[Deirdre Arroyo]

At a rural clinic in south central Virginia, we identified transportation as the greatest barrier to access to care in this community. Telehealth is a clear way forward for this underserved area where diabetes is prolific, and medication compliance is a problem. Current analysis of community needs indicates that videoconferencing and mHEALTH services are the most acceptable modes of telehealth among this population. The swift transition to virtual visits during the pandemic was quickly embraced by most patients indicating that access to computers at home is a viable option for most patients in this area.
A telehealth program addressing diabetes and medication compliance will require computer access, a video camera, audio, reliable internet, and end-to-end encryption for HIPPA compliance. Peripherals would enhance mHEALTH visits for diabetics, and include continuous glucose monitoring devices, stethoscopes, pulse oximeters, sphygmomanometers, and retinal scanners.
As the Chief Medical Officer of this program, my role includes identifying location eligibility, setting professional guidelines, credentialling, developing the professional tone of teleconference communication, training all staff involved, record keeping, and maintaining HIPPA compliance. Telehealth service agreements will be arranged by the Chief Financial Officer, and a program director will be utilized to oversee scheduling, provider recruitment, and optimization of workflow for all providers.
To ensure the success of this telemedicine program parameters that will be evaluated include patient and provider satisfaction, blood sugar improvement among diabetic patients, improved medication compliance, and the reduction of polypharmacy. Revenue gained will be measured against losses. It is hoped that there will also be a reduction in no-show rates which will also be evaluated.
Legal considerations include the maintenance of patient privacy especially for those using libraries or public spaces to access the internet, credentialling for providers caring for patients in other states, and maintaining HIPPA-compliant information systems, security, and data integrity. Other professionals who need to be involved include a marketing director, business manager, data analyst, and start-up consultant. Protocols needed include provider etiquette, patient conduct, prescribing restrictions, and limitations of care provided via telehealth. Informed consent will be secured before new virtual encounters and will be saved in the patient chart.

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