ADDRESSING TELEMEDICINE IMPLEMENTATION CHALLENGES IN MEDICALLY UNDERSERVED AREAS
Puerto Rico’s (PR) health system are still in the beginning stages of implementation and acceptance of telehealth and telemedicine. The PR-Geriatric Workforce Enhancement Program, at the Graduate School of Public Health of the University of PR Medical Sciences Campus UPR-MSC targets a geographic region facing multiple difficulties in the implementation of Telemedicine due to its geographic isolation, interconnectivity challenges, and shortage of healthcare professionals. The PR Government established policies to facilitate the use of Telemedicine and Telehealth allowing doctors to curtail health risks presented by COVID-19. However, some health insurance companies provided limited coverage of these services, covering only telephone consultations. Other barriers were the lack of experts in telemedicine knowledge, and limited patients and community’s acceptance of telemedicine strategies.
This project, sponsored by HRSA funds, aimed expanding the telehealth service provision capacity and promotion of best practices by training UPR-MSC physicians, residents, and community-based partners providers, providing technical assistance to develop the necessary protocols, guidelines, and processes to implement telehealth services. Lastly, an educational campaign was developed to inform the community served by our CBO partners of available telehealth services and how to access them. Training activities were provided through distance education strategies.
The project was developed in four phases:
1) Development of protocols and guidelines for telehealth service provision to patients,
2) Training of healthcare providers,
3) Telehealth promotion campaign for patients, families, and caregivers, and
4) Development of collaborative agreements and protocols for telehealth consultations.
The Evaluation plan included data collection about the number and disciplines of individuals receiving training, and number of patients receiving services offered in our partners sites by telehealth strategies. A paper-and-pencil and a phone short survey were also used as part of the telehealth strategies to assess patients and caregivers’ profile. CMS Telehealth Reimbursement Measures were also collected in participating healthcare facilities using the following codes: 99441, 99442, 99443 and G2012, corresponding to telehealth visits with their primary care providers.
We were able to train 76 healthcare providers (General Medicine and Family Medicine physicians, Psychiatrists, Nurses, Clinical Social Workers, Clinical Psychologists and Direct Care Workers) from eight sites and were able to reach (registered) at least 1,145 patients with the promotion campaign through diverse strategies. Before the pandemic, there were no services by Telehealth. Since April 2020 to March 2021, primary care participating sites reported as follows: 43, 901 events (site 1), 1,337 events (site 2), and 6,555 events (site 3). No virtual check-ins or e-visits were reported for this period.
Training webinars, an electronic module, promotion materials and collaborative agreements were developed with this initiative and are available for further use. Moreover, results from this project led to further funding of 4.2Million telehealth grant from the PR Department of Health’s “Telemedicine Program” from the Coronavirus Relief Fund. There is still more work to do to expand the use of Telehealth and Telemedicine approaches.