Zooming in on Better Healthcare

by Keli'i Akina, Ph.D., President / CEO, Grassroot Institute of Hawaii, Nov 5, 2023 

Could broader use of telehealth improve the quality of healthcare in Hawaii?

I think so, and let me tell you why.

Telehealth — sometimes called telemedicine — is when patients consult with their doctors over the internet via Zoom, Skype, Google Meet or some other video conference program without the significant inconvenience of having to make an in-person office visit.

The COVID-19 lockdowns increased public awareness of telehealth, since so many people were confined to their homes during that seemingly endless period. But it is important to reinforce the message that telehealth remains an important healthcare option, and, in fact, has the potential to change medicine as we know it.

For example, telemedicine is currently being used by emergency medical technicians to ensure better outcomes for stroke victims. At a recent briefing for the state House Committee on Health and Homelessness, Dr. Matthew Koenig of Queen's Health Systems explained how telemedicine has helped save the lives of stroke victims. He said its use from an ambulance can let a neurologist at the hospital examine the patient, speak to witnesses and activate the hospital’s stroke team ahead of time.

Telehealth can be used for more mundane situations as well, such as discussing lab test or X-ray results, dealing with prescriptions, post-surgical follow-up, physical and occupational therapy, mental health treatment and urgent care issues such as colds, coughs, and stomach aches.

For doctors, telehealth can let them stay in closer contact with their patients, attract more patients because of the convenience, and reduce office costs such as front-desk support and space for medical examination rooms.

In a state where geographic conditions and a shortage of healthcare workers creates significant challenges to access, expanding telehealth is more than just a good idea, it’s a necessity.

Creating an accessible, smoothly operating telehealth system will be a long process. We must start by addressing the technological barriers that prevent providers and patients from making full use of telehealth options.

For one thing, not everybody in Hawaii has internet access. Programs abound that are dedicated to improving digital access for underprivileged communities, but this issue will require ongoing support. Meanwhile, in doctors' offices, better integrated technology is needed for telemedicine to take hold.

Then there is the question of how we can expand telehealth. Currently, Hawaii law says that only doctors with a Hawaii license can treat patients in Hawaii. But if you live in Hawaii and want to talk with a medical specialist on the mainland who isn’t licensed to practice in Hawaii, you can’t do that.

This is a real problem for Hawaii residents whose only option in certain life-or-death cases has been to travel to the mainland to find the doctors they need — if they can even afford to do that.

The good news here is that the Legislature and governor approved legislation earlier this year allowing Hawaii to join the Interstate Medical Licensure Compact, which by 2025 will make it easier for doctors from 41 other states and Guam to obtain a Hawaii license and consult remotely with patients in Hawaii.

But we could do more. Twenty-six states have special license or telehealth registration programs that allow out-of-state doctors to offer telehealth services. Idaho, for example, allows licensed doctors to offer telehealth care to patients with whom they have an established relationship but are in the state only temporarily. Florida has an even better option. Licensed out-of-state providers can practice telehealth by merely registering with the state medical board and agreeing to certain conditions such as liability coverage.

Hawaii's policymakers demonstrated a willingness to take bold action in addressing our healthcare crisis when they approved the Interstate Medical Licensure Compact for doctors. Their next steps should be to let the state join more medical compacts — such as for nurses, emergency medical technicians, physical therapists and more — and expand telehealth.

It is time for Hawaii to fully embrace the potential benefits of telehealth and enact policies that will expand its availability and effectiveness.

E hana kākou! (Let's work together!)