Student pharmacists from the will assist HMSA and University Health Partners to perform Medication Therapy Management (MTM) for people with chronic diseases in the state of �鶹��ý.

“Our most qualified students will be putting their technical knowledge and people skills to work to help patients achieve better outcomes from their medications,” said DKICP Dean Rae Matsumoto.

MTM services will be available statewide via telehealth. HMSA will identify a subset of members that will be eligible for this early phase of the program. MTM students will help review a patient’s medication to ensure they are being used appropriately, answering any drug-related questions and determining the most cost-effective options. MTM students will help review a patient’s medication to ensure they are being used appropriately, answering any drug-related questions and determining the most cost-effective options.

“Studies show that using pharmacists to provide MTM services improves medication adherence and ensures patients are on the appropriate medications and doses,” said Camlyn Masuda, DKICP associate specialist and a coordinator for the new program.

Students can apply and interview for the MTM consultant positions, which will be in addition to their academics. Working under the guidance of a pharmacist, students conduct one-on-one phone consultations with each patient about all the medications they are taking, document the information and any recommendations and share it with the patient’s physician.

“This type of work experience puts our students on the forward edge of pharmacy services being offered in healthcare today,” said Matsumoto. “We are very excited to have this opportunity to work with HMSA and University Health Partners, two of the largest healthcare providers within the state, to help in delivering better care to their patients.”

DKICP will expect the first students to be hired and start providing MTM services after the fall semester begins.

Read more at the .

Telehealth proved to be an effective tool during the COVID-19 pandemic, especially for maternal-fetal medicine—more than 50% of those patients utilized telehealth visits.

“Compared to all other subspecialties, we had over 50% of our patients being seen by telehealth visits,” said Men-Jean Lee, Maternal-Fetal Medicine Fellowship Program director at the University of �鶹��ý at ����ԴDz� (JABSOM).

Leaders from local health plans, hospital systems and the community gathered in August for the 2023 Maternal Telehealth Summit sponsored by JABSOM and the UH ����ԴDz� to learn how to make telehealth even more effective for rural areas across the state.

“We want this to be sustainable. Telehealth is just the intersection of healthcare, health policy, social determinants and social science,” Lee said. “There are a lot of barriers for our pregnant patients coming from the neighbor islands to fly over. They would have to take a whole day out of work in order to fly to Honolulu. They might have to find childcare for their children.”

How maternal telehealth works

Under the guidance of a medical professional using innovative technology, maternal telehealth allows patients to stay home—even for ultrasounds, which traditionally required an in-person visit.

“An ultrasound probe can be attached to a cell phone or an iPad,” Lee explained. “We then have a medic or a mobile technician do the ‘street ultrasound’ by meeting the patient where they’re at. That could be at their home. We also serve the houseless population, which could be at their tent.”

The physician would connect with the medical professional on the ground via a computer or tablet and guide them as they performed the ultrasound. These virtual exams aren’t just reserved for ultrasounds.

“We’ve done telehealth counseling for diabetes and hypertension outside of a gas station in somebody’s car,” Lee recalls. “We’ve taught patients how to use finger sticks and how to inject themselves with insulin totally by telehealth. Now, those women who cannot fly to Honolulu can have all this extra diabetes teaching back on their neighbor islands.”

Looking to the future

As telehealth expands in �鶹��ý, those attending the summit called for more access to technology and more medical professionals who act as the link between physician and patient.

“If the appointment is straightforward, it can just be me and the patient talking over Zoom,” Lee said. “For the more complex cases, we need telehealth navigators to go into the field and bring that technology to the patient. This is that hybrid model where we do need a second human being with some basic medical training that knows how to connect up to the subspecialist at the home base to triage which patients need to come in and which ones can stay home.”

Looking ahead, more digital navigators are being hired through a partnership with University Health Partners. Hawaiʻi Libraries are also getting involved by setting up telehealth kiosks in libraries across the state for patients to visit and conduct their telehealth appointments.

Lee said this partnership is crucial because it aids in the digital divide that plagues many rural areas.

“We know libraries will have good broadband access. The librarians have agreed to be the digital navigators for the patient to help them connect with their physicians and providers,” Lee said.

The University of �鶹��ý has established a new UH Rural Health Research & Policy Center (RHRPC) with a $1 million grant from the U.S. Department of Health and Human Services Health Resources and Services Administration. This funding was championed by U.S. Sen. Brian Schatz and U.S. Rep. Ed Case in the FY22 federal appropriations process.

Launched in September, the new center is focused on improving rural health care challenges in �鶹��ý through policy-relevant research and actionable, evidence-based strategies and recommendations, specifically on health workforce and health equity.

“�鶹��ý faces unique challenges as a non-contiguous state with multiple islands, such as problems with accessing health care for residents especially on neighbor islands, provider shortages and underrepresentation of Native Hawaiians and Pacific Islanders in the health care workforce,” said Principal Investigator Aimee Grace, director of the . “While many of these issues impacting rural health in �鶹��ý are well-known, a critical gap has been translating these challenges into specific policy solutions that are actionable and evidence-based.”

In the short term, UH RHRPC plans to focus on areas of priority to the rural health community and related challenges to �鶹��ý’s health workforce, including improving Medicare payments and making federal designations, such as the Health Professional Shortage Area scoring system, to be more reflective of �鶹��ý’s unique needs.

“The need for far more focused action to close �鶹��ý’s rural health divide has never been so acute,” said Congressman Ed Case (HI-01). “The University of �鶹��ý’s new Rural Health Research and Policy Center will play a critical role to address the specific and unique health care needs of �鶹��ý’s rural communities. I am very pleased that Congress approved my funding request to support the creation of this center and look forward to continuing to work with UH and other key rural health stakeholders in �鶹��ý to further these efforts.”

New initiative to collaborate with health partners

The center will collaborate with key rural health partners, including the �鶹��ý State Rural Health Association, the State of �鶹��ý Office of Primary Care and Rural Health, the and the . Focus groups and site visits to impacted regions across the state and with key stakeholders will provide the Center with critical information to support its research and policy efforts.

The need for far more focused action to close �鶹��ý’s rural health divide has never been so acute.
—U.S. Rep. Ed Case

“We want to ensure that RHRPC’s work is aligned overall with the needs of our rural communities and encompasses the concerns and potential solutions from rural health stakeholders from across �鶹��ý,” said Kelley Withy, co-investigator and director of the �鶹��ý/Pacific Basin Area Health Education Center at the .

The grant will fund RHRPC for one year with core staff, a partnership award with the �鶹��ý State Rural Health Association for outreach and stakeholder engagement, and subcontracting services as needed to fulfill key research needs. RHRPC also plans to pursue grants and additional funding opportunities to ensure ongoing sustainability of the center.

“As �鶹��ý’s only public institution of higher education, UH and its health sciences programs play an essential role in educating the health care workforce of the state and region and addressing health challenges. RHRPC has a critical role in advancing research and policy solutions to improve health for rural communities in �鶹��ý, and we sincerely thank Sen. Schatz and Rep. Case for their support of the establishment of this Center,” said Grace.

A new telehealth toolkit is helping to train the future healthcare workforce across the state. A $130,000 innovation grant supported the University of �鶹��ý at ����ԴDz� (NAWSON)’s creation of a telehealth training toolkit that is culturally appropriate, immersive and experiential for healthcare providers and students, so they can provide high quality team-based healthcare.

In April 2020, NAWSON was awarded an innovation grant from the the State of �鶹��ý , as part of the federal CARES Act. NAWSON received one of 31 innovation grant awards encompassing STEM education, project-based learning opportunities and leadership development programs. NAWSON’s Telehealth Training grant was one of 11 UH System GEER grants and was recently successfully completed.

Related: From aerospace to agriculture, grants to UH programs for COVID responses

GEER aimed to fund innovative initiatives that address the impact the COVID-19 pandemic has had on students, families and educators across the state. Initiatives included creating digital equity, providing support for families and distance learning. The grants also supported continuing efforts to provide quality and impactful educational services and to support the ongoing function of schools and campuses.

NAWSON’s Deborah Mattheus and Lorrie Wong were co-principal investigators on the Telehealth Training GEER grant.

“Telehealth has emerged as an important tool for healthcare providers,” said Mattheus, Nancy Atmospera-Walch Professor in School Health and associate professor. “By educating nursing students, we can ensure that our graduates are prepared to function utilizing telehealth which can expand quality healthcare to the people of �鶹��ý without expanding the cost.”

Mattheus and Wong accomplished four key deliverables:

• Developed a telehealth toolkit for five UH System nursing programs: , , , and UH ����ԴDz�. The toolkit is available online and includes: the basics of the telehealth process; training on how to write, facilitate and debrief a telehealth simulation; and pre-recorded telehealth simulation scenarios and videos related to behavioral health, pediatric illness, acute and chronic disease management for elderly; and women’s health.
• Purchased telehealth equipment and software licenses for the five UH System nursing programs and provided training on use of the equipment.
• Trained nursing faculty at the five UH System nursing programs on the implementation of the telehealth toolkit to optimize student learning.
• Evaluated the five UH System nursing programs trainings.

“Our nursing program is always at the forefront of innovation and technology,” said Wong, interim associate dean for academic affairs, director of UH Translational Health Science Simulation Center and HMSA distinguished professor. “To ensure that our students are prepared for the ever-changing healthcare environment, we quickly integrated telehealth into our nursing curriculum. Telehealth aligns with the existing technology modalities already utilized in our program. We were quite fortunate to receive this grant and were pleased to purchase telehealth equipment and provide training to the other UH nursing programs.”

Faculty at the UH System nursing programs are currently implementing the telehealth equipment and simulation trainings during the 2022–23 academic year. The dissemination of the telehealth equipment and the telehealth toolkit across the UH System programs allows for statewide training of the future healthcare workforce.

Telehealth has emerged as a vital resource during the COVID-19 pandemic. Expanding and improving telehealth opportunities across the Pacific was one of the topics at a conference hosted by the University of �鶹��ý at ����ԴDz�.

The 2022 U.S. Affiliated Pacific Island Countries & Territories (USAPICT) Telehealth Workshop was presented by the (PBTRC) in the UH ����ԴDz� in August. The conference welcomed participants from American Samoa, Chuuk, Commonwealth of the Northern Mariana Islands, Guam, Kosrae, Pohnpei and Palau.

“Telehealth is a new norm in health care; together we have to navigate these changes, opportunities, share lessons, resources and information, and focus on low hanging fruit and keep the momentum going,” said Christina Higa, co-director of PBTRC.

Representatives from public hospitals and health agencies in the USAPICT were joined by technical specialists and subject matter experts to engage in rooted discussions about the following topics:

• Successes, needs and opportunities in telehealth
• Develop goals and objectives for short-, medium- and long-term initiatives
• Receive hands-on training on technology
• Learn various models and modalities for service delivery
• Recap policy and legislation needs
• Hear examples of innovative telehealth programs during and post-pandemic

Various success stories were shared, including the Guam Memorial Hospital Authority tele-intensive care unit connecting off-island intensivists for around-the-clock care and provider-to-provider consultation through the Swinfen Telemedicine Network for the Kosrae Community Health Center. Participants also received brief hands-on training of various technologies available for telehealth at the at the UH ����ԴDz� .

Like other sectors steering towards a post-pandemic norm, the three-day workshop focused on reconnecting, resetting, reengaging and rebuilding a way forward for accessing health care and services through telehealth in the Pacific.

The 2022 USAPICT Telehealth Workshop was a sequel to the 2016 USAPI Telehealth Champion Building and Planning Workshop, which focused on fostering a critical mass of stakeholders and telehealth champions in the USAPI.

For more, visit .

For the past 11 years, the (PBTRC) at the University of �鶹��ý at ����ԴDz� has provided vital telehealth assistance to meet the health needs of underserved populations throughout �鶹��ý and the Pacific.

PBTRC’s outstanding work in advancing telehealth through education, training and strategic planning, has earned them and co-director Christina Higa the 16th annual Supporting the Safety Net Award from the Association for Community Affiliated Plans (ACAP). The national award, the first for a �鶹��ý community-based organization, was presented to Higa at the ACAP CEO Summit in Washington, D.C. on October 28. Higa was also honored with a $1,000 donation to go toward the program’s UH Foundation account.

• Related UH News story: �鶹��ýpromotes the use of telehealth since 2010, April 17, 2020

“It is an honor to receive this award for PBTRC and UH as it highlights the strong partnerships and value of our UH faculty and programs in our communities,” said Higa, a faculty member in the UH ����ԴDz� . “I work with many individual champions who are very passionate and driven to make a difference, including my awesome team at UH Telecommunications and Social Informatics (TASI) Research Program and PBTRC.”

PBTRC serves the most underserved, rural and asset-limited populations, offering service to two million people spread across an ocean area slightly larger than the size of the continental U.S. The complex region has unique challenges to healthcare access including major geographic isolation and separation by ocean, a critical shortage of primary and specialty care, extremely high costs of travel and broadband, smaller populations and differing political and cultural environments.

“When the COVID-19 pandemic laid bare disparities that often complicate access to care, we watched telehealth fill critical gaps,” said ACAP CEO Margaret A. Murray. “In PBTRC’s service area—where seeking care at any time might require travel by boat or plane—Ms. Higa and her team provide a vital service, [to work towards] ensuring that every person can access the care they need. We’re thrilled to honor their tireless efforts.”

AlohaCare nomination

ACAP member plan nominated PBTRC and Higa for the national award for their crucial role in helping to make telehealth services accessible and significantly improving telehealth access for its members with Medicaid and the providers who care for them.

AlohaCare wrote, “Ms. Higa is someone who has been told she can be too optimistic, but that just makes her dig deeper into the details to make things work. She says, ‘I just want to make a difference and do the best I can to help people. That’s what drives a lot of us, the desire to want to make the world a better place.’ And that is exactly what they’re doing.”

“Mahalo to AlohaCare for the nomination and ACAP for the recognition of those who are dedicated to creating and supporting the safety net for people who need help,” Higa added.

More on Higa

Higa has served as co-director of PBTRC in the College of Social Sciences Social Science Research Institute since 2014. She also serves as associate director of the TASI Research Program/Pacific Health Informatics and Data Center. An alumna of UH ����ԴDz�, she earned her PhD in communication and information sciences, and her bachelor’s and master’s degrees in communications.

This recognition is an example of UH ����ԴDz�’s goal of (PDF), one of four goals identified in the (PDF), updated in December 2020.

Now, more than ever, the need for telehealth and telemedicine is crucial because of the COVID-19 pandemic. The University of �鶹��ý at ����ԴDz� Maternal Telehealth Network for Maternal Fetal Medicine at the (JABSOM) was awarded $899,106 for internet connectivity and video conferencing services as well as electronic fetal monitoring devices and interfaces to allow for remote, essential women’s and prenatal health care.

This was just one of 62 applications from across the U.S. to the Federal Communications Commission (FCC) for funding commitments totaling $41.98 million for Round 2 of its COVID-19 Telehealth Program toward the purchase of equipment and hardware. The FCC program supports the efforts of healthcare providers to continue serving their patients by providing reimbursement for telecommunications services, information services and connected devices necessary to enable telehealth during the COVID-19 pandemic.

The award will allow physicians, the UH ����ԴDz� (PBTRC) and JABSOM to upgrade and expand capacity to treat their patients virtually, not only in the American Territories, but closer to home across the state of �鶹��ý. The team of physicians is led by Men-Jean Lee, chief of maternal-fetal medicine in the Department of Obstetrics, Gynecology, and Women’s Health at JABSOM, a physician with University Health Partners, and the medical director of the Fetal Diagnostic Center at Kapiʻolani Medical Center for Women and Children.

“We were not successful last year to secure funding in Round 1 of the FCC COVID-19 Telehealth funding to provide maternal telehealth services in the state of �鶹��ý since our numbers of COVID-positive patients were too low,” Lee said.

According to Lee, previous telehealth equipment funds were secured to provide maternal telehealth equipment to link JABSOM with American Samoa through a USDA Rural Health Development Grant for American Samoa, with the assistance from Christina Higa of the PBTRC, a consortium of health care experts experienced in telehealth networks services in �鶹��ý and the U.S. Pacific Basin.

• Related UH News story: $667 boosts prenatal healthcare, telemedicine network for American Samoa, March 5, 2021

Supporting �鶹��ý’s rural hospitals, health centers

Maternal telehealth consists of equipment that allows pregnant women in rural �鶹��ý to have specialist consultations that include tele-ultrasound in their local communities, remote fetal monitoring to reassure pregnant woman and their providers that the fetus is healthy, and other innovative technologies that can provide increased access to healthcare providers without having to fly to Honolulu during a pandemic.

Lee added, “This latest grant gives us the opportunity to develop a maternal telehealth network across the State of �鶹��ý. We are delighted to be using these funds to support our rural hospitals and Federally Qualified Health Centers on Oʻahu and the neighbor islands.”

As the state begins to emerge from the COVID-19 pandemic, , a free health service tool developed by the University of �鶹��ý at ����ԴDz� (JABSOM), is reminding the public its behavioral health telemedicine program is still available for neighbor island residents.

The online telepsychiatry and telepsychology platform allows individuals to talk to a licensed professional about worries, stress, anxiety, substance use or other concerns at no charge. The service aims to provide mental health service to rural populations who might experience time constraints, financial burdens and transportation barriers when trying to access services.

�鶹��ý UTelehealth is staffed with a licensed mental health counselor, psychiatrist, psychologist, nurse practitioner and physician. The telehealth platform offers services from telehealth coordinators who can teach patients how to utilize telehealth eligible devices and gain technological literacy. Services are available until August 31, 2023. Call (808) 375-2745 for additional assistance or to set up your first appointment. Translators are available upon request.

The tool was developed by JABSOM in collaboration with the in the UH ����ԴDz� . Other partners include �鶹��ý State Rural Health Association and the �鶹��ý State Department of Health.

“These are trying times for everyone. It’s nice to have a number to call to get help,” said Kelley Withy, executive director of JABSOM’s .

Federal Communications Commission support

This month, the Federal Communications Commission (FCC) selected JABSOM’s �鶹��ý UTelehealth to be part of its , providing $320,535 to support their efforts. The program will offer guidance on eligible services, competitive bidding, invoicing and data reporting for selected participants. It joins other 58 pilot projects being conducted in 30 states plus Washington, DC. The Pilot Program will make available up to $100 million from the Universal Service Fund over a three-year period for selected pilot projects to help defray the costs of providing certain telehealth services for eligible health care providers, with a particular emphasis on providing connected care services to low-income and veteran patients.

U.S. Senator Brian Schatz, a member of the Senate’s Appropriations Committee, has led efforts to expand the use of telehealth services. Last month, he reintroduced the , the most comprehensive bipartisan telehealth bill in Congress.

“JABSOM has put together an impressive project that uses telehealth to help connect patients across �鶹��ý with health care providers. This new funding will help launch the project and get more people the care they need,” said Schatz.

Additional resources

For families and households struggling to afford internet services during the COVID-19 pandemic, the is a relief program to help bridge connectivity.

The Emergency Broadband Benefit will provide a discount of up to $50 per month towards broadband services. Low income households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers if they contribute more than $10 and less than $50 toward the purchase price.

Go to to apply online and to find participating providers near you. After you apply, contact a participating provider to select an eligible plan.

When the COVID-19 pandemic severely disrupted University of �鶹��ý at ����ԴDz� operations in March 2020, the University Health Services Manoa (UHSM) became a leader in the campus response to the health crisis. Since its opening in 1932, the campus clinic has served primarily students by offering a wide range of health services and programs. In response to COVID-19, UHSM was part of the team that established the COVID-19 prevention guidelines adopted across the 10-campus system while also offering COVID-19 resource and support services to the ����ԴDz� campus.

“The hardworking and dedicated team at University Health Services has been crucial to ����ԴDz�’s response to the pandemic and to minimize the spread of the virus on campus,” said UH ����ԴDz� Provost Michael Bruno.

From the beginning of the pandemic, the clinic never closed as it quickly adapted to add telehealth services to continue to provide medical care to the UH ����ԴDz� community.

“We expanded our role to keep our patients and campus community healthy and safe,” said UHSM Director Andrew Nichols. “We worked closely with the �鶹��ý Department of Health (DOH) and met frequently with campus leaders and the to quickly develop and implement a campus response plan.”

Mary G. Boland, dean of the , is co-lead of the Health & Well-Being Group, and worked with Nichols and the UHSM team to put together ����ԴDz�ʻs COVID-19 response plan.

“UHSM has been a key player from the very beginning of this pandemic,” said Boland. “Serving as the designated point of contact for all COVID-19 health matters is a huge undertaking. They have done it well, all while taking care of other health matters from our campus community.”

Managing COVID-19 on campus

UHSM is responsible for testing, contact tracing and telehealth monitoring of all positive cases reported on the UH ����ԴDz� campus. The COVID-19 Response Team supports diagnosed or exposed individuals and monitors them daily through their isolation/quarantine period. They provide care instructions, advise when to seek medical attention and determine when individuals can return to work or class. They also identify close contacts and provide those individuals with support.

The health clinic is in regular communication with DOH and coordinates with multiple campus units including student housing, athletics, facilities and communications on numerous efforts including accommodating student residents who test positive, identifying rooms and buildings that have been exposed and the timely announcement of positive cases.

COVID-19 forced us all to make changes faster than were going to occur naturally. —Nichols

“Our team is committed to provide a rapid response to manage our campus cases. Our focus is on identifying and minimizing the spread of COVID-19 on campus,” said Nichols.

In the spring 2021 semester, UHSM started surveillance testing of student housing residents and staff. About 5% of the student resident population and 10% of the staff are tested each week for about 50 tests a week.

“Our point is to identify asymptomatic carriers of the virus,” said Nichols. “The results indicate a very low prevalence on campus, at least so far.”

Students and employees take the self-administered swab tests on a covered lanai outside the UHSM building on East-West Road. Couriers pick up the test specimens the same afternoon the tests are administered and the results come back in less than 48 hours.

A shift to telehealth

Prior to COVID-19, UHSM was predominantly a walk-in clinic that averaged 16,000 visits per year and only 25% were scheduled appointments. Patients now are seen by appointment only and telehealth sessions are offered.

“With so many students in the residence halls, so close to campus, we didn’t know how much need there was, but with telehealth, we’ve had 600 telehealth visits in the first 10 months,” said Nichols. A portion of these sessions also included faculty and staff.

The clinic reduced operating hours in the initial months of COVID-19, but have since resumed normal business hours and have also started to accept a limited number of walk-in patients.

In addition, an after-hours phone line is available for those seeking to speak to a healthcare professional outside of the clinic’s normal operating hours by dialing the main office number (808) 956-8965.

“We made a remarkable shift. COVID-19 forced us all to make changes faster than were going to occur naturally,” said Nichols who also praised the collaboration among the many UH ����ԴDz� units that had little interaction before the pandemic. “When we put our combined efforts together and enlist the expertise of many persons, it’s amazing what we can accomplish in such a short period of time.”

Nichols is hopeful that UHSM can begin to administer the COVID-19 vaccine, similar to how the clinic provides the flu and other vaccines. “The Get Vaccinated UH campaign is helping to get to the critical mass, our students. We’ll be better off once we get to herd immunity. However, it’s also important to realize with vaccines there won’t be any significant relaxation of mitigation measures for some time. Physical distancing and masks will not be going away anytime soon.”

Contact the clinic

Visit the UHSM website to learn more about their services or call (808) 956-8965.

COVID-19 related questions can be emailed to uhsm.covid@hawaii.edu.

—By Arlene Abiang

An interdisciplinary team of University of �鶹��ý experts recently took the global health stage to bring awareness to the unique health needs and challenges faced in �鶹��ý and the Pacific region. As part of the , UH presented the free pre-conference satellite session on March 9, . The session drew more than 100 participants from around the world through Zoom. It was the first time UH has presented at the conference since becoming a member of CUGH in 2018.

“By virtue of its geographic location and longstanding partnerships with academic institutions and ministries of health in the Asia-Pacific region, UH is strategically positioned to provide a Pacific-focused perspective to the global health conversation,” said Aimee Grace, director of the and lead organizer for the event. “We are honored to have had the opportunity to exchange knowledge and resources with our colleagues around the globe.”

The panel, organized by members of the UH ������ٱ�’s Global Health and Social Justice Work Group in partnership with the , covered key issues during the three-hour session, including climate change, chronic diseases, mental health, health inequities, health workforce development and telehealth.

Speakers included:

• Maya Maxym, assistant professor, John A. Burns School of Medicine (JABSOM)
• Keawe Kaholokula, professor, JABSOM
• Neal Palafox, professor, JABSOM
• Lee Buenconsejo-Lum, associate dean, JABSOM
• Chip Fletcher, associate dean, School of Ocean and Earth Science and Technology
• Davis Rehuher, JABSOM
• Sara Haack, assistant professor, JABSOM
• Seiji Yamada, professor, JABSOM
• Tetine Sentell, professor, Office of Public Health Studies
• Kristine Qureshi, associate dean, School of Nursing and Dental Hygiene
• Christina Higa, co-director, Pacific Basin Telehealth Resource Center

The session included interactive chats among the attendees and the presenters, which allowed them to connect with one another, share resources and knowledge, and learn more about global health in �鶹��ý and the U.S.-Affiliated Pacific Islands. There was significant interest by attendees across the globe in further engaging to improve health in the region.

“The CUGH conference provides an excellent opportunity to draw attention to the needs of �鶹��ý and the Pacific region, while showcasing both the strengths of our healthcare community and our commitment to social justice and health equity,” said Maxym, who served as moderator for the UH session. “We were thrilled to have such a high level of international engagement and we look forward to further expanded partnerships moving forward.”

“The UH ������ٱ�’s UHealthy Global Health Workgroup highlighted the historical challenges and significant strengths of the peoples across �鶹��ý and the U.S.-Affiliated Pacific Islands,” said Qureshi, who was recently elected to the CUGH Board of Directors. “Our ongoing collaborative efforts across the Pacific serve to improve the quality of life and health for all of us who call this region our home.”

continues with the official virtual conference taking place March 12–14, 2021, featuring a keynote address by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. A recording of the UH satellite session will be made available following the conference. Visit .

A USDA rural development grant has resulted in big gains for prenatal healthcare for pregnant women in American Samoa. The $667,665 grant, part of $42 million for rural development across the United States and its territories, will be used to establish a maternal telemedicine network at the , the only hospital in American Samoa, working in collaboration with the University of �鶹��ý at ����ԴDz� (JABSOM).

Years of working together on continuing education, distance learning, health workforce development, cancer prevention, control, and surveillance and telehealth laid the foundational groundwork for receiving this grant.

“Samoa is a lovely place with a rich Polynesian culture. It is relatively isolated, its population is about 55,000 people, and there is definitely a shortage of doctors,” said Kareem Khozaim, an associate professor at JABSOM and a University Health Partners physician. Khozaim worked and lived in American Samoa from 2014 to 2017.

Khozaim added, “Women there are eager for prenatal care and they would prefer to stay in American Samoa rather than fly to Honolulu for specialist services. The grant will make it possible for improvements such as new diagnostic and telehealth equipment so pregnant women living across four different islands can receive maternal-fetal medicine specialist services. Together, we help them manage pregnancy conditions on the ground, and coordinate transport for those with serious issues to �鶹��ý.”

Additional funding to train healthcare workers

“Back in 2016–2018 when the Zika virus was severely impacting American Samoa, the CDC provided funding for an ultrasound machine. We found a high-definition ultrasound machine that was reconditioned and repurposed, so we helped them purchase it,” said Men-Jean Lee, chief of maternal-fetal medicine at JABSOM. “That machine was able to detect Zika-related anomalies in the fetus. However, during a visit, we discovered that no one there knew how to run the machine.”

A collaboration between JABSOM’s Lee Buenconsejo-Lum, Lee, Khozaim, as well a Christina Higa and Ginger Porter of UH ����ԴDz�’s , was created in response to the USDA’s call for proposals to secure additional, more sophisticated ultrasound and telehealth equipment for American Samoa.

“Everyone is so grateful and excited for the grant, but it only pays for equipment,” Lee said. “So we are looking for additional funding for a team from UH ����ԴDz� and JABSOM to teach healthcare workers there how to use the equipment and assist with the launch of this telemedicine program. These types of services and missions are an important part of JABSOM.”

Read more on the .

�鶹��ý healthcare providers have ramped up their capacity to meet the new demand for telemedicine due to COVID-19, according to conducted by the (HI-EMA) in collaboration with the University of �鶹��ý.

“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 �鶹��ý.

“This survey is the only known statewide telemedicine assessment in �鶹��ý,” said Aimee Grace, the telehealth component lead for HI-EMA’s SESF #8 and director of the UH ������ٱ�’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 �鶹��ý 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 ����ԴDz�’s (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 �鶹��ý desired numerous types of telemedicine services.

Obstacles remain to remote patient care

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 �鶹��ý far into the future,” said Steven Hankins, SESF#8 lead coordinator and a JABSOM family medicine physician.

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 �鶹��ý. Without such equipment, facilities and practices may not be able to provide desired services such as remote patient monitoring and mobile health.

Results to help provide path forward

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 �鶹��ý 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 �鶹��ý 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 �鶹��ý.”

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.

• Related �鶹��ýNews story: UH promotes the use of telehealth since 2010, April 17, 2020

The full report is available for public review on the .

The University of �鶹��ý continues to play a key role in the expansion of telehealth care during a critical time, especially as healthcare providers rethink the way they deliver care with the COVID-19 pandemic.

While larger healthcare organizations were able to quickly adapt to telehealth, �鶹��ý’s community health centers—federally qualified health centers—serving the state’s vulnerable populations, needed to get up to speed. Patients who receive care at these centers pay for their care on a sliding scale discount, depending upon their household incomes.

UH ����ԴDz�’s (AHEC) and the UH (PBTRC), in collaboration with the Department of Health (DOH), played a key role in providing the necessary policy guidance and technical support for community health centers to take advantage of new federal telehealth reimbursement policies. This has included weekly webinars on the basics of telehealth for providers.

• Related �鶹��ýNews story: UH promotes the use of telehealth since 2010, April 17, 2020

“With our extensive network of telehealth resources prior to the public health emergency, we were able to mobilize the support needed for advancing telehealth in our community, helping our most vulnerable populations,” said PBTRC Co-Director Christina Higa. “We really appreciate the partnership and will continue to work through the transition to our new normal, which will certainly include continued use of telehealth in healthcare.”

State and federal telehealth grants totaling $670,000 aided UH and the DOH to provide vital support to community health centers statewide, including:

• Hāmākua Health Center (�鶹��ý Island)
• Kaʻū Rural Health Community Association, Inc. (a community-based nonprofit organization in Pāhala on �鶹��ý Island)
• Lānaʻi Community Health Center (Lānaʻi)
• Hoʻola �����ܾ� �鶹��ý (Kauaʻi)
• Wahiawā Health Center (Oʻahu)
• Waiʻanae Coast Comprehensive Health Center (Oʻahu)
• Kōkua Kalihi Valley (Oʻahu)
• UH ����ԴDz� John A. Burns School of Medicine—Area Health Education Center

In addition to primary care, patients have been able to access behavioral healthcare services and COVID-19 screening via . The screening tools were developed by JABSOM in collaboration with PBTRC. Other partners include University Health Partners of �鶹��ý and DOH.

“Through �鶹��ý UTelehealth, we are hoping to reach the patients without insurance, without a provider, or outside of the reach of the usual healthcare system,” said Kelley Withy, AHEC Director.

AHEC in the aims to improve the health of the underserved through education, focusing on recruitment, health and workforce needs assessments, and improving distance learning and telehealth utilization.

Since 2010, PBTRC in the has been advocating for telehealth. The center has been essential in the response to the COVID-19 pandemic as the demands for screening, testing and safe healthcare continue to skyrocket.

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It’s natural to feel worried, stressed and anxious during these trying times. has made an online portal available for �鶹��ý residents to speak to behavioral health professionals about these concerns and more. The first visit is free to the patient, and some health care providers offer all free visits for those without insurance.

The telemedicine service is provided by the University of �鶹��ý at ����ԴDz� (JABSOM) and the �鶹��ý Department of Health.

“We want to offer a safety net for individuals who can’t reach health care and mental health care during this trying time and into the future,” said Kelley Withy, director of the JABSOM .

The following health professionals are among those available to patients:

• Psychiatrist
• Psychologist
• Clinical social worker
• Certified substance abuse counselor
• Treatment of drug use and chemical dependency
• Psychiatric advanced practice nurse practitioners
• Licensed mental health counselor

Patients can call between 8 a.m. and 6 p.m., Monday through Friday for an on-demand telehealth session, or schedule an appointment with a provider.

�鶹��ý UTelehealth also provides a that lists testing locations and links to other general information.

A new health hotline and telehealth service provided in partnership with the University of �鶹��ý and the �鶹��ý State Department of Education (HIDOE) will deliver access to health resources and care for public school students. The services will be provided by the (HK) and will launch on Friday, May 1.

The HK program is part of UH ����ԴDz�’s and offers school-based health services during the academic year and nursing coverage from registered nurses (RNs) and nurse practitioners (APRNs) to every HIDOE complex area in the state.

Due to the COVID-19 pandemic shifting classes to online learning, HK will offer a no-cost health hotline and telehealth visits as an extension of services provided to students in the traditional school health room.

“This partnership helps to ensure continuity of care for public school students during this unprecedented health crisis,” Deputy Superintendent Phyllis Unebasami said. “Students and families can call the health hotline from anywhere. They will receive health guidance and may be scheduled for a telehealth visit when appropriate. Students will be referred to the appropriate medical and/or mental health care when indicated.”

Health hotline and telehealth visit

The health hotline can be reached at (844) 436-3888 (toll free) and is available Monday through Friday from 8 a.m. to 4 p.m., excluding holidays. HIDOE students and families who call the hotline will speak with an RN or APRN. The nurse will perform a basic triage assessment over the phone regarding the caller’s health concern or question about their child. The caller may receive basic health advice or information and, with parental consent, the student may be scheduled for a telehealth visit with a HK nurse practitioner. Nurses staffing the hotline have been working in schools statewide and are familiar with many families and students.

HK nurses will screen for general health concerns and can connect students with other service providers such as HIDOE support staff such counselors, social workers, school psychologists or other medical referrals. Families with medical insurance will be asked to provide their insurance information, but HK will not bill or collect copayment from families.

The health hotline and telehealth visits do not replace a student’s primary care provider but provide families with an alternative way to access health services while supporting social distancing. HK will be sending a note to primary care providers for the telehealth visit. By calling the health hotline, HIDOE students and families can be assured they will speak with a nurse who will answer health questions about their children.

Learn more about the from the UH ����ԴDz� nursing website.

When �鶹��ý Gov. David Ige touted telehealth as a key component in the fight against the COVID-19 pandemic at an April 16 news conference, it marked a milestone moment for the University of �鶹��ý at ����ԴDz� (PBTRC). Since it was established in 2010, PBTRC has been advocating for telehealth, the delivery of healthcare via telecommunications technology like video conferencing, online and telephone.

“Telehealth adoption in �鶹��ý was only about 20.5 percent before COVID-19 and now I’ve witnessed more progress in the past few weeks than I have in the last several years,” said PBTRC Co-Director Christina Higa, a UH ����ԴDz� faculty member. “It has been amazing to see so many people and organizations coming together and work tirelessly to keep people safe and healthy.”

• Related UH News story: UH med school develops COVID-19 screening tool, April 17, 2020

PBTRC helping in COVID-19 response

PBTRC plays an important role in the response to the COVID-19 pandemic as the demands for screening, testing and safe healthcare continue to skyrocket. The center is assisting the �鶹��ý healthcare community with the transition including telecommunication aspects.

“Telehealth plays a major role in minimizing patients, families and healthcare providers potential exposure to COVID-19 by providing healthcare in the safety and convenience of their home,” said PBTRC Co-Director Deborah Peters, a UH ����ԴDz� (JABSOM) faculty member. “This is especially important for people with chronic diseases and those who need ongoing care.”

The center’s decade-long commitment to expanding the availability of healthcare via telehealth has better prepared �鶹��ý for this moment. In support of the overwhelming assistance requests during this outbreak, PBTRC began conducting weekly telehealth training and arranging for experienced telehealth providers to train those just getting started. The center also assists multiple provider groups, including the �鶹��ý Primary Care Association and the Native Hawaiian Health Systems.

PBTRC and JABSOM’s plan to host training for the skilled nursing facilities, long-term care, hospice and other elderly care providers in the context of COVID-19.

UH program part of national consortium

The center is one of 14 federally funded telehealth resource centers in the U.S. and is a member of the National Consortium of Telehealth Resource Centers.

“It is one of our strengths as we have a wide network of support across the country and share best practices,” said Peters. “The consortium tracks federal law and policies that make telehealth more accessible.”

PBTRC now tracks and notifies local authorities on the sweeping federal and state emergency policies adopted in response to the pandemic.

“We work with local state agencies including the �鶹��ý Department of Health and the state Medicaid program to identify needed state emergency waivers, and policies to match federal actions and meet community needs,” said Higa.

At their request PBTRC often provides assistance to legislators as they work to address telehealth reimbursement, broadband, licensing and other issues. The center facilitated input from stakeholders that contributed to �鶹��ý’s progressive telehealth state law adopted in 2016.

More on PBTRC

The center is a collaboration between UH ����ԴDz� College of Social Sciences and JABSOM and is part of the UH ����ԴDz� Social Science Research Institute. It is funded through a cooperative agreement from the U.S. Health Resources and Services Administration. PBTRC’s service area includes �鶹��ý; Pacific Island Territories including Guam, American Samoa and the Commonwealth of the Northern Mariana Islands and the Pacific Islands with a compact of free association with the U.S. including the Federated States of Micronesia, Republic of the Marshall Islands and Republic of Palau.

for telehealth and COVID-19 resources for providers, patients and families.

A new screening tool for COVID-19 is available online that will directly connect patients to healthcare providers via telemedicine. gives information on when to immediately seek care and how to connect with a doctor by way of a live video chat. The service is free to the patient or only charged to their insurance (no-copay).

The screening tool was developed by the University of �鶹��ý at ����ԴDz� (JABSOM) in collaboration with the in the UH ����ԴDz� College of Social Sciences. Other partners include University Health Partners of �鶹��ý and the �鶹��ý Department of Health.

“We are partnering with �鶹��ý providers from all islands to bring this service to patients across the state,” said Kelley Withy, director of the JABSOM Pacific Basin Area Health Education Center.

• Related UH News story: UH promotes the use of telehealth since 2010, April 17, 2020

The telemedicine service is staffed by both volunteers and paid providers from 8 a.m. to 6 p.m., seven days a week. During that time, Withy said, the tool can connect anyone to a telehealth provider in as quickly as two minutes.

The website also lists testing locations and links to other general information. At the beginning of the online screener, it will direct patients to call 911 or their hospital if they are experiencing potentially life-threatening symptoms. Otherwise, the next set of questions will ask the patient if they are having symptoms that could indicate infection with COVID-19. If the patient has symptoms, they are recommended to contact their primary care provider or can choose to be connected to a telehealth provider via �鶹��ý UTeleHealth.

�鶹��ý Telepsych

�鶹��ý UTelehealth also provides online telepsychiatry and telepsychology where you can talk to a behavioral health specialist about worries, stress, anxiety, substance use or other concerns.