Telehealth has become a key concept in fighting the COVID-19 pandemic, and the Indian Health Service signaled this week that it is part of its technology-enabled strategy. Telehealth is the practice of using secure video communications to handle patients’ health needs, and includes electronic transfer of records and mobile apps that can help manage patients’ health.
While telehealth has long been considered a good idea, to handle routine q-and-a type checkups, or for patients in rural areas to get medical advice, it is even moreso in this time of emergency. The highly contagious virus has overwhelmed hospitals and endangers the health care workers who are heroically trying to stem the tide. The last thing anyone needs is patients who may already — or may not yet — have the virus coming in and out of medical facilities.
“Expanding telehealth allows more American Indians and Alaska Natives to access healthcare they need from their home, without worrying about putting themselves or others at risk during the COVID-19 pandemic,” said Health and Human Services Secretary Alex Azar in an HHS press release.
The moves by IHS are in line with the overall embrace of telehealth in the plans devised by HHS and the Trump administration. For instance, Medicare has been expanded to include more telehealth coverage, and the HHS Office of Civil Rights has resolved to be more flexible in regards to compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulatory requirements that apply to telehealth.
The latter move can be an important one for Natives, who as a group are the most disadvantaged by the digital divide. Apps like Facetime Video, Skype and Zoom video conferencing would normally not meet the compliance standards, but any connection is better than no connection when social distancing is the best defense we’ve got against a highly contagious virus.
Still, the guidance offered this week by IHS fast-tracks upgrades to Tribal telehealth systems, which will serve Native patients during this crisis and beyond. The compliant standard is the secure and encrypted Cisco Meeting system, which until recently was used to a limited extent in Indian Country, by the Telebehavioral Health Center of Excellence as well as the Albuquerque, Billings and Great Plains Areas. Last week, six IHS sites in the Oklahoma City and Navajo areas participated in a pilot program using Cisco Meeting, and IHS began training its healthcare workers on how to use the system.
The current shortcomings of the brick-and-mortar healthcare services are familiar to Natives who’ve grown up reliant on IHS. In an American Bar Association webinar broadcast on Wednesday, Stacy Bohlen, Executive Director, National Indian Health Board, remarked that conditions in overwhelmed hospitals across the country are “reminiscent of everyday life in Indian Country.”
“Using a priority system … trying to find specialists who will help our people, trying to get the right number of physicians and health care providers — that’s every day in Indian Country,” she said. “And it gives me no pleasure to acknowledge that this is what the rest of the country is experiencing.”
Mainstream America is learning the hard way what it’s like to be in an overstressed system, but the solution for people everywhere, in this crisis and beyond, looks a lot like the healthcare practices pioneered by Alaska Natives.
In the 49th state, with populations located in remote areas, Alaska Natives are ahead of the telehealth curve. As described in a Native Business report in our March “Infrastructure” issue, telehealth has been practiced, in one form or another, by Alaska Natives for over 50 years. Early adoption consisted of healthcare workers and patients communicating over sideband (ham) radio in the dark ages of the 1960s. Since 1982, the Southcentral Foundation has kept on the cutting edge of telehealth, providing care using a network with six regional hubs that stock medical treatment materials and prescription drugs that can be given to patients immediately, on doctor’s orders.
Because many in Alaska are socially distanced, the Alaska Native system doesn’t limit its services to Tribal members. “They care for whoever, with equanimity,” Dan Harman, Medical Director in Primary Care at the Southcentral Foundation, told Native Business. In times of COVID-19, we can only hope that the steps the IHS and HHS are taking bring us closer to the telehealth practices of Alaska Natives.