The state made great strides in improving remote access to medical care during Covid, experts say, but barriers remain for many groups.

A 58-year-old man was experiencing speech problems, a weakness on his right side and a drifting of the gaze of his left eye. Fortunately, a neurologist was able to examine the patient by video while he was being transported by ambulance to The Queen’s Medical Center in Honolulu.

The doctor took the patient’s history, reviewed his medications, talked to witnesses and obtained consent for treatment through the help of Pulsara, a telehealth communication platform.

At the hospital the stroke team had already been activated. When he arrived, they quickly treated the patient with a blood-thinning medication used to clear blood clots.

Two days later, after being treated for left middle cerebral artery occlusion, the patient was able to leave the hospital.

Burt Lum, Matthew Koenig and Christina Higa at Monday’s informational briefing on telehealth at the state Capitol (Screenshot/2023)

That story comes from Matthew Koenig, medical director of virtual care at the The Queen’s Health Systems, who shared it Monday morning at a House Health and Homelessness Committee briefing.

Koenig used the story to illustrate how telehealth can dramatically speed up access to early treatment.

Telehealth services, the committee learned from Koenig and other experts, have accelerated significantly since the advent of the Covid-19 pandemic. Telehealth has also taken on a new urgency on Maui, where the August wildfires illustrated the vulnerability of remote communities.

But there are still barriers to “digital equity” in Hawaii. Digital equity is defined by the nonprofit National Digital Inclusion Alliance as a condition in which all people and communities have the information technology capacity necessary for “full participation in our society, democracy and economy.”

The communities with unique medical needs include people over 60 years of age, people with disabilities, people with language barriers, military veterans, rural residents, Native Hawaiians and racial and ethic minorities.

DBEDT has identified a number of barriers to digital equity in telehealth. (Screenshot/2023)

Another challenge: Not everyone feels comfortable talking about their health by video, let alone operating the technology via smartphone or laptop — the so-called “digital divide.” As Koenig, a stroke neurologist, observed, telehealth “can’t replace in-person care.”

In many ways, though, the experts agreed that telehealth, consumer trends and the power of modern communications will complement traditional doctor-patient care, and probably save money and lives along the way.

That’s where government comes in — to “act as a convener,” said Koenig, by bringing stakeholders along with the passing of laws and appropriations.

Another telehealth expert, Christina Higa, is co-director of the Pacific Basin Telehealth Resource Center and an adjunct assistant professor at the UH John A. Burns School of Medicine. She reminded the legislators that they approved “one of the most progressive” telehealth laws in the nation as far back as 2016.

Act 226, which applies to Medicaid and private insurers, requires parity for telehealth service and payment in comparison to in-person services, requires malpractice coverage for telehealth, and allows providers to get paid for delivering services to a patient who is in their home.

But Higa also said Hawaii has medical licensure laws that can make continuity of care challenging. If a university student moves to Hawaii, can they continue their mental health treatment with California professional via telehealth? Yes, if that provider is licensed in Hawaii.

The components of digital equity in telehealth in Hawaii, according to DBEDT. (Screenshot/2023)

Higa credited the Legislature for passing Senate Bill 674 last session, which adds Hawaii to the Interstate Medical Licensure Compact that includes 41 states and Guam. She said it would streamline the process for medical licensing, assist with the health care provider shortage and provide access to those providers via telehealth.

But the Legislature did not advance a House concurrent resolution that would have set up a working group to identify public policy initiatives at the state and federal level to “optimize telehealth utilization,” as the resolution called for.

HCR 49’s co-introducers included Della Au Belatti and Jeanna Takenouchi, the chair and vice chair of the health and homeless committee.

The committee also heard from Sylvia Mann, formerly supervisor of the Genomics Section of the Hawaii Department of Health, and Stacey Aldrich, the state librarian. They shared ongoing efforts to increase telehealth access through state libraries and mobile clinic vans. Libraries are ideal locations because they are located throughout the state, including in rural areas. They also have the technology and connectivity to facilitate telehealth.

The challenge, Aldrich told legislators, is ensuring there are enough hotspots for telehealth services to work, and enough tele-navigators to provide human assistance. And Mann described as a “stumbling block” the state’s sluggish emergency procurement process to help libraries in Kihei and Kahului, as Lahaina’s library was destroyed by the fires.

Belatti promised that she and her colleagues would use their influence to help expedite the telehealth access projects. She also said there would be more informational briefings on telehealth in the months ahead.

“We have to look at what other states are doing,” she said, and said that the work that will involve “conversations with all the players.”

The path toward digital equity is a collaborative effort that is — for now — paved with $400 million in federal funds. But ultimately Hawaii will have to chart its own way.

“We are in the middle of the Pacific,” said Burt Lum, the state digital equity coordinator with the Department of Business, Economic Development and Tourism. “We have to do this on our own. We cannot depend on other states.”

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