ATA - American Telehealth Association and COVID-19

Tania Malik on the ATA, Telemental health and being an entrepreneur

COVID-19 has thrown our healthcare system into disarray. It has created challenges of how to keep patients at home while continuing to deliver them. Quality care telehealth presents a solution whose time has come. The American Telemedicine Association now is known simply as the ATA, has been preparing for this moment for 20 years. Our guest on the podcast is Tania Malik, an entrepreneur, and the telehealth field and the Chair of the Telemental Health Special Interest Group for the ATA. I hope you enjoy this conversation on the "People Always, Patients Sometimes" podcast.

Janet Kennedy (00:39):

Spencer Health Solutions has invited Tania Malik to join us on the podcast today to have a chance to learn more about telehealth and how it's impacting our health care system. Tania is the chair of the Telemental Health Special Interest Group for the ATA and she's also CEO of Virtual Medical Group. My name is Janet Kennedy and I'm your host for the "People Always, Patients Sometimes" podcast, a production of Spencer Health Solutions. I'm really looking forward to my conversation with Tania on the podcast. Welcome to "People Always, Patients Sometimes". Tania!

Tania Malik (01:12):

Hi. Thanks for having me.

Janet Kennedy (01:13):

Tania, you've been involved with the ATA for many years and you're also very involved in running a special interest group specifically on telemental health, but I'm not sure that everybody's really familiar with the ATA, so do you mind giving us a little background on the organization?

Tania Malik (01:30):

The ATA is the organization that is maniacally focused on the implementation of telehealth. We have been around for over 20 years Ann Mond Johnson is the CEO who has been at the helm for about two years. She is reshaping the organization. One of the things she did was re-brand it. It was the American Telemedicine Association and now we go by ATA. As Anne said, everything was great with our name except the first two words, meaning that it's not just America and telehealth is global and really it's health. It's not necessarily telehealth. We are delivering good quality care to patients where and when they need it through a different medium and that's it.

   

Janet Kennedy (02:17):

Let me ask you a question then. Is there a difference between telehealth and telemedicine?

Tania Malik (02:22):

If you went and Googled it and looked it up, there would be multiple definitions. In policy? Yes, there probably is and there is definitions and social security act and other places, but in reality, telemedicine and telehealth are basically the same things.

Janet Kennedy (02:38):

The way I would look at it as an outsider is that telehealth would be focused on keeping people healthy and living good active lives. Whereas telemedicine might be specifically about solving a health or medical problem.

Tania Malik (02:53):

I like how you did that. Well, you can have it, that's fine, but in what we're saying is we're delivering care via the internet, via telecommunications, basically as what we're saying.

Janet Kennedy (03:07):

And the organization was founded by the companies that were actually doing the technology or was it a joint partnership with the clinicians who wanted to use the technology?

Tania Malik (03:19):

It actually large academic and government focus and still does today, but a lot of the research since we are several decades, all came from academics and the government. Then the government was really the VA in particular, one of the first and largest and today is the largest user of telemedicine. So that's where it came from. And then the conglomeration just grew with vendors, individual practitioners, and it's still government, academia. All of that.

Janet Kennedy (03:52):

Now 20 years ago, I don't even think I had a cell phone, so what kind of tele health would I have had 20 years ago.

Tania Malik (04:00):

It's funny you say that because some people, when people ask me for evidence that telehealth is effective and patients are satisfied with their interaction, I point to a study that one of our members did. That was in the early 1980s so hello. Psychiatry, in particular, has been around for such a long time. You didn't have to use a cell phone, but the equipment back then was much bigger, much more cumbersome, harder to implement than today. Of course, whereas forward the software is almost ubiquitous and a commodity.

Janet Kennedy (04:36):

Oh, you know, I just realized I've made a big mental error. I assume telehealth means actually being face to face, but telehealth is as long as you have a communications mode with someone. So it's been obviously via phone and that's how you all got started.

Tania Malik (04:53):

That's also an interesting question because there's something called store and forward and some of the first telemedicine occurred that way, which means when you think about radiologists, you would send the images, digital images to a radiologist who was remote, who would read them and send them back. So asynchronous store and forward transmission of health data. That includes telemedicine, asynchronous. Asynchronous meaning not at the same time. So synchronous communication can occur via the phone or video and that is state to state. Each state has its own definition of what telemedicine is and sometimes it includes phone and sometimes it does and generally, it does not include email.

Janet Kennedy (05:41):

Oh, that's interesting. Okay. I hadn't thought about that piece either. Let's go back to the "every state has a different definition". What a nightmare.

Tania Malik (05:50):

Yeah, in that fun. Also, the practice of medicine is state-regulated period. They can do the definition. They can say whether other clinicians can practice in their state, which of course hardly anybody says, I can almost safely say nobody and why I'm hedging on that. There are a few states that have said if you just say doctor, cause they're all other kinds of providers that do telehealth. Say you're a doctor, there are about 10 and 12 States and say you can get a special telehealth license to try and streamline it. There are compact States for nurses where if they're in a state that's a compact and you can have reciprocity and work in that state, but otherwise each state can talk about who can practice in their state too. It can be complex.

Janet Kennedy (06:39):

I know we're going to talk about COVID-19 and the effect the Corona virus has had on telemedicine, but since we're talking about licensing, some governors have made outright calls for please come to my state and help as this also impacted the use of telemedicine.

Tania Malik (06:57):

Yes, 100%! There's so many things that have changed now with this crisis. I just want to tell you what the baseline was. The requirements for telemedicine or telehealth are in 1834AN at the Social Security Act and basically the restrictions because I'm getting ready to tell you what's been waived and this is what ATA was moving forward, asking Congress to waive these restrictions, which was the originating site basically had to be a rural site and the location of the patient at the time, that's what the originating site is, where the patient is. The distant site is where the provider is. Well, the patient had to be sitting in a physician's office or a hospital or a rural health clinic or something like that. There's about eight to 10 on the list of where they could be sitting, but where they couldn't be sitting was their home.

Tania Malik (07:48):

So that was how we deliver telehealth and the type of provider mattered. You had to be an MD clinical nurse, midwives, psychologist that you couldn't be, say a speech pathologist or even a licensed clinical social worker, but the type of provider mattered. So these were the restrictions that we had. So now the ATA did is to push forward for a waiver of those restrictions. I'm digressing a little bit on your question about state licensing, but now lots of States have these waivers. To get back to your question, there is a March 24th more than 25 States took some actions to address exactly what you're talking about. So in North Carolina in particular, North Carolina has waived the licensure requirements for healthcare and behavioral healthcare personnel who may be licensed in another state to treat North Carolina patients. That North Carolina statement is the same statement that about 25 other states have done. So that is huge because it's opening up physicians or any behavioral health, psychiatrists anywhere that maybe are sitting in Idaho maybe aren't experiencing it as bad as New York is, and they can help deliver care now. So it's a huge sea change.

Janet Kennedy (09:07):

And we've also changed the patient doesn't need to be in a physical office.

Tania Malik (09:12):

Yes. So there are lots of other changes. That one's a big one that the patient can be at hunting. So when you think of this crisis and you think of who it's affecting the most, which is our elderly, then they can stay at home and get care. That is another big sea change for us. They have also waived, when I say they, it's either it's happened through congressional action or the Department of Health and Human Services or even when president Trump declared it a national emergency, some other things fell from that through the Stafford Act, but the major waivers have been they waived HIPAA, but let me be clear, they are in waived enforcement of HIPAA and if anybody's in healthcare, you know the Health Insurance Portability and Accountability Act. If you are in good faith trying to maintain HIPAA, then they're going to waive enforcement.

Tania Malik (10:05):

It doesn't mean that there might be some state other things you need to think about or privacy that the federal government is saying, Hey, we know that you're trying your best here in this crisis to deliver care. We're not going to be all over you about using Skype. Basically things like that. They're saying, I don't wanna throw Skype under the bus and be the only one. They've waived the certain types of technology that can be used for telehealth. They have waived the originating site, which of course is now can be the home. They've also expanded the type of providers that can be reimbursed. So like I was saying, the speech pathologist, physical therapy, those things are now they can be telehealth providers and get reimbursed.

Janet Kennedy (10:44):

Do you think all of this has been enabled because there is an actual organization that is overseeing the telemedicine side of the equation? Sure.

Tania Malik (10:55):

I, I mean ATA has really been instrumental in taking the lead in this, but it is a conglomeration and a coalition of other people. Like in our letter to Congress, there were probably five signers on that, the eHealth Initiative and some other partners that we work with regularly. So we're all in the same. But there are a lot of people who are focused on telehealth and we're all in the same boat and trying to get the waivers and other restrictions lessened to be able to combat this crisis.

Janet Kennedy (11:21):

So I understand people can actually have a telemedicine visit with their clinician via phone now, but is the standard of care trying to go to a video based call?

Tania Malik (11:35):

It differs and standard of care, like we said is back to the is always in the States. But I think it just depends on what your condition is and what the provider needs to see and what other data may have been transmitted electronically to them already. Remote patient monitoring has a firm hand and in medicine now and there's a lot of data that can get transferred to the physician so they could be on the phone and be looking at a lot of your health data. There could be some other conditions where you have to have video, dermatology and other things may, so it's very helpful in our field and tell them mental health both ways to either have the video or the phone and then the patient could have the choice. And then it also depends on our elderly population. It's sometimes easier for them to just pick up the phone and be able to have a visit as opposed to video.

Janet Kennedy (12:27):

Well that was actually my next question was about the elderly and how are they dealing with the advent of trying to call in or do a video visit with their clinician?

Tania Malik (12:39):

Well, I can just speak from my personal experience because I'm in the same which generation and so my mom had a primary care visit and there was just simply no way as she's approaching 80 that I was going to take her in for something that was routine. All of my parent's doctor's offices are offering telehealth visits now that quickly pivoted and did that and then they worked really hard in my mom's got on the phone and had the visit. Of course, the script gets sent electronically now and now on the script, it gets delivered to her door so she never has to leave. So I would say that the transition has been smooth and all of the physicians' offices that I have heard about have taken routine patients off their docket to make room for those that really need to be seen and they're seeing them in telehealth.

Janet Kennedy (13:26):

I had an appointment canceled yesterday, so there you go. Well, how about from the standpoint of the medical side of the equation? Are there rules or any kind of guidelines about what should and should not be treated via telehealth?

Tania Malik (13:43):

Well, I think that goes back to what you said about the standard of care. So we're still providing care. We've just changed the medium in which it happens. So all your medical training still applies all your common sense and all applying standard of care. What generally happens is a telehealth visit can occur and then if they so saved this was not a crisis, then they can determine if they needed to come in for a visit and they're all kinds of different ways the money works on that. Maybe your copay gets applied in person. There are lots of different things that happen depending on different rules and regulations, but that's generally what happens. So I wouldn't say that there are conditions that cannot be seen telehealth, and these are the ones that are, and it's always left up to the clinician.

Janet Kennedy (14:29):

Okay, so the 64,000 or million or billion dollar question is, is the horse out of the barn? And we're not going back.

Tania Malik (14:41):

It would be great. We've been having this conversation lately, as you can imagine, what will we need to do? What, what this crisis does is afford us the opportunity to track outcomes and provide data showing that this mode can be instituted just like they're doing right now, where patients are satisfied, providers are satisfied, care is where and when people need it and it's good quality care, efficient and effective. So this gives us the chance to provide the data to prove that this is effective.

Janet Kennedy (15:20):

Oh, excellent. Well, I'm very excited about hearing of the evolution of the ATA and where it's going after this dust settles from the COVID-19 pandemic. I think it's an amazing opportunity for telehealth to really become an integrated daily use service to the patients out there because it solves so many problems, not just for the elderly, but for individuals with co-morbid conditions and have chronic conditions that make it hard for them to get to the office. So I am very excited about the future for the ATA.

Tania Malik (15:58):

Thank you. And we've anecdotally, we've heard patients say, 'wait a minute, I could have been doing this before?' And, and now instead of getting and waiting in your doctor's office for that long, the sea change now may come from the patients who are extremely satisfied with this way of receiving care.

Janet Kennedy (16:16):

Well, that sounds great and a positive note in all the difficulty that we're dealing with. Well, Tania, thank you so much for joining me, for "People Always, Patients Sometimes", and I look forward to connecting with you, telehealth wise.

Tania Malik (16:31):

Yeah, that sounds great. Thank you, Janet.