For years, health care providers have been looking for ways to connect residents in rural areas to medical providers in simpler and less expensive ways. One of the effects of the coronavirus pandemic was to quickly speed up adoption of one of those options: telehealth, or health care services provided through communications technology like phones or video chat.

Telehealth options have gained more traction in recent years, but recent public health orders, social distancing measures, and concerns about infection hotspots have prompted legal changes that made it easier for medical professionals to quickly transition more patients to telehealth.

“There are some regulations that have eased, which made it easier to put telehealth into place quite quickly,” said Zach Wojcieszek, director of revenue cycle at MRH.

Health care providers at Moab Regional Hospital, the Moab Free Health Clinic, and the Moab Veterans Affairs Clinic shared how they are managing the telehealth shift.

sub: Security concerns

The Department of Health and Human Services has officially acknowledged the importance of telehealth during the pandemic, issuing a notice on March 30 assuring health care providers that they would be shown leniency if telehealth services offered in good faith led to breaches of the 1996 Health Insurance Portability and Accountability Act (HIPAA). HIPAA created guidelines for the management of patients’ health information and privacy protection.

Transmitting patient information remotely can be risky. Some platforms used for video-teleconferencing can be prone to security breaches. Some of those platforms, like Zoom, have created special packages for medical providers that promise to be secure and HIPAA compliant.

Still, the Department of Health and Human Services notice says that the Office for Civil Rights within HHS “will exercise its enforcement discretion and will not impose penalties for noncompliance” with HIPAA regulations “in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.”

Moab Regional Hospital

Before coronavirus changed procedures, providers at Moab Regional Hospital were using telehealth technology for some circumstances, such as for consultations with the University of Utah health center for patients with burns or symptoms of a stroke.

Use of the technology has expanded since the pandemic. Telehealth can facilitate things like mental health and therapy sessions; visits like obstetrics or surgery follow-ups must be conducted in-person.

To meet with patients virtually, MRH is using Doxy.me, a secure platform with features like a virtual waiting room, a chatbox, photo capture, and screen sharing. Patients are for the most part connecting with health providers at MRH from their homes using personal devices like cell phones or laptops. That makes the platform widely accessible, but it also makes troubleshooting a challenge for IT staff at MRH.

“We don’t know what device the patient is going to be using and what location they are going to choose, both of which can greatly impact the success and quality of the call,” said Ian Mitchard, clinical informatics registered nurse at MRH.

Under changes made this spring by the Centers for Medicare and Medicaid Services, hospitals can now bill for many telehealth services at the same rate they would charge for an in-person visit.

“Before the COVID-19 crisis it was often difficult to get paid for a telehealth visit,” said MRH’s Wojcieszek.

“Now, most payers recognize that telehealth is a needed service, and we are getting paid for providing it,” he said

“Both telephone and virtual visits are reimbursed at the same rate, encouraging our providers to connect with the patient in the most effective way,” said Mitchard.

Wojcieszek added that patients are seeing the value of remote health care and embracing that option. Mitchard said the hospital is working on creating a survey to find out more about how patients feel about telehealth. That survey will help guide the hospital’s telehealth policy and offerings when coronavirus-related fears and restrictions have lifted.

“It is not entirely clear what the future will hold with regards to telemedicine, but as we are seeing that this pandemic has forever changed our world, I would expect telemedicine to be a role in providing healthcare on some level,” said Mitchard.

He added that while telehealth has played a crucial role in maintaining health services during the pandemic, face-to-face health care will always be necessary.

“An in-person visit is a vital part of treating a patient,” Mitchard said.

Moab Free Health Clinic

The Moab Free Health Clinic uses volunteer health care providers and funding from grants and donors to provide care for uninsured and under-insured patients.

Angela Settle, Development Director at Moab Free Health Clinic, said that patients can make in-person appointments at the clinic, but staff are offering telehealth as an alternative for many kinds of appointments.

Settle said most patients at the Free Clinic are seeking primary care for ongoing conditions such as diabetes or hypertension. Consultations for prescription refills or dietary recommendations can be conducted via telehealth, and onsite nurses can handle logistics.

To offer more advanced telehealth services, the clinic has recently purchased specialized equipment for remote exams.

“We were able to invest in some really amazing camera equipment,” Settle said, describing a dermatology specific camera, an attachment to examine the ears and nose, and a stethoscope that a nurse can administer to a patient in-person and transmit the sound to a doctor digitally.

“We probably never would have purchased that equipment had we not been forced into telemedicine,” Settle said.

She was particularly excited about the dermatology camera, noting that the clinic treated two patients for skin cancer last year. A dermatologist based in Grand Junction has been volunteering services to the clinic every other month. With the new camera, patients can send detailed images of a suspicious skin lesion to the provider any time and quickly find out whether it warrants a follow-up appointment, rather than waiting weeks for an in-person exam.

“We feel like we can actually provide more timely medicine” via telehealth, Settle said, adding that patients seem receptive to the new technology.

“We haven’t had one patient walk out that hasn’t felt like they’ve gotten as good of care via telehealth as they would have in person,” she said.

The Free Clinic is using a Zoom package specifically for health care providers to conduct doctors’ visits. Patients come to the clinic building to use computers and equipment on site.

“The technology burden on the patient is non-existent,” Settle said.“The only hitches we’ve really had are with the internet.”

With so many people working from home or using the internet to stay informed and/or entertained during the shut-down, sometimes the clinic’s internet connection falters.

“We haven’t let it stop us, we just kind of power through,” Settle said.

She added that staff from the Moab Valley Multicultural Center have continued to partner with the clinic.

“The Multicultural Center has been amazing in adapting beside us and learning to use Zoom,” said Settle, noting that a significant portion of patients at the Free Clinic need language interpretation services. “We’re super grateful to them over there for doing what they do.”

With restrictions beginning to lift, the clinic is restarting some of the programs they had suspended during the initial shutdowns, like testing for sexually transmitted diseases. Testing is available on Tuesdays from 1 to 2 p.m., or by appointment.

In-person mental health appointments will also be available again.

While bringing back some of these services, the clinic is still exercising caution and taking the familiar steps of frequent hand sanitizing and wearing masks; they are also checking employees’ temperatures when they report to work.

While telehealth has in some ways improved services at the Free Health Clinic, Settle said they are looking forward to resuming more in-person appointments.

“We love having our doctors and nurses,” said Settle.“Everybody’s craving in-person contact right now, and we’re the same way.”

“Patients feel like they get more out of it when they’re talking to a doctor face to face in the same room,” Settle said.

Veterans’ Affairs Clinic

The Department of Veterans’ Affairs has been using telehealth for years. In 2017, they introduced VA Video Connect, a platform exclusive to Veterans’ Affairs, to facilitate remote healthcare. The platform was designed so that users could securely lock a session, making it HIPAA compliant.

The video platform also has features that facilitate the sharing of medical charts or images like X-rays and is designed for patients to consult with doctors from their homes, rather than contacting providers from clinics.

“This is set up so it’s very simple where it’s just a laptop or a smartphone or a regular computer,” said Nichole Artaz, supervisory program specialist for telehealth services with the VA Western Colorado Health Care System, which oversees the Moab VA Clinic.

Dr. Renee Dunn, who lives in Monticello, Utah, was providing in-person medical visits to patients at the Veterans Affairs clinic in Moab two days a week. She said that even traveling to rural clinics could be a burden for some VA patients.

“A lot of my patients have to drive several hours,” she said. “Using this VVC method, since the nurses and everybody was already used to it, it was really easy to implement it.”

The VA has been designing other technologies to help veterans with health maintenance. An application for veterans called Annie sends automated messages like medical reminders or motivational prompts to users to help them track and manage their health. The app is named for World War II Army nurse Annie G. Fox, who treated soldiers at Pearl Harbor when the US naval base was attacked in 1941.

Artaz said the VA is working on technology that could be distributed to veterans and allow them to measure their own vitals—like blood pressure, oxygen levels, weight, and temperature—and send the results digitally to a medical provider.

While the VA has already largely embraced telehealth technology, Dunn said the coronavirus still had the effect of increasing telehealth use by VA patients. She expects that now that patients have experience with the technology and how it can cut travel and wait times, that increased use will carry on beyond the pandemic.

“We probably will be seeing more use of video visits than we have in the past,” Dunn said.