Tribal Communities See Benefits and Challenges in Using Telehealth

Tribal communities across the country often turn to telehealth to access care, but they still face challenges using the technology and addressing gaps in care.

That’s the take-away from a report prepared by the eHealth Initiative and Foundation (eHI) following a recent roundtable discussion with representatives from the Indian Health Service (IHS) - which provides healthcare services for roughly 2.6 million American Indians and Alaska Natives - the Chinle community in Arizona, the Lummi Tribal Health Center in Washington state, and telehealth provider Philips Healthcare.

Telehealth is used in tribal communities across the country, with telehealth visits making up 60 percent to 70 percent of their healthcare services. Telehealth use has especially climbed in these communities during the coronavirus pandemic, with providers wanting to limit in-person contact. The IHS serves 574 federally recognized tribes and is a key player in helping to provide telehealth services.

The report notes how the Chinle community in Arizona, consisting of roughly 4,000 members and a part of the Navajo Nation, adopted telehealth use despite having very little infrastructure to support it. 

The community was quick to turn to telehealth visits when the pandemic hit, Eric Ritchie, PhD, clinical director of the Chinle Service Unit, said during the roundtable discussion. The Chinle Service Unit offered audio-visual telehealth visits through many of their clinics to treat sick patients while avoiding the risk of COVID-19 transmission.

The Lummi Nation in Washington state, meanwhile, are also frequent users of telehealth. More than half of their healthcare visits are delivered via telehealth. The tribal community uses telehealth methods for physical therapy, dentistry, and psychiatry, and their behavioral health program is now 100 percent telehealth.

Telehealth use for behavioral health services has increased in the Lummi Nation due to the heavy stigma that surrounds mental health care. The privacy that telehealth offers patients was a big factor in the increased adoption during the pandemic, Justin Iwasaki, PhD, MPH, the director of special projects at the Lummi Tribal Health Center, said during the roundtable discussion. 

The report drafted from this roundtable emphasizes the impact of successful collaboration between tribal leaders and the IHS. For example, the Chinle tribal leaders worked with federal IHS leaders to disseminate information and plan courses of action when the pandemic hit. The frequent communication led to the implementation of several telehealth practices for the community. 

Working with the IHS, the Chinle Service Unit provided iPads connected to a cellular network reserved for healthcare emergency first responders to patients with poor internet connection, making it easier to attend telehealth visits from their homes. They also set up telehealth kiosks in easily accessible locations such as chapter houses and senior centers. 

The IHS offers several telehealth resources for tribal communities, including education and resources on clinical documentation, an IHS telehealth toolkit, and multiple telehealth webinars, Mitchell Thornbrugh, the organization’s chief information officer, said during the roundtable. 

Despite these telehealth success stories, there are still roadblocks. Many Tribal communities are in rural and isolated locations and, like Chinle, face challenges in telehealth delivery. Access to adequate cellular coverage and internet connectivity is scarce, according to Ritchie. Less than 1 percent of Apache County has access to high-speed internet.

"Overcoming barriers such as broadband access, digital literacy, and hesitancy are critical to ensuring all communities have equal access to healthcare,” Jen Covich Bordenick, chief executive officer of eHI, said in a press release accompanying the report.

Without reliable internet connectivity, telehealth visits can be interrupted and unproductive for patients and providers. In communities with crowded households, there are limits to privacy for patients who want to discuss health issues with caregivers. 

At the beginning of the pandemic, many Tribal communities had difficulty synching their health data with electronic health records platforms.

“Our greatest challenge during the pandemic was the lack of access to needed data from state records and Indian Health Service records, to find out who tested positive so that we could contact individuals to conduct contact tracing,” Anita Frederick, president of the Tribal Nations Research Group, said during the roundtable.

In response, IHS launched the Four Directions Hub pilot, which will connect remote patient monitoring devices to existing federal infrastructure. This will help modernize the health IT infrastructure and ensure easier access to data. 

The roundtable and the report it produced serve to highlight the challenges faced by underserved populations in accessing and benefitting from connected health services. The potential is there and the successful use cases are evident, Bordenick and her colleagues point out, but the journey to full telehealth adoption is by no means complete.