At the Health IT Summit in Nashville, Next-Door Neighbor Georgia Offers Lessons in Rural Telemedicine Advances | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

At the Health IT Summit in Nashville, Next-Door Neighbor Georgia Offers Lessons in Rural Telemedicine Advances

June 28, 2018
by Mark Hagland
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Suleima Salgado shared with attendees insights on the advances in telemedicine being made on behalf of rural Georgians

For every challenge in healthcare delivery, there is some potential approach for improvement; that was a broad theme underlying the message delivered by Suleima Salgado, of the Office of the Chief of Staff of the Georgia Department of Health, on Thursday morning at the Health IT Summit in Nashville, sponsored by Healthcare Informatics. Speaking to an audience at the Sheraton Nashville Downtown, Salgado delivered a presentation entitled “Telemedicine: Improving Population Health through Collaboration and Partnerships.”

The Atlanta-based Salgado sketched a portrait of the state of Georgia that many in Tennessee and throughout the Southeast and Appalachia would find relatable, of a state with vast rural areas that remain underserved for their residents, and in dire need of the benefits of telehealth/telemedicine solutions and strategies. “We have 159 counties in Georgia, and 110 of those are rural,” Salgado noted. “Meanwhile, here in Tennessee, you have 89 rural counties and only six urban counties, according to your state office of rural health. We need to find ways to provide access to quality care for a huge percentage of the residents of our states,” she said. And that involves facing up to daunting challenges of all kinds, from funding to staffing to data and information infrastructure challenges. “The reality at the end of the day is that most of our rural health partners are facing severe data issues,” she said, noting that, just to take one smallish example, “Clinics tell us that they have to schedule their participation in webinars around potential data crashes.” Many rural clinics have fragile Internet connections; what’s more, some have only one active nurse on staff, so if that nurse drives to a live educational session, that particular clinic has to shut its doors for a day.

Suleima Salgado

Of course, every state has its own peculiarities in terms of addressing rural health issues, as well. Salgado pointed out that, while the Georgia Department of Public Health is overseen by one commissioner and one board of public health, and that one commissioner appoints the 18 district health directors who oversee the state’s 18 public health districts, its 159 county governments each have their own county health departments and county boards of health, which are managed independently and which independently implement broad statewide policies. “Our state health commissioner employs the health directors, but has no control over policies implemented at a local level,” she noted. Still, that fact in itself is not necessarily negative, she pointed out. “I’ve worked in a state office and in a county office. And to me, the work happens at the county level. At the end of the day, most of the work and effort come from those county organizations,” she said. So the independence of county health organizations is not in itself a problem; it just adds to the complexity of addressing broad rural healthcare policies, she emphasized.

One positive in the landscape around rural health in Georgia has been around funding, Salgado said. “In Georgia, we’re always looking towards the federal, state, and local organizations that can help us. And Georgia [health] has undergone a dramatic change in the last ten years as a result of increased federal funding, state legislative support and intra-state collaboration.”

The Georgia Telehealth Network

That increased funding has been absolutely necessary to address some disparities around access to quality healthcare in Georgia. “About 60 of our 159 counties don’t even have specialists in certain specialties; people are having to drive four to five hours to see a specialist,” Salgado noted. “So we established a telemedicine network through the state,” she reported, with an initial funding grant of $2.3 million to establish the Department of Health-led network. But, she quickly added that, though that figure sounded large in the abstract, in practice, “when you start figuring in technology, data, and other costs, it wasn’t a lot. Still, it provided a strong start. “The goal of the Department of Health,” she continued, “is to connect patients to providers in their local communities and not extract business/medical services from the local economy. We’re trying to help those counties without specialists in specific specialties. We want to help those counties so that people don’t have to drive to Atlanta or Jacksonville or across the state line to Alabama. It’s not a replacement, and we’re not using it as a medical home.” Indeed, she said, she and her colleagues have emphasized to the local communities they’ve reached out to, that providing adequate telemedicine medical specialty services actually helps local communities, and does not take resources out of communities. In that regard, she said, “Significant inroads have been made with private physicians, local hospitals and other telehealth entities within Georgia to advance towards a cross-collaborative network,” with the goal of the telehealth network “as a means to better communicate between each other and most importantly as a way to provide access to specialty care for our patients.”

Among the key points made in her presentation, which included a slide presentation, were the following:

  • It is the goal of DPH to connect patients to providers in their local community and not extract business/medical services from local economy.
  • In situations where a provider is not available within the community or through existing DPH referral services, DPH will look to surrounding counties and then eventually to metropolitan areas to find services.  
  • DPH also has an agreement with the Georgia Partnership for Telehealth, for access to their telemedicine network, when needed.
  • The Georgia Partnership for TeleHealth is a non-profit, Open Access Network, with over 200 specialists and providers that represent more than 30 medical specialties.
  • In addition, DPH contracts directly with local, specialty providers to meet the healthcare needs of our patients. 

Meanwhile, the list of clinical areas involved is wide. Salgado noted the following areas:

  • Administration
  • Asthma/Allergy—pediatric
  • Audiology—pediatric
  • Behavioral Health counseling—pediatric
  • Dermatology—pediatric
  • Diabetes Education—adult and pediatric
  • Dental Services (School Based)—pediatric
  • Emergency Preparedness-
  • Endocrinology—pediatric
  • Genetics/Developmental—pediatric
  • Infectious Disease—specialty clinical care for HIV/AIDS patients
  • Interpreter Services—health department clinical services
  • Lactation Support/WIC—adult
  • Maternal Fetal Medicine—adult
  • Nephrology—pediatric
  • Neurosurgery—pediatric
  • Nutrition/WIC—adult and pediatric
  • Sickle Cell —adult & pediatric


“What does telemedicine look like in Georgia?” Salgado asked. “Private providers use their own platforms, but we’re Cisco-based with a Cisco suite, and a full telemedicine backup,” in terms of telecommunications and medical equipment. Often, the telehealth applications involved are not necessarily purely medical in the strictest sense; in fact, she noted, nutritional counseling and behavioral health services are two key telehealth services that have been broadly helpful. For example, she noted, “In many cases, there is one nutritionist serving four rural counties. In the past, that single nutritionist might have been driving across four counties to deliver health-related services. Now, she can see people everywhere.” The same goes for the expanded access to behavioral health afforded by the state’s statewide network.

Among other strategies to maximize resources, Salgado reported, “We realized and leveraged the fact that the FCC [Federal Communications Commission] has telecommunications funding to give you reduced cost per circuit for these kinds of projects. So we decided to put our hub in the third most rural county in Georgia, Waycross County, to get that discount. And we leveraged existing teams that had already created and were maintaining technology in various places. And now we’re running our network.” She cited a cost of $800,000 so far in terms of the cost of running the network. “But we did well,” she said. Initially, at least, she noted, “We couldn’t do a cloud-based infrastructure, we had to do traditional T1 lines. And everything coming back to the hub” in Waycross County. “We’re changing the model over time, and eventually moving to cloud-based. But keep in mind that five rural counties still have no Internet connectivity.”

One very concrete example of resource savings and gains over past dislocation has been around clinician education, Salgado noted. “The Department of Health had been offering a two-day refresher course in Macon for nurses who treat STDs. IN the past, that involved local healthcare provider organizations having to pay for lodging and travel costs, which figured out to about $500 per nurse. And some of those clinics are so rural that they have only one nurse on staff, so they would have to shut down their local clinic to send their nurse to that course.” Providing the educational course via weblink eliminated those costs and dislocative elements.

Meanwhile, the need for ongoing development of telemedicine and telehealth services remains absolutely crucial, Salgado emphasized. “Fifty-two counties in Georgia do not have OB/gyns who can support high-risk pregnancies. That means that for many pregnant women in rural areas, it requires a four-hour drive each way in order to be seen by a physician who can meet their medical needs.” Telemedicine offers an incredible advantage for those women in terms of accessing the specialized medical care they need.

Similarly, she reported, there is a huge need for teledermatology and teledentistry. In the case of teledentistry, the statewide telemedicine program has sent dental hygienists into schools to provide cleaning, fluoride treatment, x-rays, and dental education in schools. Dentists can remotely view the x-rays that the hygienists administer, and can communicate with them regarding potential treatment for the children. That program has been very popular with schoolchildren, she added.

The work will continue to evolve forward in this program, Salgado said, but the advances already made are proving heartening for all involved, and demonstrate what can be done collaboratively to improve healthcare access and quality to rural residents.

Among the many partner organizations in this program include the Georgia Partnership for TeleHealth, the Georgia Department of Behavioral Health and Developmental Disabilities, the Georgia Department of Community Health, the U.S. Department of Agriculture, the Georgia Department of Juvenile Justice,  Voices for Georgia’s Children, Children’s Healthcare of Atlanta, Georgia Regents University, the Augusta University Medical College of Georgia, and the University of Florida College of Medicine-Jacksonville.




2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


Senate Passes Opioid Response Bill with Substantial Health IT Elements

September 18, 2018
by Rajiv Leventhal, Managing Editor
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The U.S. Senate yesterday passed The Opioid Crisis Response Act of 2018, which includes numerous important health IT provisions, by a vote of 99-1.

The bill was originally sponsored by Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.), and includes proposals from five Senate committees and over 70 senators. The House passed its version of the legislation in June and now it’s expected that a committee will be convened to reconcile the differences between the two.

The legislation’s core purpose is to improve the ability of various health departments and agencies—such as the Department of Health and Human Services (HHS), including the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA), and the Departments of Education and Labor—to address the opioid crisis, including the ripple effects of the crisis on children, families, and communities, help states implement updates to their plans of safe care, and improve data sharing between states.

There are several key health IT provisions in the legislation, including: enabling the Centers for Medicare & Medicaid Services (CMS) to test various models that provide incentive payments to behavioral health providers for the adoption and use of certified electronic health record (EHR) technology to improve the quality and coordination of care through the electronic documentation and exchange of health information; requiring the use of electronic prescribing for controlled substances within Medicare Part D; facilitating the use of electronic prior authorization within Medicare Part D; and expanding access to telehealth services for substance use disorders.

Regarding telehealth specifically, the Senate version of the bill will allow for payment for substance use disorder treatment services, via telehealth, to Medicare beneficiaries at originating sites, including a beneficiary’s home, regardless of geographic location. It also requires guidance to cover state options for federal reimbursement for substance use disorder services and treatment using telehealth including, services addressing high-risk individuals, provider education through a hub-and-spoke model, and options for providing telehealth services to students in school-based health centers.

Health IT Now's Opioid Safety Alliance—a working group of prescribers, health systems, technology companies, pharmacies and pharmacists, professional societies, and patients advocating for the use of technology to fight illegitimate opioid use—supported the Senate’s passing of the bill. Said Joel White, HITN Opioid Safety Alliance executive director, “We are especially encouraged by the inclusion of commonsense Opioid Safety Alliance-endorsed language in this bill that will remove bureaucratic barriers to vital telehealth services for those suffering from addiction, modernize prescribing practices for controlled substances, and streamline prior authorization claims to improve efficiency while bolstering patient safety. These solutions can make a world of difference both in dollars saved and, more importantly, lives spared."

White did add, however, as Congress convenes a committee to reconcile the differences in the House and Senate-passed bills, lawmakers ought to include the House-passed OPPS Act (H.R. 6082) as part of any final conference agreement, “thereby ensuring that addiction treatment records are no longer needlessly isolated from the rest of a patient's medical history—a practice that has hindered informed decision making and threatened patient safety for too long.”

Indeed, the Senate version of the bill requires HHS “to develop best practices for prominently displaying substance use treatment information in electronic health records, when requested by the patient.”

White also noted, “Additionally, OSA remains concerned about the lack of real-time, actionable data provided to clinicians by states' prescription drug monitoring programs (PDMPs). With lawmakers poised to devote additional resources toward these programs, we should know if taxpayers are getting a return on their investment. We support the inclusion of language that would require an objective study and report on states' use of PDMP technology." 

As stated in the bill, states and localities would be provided with support to improve their PDMPs and "implement other evidence-based prevention strategies.” The bill also “encourages data sharing between states, and supports other prevention and research activities related to controlled substances."

What’s more, another section of the bill reauthorizes an HHS grant program “to allow states to develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology.”

Sen. Alexander, meanwhile, said yesterday he is “already working to combine the Senate and House-passed bills into an even stronger law to fight the nation’s worst public health crisis, and there is a bipartisan sense of urgency to send the bill to the President quickly.”

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Survey: Healthcare Organizations Report Gaps in Disaster Preparedness Plans

September 12, 2018
by Heather Landi, Associate Editor
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As Hurricane Florence churns toward the East Coast this week, disaster preparedness is a timely topic, yet a new survey finds that only 72 percent of healthcare providers believe their organization’s disaster plan is comprehensive enough to cover a variety of disaster scenarios both inside the organization and across the community.

The findings are even more troubling among specialty care providers, such as cardiologists and endocrinologists, who provide critical treatment to individuals with chronic diseases, with just 29 percent reporting that they have a comprehensive disaster plan in place. More than two-thirds (68 percent) of survey respondents were affected by two or more disasters in last five years, according to the survey, yet most respondents doubt their organization’s disaster plans are up to the task.

DrFirst, a provider of e-prescribing and medication management solutions, surveyed 109 healthcare professionals across acute, ambulatory, hospice and home care about disaster preparedness. According to the DrFirst, the results are critical for addressing potential safety issues that affect the health and lives of millions of Americans who are increasingly subject to hurricanes, wildfires, and floods as well as other man-made disasters like digital and criminal attacks.

“The fact that almost 70 percent of the surveyed healthcare providers have been affected by more than two disasters in the last 5 years should be a major wake-up call for the healthcare industry,” G. Cameron Deemer, president of DrFirst, said in a statement. “As we learned in the aftermath of major disasters such as hurricanes Maria and Harvey, natural disasters lead to surging demands for acute and emergency care, especially from the most vulnerable patients who may have been displaced from their homes without medications or critical medical supplies, like oxygen or diabetic testing equipment. We must take measures now to address the critical gaps impacting patient care and safety, such as communication challenges and ready-access to medical records and specialty care providers.”

The survey revealed another key vulnerability—the widespread dependence on disaster communications methods that fail to meet legal requirements for secure communications between medical teams, pharmacies, and patients, according to the survey. Under the federal law known as the Health Insurance Portability and Accountability Act (HIPAA), a patient’s private health information can only be shared with the patient or other providers via secure methods such as password-protected portals and secure messaging.

One-third or more of clinicians surveyed across acute, ambulatory and hospice/home health state that calling by phone is their top method for communicating with pharmacies, EMS units, patients and families, local authorities, and community health providers in times of disaster. Secure messaging and email complete the top three modes of communication.

A striking number of clinicians use regular unsecured text messaging to reach hospitals: more than one-quarter of respondents use this mode to communicate with hospitals during and immediately after a disaster strikes, and 22 percent report using unsecured texting to communicate with patients or their family members. According to the Centers for Medicare and Medicaid Services (CMS), the use of phones for texting of patient health information is only permissible through a secure messaging platform that provides message encryption. Encryption is also required when emailing patient health information.

Healthcare professionals working in hospitals were more aware of the need for secure messaging tools than individuals working in other settings, including specialty care providers. Forty-four percent of hospital-based respondents said that secure, HIPAA-compliant medical messaging is a key requirement of a disaster preparedness plan.

In fact, hospital-based respondents indicated that the only requirements more important than secure messaging were the installation of backup generators in case of power outages (56 percent) and the ordering and maintaining of extra inventory of supplies and medications (52 percent). Yet, specialty providers place the need for including secure messaging at the very bottom of their disaster planning requirements.

Survey respondents also see telehealth is a viable disaster solution, as 45 percent cited telehealth as an effective option to provide care to patients across the community during or immediately after disasters or emergencies. However, more than half expressed concerns that connectivity and other technical issues could impact the reliability of telehealth, and only 27 percent believe their organization has deployed adequate telehealth capabilities.

Another key finding from the survey is that many organizations preparing for an impending disaster still rely heavily on paper, with most advising patients to keep copies of their medical records. Just 40 percent of respondents believe their electronic health record (EHR) has sufficient information available to take care of all patients during a disaster.


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CPT Codes Updated to Reflect HIT Advancements

September 6, 2018
by Rajiv Leventhal, Managing Editor
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The American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set, with changes reflecting new technological shifts in the industry.

According to the AMA, there are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the healthcare community’s “combined annual effort to capture and describe the latest scientific and technological advances in medical, surgical and diagnostic services.”

Among this year’s changes to CPT include three new remote patient monitoring codes that reflect how healthcare professionals can more effectively and efficiently use technology to connect with their patients at home and gather data for care management and coordination. Also, two new interprofessional internet consultation codes have been added to reflect the increasing importance of using non-verbal communication technology to coordinate patient care between a consulting physician and a treating physician, according to AMA.

“The CPT code set is the foundation upon which every element of the medical community—doctors, hospitals, allied health professionals, laboratories and payers—can efficiently share accurate information about medical services,” AMA President Barbara L. McAneny, M.D., said in a statement. “The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice, and ensure the code set can fulfill its trusted role as the health system’s common language for reporting contemporary medical procedures. That’s why we believe CPT serves both as the language of medicine today and the code to its future.”

McAneny added that the AMA has urged the Centers for Medicare and Medicaid Services (CMS) to adopt the new codes for remote patient monitoring and internet consulting and designate the related services for payment under federal health programs in 2019. “Medicare’s acceptance of the new codes would signal a landmark shift to better support physicians participating in patient population health and care coordination services that can be a significant part of a digital solution for improving the overall quality of medical care,” she said.

In July, as part of CMS’ proposed Physician Fee Schedule and Quality Payment Program rule, the agency recommended various provisions that would aim to support access to care using telecommunications technology, such as: paying clinicians for virtual check-ins, paying clinicians for evaluation of patient-submitted photos; and expanding Medicare-covered telehealth services to include prolonged preventive services.

New CPT category I codes are effective for reporting as of Jan. 1, 2019. Additional CPT changes for 2019 include new and revised codes for skin biopsy, fine needle aspiration biopsy, adaptive behavior analysis, and central nervous system assessments including psychological and neuropsychological testing.

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