IHS expanded telehealth to provide care during COVID-19 pandemic

by Rear Adm. Michael Toedt, M.D., F.A.A.F.P., Chief Medical Officer, Indian Health Service

The Indian health system provides care in a wide range of settings,
including many rural and remote locations settings. Telemedicine is
therefore an ideal, if not essential, component of our care delivery.
Telehealth is can include clinical health care, patient and professional
health-related education, public health and health administration using
technologies such as videoconferencing, the internet, store-and-forward
imaging, streaming media, and wireless communications.

The
IHS has a long history of using telehealth
to meet its mission and the needs of its patients, dating back to the
mid-1970s when IHS partnered with NASA and Lockheed Martin to provide
telehealth to the Tohono O’odham Nation in Arizona. Currently, IHS has two
national telehealth programs. The
IHS Teleophthalmology Program
was established in 2000 and provides screenings at more than 100 sites to
help prevent diabetes-related blindness. The
Telebehavioral Health Center of Excellence
has been providing telebehavioral services to 26 sites across the U.S.
since 2009. There are also numerous regional telehealth programs that
support patient care in various IHS Areas including regional approaches to
both tele-emergency medicine and tele-specialty care.

The COVID-19 pandemic has been devastating for American Indian and Alaska
Native people. Data shows that American Indians and Alaska Natives are at
higher risk of hospitalization and death associated with COVID-19. The
burden of underlying diseases such as diabetes, obesity, heart disease and
chronic lung disease occurs in Native people at much younger ages, and
likely is a major contributing factor to this disparity.

IHS took immediate and bold action to prevent, detect, treat, and recover
from COVID-19. The agency made it a priority to use the expanded access to
telehealth made possible by HHS under the authority granted to it during
the Public Health Emergency, significantly expanding the use of
telemedicine to provide services in Indian country. Beginning in March
2020, IHS facilities rapidly ramped up virtual care services from a
pre-COVID average of under 1,300 per month to a peak of nearly 43,000 per
month at the height of the initial surge. Additionally, for the first time
IHS clinicians could provide services into patients’ homes on almost any
device. This allowed for continued access to care while protecting patients
and health care workers.

Unfortunately, as IHS expanded telehealth services the Digital Divide in
many Native communities became increasingly apparent. In these areas,
patients often do not have the necessary equipment such as a smart phone or
laptop, or sufficient broadband connectivity in their home or community to
support video consultation. In these cases, telephone only connections have
allowed care to continue. During the COVID-19 emergency, 80 percent of IHS
telehealth encounters have been conducted using telephone only. We
recognize that some of these issues are challenging to resolve, but we are
working to do our best to look at technology that is scalable and can move
from video to telephone support based on technical needs.

Telehealth expansion has been instrumental in meeting the needs of patients
at tribal facilities during this difficult time as well. For example, the
Cherokee Nation reported that prior to COVID-19, virtually no service for
HIV treatment and pre-exposure prophylaxis, also known as PrEP, prescribing
were delivered via telemedicine. Currently 99% of this care is being
delivered via telehealth for provider visits, in conjunction with home
visits for labs. At-home self-testing for HIV has been implemented via an
automated texting service. More than 90% of their patients surveyed
reported feeling safer and supported using telehealth.

There is more work to be done. We have heard from our patients, our
providers, and tribal leaders that we need to continue sustainable access
to expanded telehealth, even as we continue to work to deal more
definitively with bridging the Digital Divide. IHS continues to assess and
evaluate the impacts of telehealth while exploring new technologies,
resources, and processes that will further increase access to care during
and beyond the Public Health Emergency. You can learn more about IHS
telehealth efforts at
https://www.ihs.gov/telehealth/.

Related Content:

History of IHS and Telehealth

Indian Health Service Announces Expansion of Specialty Care in Billings Area

Indian Health Service launches telehealth program to expand health care access for Native Veterans

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