chris.landon@ventura.org .

Pacific Telemedicine Newsletter #4

June 2019

Welcome to the Pacific Telemedicine Network American Samoa Newsletter. PTN is a Telemedicine and Education Program funded through USDA providing care where and when it is needed.  This month we look at Social Determinants of Health in Telemedicine.

=====================================

Social Determinants of Health and Telemedicine

What is the role of  Social Determinants of Health in Telemedicine?  Are there specific areas of importance such as with OUD/SUD treatment or Infectious Disease treatment and management? 

CMS now permits Medicare Advantage and Part D plans that offer supplemental benefits that address the social determinants of health (SDOH).  Updates include provisions that would allow Medicare Advantage and Part D plans to care for patients who may be impacted by Opioid Use Disorder. Newly allowed flexibilities include supplemental benefits for patients with opioid use disorder and cost-sharing reductions for patients with chronic pain.  Medicare Part D plans will be encouraged to offer at least one overdose reversal drug on a low cost-sharing tier, improving patient access to these types of medications.  The new CMS rules have the potential to increase the role of telehealth and telepsychiatry in OUD/SUD treatment and recovery programs. 

CMS stated it would allow for telehealth use for prolonged preventive care, patient check-ins using remote patient monitoring tool and treatment in home health settings. Each of these efforts aims to promote more use of remote patient monitoring which can help expand patient care access and treatment outside the four walls of the hospital or clinic.  This rule also innovates and modernizes home health care by allowing remote patient monitoring.

ICD-10 Codes can be used to track many Social Determinants of Health.  The ICD-10-CM Code Category includes: Z55 – Problems related to education and literacy, Z56 – Problems related to employment and unemployment, Z60 – Problems related to social environment, Z62 – Problems related to upbringing, Z63 – Other problems related to primary support group, including family circumstances, Z64 – Problems related to certain psychosocial circumstances, Z65 – Problems related to other psychosocial circumstances.

What other ICD-10 codes or data fields for your EHR are needed for American Samoa?  Send ideas and recommendations to timothy@rain.org  and we will continue the discussion regarding Social Determinants of Health in Telemedicine. 

====================================

Telemedicine and OUD / SUD Treatment

Opioid Use Disorder and Substance Use Disorder are generally behavioral health or mental health issues, and treatment often includes mental health care. Telehealth can play a life-saving role in connecting patients to the resources they need.

Tele-Behavioral Health / Tele-Psychiatry is an important new part of telemedicine. Virtual care through video and remote diagnostics offer mental health specialists, like psychiatrists, psychologists, and behavioral health counselors, a tool for extending care beyond the office or clinic and into the communities where access is limited. For patients dealing with mental health issues, treatment can be accessed at home, through a laptop or tablet, securely and in privacy which can make a tremendous difference in therapy and treatment outcomes.

Along with using telehealth for individual treatment, Specialists can now use secure video conferencing for group therapy sessions, allowing treatment to be provided to more patients in multiple locations without the need for provider or patient to travel.

Along with the use of tele-behavioral health and telepsychiatry tools, we can apply Telemedicine to support front-line Providers who deal with OUD/SUD emergencies, such as community health workers, and EMS Medics.

Update on the Drugs and Alcohol Task Force

 Mr. Motusa Tuileama Nua and the Department of Health Team are an important part of the Drugs and Alcohol Task Force.  The Department of Health role in Testing, Treatment/Counseling and Coordination is central to the success of the Task Force.  The Alcohol and Drug Policy has been approved by the Senate and is now a Law that all Government Departments and Agencies have to follow.  During our June video conference call, we will discuss how the Telemedicine Project can assist.

=================================

Telemedicine and Seniors:

For some patients traveling to see a doctor can be a challenge, particularly for older adults who face transportation as well as mobility challenges.  Health care delivered via Telemedicine from a doctor off-site provides a solution for seniors to get the health care when and where they need it.

Seniors are statistically more likely to experience chronic conditions such as heart disease and diabetes which require routine monitoring from healthcare providers. The increased opportunities for communication by video, smartphone, and patient-worn devices which telemedicine allows for permits health care professionals and caregivers alike to assess the status of patients when needed without repeated visits to the doctor’s office or hospital. This can include monitoring everything from medication taking and blood levels to telemonitoring vital signs, interacting with blood pressure cuffs and glucose monitors, and notifying caregivers about changes which may indicate illness.

The “Reducing Unnecessary Senior Hospitalizations (RUSH) Act of 2018 is an effort by Congress aimed at reducing rehospitalizations at qualified SNFs by giving them more incentives to use telemedicine and telehealth to improve patient care.  We will look at this and other Senior Health Care focused telemedicine issues in our next Newsletter.

==================================

Project Notes:

 If you would like to take part in the project Advisory Committee send an email to timothy@rain.org.

Do you know a school or library that should also take part in the telemedicine project? Send an email with your suggestion to rain@rain.org and we will contact them.

Are there Clinical issues you would like to see the project provide resources for? Send an email with your suggestion to chris.landon@ventura.org .

To sign up for the Telemedicine Technology Skills Course send email to camp@campinternet.net with your name and email and we will contact you regarding class requirements.

Next video conference call is Thursday, June 27, 9 a.m. .  Invitations will be sent out by email.

Pacific Telemedicine Newsletter #1

Welcome to the first issue of the Pacific Telemedicine Network American Samoa Newsletter.

January 2019 begins a 3-year Telemedicine and Education Program funded through a USDA Distance Learning and Telemedicine Program grant. The grant brings a full suite of diagnostic equipment for the LBJ Tropical Medical Center and 9 Community Clinic sites. Working with the American Samoa Department of Health and the LBJ Tropical Medical Center, the project will establish video consultations and health information exchange with Specialists in California as well as an Opioid Use Disorder treatment and education program.

The Pacific Telemedicine Network Newsletter will follow the progress of the new program and provide a place for you to ask questions and make suggestions. Dr. Chris Landon, (chris.landon@ventura.org ) Director of the Landon Pediatric Foundation, based in Ventura, California, is the Medical Director for the Program. Timothy Tyndall, (timothy@rain.org ) Director of RAIN Live Oak Technology, is the Network and Education Director for the Program.

During the coming year we will report on some of the most important issues for successful Telemedicine. Issue #2 will look at the use of Health Information Exchange for telemedicine and at the project Education Program. The grant brings Education resources developed by RAIN Live Oak Technology to provide essential telemedicine technology skills training for Nurses, Physician Assistants, Medics and Care Providers. One goal of the project is to establish an ongoing learning resource for American Samoa that builds health care job skills for the future.

Future issues of this Newsletter will cover subjects such as Telemedicine Reimbursement, updates on telemedicine and mobile health technologies now available in American Samoa and news on the continuing progress in the use of telemedicine for Opioid Use Disorder treatment and education.

If you would like to take part in the project Advisory Committee send an email to timothy@rain.org .

Do you know a school or library that should also take part in the telemedicine project? Send an email with your suggestion to rain@rain.org and we will contact them.

Are there Clinical issues you would like to see the project provide resources for? Send an email with your suggestion to chris.landon@ventura.org .

To sign up for the Telemedicine Technology Skills Course send email to camp@campinternet.net with your name and email and we will contact you regarding class requirements.

Telemedicine News and Research Update #1

Behavioral Health and Clinical Care Integration

The new telemedicine grant for American Samoa has a strong focus on use of telemedicine to help with opioid use disorder treatment. We will report on the integration of Behavioral Health and Clinical care and provide updates on programs and best practices throughout the year.

The following is an Introduction to a recently published study “Integrating Clinical and Mental Health: Challenges and Opportunities” completed by the Bipartisan Policy Center. You can read the full study at
https://bipartisanpolicy.org/wpcontent/uploads/2019/01/ – Integrating
Clinical-and-Mental-Health-Challenges-and- Opportunities.pdf or email me and I will send you a copy.

“Nearly 45 million American adults suffered from some form of mental illness in 2016. Although there is little change in the estimates of those with mental illness over the last few years, rates of death due to drugs, alcohol, and suicide are increasing. In 2016, about 45,000 Americans age 10 and over died by suicide.1 Twenty-five states experienced at least a 30
percent increase in suicide rates between 2014 and 2016.2

The national opioid crisis has resulted in significant attention to federal policy associated with substance use disorder (SUD). Mental illness along with SUD comprise a broad category of illness commonly referred to as “behavioral health.” In 2016, 44.7 million American adults experienced a mental illness, 20.1 million experienced a SUD, and 8.2 million experienced both— and these numbers are likely underestimated due to lack of identification and issues of stigma. Collectively, more than 1 million people have died from drugs, alcohol, and suicide over the past decade. If these trends continue, the death rate could grow to claim 2 million more lives by 2025.

The purpose of this paper is to examine the barriers to the integration of clinical health care and mental health services, and to identify policy options for consideration in advancing integration of services. In 2018, the Bipartisan Policy Center hosted a series of public and private discussions on this topic. As part of this research, BPC consulted patient
advocates; clinical and behavioral health care providers; federal, state, and county agency officials and staff; insurers; academics; and other experts. The goal was to identify barriers to integration caused by federal policy, to identify policy options to mitigate or remove those barriers, and, through policy changes, to advance evidence-based treatment for mental health in the United States.”

Issue 1 – January 28, 2019

Instructional videos for Clinic In A Bag:

https://www.youtube.com/user/getmovingtv