The Journal of the Arkansas Medical Society Med Journal July 2019 Final 2 | Page 20

by Casey L. Penn
Developing a Telemedicine Program in Arkansas:
A River Runs Through It
Presenter: Stephen Canon, MD
Chief of Pediatric Urology, Arkansas Children’s Hospital
“I have a love and hate re-
lationship with telemedi-
cine,” said Dr. Canon, who
is an associate professor at
UAMS and is chief of Pedi-
atric Urology at ACH. “This
is going to be as close to
reality as I can paint it.”
I
· Real-time interactive refers to facetime
interactions.
Of telemedicine, Dr. Canon said, “There’s an
inevitability that you see with the course of a river,
basically creating its path. I think telemedicine is
very much that way. It’s going to be a part of our
practice – not if, but when and how are the questions
in my opinion.”
Telemedicine can be applied in many areas of
practice, from the originating site (where patient is,
where the care starts) to the distant site (where the
provider is). “Believe it or not, it’s been around longer
than you might think,” said Dr. Canon, referring to work
by NASA in the 1960s and 1970s to use telemedicine.
Regarding technical help, Dr. Canon cited a
company he has no affiliations with, Innovator Health
(innovatorhealth.com), as a cutting-edge provider of
telemedicine.
How does telemedicine achieve improved
outcomes? Dr. Canon shared findings from the 2015
Cochrane Review, which found that telemedicine
(as opposed to traditional delivery) was effective
in treatment of diabetes, blood pressure, and
hypertension, with less clear benefit for congestive
heart failure and mental health. “There’s a relative
shortage of mental health providers in Arkansas,”
he added, “so there may be opportunity – through
telemedicine – to provide more care to those who
don’t have access.”
n addition to his achievements Requirements & Effectiveness
Dr. Canon recommended Broadband ISDN as Legal Barriers & Arkansas Policy
as a physician and researcher,
Stressing the importance of following the law, Dr.
standard, with upload speeds of at least 2-10 MBPDs.
Stephen Canon, MD, has become
Canon
said, “Physicians prescribing over the internet
“Low bandwidth will be too frustrating,” he said.
an authority on telemedicine by Other considerations before starting to implement must hold a state license where the patient is located
implementing it into his pediatric telemedicine include equipment capability and and must be compliant with the state laws there. The
urology practice. Drawing from his experi- compatibility, security and privacy, interoperability Interstate Medical Licensure Compact can help you
ences in practice, Dr. Canon educated members on
technology, effectiveness, policy, and payment for
telemedicine. He also covered some alternative paths
to utilization and shared his goals for telemedicine in
Arkansas.
Telemedicine is defined as the use of electronic
communications and information technology to
provide clinical services when participants are at
various locations. The basic types of telemedicine
include the following:
with electronic health records, and process flow
standardization (check-in, etc., which must be done
on both ends).
“These are dependent upon your institution,”
he explained. “If you’re in private practice, that’s one
thing. If you’re at UAMS, that’s another. I think a lot of
this – the tech component – is incumbent upon the
institution’s investment in what you’re doing.”
· Store and forward refers to a not-in-real-time
method involving the practitioner making a video,
sending it around, and waiting for patients to
respond with another video
· Remote monitoring refers to monitoring a
patient in his or her home or location (no back
and forth)
20 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
get licensed in multiple states.”
Summarizing current Arkansas policy, he talked
through Arkansas’s hard-won telemedicine legislation
– Act 887 (2015) and Act 203 (2017). “[With Act 887,]
the medical board took a conservative approach to
establishing the physician-patient relationship,” said
Dr. Canon.
Act 203 further safeguarded and clarified key
aspects of Act 887. It expanded the “originating site”
definition to include the patient location; broadened
the definition of “telemedicine” to include all types
of “electronic information and communication
technology;” added “store and forward” and “remote
patient monitoring” to the definition of telemedicine;
clarified that once a professional relationship is
established, the use of any type of telemedicine,
is allowed; and provided insurance coverage and
reimbursement parity for not just physician services,
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