Last year was the twentieth anniversary of the Institute for Digital Health & Innovation’s (IDHI) High-Risk Pregnancy Program (HRPP) at the University of Arkansas for Medical Sciences. In the decades of its existence, the HRPP has built a model of success so robust that leaders from other states and other nations have made site visits to Arkansas with hopes of replicating this type of maternal health in their own communities.

“When the High-Risk Pregnancy Program first started out, online education was limited, resources were few and far between, and reliable, high-speed, internet access was scarce in several parts of the state,” says Joseph Sanford, MD, director for IDHI. “Today, with the growth of infrastructure and technology, we have capabilities of reach and care that covers the entire state and beyond.”

“Our High-Risk Pregnancy Program leverages advanced technology to provide comprehensive support and medical expertise,” says Rosalyn Perkins, MNSc, APRN, WHNP-BC, APRN Coordinator and High-Risk Pregnancy Program Director, “ensuring the best possible outcomes for both mother and baby, particularly in complicated pregnancies.”

 

Find out more about the High-Risk Pregnancy Program:

Learn More

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The Culinary Medicine program at the University of Arkansas for Medical Sciences (UAMS) aims to provide patient-centered care around health and nutrition that is local and cost-effective. We recently had the opportunity to attend one of the program’s Virtual Teaching Kitchen sessions, where attendees learned to bake a low-fat sweet potato pie. The event was hosted by Culinary Medicine’s own registered dietitian Alyssa Frisby, M.S., LD, RD, who was assisted by a UAMS medical student and Arkansas Minority Health Commission intern.

From making the dough for the crust to preparing the filling, both hosts spoke in detail about each step of the pie-making process as well as the healthy benefits of the ingredients used. The result was a healthy and delicious pie!

The event was hosted live over Facebook and lasted just over half an hour.

The Culinary Medicine program has events open to the public and some that are only open to UAMS faculty and staff. You can view their calendar HERE.

Visit HERE to learn more about the program.

Sources

1. https://culinarymedicine.uams.edu/
2. https://culinarymedicine.uams.edu/about-us/

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Telehealth services have increased access to health care for many residents in rural Arkansas. However, the use of telehealth services requires a good Internet connection, which is still a problem in more rural areas across the state. In cities like DeWitt, the nearest hospital is 40 minutes away. If DeWitt residents don’t have a strong Internet connection to use telehealth services, they are playing a game of minutes, rushing to get critical care while others don’t have to leave their houses.

The Importance of Broadband

The Substance Abuse and Mental Health Services Administration (SAMHSA) calls digital access a super (or maybe not-so-super?) determinant of health due to its impact on other social determinants, such as education, health, and employment. Health care clinics and hospital systems must have robust, high-speed Internet connections in order to provide telehealth services.

The Federal Communications Commission (FCC) defines “high-speed Internet” as an Internet service with download speeds of at least 25 megabits per second and upload speeds of 3 megabits per second. Additionally, the majority of telehealth services must be fiber-driven in order to handle the speed and bandwidth needs for telehealth services.

According to Broadband Now, as of 2017, 78 million U.S. residents (24% of Americans) in rural areas lack access to coverage from fixed networks offering high-speed Internet. Another 14 million lack access to any broadband whatsoever.

Broadband Expansion Initiatives

Luckily, there have been several federal initiatives designed to make telehealth and broadband expansion a top priority. For Arkansas, the University of Arkansas for Medical Sciences (UAMS) formed the Institute for Digital Health & Innovation (IDHI) in 2019 to eliminate health disparities in Arkansas through digital health and health care innovations that improve access to and the quality of clinical care, education, and research.

IDHI joined with other Internet service provider (ISP) partners, including Middle Mile Fiber, to create the first and most robust optical network for Arkansas. IDHI has administered 162 grant awards and counting throughout the state, all designed to increase broadband access statewide.

Chris Charlton, Broadband Director for IDHI, said that, with more federal funding on the way thanks to the Broadband Equity, Access, and Deployment (BEAD) program, Arkansas will see 250-300 digital equity, literacy, telehealth, agricultural nursing, and broadband expansion programs across the state.

“Thanks to BEAD funding, UAMS IDHI contracted with Economic Development, a division of the Arkansas Department of Commerce, on a $555 million project dedicated to deploying ISP networks statewide,” he said. “We received our last round of funding in January 2023 before BEAD funding kicks in in early 2024.”

Around 210,000 households in Arkansas still do not have reliable broadband access. 110,000 of those households are the current focus areas for 40 active expansion projects. The rest of the households are those far off the grid. Because the installation costs per mile are so high, Charlton said that IDHI will rely on BEAD funding to provide a cushion. “By the end of 2026, we hope to reach 75% of the 210,000 households that remain without access,” he said.

Broadband Expansion Impact

To really understand the impact of Arkansas’ broadband expansion initiatives, Charlton said, you need to view the Broadband Coverage map. While it can be a bit overwhelming, this map breaks down broadband coverage for the entire state of Arkansas by census blocks. You can see how each county stacks up in broadband coverage.

As shown from the map, nearly every county in Arkansas, including Pulaski County (pictured), has areas of red, indicating gaps in broadband coverage.

“The red portions that you see on the map indicate gaps in broadband coverage,” Charlton said. “Green means that those areas are good to go. They have 100% broadband coverage. Each of the other colors represents funding projects currently in place, with light blue being broadband projects we’ve already built out with Economic Development and UAMS IDHI.”

From looking at the map, it’s clear that every county except Clay County in the far northeast corner of the state has at least one census block with no broadband coverage. “Some of the areas in west to northwest Arkansas are national forests. We’re not allowed to reach some of those areas due to rules and regulations regarding building on those lands,” Charlton said. “Even if you disregard the area with national forests, we still have a lot of work to be done. The 2024 project will help us reach health care constituents in those rural areas in red.”

Despite the progress to be made, Charlton has already begun to hear from state leaders about the impact the broadband expansion has had on rural Arkansas. “I’ve been out on road shows and had county judges and mayors from rural cities come up to me and tell me how their community wasn’t able to get broadband access until we started this expansion project. It’s just phenomenal to hear and see the impact we’re making throughout the state,” he said.

What can providers in these rural areas do in the meantime?

Until the broadband expansion projects begin in some of the more rural areas of the state, Charlton said it’s a waiting game. “The best thing to do right now is to reach out to your local mayor, county judge, or state legislator and let them know your area is underserved,” Charlton said. “Tell them you need access to be able to effectively care for patients in your area.” Getting legislators involved will allow for quicker delivery of broadband expansion in rural areas of the state once BEAD funding kicks in in 2024.

For health care clinics and hospital systems in the state who wish to provide telehealth services but need assistance in implementing a telehealth program, UAMS has implemented eLink. “eLink” helps in planning and implementation and manages the USAC Consortium, which offers connectivity for eligible sites at a discounted rate. Joe Schaffner, assistand director for UAMS IDHI and the South Central Telehealth Resource Center, said “eLink provides broadband access and equipment, such as telehealth carts, remote patient monitoring devices, and iPads, at a discount. Instead of paying tens of thousands of dollars outright for equipment, you can pay a monthly or annual fee.” UAMS also provides maintenance and technical assistance for involved parties. Learn more about eLink and the benefits it can provide.

What resources can patients in rural communities use to get access to telehealth services?

Even if broadband was available in these smaller communities, high installation and service costs often make it unaffordable for lower-income households. The American Health Information Management Association estimates that while 8 in 10 households with incomes of around $100,000 used wired high-speed Internet service at home, only 5 in 10 households with incomes below $25,000 did in 2021.

For residents who struggle to afford the high costs of Internet service and equipment, the FCC implemented the Affordable Connectivity Program (ACP), a benefit program that offers discounts of up to $30 per month toward Internet service for eligible households and up to $75 per month for households on qualifying tribal lands. Additionally, ACP provides discounts on laptops, tablets, and desktop computers.

UAMS eLink is leading the ACP efforts in Arkansas, providing assistance and support for families benefitting from these discounts. “Right now, we’re really focusing on outreach for ACP,” Schaffner said. “The funding has been provided by the FCC, but only about 30% of Arkansas households have tapped into this resource.”

Learn more about the eligibility requirements and see if ACP is right for your household.

Additional Telehealth Support

Telehealth Training. For those who need guidance, education, and resources for telehealth services, the South Central Telehealth Resource Center (SCTRC) offers services to Arkansas, Mississippi, and Tennessee residents.

SCTRC and UAMS IDHI have combined resources to provide guidance and support for health care providers who need education and training on telehealth and telemedicine. They provide self-guided learning, including podcasts, videos, and online resources, as well as instructor-led learning, including telehealth training kits, meetings and conferences, and webinars and virtual events.

UAMS HealthNow. UAMS HealthNow provides real-time access to a provider via video chat using your smartphone, tablet, or computer to patients within the state of Arkansas. For patients who have to travel long distances for routine checkups with their primary care provider, UAMS offers HealthNow, a virtual video appointment with a provider. HealthNow offers a variety of easy-to-use telehealth services, including virtual urgent care, telePrEP, a virtual hernia clinic, and COVID-19 services.

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Source: https://www.afmc.org/blog/broadband-access

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The keynote speaker, Shawn DuBravac, PhD, gave a thought-provoking presentation on the evolution of technology and health care in his talk titled, “Futurescape: Defining the Future of Health Care.” He framed the issue around data defining our environment, data making predictions inexpensive, data redefining processes, and data blurring the lines between the digital and physical world.

“The next big inflection point is upon us,” claimed DuBravac. He was alluding to artificial intelligence (AI) but before tackling such a robust topic, DuBravac took us on a history lesson of the ice industry from the 1840s to the 1940s. From cutting ice out of natural bodies of water to having an ice box where individual homes had instant access to ice, this was a story about a century industry devolution in the face of growing technology. When expensive, scarce resources evolve into inexpensive, abundant resources, we have new use case scenarios play out. Look at data and storage, for example – the thought of taking photos of food in the early days of cell phones was unheard of simply because of the idea of limited storage. Now, data storage is nearly unlimited and free.

According to DuBravac, what we’re going to start to see in health care is the use of AI as the initial encounter between an individual and their provider. AI will be able to triage the patient and have all the health information ready for the provider to review. “That’s the great promise of AI,” said DuBravac, “to make predictions.”

The last panel of the event centered around innovations and opportunities. Discussions began by reflecting on DuBravac’s presentation. Harold Betton, MD, commented that we should “stop concluding there are things we cannot do.” In line with the theme of evolving technology and workforce, Kevin Sexton, MD, remarked that the “calculator was a job position before it was a device.” The group then discussed what they thought the next few years would look like. “AI can summarize, bring things to the forefront that I will miss,” said Sexton. “That’s where we’ll see it first.” He continued by suggesting we will see large leaps forward “when we figure out how to remove the barriers that impact the patients and take action instead of summarization and risk stratification.”

For more information about the Arkansas Center for Health Improvement, go here: https://achi.net/. For more information and free resources regarding telehealth, visit here: https://learntelehealth.org/.

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Source: Center for Connected Health Policy

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How Can I Qualify?

• You or your child or dependent are enrolled in government programs like Medicaid, SNAP, WIC, or others.
• Based on your household income.

Visit the FCC’s ACP site HERE to view more info on qualifying.

Potential Program Benefits

• Service discount up to $30/month
• Service discount up to $75/month on qualifying Tribal lands
• Device discount of up to $100 for a qualifying device

Click HERE if you’re interested in applying for the ACP benefit.

For more information and FAQs, visit the IDHI’s ACP page HERE.

The post UAMS IDHI Now Promoting FCC’s ACP Benefits Across Arkansas appeared first on LearnTelehealth.

HIPAA and Telehealth

All platforms and programs must now be HIPAA compliant. Enforcement and penalties have resumed. During the PHE, lesser encrypted platforms (e.g. Skype, Facetime) were allowed. Now, all telehealth services (including audio only) will need to be provided using HIPAA compliant platforms. You can read more here: https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html

Medicare and Telehealth

Centers for Medicaid and Medicare Services (CMS) extended many Medicare PHE services of telehealth through December 2024, such as:

• People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
• People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
• Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer.

The expanded evaluation and management codes Medicare allowed to be provided without supervision under the primary care exception ended May 11.

Additionally, after December 31, 2024, when these flexibilities expire, some Accountable Care Organizations (ACOs) may offer telehealth services that allow doctors and other practitioners participating in the ACO to care for patients without an in-person visit, no matter where they live. If a health care provider participates in an ACO, individuals should check with them to see what telehealth services may be available.

View the list of all covered CMS telehealth services here: https://www.cms.gov/medicare/medicare-general-information/telehealth/telehealth-codes

Medicaid, CHIP, and Telehealth
Medicaid and the Children’s Health Insurance Program (CHIP) telehealth flexibilities vary by state: some are tied to the end of the COVID-19 PHE, some are tied to state PHEs and other state emergency declarations, and some had been offered by state Medicaid and CHIP programs long before the pandemic. Post-PHE, Medicaid and CHIP telehealth policies will continue to vary by state. Here are some Medicaid resources for each state in our region that may be useful:

Arkansas:

https://humanservices.arkansas.gov/covid-19/dhs-response-to-covid-19/updates-for-providers/changes-to-medicaid-ending-effective-december-31-2022/

Mississippi:

https://medicaid.ms.gov/preparing-for-the-covid-19-public-health-emergency-unwinding/

https://medicaid.ms.gov/late-breaking-news/

https://medicaid.ms.gov/wp-content/uploads/2023/04/DOM-UP-Plan_March-2023.pdf 

Tennessee:

https://www.tn.gov/tenncare/information-statistics/unwinding-the-phe-for-partners.html

https://www.tn.gov/content/dam/tn/finance/fa-benefits/documents/coronavirus_benefits_info_03_31_23.pdf.pdf

Private Health Insurance and Telehealth
Private health insurance coverage for telehealth and other remote care services vary by private insurance plan and by post- PHE. When it covers telehealth and other remote care services, private insurers may impose cost-sharing, prior authorization, or other forms of medical management on such services. For additional information on an insurer’s approach to telehealth, patients should contact their insurer’s customer service number located on the back of their insurance card.

Drug Enforcement Administration (DEA) Rules and Telemedicine Prescribing
The DEA and SAMHSA have issued a temporary rule extending the controlled substance telemedicine flexibilities through November 11, 2023. Further, practitioners who have established relationships with patients via telemedicine on or before November 11, 2023, may continue prescribing controlled medications to these patients without conducting an in-person medical evaluation regardless of the practitioner being/not being registered with DEA in the state in which the patient is located until November 11, 2024. The DEA and SAMHSA plan to issue final rules by November 11, 2023.

Read more here: https://www.samhsa.gov/newsroom/press-announcements/20230509/dea-extend-covid19-telemedicine-flexibilities-prescribing-controlled-medications

The NCTRC have a huge collection of “End of PHE” resources. You can view them here: https://telehealthresourcecenter.org/collections/end-of-the-public-health-emergency/

Sources:

https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/covid-phe-end.html

https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency

https://www.hhs.gov/about/news/2023/05/10/hhs-fact-sheet-telehealth-flexibilities-resources-covid-19-public-health-emergency.html

https://www.hhs.gov/about/news/2023/05/10/hhs-fact-sheet-telehealth-flexibilities-resources-covid-19-public-health-emergency.html

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The SCTRC partnered with the University of Arkansas for Medical Science (UAMS) Institute for Digital Health & Innovation (IDHI) to provide a comprehensive package of demonstration, presentation, and hands-on learning.

SCTRC Program Manager, Amy Moses, took on most of the facilitating and coordinating of the site visit. “It was an honor to have visitors from across the world come to UAMS to learn more about implementing successful digital health programs,” said Moses.

The first day was loaded with heavy topics like telemedicine business planning, economic development, technology and infrastructure, research, DTC telehealth, and HROB, while also touring the UAMS telenursery and NICU. The second day, the group took a field trip to Batesville, AR, where partners from the UAMS Stroke Program at the White River Medical Center simulated a telestroke event, ending with a tour of the emergency department. The final day of the visit took our guests through the UAMS Simulation Center where many of them were allowed to practice with the learning tools and technology firsthand, then finishing the program with virtual dissection and a presentation from UAMS BioVentures.

The experience was rewarding for all parties involved. Hearing about policies, practices and barriers in foreign countries and sharing our own provided that rare insight that makes the world that much smaller and closer.

“We are honored that USTTI and this diverse group of international visitors chose to travel from so far away to see how UAMS has implemented telemedicine and digital health to help rural communities in Arkansas,” said Wendy Ross, IDHI Director of Programs and Co-Director for the SCTRC. “The learning has gone both ways, of course, and we are inspired by our visitors’ passion to improve health outcomes in their own countries.”

Reference: https://news.uams.edu/2023/03/13/uams-hosts-united-states-telecommunication-training-institute-ustti-for-digital-health-training-program/

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