Federal agencies that support, deliver, and evaluate healthcare services, such as the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the Departments of Veterans Affairs (VA) and Defense (DoD), and the Agency for Healthcare Research and Quality (AHRQ) play critical roles in the drive to improve access and quality by advancing the use of health information technology (IT), including telehealth services in rural, remote, and underserved urban areas. The IHS exemplifies the use of innovative technologies to address critical needs in resource-constrained environments. IHS and tribally operated health facilities have long used the Resource and Patient Management System (RPMS), a comprehensive software platform that helps streamline healthcare delivery and evaluate clinical processes and outcomes. The RPMS electronic health record (EHR) supports a wide variety of clinical functions with a customizable user interface that can accommodate different information and workflow needs, including those of researchers. RPMS also supports iCare, a population management software tool that gives providers and researchers the ability to create “virtual cohorts” of patients with common characteristics (e.g., age, diagnosis, community) and view patient and population data in customizable ways.1
The IHS, in collaboration with National Institutes of Health (NIH), also supports innovative research partnerships through its Native American Research Centers for Health (NARCH) program, in which American Indian and Alaska Native (AI/AN) tribal organizations take the lead in formulating research questions and directing projects in collaboration with academic investigators.2
This approach ensures that resources are distributed equitably among partners and that projects address questions of importance to tribal communities. For example, rheumatic diseases (e.g., arthritis) are over-represented in AI/AN populations. Supported in part by the NARCH program, clinician scientists in Oklahoma are discovering novel patterns of autoantibody markers in these populations, which may help improve diagnostic and prognostic accuracy and perhaps even point the way to better therapy. At the same time, they are helping tribes develop specialty clinics in rural areas to bring advanced rheumatology care to residents, using telehealth applications as “physician extenders,” transmitting laboratory and x-ray results, providing medication assistance program information, and holding Web-based videoconference training sessions for physicians across the state, facilitating collaborations throughout Oklahoma and as far away as the Alaska Native Medical Center in Anchorage.
As these examples illustrate, telehealth, encompassing the terms “health IT,” “e-health,” and “mobile health” as well as telemedicine, is a set of enabling tools and toolkits both for healthcare generally and for clinical and translational research and education. Exciting new “technology-enabled” service models are evolving for different specialty areas, such as expert triage via telehealth consultations. Research partnerships are crucial for assessing the feasibility and impact of telehealth technologies, and to compare, contrast, and analyze their ability to meet the needs of diverse communities. Providers also need to demonstrate sound business models for implementing these technologies, which tend to be disruptive, at least initially, and challenge established service models.
Linking science to practice ultimately hinges more on human relationships than on technology. New technologies must enable and enhance relationships if they are to be effective and embraced, especially in chronic disease care management. Relationships built around high-priority research endeavors in primary care settings, e.g., implementation research and testing health promotion and disease prevention interventions, can lead to better relationships revolving around specialty care, including clinical trials for new therapeutic interventions. Such research must include a public health perspective, focusing on communities that are most vulnerable and most in need, making sure they are included and have access to the tools and relationships that NIH is trying to support and develop. This will require more shared dialogue across diverse translational communities, from researchers to clinicians, patients, families, and community organizations.