For its annual EDICT Grant Program lecture on April 29 at the Egan School of Nursing, Fairfield University called on Joelle Fathi, clinical associate professor in the University of Washington School of Nursing, to offer the presentation “We Have Arrived: Preparing Healthcare Providers for Collaborative Practice and Programmatic Advancement of Telehealth.” Fathi’s presence at the university was designed to offer insight into a subject that is not as common in Connecticut as it is in other states – a survey by FAIR Health placed Connecticut among the bottom five states in 2017 for telehealth claim lines as a percentage of all medical claim lines.
Fathi has seen rapid advances in the cost-effectiveness and digital sophistication of telehealth services in health care.
“Historically, the technology has been expensive,” she noted. “But as we’ve progressed, it has rapidly become much easier to use and cheaper to invest in. Five years ago, I started a telehealth clinic in Seattle and the equipment was much more bulky, space occupying, expensive, clunky, not as streamlined, and it had its quirks in terms of connectivity. Just jumping three or four years ahead, the software is so much more adaptable and there is more interoperability on a multitude of devices, including smartphones.”
The American Hospital Association estimated that 76% of U.S. hospitals use telehealth, but Fathi – who serves on the American Nurses Association Telehealth/Connected Health Committee – observed that telehealth spans a variety of modalities ranging from face-to-face consultations or information exchanges that do not require real-time communications. What percentage of telehealth is being used for which particular practices is unclear, Fathi added, although she observed “we know the uptake is expeditious.”
In her lecture, Fathi noted how her university was preparing the next generation of nurses to become experts in understanding how telehealth fits into today’s health care environment.
“We are teaching our nursing students what the standards are in terms of modality of clinical practice, what the foundational requirements are as well as practice considerations – state licensure, what it means to practice across state lines and how to protect yourself from liability while ensuring it is a safe environment for patients,” she continued. “There are various approaches to that. In the School of Nursing, we’re working on didactic training and skill-based learning in the lab on a real telehealth platform that is triple-encrypted in a simulation lab, with our students getting real-time experience with virtual visits with live patients.”
Encryption is a key element to telehealth, she added, noting the technology needs to consider the basics of patient safety and security while also meeting the latest HIPAA compliance mandates. One area that is also evolving involves reimbursement of telehealth services, with Fathi pointing out changes are coming, though perhaps not at a rapid pace. She stated the Center for Medicare and Medicaid Services (CMS) previously “would only reimburse for telehealth services that were face to face, synchronous and live and in areas that were designated as health professional shortage areas, such as rural areas. They are beginning to recognize other areas that are in great need, like tele-mental health, dialysis centers for people who are in kidney failure, so they are slowly but surely expanding the cadre of services they are willing to reimburse. Medicaid is administered state by state, but the Medicaid plans across the U.S. have largely followed behind CMS.”
As for private health care insurers, Fathi said they have “increasingly gotten on board for reimbursement. However, state-by-state reimbursement for in-person visits in the clinic versus synchronous visits in the telehealth setting have not been equitably reimbursed.”