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Disaster Preparedness, Disaster Preparedness Plan, Telehealth services, Disaster Preparedness ReportAre your telehealth services prepared for another COVID surge? Now might be the time to consider developing a telehealth disaster preparedness plan. As cities around the country are struggling to deal with the rapidly escalating COVID surge, announcements are pouring in from many different beleaguered healthcare groups. For example, in Austin, the Emergency Medical Services Association President Selena Xie announced, “Medics are ‘exhausted’ and ‘hopeless'” as COVID cases surge. She continued, “EMS workers are understaffed, but their call volume is skyrocketing.” Now that recovery from COVID-19 is getting more complex than previously imagined, it may be an important time to consider some of the key resources for developing your telehealth disaster preparedness plan to be ready for another behavioral health surge in demand.

A February 2021 study released by the Healthcare Leadership Council and the Duke-Margolis Center for Health Policy called National Dialogue for Healthcare Innovation proposed a national strategy for preparing for the next pandemic or disaster that includes increased access to and coverage of telehealth and a provider licensure plan. “This initiative was well-positioned to help clarify, shape, and coordinate the execution of that strategy among governmental and private sector leaders,” the report notes. “The report is unique in its focus on private-public coordination; in developing recommendations applicable to a broader spectrum of disaster responses beyond pandemics (including natural disasters, bioterrorism, cybersecurity, and others); and in creating targeted, bold recommendations that private sector leaders, the new Congress, and the Biden Administration can adopt in the immediate term.” Using Healthcare Leadership Council’s sister preparedness report, you can develop your own checklist for how to proceed in developing your behavioral telehealth response for another COVID surge due to the Delta and perhaps the Lamda variants, as well as for any other national or international disaster.

National Dialogue for Healthcare Innovation Disaster Preparedness Report

The National Dialogue for Healthcare Innovation initiative’s stated objectives are:

  • Improving data and evidence generation
  • Strengthening innovation and supply chain readiness
  • Innovating care delivery approaches

To reduce the chance of infection, telehealth is identified as relieving the pressure on hospitals and improving access to care for people at home. Those actions are part of the report’s recommendation to “harmonize conflicting requirements during emergencies to improve health care mobility and surge capacity.” The Disaster Preparedness Report report continues, “The Congress and state legislatures should update disaster response legislation to provide for fast waivers that can grant needed flexibility during emergencies, such as those allowing for licensure portability, greater telehealth accessibility, temporarily lift communications restrictions to allow for coordination of care and with public health, and to access PPE stockpiles quickly,” the Healthcare Innovation report states. “These waivers could be implemented through multiple approaches: the legislation could outline which types of emergencies warrant certain waivers or flexibilities, all waivers or flexibilities could go into effect shortly after an emergency has been declared unless specifically not needed as noted in the emergency declaration, or the legislation could identify a tiered or categorized approach that could be specified by the emergency declaration,” it adds. See Telehealth Services Can Reduce Burden on Emergency Departments, Mental Health Services. Many federal and state offices have taken steps to allow care providers to treat patients in other states, mainly through licensure portability. See CCHP’s Cross-State Licensing search engine for a regularly updated database to help identify which states currently allow out-of-state professionals the authority to enter foreign states.

Healthcare Innovation Report’s Message to Licensing Boards, the FDA & Payers

The Healthcare Innovation report also recommends a virtual care strategy that includes an inventory of regulatory constraints to telehealth use so that state and federal governments can tailor their waivers to reduce those barriers during an emergency. This would include identifying geographic regions where broadband access is an issue, developing best practices for telemental health, and identifying opportunities to standardize definitions and terminology for such topics as modalities, sites of services, and allowable tools.

“The (Food and Drug Administration) should evaluate how regulations can encourage better deployment of digital technology during public health emergencies, drawing on the regulatory discretion used already for mobile apps and other software,” the Healthcare Innovation report adds. “CMS, state Medicaid agencies, and commercial payers should examine how payment and coverage policies affect the uptake of virtual care technologies, with special consideration of how flexibility on using virtual care technologies could be included in alternative payment models.”

With licensure, the report recommends that Congress establish a national emergency licensure policy, allowing hospitals and health systems to address needs by using out-of-state providers and giving those providers – including those in medical school – an opportunity to treat patients where needed. The Healthcare Innovation report also calls on professional organizations and state legislatures to identify how to improve the license portability process, creating guidelines and standards for practice flexibility during emergencies.

Disaster Preparedness in Hospital Emergency Departments

Past data reinforces the need and usefulness of the proposal. Over the first nine months of the COVID pandemic, emergency departments (EDs) had an unfortunate but unique opportunity to test the viability of various virtual interventions. As described in the study “Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments” in the Journal of the American Medical Informatics Association, “participants experimented with more than a dozen different types of telehealth applications, including tele-isolation, tele-triage, teleconsultation, virtual post discharge assessment, acute care in the home, and tele-palliative care.” 

The study reported that emergency departments could quickly implement these virtual solutions, especially if they had prior systems in place for any other telemedicine intervention. Additionally, the EDs quickly pruned away unnecessary applications when they had outlived their usefulness. Both results speak to both the speed and versatility of telehealth applications. The results also suggest that virtual solutions do not add long-term bureaucracy or slow down an existing system. Emergency departments can quickly implement them in times of need and eliminate them after addressing the need.

Telehealth in Natural Disasters

With California wildfires already raging, paying attention to increasing telehealth access also is reasonable. See California Secures Presidential Major Disaster Declaration to Support Wildfire Response and Recovery Efforts for an 8/24/21 update on the seriousness of the California wildfire situation. Tess Meehan, MHA, writing for Health Recovery Systems, made further relevant natural disaster arguments for telehealth applications in her piece, “Applying Telehealth to Natural Disasters.” She explained how virtual solutions could address damage to the physical infrastructure, such as hospitals and clinics, help remain connected to evacuated citizens, and support existing emergency systems such as 9-1-1. Through case examples including blizzards, hurricanes, flooding, and wildfire, Meehan repeatedly demonstrated how the use of telehealth applications ensured that existing systems remained viable. Virtual solutions provided the additional necessary resources to support people before, during, and after natural disasters. Whether struggling with acute issues such as significant physical harm, searching for information, or reaching out for psychological support, individuals in natural disasters had more readily accessible help when telehealth applications were part of the emergency response.

Telemedicine and e-Health in Disaster Response,” an article in Telemedicine Journal and e-Health, also spoke to the importance of telehealth services in disaster responses. Going back to the 1980s and the Mexico City earthquake and Armenian Spacebridge disasters, the article demonstrated how NASA effectively used early telehealth applications to respond to both situations. The article also demonstrated how the U.S. Military has effectively utilized telehealth applications for global humanitarian missions. Even in unstable situations where the military had to deal with open hostility, for example, in Haiti, telehealth applications increased the effectiveness of the mission. It also allowed the U.S. to provide resources in areas where sending in human personnel might endanger others, like the Ebola outbreaks in Liberia and Guinea during the mid-2010s.

As with the ED interventions noted above, telehealth services repeatedly demonstrated their ability to provide productive assistance when existing systems and resources might be reaching their breaking point. They can be quickly implemented in times of disaster and equally rapidly removed when the crisis has passed. 

Telehealth Provider Guidance: Pairing Telehealth Services With Existing Guidelines

Providers and provider networks can also benefit by preparing now for how they can help with the current disasters. Health and Human Services has previously provided advice to telehealth providers in their paper “Creating an emergency plan.” The organization outlines several questions to ask, discuss, and answer with clients using telehealth services during emergency circumstances. These questions allow the provider to stay connected with the client or patient and be aware of their location should further intervention or rescues be necessary. The questions should also help clients and patients better understand their present situation and plan for going forward. They can be particularly helpful in working with people with a wide variety of disparities. For more insight into how you can help people struggling with disparities, see Telehealth and Health Disparities and Telehealth Disparities Under the COVID-19 Pandemic.

These guidelines provide an easy-to-follow path for establishing and maintaining telehealth services during emergencies. They reinforce the usefulness of the above proposal by demonstrating the necessity of telehealth applications in response to disasters and the ability to use such applications in a measured way.

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