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From the President: Emerging Issues

 Developing Strategies for Accessing Services Using Telehealth for Children with Special Health Care Needs and Other MCH Populations

Sara Miller
Program Analyst
AMCHP

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Imagine living in a rural community where going to the nearest pediatric specialist requires a full day of planning. The logistics involved in setting an appointment with the specialist can be daunting for parents: arranging transportation and allocating money for travel, taking time off from work, taking a child out of school, and speaking with insurance companies to determine which services will be covered and which will be paid out-of-pocket. Telehealth uses technology and partnerships to provide services at a distance, offering greater access to care and more opportunities for those in need of services.

For many families with children with special health care needs, the growing use of telehealth services offers promising solutions. Telehealth offers a variety of modalities such as synchronous or live video, remote patient monitoring, asynchronous or store-and-forward, and mHealth (mobile health) and provides sub-specialty services. At the AMCHP 2018 conference, experts from the Center for Connected Health Policy (Mei Kwong) and the Washington Department of Health(DOH)- (Ellen Silverman, Bradley Klos, and Amy Edmonds) presented on the benefits of telehealth for children with Autism Spectrum Disorder and other developmental disabilities (ASD/DD). Telehealth is conducive to Autism treatment because of its tiered-delivery model, which involves in-person treatment planning and monitoring, synchronous and asynchronous telehealth sessions, and parent training on ASD/DD intervention techniques.  In addition to treatment for ASD/DD, successful telehealth programs exist in psychiatry, neonatology, maternal depression prevention, nutrition, and endocrinology.

The Washington DOH team has integrated state systems of care for children and youth with ASD/DD, with an emphasis on medically underserved populations. A focus for the project is strengthening the state's telehealth infrastructure to increase access to services in rural and other medically underserved communities. The Washington DOH has undertaken research approaches to determine the effectiveness of telehealth services for this population, including key informant interviews, an online provider assessment, an online family survey, and in-depth family interviews. Results demonstrated that telehealth offers less disruption of daily schedules, cost-effectiveness, increased access to pediatric specialists and less stress for children and caregivers. Access to specialists and cost-effectiveness is a result of state and federal telehealth policies.

Telehealth offers benefits and opportunities, but like many health care services, it is not a one-size-fits-all solution, and many factors impact its success.  Uptake of various telehealth modalities, including live video, store-and-forward (asynchronous), remote patient monitoring and hub-and-spoke (one main provider is the hub and branches out to other organizations), may show success or failure depending on state regulations, geography and other factors. Investment in telehealth infrastructure, including satellite offices and equipment; professional development, greater collaboration among health care providers, and parent education are opportunities for growing and strengthening telehealth functionality and usage.

Mei Kwong from the Center for Connected Health Policy spoke of the complexity and diversity of telehealth federal and state regulations.  45 states have a "telemedicine" definition, 34 states and the District of Columbia have a "telehealth" definition and one state, Alabama, did not have a definition for either. At the federal level, there are telehealth regulations regarding geography, providers and services. Medicare will reimburse physicians, nurse practitioners, physician assistant, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists and registered dieticians. For Medicaid, telehealth policies on services and reimbursement vary by state. For the advancement of telehealth, billing and reimbursement, HIPAA regulations and safety issues remain challenging.  But telehealth is a promising means of increasing access to care for MCH populations.