Telemedicine Is Transforming Patient Care in California –
With Some New Challenges
By Tanu Henry, California Black Media
When Dr. Andrea Goings, MD, launched her
mobile medical service, offering at-home doctor visits and
virtual consultation sessions via video in 2016 in the Los
Angeles area, she did not know that just four years
later her business model would be more the norm than not.
Goings, an African American pediatrician and Toledo native
(the daughter of Bill and Laneta
Goings), launched her service in West Lake Village, a city
about 40 miles northwest of Los Angeles near the Ventura
County line. She made house calls to patient homes across
the metropolitan area.
“Technology has changed the way we approach and experience
so many aspects of our lives, so I thought at the time, why
not apply it to the work I do,” said Goings, who has been
able to provide care to patients in various parts of the
country while she is temporarily in Toledo caring for her
mom as she recovers from a surgery.
“Being able to save busy parents from long waits in the
emergency room or long drives to doctor appointments or
giving them around-the-clock access to medical advice from
the comfort of their home are all
reasons clients have appreciated BabyDocHouseCalls.com over
the years. Now, there is an added safety component that
makes the service convenient, even necessary, for so many.”
Goings said because her businesses gave her a head start.
Therefore, pivoting to respond to the constraints COVID-19
safety measures have imposed on clinical care, has been easy
for her.
“Telehealth is a really good option for young adults who
have returned to college campuses and dorms,” she says.
The California Department of Health Care Services (DHCS) says remote
consultations like the kind Goings provides should be not be
technically regarded as a distinct service, but an
“allowable mechanism” through which medical practitioners
can provide clinical services.
“The standard of care is the same whether the patient is
seen in-person, by telephone, or through telehealth. As a
result, DHCS has strongly encouraged all counties to work
with providers to maximize the number of services that can
be provided by telephone and telehealth, to minimize
community spread of COVID-19,” said Ivan Bhardwaj, section
chief, Community Services Division at the DHCS.
The DHCS has requested that all medical care providers
adhere to all federal, state, and local guidelines.
The U.S. Department of Health and Human Services Office of
Civil Rights says it will use “enforcement discretion”
and it will not impose penalties for non-compliance with all
aspects of the HIPAA rules when healthcare providers use
telehealth in “good faith” during the COVID-19 public health
emergency. The DCHS has also relaxed some its rules to
accommodate telehealth, expanding platforms allowed to
include popular video services such as Apple’s FaceTime,
Facebook’s Messenger video chat,
Google’s Hangouts and Skype.
“So far it’s been great. No problems. We’ve been able to
keep all of our doctor appointments and do it safely” said
Joe Bowers, a Ladera Heights resident in Los Angeles
County who is retired and writes a column on education for
California Black Media. Bowers says, “My wife, Margaret and
I appreciate the convenience of visiting with our
doctors — from the comfort of our home.”
For some critical mental health services that are vital to
some of the most vulnerable Californians during the
pandemic, like Medication Assisted Treatment (MAT) for those
struggling with opioid use disorder (OUD), DHCS has
increased its support.
“The Department of Health Care Services, in partnership with
The Center at Sierra Health Foundation (The Center), is
funding 21 sites to provide telehealth substance use
disorder and mental health services for individuals in
counties that have been impacted by COVID-19, or in the case
of providers, who have experienced trauma as a result of
treating individuals with the coronavirus,” said Bhardwaj.
“DHCS and The Center additionally launched the Behavioral
Health Telehealth funding opportunity in 2020 for non-profit
behavioral health providers to receive up to $50,000 each
for telehealth infrastructure beginning September 1, 2020
through June 30, 2021,” he added. “Providers applied for
telehealth equipment, including laptops, desktops, monitors,
electronic health record software licenses, internet
subscriptions, cell phones for providers, and telehealth
training. Providers that were awarded through this
opportunity will receive funding in Fall 2020.”
DHCS is also providing Personal Protective Equipment so
that facilities that provide in-person mental health
services and MAT sessions can continue to do so without
interruption.
California’s public awareness campaign titled “Choose
Change California” provides
information on opioid use disorder and a list of centers
across the state where people misusing opioids or other
substances can go for treatment and community-based
wraparound services. The campaign is a collaboration
operated by Sacramento- and Fresno-based The Center at
Sierra Health Foundation and funded through the California
Department of Public Health MAT Expansion Project.
DHCS’ efforts
have resulted in helping some medical institutions to
survive the pandemic and move closer to their pre-COVID levels
of clinical care by transitioning to telehealth
services, but they have come with some challenges. For
example, the DHCS says some providers do not have
enough funding to fully invest in telehealth infrastructure.
On the flip side, some patients cannot afford or do not
have sufficient broadband services and the
required equipment to receive services through telehealth. Other patients,
depending on their living situations, do not have adequate
privacy to engage in telehealth sessions.
Goings pointed out that there are some obvious limitations
to telehealth, too. With some conditions involving trauma or
physical injury or pain, there is no way around seeing the
patient in-person, she said.
“Now, that school has started, it’s difficult because you
don’t know if someone has the flu or COVID,” she says. “I
can’t give a clearance note, until you’ve been seen, tested
and quarantined, if necessary,” she says.
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