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IHS expanded telehealth to provide care during COVID-19 pandemic

by Rear Adm. Michael Toedt, M.D., F.A.A.F.P., Chief Medical Officer, Indian Health Service

The Indian health system provides care in a wide range of settings, including many rural and remote locations settings. Telemedicine is therefore an ideal, if not essential, component of our care delivery. Telehealth is can include clinical health care, patient and professional health-related education, public health and health administration using technologies such as videoconferencing, the internet, store-and-forward imaging, streaming media, and wireless communications.

The IHS has a long history of using telehealth to meet its mission and the needs of its patients, dating back to the mid-1970s when IHS partnered with NASA and Lockheed Martin to provide telehealth to the Tohono O’odham Nation in Arizona. Currently, IHS has two national telehealth programs. The IHS Teleophthalmology Program was established in 2000 and provides screenings at more than 100 sites to help prevent diabetes-related blindness. The Telebehavioral Health Center of Excellence has been providing telebehavioral services to 26 sites across the U.S. since 2009. There are also numerous regional telehealth programs that support patient care in various IHS Areas including regional approaches to both tele-emergency medicine and tele-specialty care.

The COVID-19 pandemic has been devastating for American Indian and Alaska Native people. Data shows that American Indians and Alaska Natives are at higher risk of hospitalization and death associated with COVID-19. The burden of underlying diseases such as diabetes, obesity, heart disease and chronic lung disease occurs in Native people at much younger ages, and likely is a major contributing factor to this disparity.

IHS took immediate and bold action to prevent, detect, treat, and recover from COVID-19. The agency made it a priority to use the expanded access to telehealth made possible by HHS under the authority granted to it during the Public Health Emergency, significantly expanding the use of telemedicine to provide services in Indian country. Beginning in March 2020, IHS facilities rapidly ramped up virtual care services from a pre-COVID average of under 1,300 per month to a peak of nearly 43,000 per month at the height of the initial surge. Additionally, for the first time IHS clinicians could provide services into patients’ homes on almost any device. This allowed for continued access to care while protecting patients and health care workers.

Unfortunately, as IHS expanded telehealth services the Digital Divide in many Native communities became increasingly apparent. In these areas, patients often do not have the necessary equipment such as a smart phone or laptop, or sufficient broadband connectivity in their home or community to support video consultation. In these cases, telephone only connections have allowed care to continue. During the COVID-19 emergency, 80 percent of IHS telehealth encounters have been conducted using telephone only. We recognize that some of these issues are challenging to resolve, but we are working to do our best to look at technology that is scalable and can move from video to telephone support based on technical needs.

Telehealth expansion has been instrumental in meeting the needs of patients at tribal facilities during this difficult time as well. For example, the Cherokee Nation reported that prior to COVID-19, virtually no service for HIV treatment and pre-exposure prophylaxis, also known as PrEP, prescribing were delivered via telemedicine. Currently 99% of this care is being delivered via telehealth for provider visits, in conjunction with home visits for labs. At-home self-testing for HIV has been implemented via an automated texting service. More than 90% of their patients surveyed reported feeling safer and supported using telehealth.

There is more work to be done. We have heard from our patients, our providers, and tribal leaders that we need to continue sustainable access to expanded telehealth, even as we continue to work to deal more definitively with bridging the Digital Divide. IHS continues to assess and evaluate the impacts of telehealth while exploring new technologies, resources, and processes that will further increase access to care during and beyond the Public Health Emergency. You can learn more about IHS telehealth efforts at .

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Rear Adm. Michael Toedt, M.D., F.A.A.F.P., Chief Medical Officer, Indian Health Service

Rear Adm. Michael Toedt, M.D., serves as the Chief Medical Officer of the Indian Health Service. He provides national leadership for the clinical and community-based health programs of the agency and serves as the primary liaison and advocate for IHS health professionals.