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Are telemedicine and distance learning finally having a chance? | Guest View

Series: Coronavirus | Story 162

Last updated 5/9/2020 at 11:48am

Back in 1994 and 1995, I wrote grant proposals for telemedicine and distance learning. These new technologies were "the next big thing," so we thought.

Even with the subsequent rise of the internet, both telemedicine and distance learning have undergone 25 years of fits and starts to catch on. Now, a pandemic is giving these technologies a chance to prove their worth.

On a personal level, I've recently had two telemedicine sessions at my home in Edmonds, and my physicians will supposedly be paid as if I had visited their clinics in person.

Since the '90s, telemedicine has been stymied by the refusal of the Health Care Financial Administration (HCFA, now CMS), the federal agency in charge of reimbursing doctors, to pay doctors for telemedicine visits. In most cases, unless the doctor sits in a room face-to-face with their patients, it's a free service from the physician.

With COVID-19, the reimbursement restriction been lifted; also, patient co-pay and HIPAA (patient privacy) rules have been relaxed. Removing co-pay may increase the risk of fraud by unscrupulous doctors, but CMS is averting its eyes for now.

Secondly, each state has its own licensing laws, making it illegal for a physician to treat a patient across state lines in all but a handful of states. Those restrictions have also been eased somewhat by CMS, at least temporarily, though questions of interstate liability and local turf laws are keeping most states in limbo-land.

Back to the present: Neither of my recent telemedicine sessions went smoothly at first due to login hurdles. I blame user ignorance and lack of full instructions from the doctors' offices. (Think settings: "Allow cookies," "turn off web blocking." etc.)

For my annual wellness checkup, which finally got underway 45 minutes late both on my end and on my primary care physician's, I answered a raft of questions about my health. My doc had me walk around in the house a little to verify I was physically functional.

I kept all my clothes on.

Though not required, I gave him my blood pressure reading from earlier in the morning. We chatted amiably and he renewed some prescriptions. He seemed surprised that I had done most of the teleconference from not only the safety and comfort of my own home, but also from my bed.

A couple of days later, my annual prostate checkup went far better than I had feared. Since my PSA (prostate specific antigen) numbers were stable from a recent blood draw at the clinic, further testing was not needed. The dreaded "hands-on" exam was averted.

Federal grant

Our hopes for telemedicine were boosted in 1994 after my team won a federal grant at the University of Washington School of Medicine. Participating medical specialists at Children's Hospital, Harborview Medical Center, and all nine departments of the medical school – including psychiatry – gave the experiment a thumbs-up.

Clinicians at our far-flung test sites in Washington, Alaska, Montana, Idaho, and Wyoming were also pleased. The specialists in Seattle really were able to help doctors in remote locations. Mainly, they helped the local docs make informed decisions whether to treat difficult cases themselves or risk their patients' lives by sending them off in an airlift. Our test clinic in southeast Alaska, for example, was plagued by fog, making airlifts extra risky.

Will telemedicine continue in some form after the current pandemic settles? While face-to face contact is not likely to be replaced, many users of telemedicine may be content to keep using it, at least occasionally.

A telemedicine exam could be made more comprehensive if patients at home had a basic kit. It could include a blood pressure monitor, fever thermometer, and bathroom scale. The kit might also have an oximeter that can be placed on a finger to check blood-oxygen saturation levels.

For a higher level of patient involvement, a kit might eventually include test swabs and vials for urine or saliva samples, which could be dropped at a clinic before a telemedicine appointment or even analyzed at home.

Adding to that, a more costly feature might be body sensors that measure heart rate, pulse, and blood pressure in real time, and transmit the data on secure lines to physicians.

On the other hand, when the pandemic ends, telemedicine might stall again if the temporary federal and state regulations return. Patients are loath to give up the psychological boost they get from actually sitting with their doctor, so they may not push hard to keep telemedicine going.

While health clinics might find them cost-effective, don't expect a lot of support from the doctors unless they are fairly compensated.

Will distance learning stay with us?

Our grandkids, who live with us, plugged into their Edmonds schools via computer screen on March 26. This is the first distance learning I had seen directed at children by a school district.

In the mid-1990s, I co-authored optimistic proposals for distance learning for a community college and for a school district south of Seattle. While colleges and universities have gradually integrated distance learning, it has not progressed much in schools.

Many districts across the country have been interested, but experiments have shown lackluster results. Also, funding was sparse, and competition was keen. My school-based proposal was up against 9,000 others, and there was no second place – otherwise we would have gotten some money!

After our local schools shuttered their doors a few weeks ago, my wife, son, and I started up our own home school that kept our grandkids' brains alive. We found activities all around home and in nature that could be integrated into learning. Our day always started with multiplication tables and spelling, which have already born fruit.

The third and fifth grader in our mini-school are privileged. They have three adults helping, two with training in education, and two who are especially computer savvy. And we have the computing equipment.

After the school district plunged into distance learning in late March, the first couple of weeks were chaotic. The teachers had not had time to prepare. With each passing day, distance learning in our household has been running more smoothly. Recently, the school district provided a direct line to its teachers, so we can call directly if needed.

Though it's smoother, the content seems limited, and we run out of material (and energy) after about two hours. Unless home learning continues through the summer (which we plan to do), I predict that most students will have lost half a year's learning when the next school year starts.

Single parents, especially those working, are very stressed since they cannot help their students. Even parents who are at home, trying to help two or more students in different grades must be especially frantic.

Though our local elementary school provided Chromebooks for students who needed them, a teacher or techie may be needed to make it work. Students in other districts may not have access to either a computer or the internet.

For those students on the fringes and locked in poverty, the future is especially bleak. How will they fit in with their more affluent peers if they have to play catch-up all next year?

To further complicate standardized distance learning, there are homes where parents may speak a language other than English. And what about social learning from fellow students and teaching staff? Again, our grandkids' teachers are trying hard to simulate a classroom, but nothing is likely to replace being in the same room with teachers and classmates.

What lies ahead for distance learning?

If it's to survive, the software must become more user-friendly for both educators and their students, and better technical support must be available. There is no one-size-fits all in the classroom, much less so in distance learning. Anything that really works will need to be flexible enough to address the needs of each individual child.

There might be a screen or direct phone line to a teacher's aide, who could help with technical questions and coach students who ask for assistance. All material, whether generated online or externally in written form or from the home computer, should be easily uploaded to the teacher and placed in students' online files.

If and when clear and consistent goals and objectives are developed for online learning in public schools, it might be possible to begin testing and grading. An added feature would be a way for students to interact informally with each other before and after the main schoolwork assignment.

Since the deck will likely be stacked against both telemedicine and distance learning, the most important thing we can do is to push for continued funding and give these technologies a chance to be upgraded,

As users, you can give constructive feedback to your medical providers about telemedicine and schools, and advocate for continued development. In setting schedules and priorities, school districts should seek out input from parents who have been on the front lines, or worse, left out entirely.

Even when we return to brick and mortar buildings, there is little doubt that there will be new crises of some kind. Assuming the internet doesn't fail, these technologies will once again be drafted into service.

We now know that telemedicine can protect patients and distance learning can keep our students' education afloat.

Cliff Sanderlin, trained as a journalist, spent 15 years at the University of Washington in grant writing, fundraising, and public relations. He worked at KUOW Public Radio, Harborview Medical Center, the UW School of Medicine, and Fred Hutchinson Cancer Research Center. Now retired, he lives in Edmonds with his wife, one adult son, and two grandchildren.


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