Telemedicine Is Transforming Patient Care in California – With Some New Challenges

The DHCS has requested that all medical care providers adhere to all federal, state, and local guidelines.

Dr. Andrea Goings mobile medical service Los Angeles area

Dr. Andrea Goings mobile medical service Los Angeles area

When Dr. Andrea Goings 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, 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 Ohio 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’s 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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