Getting started: telehealth for American Indian and Alaska Native communities
Learn the basic requirements for treating American Indian and Alaska Native patients virtually.
Each American Indian and Alaska Native community has a unique and rich culture. These cultures are an essential asset that can help advance and improve health. However, according to Indian Health Service (IHS), there is a persistent disparity in death rates between these populations and other Americans in a variety of health categories.
Lower life expectancy and disproportionate disease burden exist for a variety of reasons, but all can be broadly traced to quality of life issues rooted in economic and social challenges. These factors often block access to high-quality care delivery and, in some cases, discourage potential patients from accessing health care at all.
Telehealth can help reduce these socioeconomic burdens and health disparities by providing a more convenient, lower-cost model of care.
How to set up a telehealth program for your community
Before taking the first steps to create a telehealth program that serves an American Indian or Alaska Native community, it’s important to ask yourself questions about what your practice is capable of offering.
Our guide to planning your telehealth workflow will give you more information on the business and technology basics, but there are several telehealth considerations specific to American Indian and Alaska Native Communities.
- How will you ensure that your telehealth platform protects patient privacy and is HIPAA compliant?
- What laws does your local reservation have regarding virtual care?
- Are you required to have multi-state licensing to use telehealth?
- How is your practice prepared to adapt if flexibilities related to the COVID-19 public health emergency change?
- What telehealth services are covered by private insurance companies and government programs, like Medicaid and Medicare, in your state?
- How familiar is your staff with cultural humility for treating American Indian or Alaska Native patients?
- Does your staff have access to translation resources or interpreters?
- How will you measure staff readiness and willingness to implement telehealth?
- How will you encourage staff who are reluctant to adopt new technology?
- How will you train staff on the new technology?
- How familiar is your organization with the Indian Health Manual and Tribally-Operated 638 protocols?
- Does your telehealth program have buy-in and support from the local community?
- Has your telehealth program been discussed with the local tribal governing body?
- What organizations can you partner with to increase the chance of success for telehealth in an American Indian or Alaska Native community (tribal leaders, advocacy groups, local laboratories, pharmacies, etc.)?
- In what specific ways will you partner with each of these organizations?
How to track and share the success of your program
Before you see your first telehealth patient, you will want to track your program’s effectiveness.
First, identify your program goals. That goal could be as simple as having enough telehealth patients to sustain the increase in business costs or appointment “show rate”, which is a measure of how often scheduled appointments are completed. You could also track new patients who joined your practice because of telehealth care.
Your goals will help you define your program’s key performance indicators. Your key performance indicators, often referred to as KPI, is a measure of the effectiveness and success of a business plan.
Once you determine your key performance indicators, you can use them to track the successes of your program. You can also track your progress with a spreadsheet or you can hire an analytics company to track your progress.
Tribal leadership will likely want to hear how the program is progressing, so be prepared to present these goals at a community meeting.
Other program measurement considerations
Share your successes with your patients and with your community. This is a great opportunity to talk to potential stakeholders, including Tribal leaders and public health officials. You can also reach more patients that could benefit from telehealth care.
Get feedback. Whether your program takes off or the early data is sluggish, getting feedback is important.
IHS offers a Patient Experience Survey that you can use as a template.
You can also ask your patients questions such as:
- What do you like about your telehealth appointments?
- What do you dislike about telehealth appointments?
- What would you change?
- What would make telehealth easier or more comfortable for you?
- What other services would you like to see offered via telehealth?
- Were your concerns heard and addressed in your telehealth appointment?
- Would you schedule another telehealth appointment?
Indian Health Service Telehealth Toolkit (PDF) — from IHS
IHS Telehealth Programs - from IHS
Project ECHO - from University of New Mexico
Best practice guide: Telehealth for rural areas - from Health Resources and Services and Administration
SpotlightBenewah Medical Center
The Benewah Medical Center, based in Plummer, Idaho, provides health care services to Coeur d’Alene Tribal members and other federally recognized tribes in the service area. The medical center used funding from Health Resources and Services Administration (HRSA) to make improvements to its telehealth infrastructure.
- Replacing the outdated switch infrastructure at the clinic
- Replacing dated batteries for data center backup;
- Upgrading the uninterruptible power supply for backup at the Marimn Health & Wellness Center
- Increasing storage to area networks
- Upgrading wireless connections
- Purchasing additional laptops and webcams
These improvements were made in response to increased demand for telehealth during the COVID-19 public health emergency and will help make Benewah Medical Center’s telehealth program more sustainable after the public health emergency ends.