Survey finds Hawaiʻi telemedicine up, obstacles remain

Hawaiʻi healthcare providers have ramped up their capacity to meet the new demand for telemedicine due to COVID-19, according to results of a statewide telemedicine assessment conducted by the Hawaiʻi Emergency Management Agency (HI-EMA) in collaboration with the University of Hawaiʻi. 

“We will be living with COVID-19 for an unknown period of time and one of the challenges our agency faces is how to mitigate against hospital capacity, and from an emergency management perspective, telemedicine is a key component in our battle with this pandemic,” said HI-EMA Administrator, Luke Meyers.

Since health care in the time of COVID-19 has increasingly shifted from in-person to virtual, HI-EMA’s State Emergency Support Function #8 (SESF #8), which is responsible for medicine and public health, decided to examine telemedicine readiness and needs in the state of Hawaiʻi.

“This survey is the only known statewide telemedicine assessment in Hawaiʻi,” said Aimee Grace, the telehealth component lead for HI-EMA’s SESF #8 and director of the UH System’s Office of Strategic Health Initiatives. “The results are helping us to better understand the capacity and needs in the state with regard to telemedicine as we work together to address COVID-19.” 

Conducted in May 2020, HI-EMA’s statewide telemedicine needs assessment received more than 100 responses across the state from private and public hospitals, Federally Qualified Health Centers, rural health clinics, independent providers, Native Hawaiian Health Care Systems and more. The majority of the respondents reported that they recently began providing virtual patient visits and tele-triage services.

“The study indicated that while Hawaiʻi has a significant capacity for telemedicine in some areas, large gaps remain in others,” said Lee Buenconsejo-Lum, associate dean for academic affairs at UH Mānoa’s John A. Burns School of Medicine (JABSOM), a member of the survey core team and SESF #8. “For example, while some telemedicine services such as telestroke, tele-triage and asynchronous store-and-forward technology could be found statewide prior to COVID-19, it was not until after the onset of the pandemic that these telemedicine services became a major presence in different counties and facilities.”

Many respondents stated their desire to start or expand telemedicine services, such as remote patient monitoring, eConsults, asynchronous store and forward technology, and real-time imaging. While specific preferences for desired services varied by facility or practice type, counties across the state of Hawaiʻi desired numerous types of telemedicine services.

While there was wide interest in including telemedicine services, some hospitals and clinics also indicated that they faced barriers including a lack of funding, poor internet connectivity and a lack of staff training. 

“HI-EMA is very grateful to Dr. Grace and the excellent team that worked so hard to put together this vitally important assessment of our states’ telehealth capacities and needs. The report will not only allow us to improve our ability to deliver medical services across during this pandemic, but it also gives us a path forward to leverage this crisis into an opportunity to improve healthcare delivery for the people of Hawai’i far into the future,” said Steven Hankins, SESF#8 lead coordinator.

The survey also showed that, in general, specialized equipment for telemedicine—including telemedicine carts, digital stethoscopes, blood pressure monitors and other peripheral devices—were not commonly found in the state of Hawaiʻi. Without such equipment, facilities and practices may not be able to provide desired services such as remote patient monitoring and mobile health. 

The results of the survey will be disseminated statewide, providing useful information to state leaders, policymakers, health care facilities and organizations and health professionals, and bolstering upcoming efforts to increase funding for telemedicine and target interventions. Results will also help to inform future telemedicine studies and endeavors. 

“As we well know, the status of COVID-19 in the state of Hawaiʻi is ever evolving,” said Christina Higa, co-director of UH’s Pacific Basin Telehealth Resource Center and part of the survey’s core advisory team. “This survey was conducted in May, when Hawaiʻi was doing well. Our results may already be outdated, and telemedicine may be in even higher demand. Further research is needed to continue to monitor telemedicine needs and usage in Hawaiʻi.”

The survey project was supported by HI-EMA’s SESF #8 and received data management analytic support from Breanna Morrison and John Chen in the JABSOM Biostatistics Core, as well as Sunja Kim in the UH System Office of Strategic Health Initiatives.

The full report is available for public review on the UHealthy Hawaiʻi website.