mHealth

Telecommuting, sometimes referred to as telework or working from home (WFH), got off to a slow start in the U.S. in the 1970s. With a viral pandemic forcing workers to consider the risk of infection from proximity to co-workers, nearly half of US workers have locked their office doors and headed for home. That’s more than twice as many as those telecommuting, at least occasionally, from 2017 through 2018, according to the Brookings Institution, a non-profit public -policy organization based in Washington, D.C.

I have spent the last year training as an infectious diseases pharmacist at Banner University Medical Center-Tucson. A large part of this has been participating in weekly HIV office visits at the Petersen HIV Clinics with Stephen Klotz, MD, Larry York, PharmD, and our lead clinical coordinator, Cesar Egurrola. This multidisciplinary team approach allows the physician to guide the patient’s care, the HIV clinical pharmacist to manage the medication aspects, and the clinical coordinator to manage the behavioral and social needs.

There is no doubt that COVID-19 has disrupted our healthcare systems and the general population worldwide in a host of ways no one could have imagined just 6 months ago. On a regular basis, we hear on the news stories about how many cases there are, how many deaths, where to get tested, hot spots, how healthcare disparities contribute to certain populations being more vulnerable than others, and how we need to social distance, wash our hands and wear masks.

In May, the Navajo Nation surpassed New York and New Jersey for the highest per-capita infection rate of COVID-19 in the US. In an area where 30 to 40 percent of residents don’t have running water and families live together in multigenerational homes, containing the spread has been difficult. In addition, residents can’t stay at home and see a healthcare provider using telemedicine, as so many of us have been able to do during the Public Health Emergency, because there’s little to no cell service or internet availability. So anyone needing healthcare or showing symptoms of COVID-19 has to travel to one of the few healthcare facilities.

COVID-19 and stay at home orders forced many practices, hospitals, urgent care, and clinics to turn their operations upside down overnight. Patients were canceling appointments left and right due to "the fear of the waiting room". Many primary care providers were seeing upwards of 80% cancellations.

Last month, Psych Associates (Springfield, MO), where I practice, went to an “online office,” which meant every provider in our practice set up a virtual therapy room in their home. We’re all trained up on Telehealth, so ready, here we go! I’m a newbie to the world of virtual therapy so I really didn’t know what to expect, but I’m brave in my work, so I trusted that everything would work out fine. The threat of coming in contact with the deadly coronavirus Covid-19 was real, and of course we all wanted to stay well, and keep our clients well, so we acted quickly. Luckily, it was a smooth transition.

Starting off as a fellow with the Arizona Telemedicine Program this past June, it got me more and more interested in the specific jargon of telemedicine. At first I often used terms like “telehealth” and “telemedicine” interchangeably but as I got more heavily involved in the literature I realized they are two distinct terms. Telehealth is a more general term encompassing a larger umbrella of services, like hospital administration and training via technology; while telemedicine specifically refers to clinical services provided at a distance.

My introduction to telemedicine was in 8th grade, while I was taking a medical science course with Dr. Weinstein, to prove that the medical school curriculum could be integrated earlier into the American school system. I remember thinking, “Wow, this is one of the coolest applications of technology, why aren’t more people using it?” It wasn’t until my sophomore year at the UofA I reconnected with Dr. Weinstein and started to explore the answer to that question I asked many years ago. As I continued to work with Dr. Weinstein I began to realize the answer to that question was more nuanced than my 8th grade self would have thought. By analyzing the Arizona Telemedicine Council (ATC), which is a non-statutory advisory council to the Arizona Telemedicine Program (ATP), for a paper on the relationship between telemedicine and governance it shed light on the legal, financial, and practical barriers of telemedicine.

In a world of go-go-go, telerehabilitation is a way to slow down and connect with a physical therapist from your own home. This one-on-one video appointment allows a physical therapist to connect virtually using technology such as your smart phone or computer. As a functional movement profession, many people are surprised to hear physical therapy can be done through video. Truth is, this has been done for years.

Home telehealth programs can help patients manage chronic disease, while receiving education and daily guidance from a nurse care coordinator or other health professional. For some reason, however, many patients in home telehealth programs do not adhere to daily check-ins. I am the telehealth specialist and facility e-consult coordinator with the Phoenix Veterans Administration Health Care System. As part of my studies toward a doctoral degree in nursing, I have found a potential solution.