On May 4th, 2017, Dr. Norman Okamura, Principal Investigator, Pacific Basin Telehealth Resource Center (PBTRC), testified at a Senate Appropriations subcommittee hearing on Telemedicine in the VA. Dr. Okamura noted that the VA is the national leader in telemedicine utilization and the largest integrated health care system in the U.S. He also highlighted the need for increased collaboration with the VA and other agencies such as the Department of Defense and academic institutions, and further advocated for increased synergy with HRSA funded Telehealth Resource Centers that serve all 50 states and Pacific Island territories.
Dr. Okamura provided his perspective on the importance of telemedicine in the Pacific Islands Region. He discussed how the vast distance and the numerous times zones that separate the Pacific Island Territories from the United States further increases the need for telehealth services for access to care for Veterans living in the territories. Finally, Dr. Okamura highlighted the ongoing challenges for veterans in the Pacific Island Freely Associated States (FAS). Under current law the VA is unable to provide these veterans services in FAS where they live, not even by telehealth, because the FAS jurisdictions are considered foreign countries. Dr. Okamura’s testimony suggests several options for the VA to improve services to the FAS veterans including the authorization of Veteran Health Benefits to provide telehealth services to the veterans who live in the FAS.
To view the full testimony: https://www.appropriations.senate.gov/hearings/telemedicine-in-the-va-leveraging-technology-to-increase-access-improve-health-outcomes-and-lower-costs
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On July 7, 2016, Governor David Ige of the State of Hawaii signed into law Senate Bill 2395: Relating to Telehealth as Act 226 (16). This Act:
- Requires the State’s Medicaid Managed Care and Fee-for-Service programs to cover services provided through telehealth;
- Specifies that any telehealth services provided shall be consistent with all federal and state privacy, security, and confidentiality laws;
- Specifies medical professional liability insurance policy requirements with regard to telehealth coverage;
- Clarifies that reimbursement for services provided through telehealth shall be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient;
- Requires written disclosure of coverages and benefits associated with telehealth services;
- Ensures that telehealth encompasses store and forward technologies, remote monitoring, live consultation, and mobile health;
- Ensures that telehealth is covered when originating in a patient’s home and other non-medical environments;
- Clarifies requirements for physicians and out-of-state physicians to establish a physician-patient relationship via telehealth;
- Ensures that reimbursement requirements for telehealth services apply to all health benefits plans under chapter 87A, Hawaii Revised Statutes; and
- Makes other conforming amendments related to telehealth for clarity.
To view the Act in its entirety: http://www.capitol.hawaii.gov/session2016/bills/GM1328_.PDF
To watch the signing ceremony: https://youtu.be/ZUufRdqIy4Q
Photo (L-R): Senator Rosalyn Baker, Hawai‘i State Legislature; Christina Higa, Co-Program Director, PBTRC; Governor David Ige, State of Hawai‘i; Deborah Birkmire-Peters, Co-Program Director, PBTRC
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On December 15, 2016, the Pacific Basin Telehealth Resource Center (PBTRC) participated in a video teleconference ceremony to launch the opening of the Pohnpei Telemedicine Room in the Pohnpei Hospital. The ceremony was attended by the Pohnpei State Governor, the Chairman of Health, Senators, and the Director of Pohnpei State Hospital, among other dignitaries. Dr. Perman, who attended the 2016 USAPI Telehealth Champion Building and Planning Workshop, led the efforts to quickly establish telecommunication links, the designated room, and funding to support the initiative. With the opening of the Telemedicine Room, they will embark on their first two consultations with Shriners Hospital for Children in Honolulu. Dr. Craig Ono from Shriners Hospital for Children in Honolulu will see two of his former patients in Pohnpei by video teleconferencing. Providers also participated in the ECHO behavioral mental health training sessions that are delivered in conjunction with the University of Hawaii, Hawaii State Rural Health Association, State of Hawaii Department of Health, and PBTRC.
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Introduced by Hawaii’s own Senator Brian Schatz (D-HI) as well as Senator Orrin Hatch (R-UT), the Expanding Capacity for Health Outcomes (ECHO) Act was signed into law by President Obama on December 14, 2016. This bipartisan bill aims to increase access to high quality healthcare and health education in rural or underserved areas. Project ECHO, which was started in 2003, allows providers to learn from specialists and consult about cases via video teleconferencing. The Act requires that the Secretary of Health and Human Services examine whether technology based projects such as Project ECHO have an impact on workforce development, access to healthcare, and the treatment of specific diseases such as chronic diseases and mental health and addiction issues. The Secretary will also report on any problems faced when adopting technology based learning models. Additionally, cost effectiveness and effective practices of those who have adopted such models will be included in the report.
Senator Schatz’s Press Release: http://www.schatz.senate.gov/press-releases/president-obama-signs-schatz-hatch-tele-training-bill-into-law
For the full text of the Act please visit: https://www.congress.gov/114/bills/s2873/BILLS-114s2873enr.pdf
Photo (L-R): Senator Brian Schatz (D-HI); Senator Orrin Hatch (R-UT)
Photo Credit: https://twitter.com/SenBrianSchatz/status/806966405488742400
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In December 2016, the Association of State and Territorial Health Officials (ASTHO) released a Telehealth Resource Guide that explains the practice of telemedicine and gives an overview of telehealth programs for seven different states including Hawaii. The guide highlights the progress made and challenges faced in each of these states and points out some potential next steps. The guide also contains practical information such as a glossary of telehealth terms and links to information on telehealth legislation and Telehealth Resource Centers for each region. A number of resources that summarize the growing evidence for telehealth as an effective manner of delivering healthcare are also included. This resource guide also contains information on topics such as reimbursement, Medicaid and Medicare coverage, and licensure requirements.
To view the guide: http://www.astho.org/Health-Systems-Transformation/Medicaid-and-Public-Health-Partnerships/Telehealth-Resource-Guide/
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The Pacific Basin Telehealth Resource Center recently provided technical support for the Pacific Basin Medical Association (PBMA) conference in Majuro, held from October 3 to 5, 2016. The conference came two weeks after the PBTRC hosted the U.S. Affiliated Pacific Islands (USAPI) Telehealth Champions Building and Planning Workshop in Honolulu. At the USAPI Workshop, participants were given a demonstration of video teleconferencing (VTC) technology. After learning about desktop VTC, the facilitators, Dr. Tom Jack, Dr. Robert Maddison, and Dr. Kino Reuben of the PBMA conference decided to use the technology to allow others to attend the conference remotely and to facilitate presentations from remote locations. In order to ensure that the technical aspects of the conference ran smoothly, PMBA invited Jose Aquino from PBTRC to be on site in Majuro to assist with setting up the desktop video teleconferencing as a communication platform for the conference. Miguel Brostrom, a PBTRC staff member in Honolulu, monitored the conference and assisted with troubleshooting. Prior to the event, PBTRC also coordinated multiple system tests. Christina Higa, the Co-program Director of the Pacific Basin Telehealth Resource Center gave a presentation via teleconference on an introduction to telehealth and summary of discussions and plans that resulted from the recent USAPI Telehealth Workshop held in Honolulu.
One fun aspect of the conference was that Zumba sessions were delivered via video teleconferencing. Dr. Jack mentioned this as an idea during the Telehealth Workshop in Honolulu. The Zumba demonstration via video teleconferencing enabled participants to evaluate the quality of the video connection. Even with participants moving and dancing, it was still possible to see their movements clearly. Christina Higa asked the doctors in the room whether the video performance was good enough to observe patient gait movement; overwhelmingly they agreed. Congratulations to PBMA for making good use of video teleconferencing to expand access and participation in the conference!
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