Telemedicine in Hawaii: Rules and Regulations

Posted by Michael Hsu on 6/5/20 8:30 AM
Michael Hsu

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The Aloha State welcomed telehealth with open arms and worked hard on the development of the practice. Hawaii has one of the best laws on telemedicine and pushes it forward in every way.

The state’s governor supported the private payer parity law in 2016, which regulated the reimbursement for telemedicine and allowed both private insurance companies and Medicaid to cover a variety of services for their beneficiaries. This law has made proper care available to more residents who have been struggling to receive it.

Long before the COVID-19 pandemic, Hawaii’s hospitals were overcrowded, and even patients with urgent conditions were not able to get appointments. Telehealth has been saving lives in the State of Hawaii. Their excellent example proves that every state can benefit from introducing remote medical services on a larger scale.

What Is Telemedicine?

Telemedicine is the provision of healthcare through a variety of digital communication channels where the doctor is in one location and the patient in another. It means that the appointments are conducted remotely. 

Telemedicine includes a range of services, from diagnosis to consultations, issuing prescriptions, and remote patient monitoring. It caused a revolution in healthcare and continues to challenge and improve traditional medicine practice.

The primary goals of telemedicine are:

  1. Providing care for more patients
  2. Improving patient experience
  3. Broadening the scope of services available to patients
  4. Cutting per-capita expenditures

Reaching More Patients

With many patients unable to receive adequate care due to their remote location or severe condition, America is in dire need of a better healthcare system. The COVID-19 pandemic made our past mistakes painfully visible. Telemedicine can be the right solution for reaching out to more people and improving the overall health of the nation.

Comfortable Experience

Another huge benefit of telemedicine is the improvement of the patient experience, which is an ongoing issue in the U.S. Most people are not satisfied with the quality of service. Long waiting hours, excessive travel time, and administrative errors are just the tip of the iceberg that should be addressed immediately. Telehealth can improve medical services by increasing efficiency and ensuring a more pleasant experience.

Cutting Costs and Broadening the Scope of Service

Remote healthcare is cost-effective, which allows healthcare providers to offer a wider range of services to their patients, and it can reduce the provider’s overhead costs. The doctors would be able to see more patients and decide whether their condition is worth the trip to the office. 

The cost of medical care is on the rise, and the U.S. is facing the consequences of the past mistakes regarding its healthcare system. Despite the enormous amounts of money spent on medicine, the States seem to have one of the most inefficient systems in the world. The need for reinvention is strong, and telehealth can help take the pressure off hospitals and health centers. It can contribute to both primary and specialist care, allowing medical institutions to focus on urgent and acute cases.

Type of Service

Definition

Example

Live Video Calls

Real-time video chat between a health provider and a patient

A medical consultation through a two-way, interactive video communication channel

Store-and-Forward

Use of electronic communication channels to transmit the recorded health history (both digital images and documents)

A physician sending scans images, blood test results, photos of skin conditions to an evaluation by a specialist

Remote Patient Monitoring

Transmitting medical data collected through a special electronic device to a doctor in a remote location

Wearing Wi-Fi or Bluetooth-enabled devices that can report patient activity in real-time(e.g., heart rate)

Mobile Health

Using mobile devices (phones and tablets) for medical purposes

Sending appointment notifications or reminders regarding medication as emails or text messages

Telemedicine and Telehealth

These two often overlapping terms have different definitions depending on the state. There is no official distinction on the federal or international level, so they are both left to interpretation. Hawaiian legislation views telemedicine and telehealth as synonyms, and you can use them both when referring to remote healthcare services.

In Hawaii, both telemedicine and telehealth refer to the practice in which telecommunications are being used to enable store-and-forward technologies, remote patient monitoring, live consultations, and mobile health. The means of communication include, but are not limited to, real-time video calls, secure interactive and non-interactive web-based tools, and asynchronous information exchange to transmit patient medical data.

Audio-only phone calls, text messages, and emails do not qualify as telehealth services according to Hawaiian law. Some states define telehealth as a much wider term that includes education and prevention, while telemedicine is used for clinical services.

Hawaii Telemedicine Law

The Aloha State is setting an example for the rest of America when it comes to telemedicine. The reasons behind their progressive regulations are grim. The most concerning one is the lack of qualified medical personnel in the state. Hawaii has been dealing with this problem since the 1980s, with several acute crises over the years.

Although it is a famous tourist hotspot, the State of Hawaii is mostly a rural environment, with many of its residents living in remote areas. With a multitude of islands scattered in the ocean, it is difficult to make a functioning system that would allow everyone to reach healthcare providers easily.

Another problem is the fact that over 60% of adult Hawaiians suffer from some kind of chronic illness. This means that the general health of the population is poor and that proper treatment and patient monitoring are much more needed than in some other states.

Since the late 20th century, there have been attempts to establish a system that would help residents have better access to medical care. One of the first such initiatives happened psychiatry, specifically, in addiction treatment. The remote sessions supporting patients during the recovery period proved to be helpful, although many concerns arose regarding the security and privacy of the communication channels. That’s why the practice was limited only to emergencies.

The first significant remote care project was Telestroke, which helped monitor patients recovering from stroke remotely. Since timing is essential with this specific condition, Telestroke enabled a prompt reaction in case of an emergency. Although it was a far cry from the tools and possibilities telemedicine has today, it provided a glimpse into what remote care could do for the Hawaiian healthcare system.

By the end of the first decade of the 21st century, the lack of medical professionals became alarming. The officials estimated that the system would collapse in five to ten years. Telehealth offered a way to take the pressure off hospitals and allow physicians to see more patients.

As it got the complete parity law in 2016, Hawaii is on the right track to regain balance in healthcare. Many practitioners are switching to telemedicine or incorporating it into their existing practice. What remains to be done is to educate the general population about the benefits of remote care as only a small number of Hawaii residents use or understand telemedicine. 

The following telehealth services are available in Hawaii:

  • Outpatient hospital services
  • Inpatient hospital services
  • Lab and X-ray
  • Rural health center services
  • Nursing facility services
  • Home health services
  • Early and periodic screening, diagnosis, and treatment for underaged individuals
  • Family planning services
  • Dentistry
  • Nurse-midwife services

The Guidelines for Practicing Telemedicine in Hawaii

The Hawaii Medical Board (HMB) offers extensive guidelines and advice on how to practice telemedicine responsibly. Its primary idea is to take the strict regulations of traditional medical practice and apply them to telehealth.

Anyone practicing telemedicine in the State of Hawaii will have to respect retention rules, confidentiality protocols, and HIPAA compliance, together with numerous other rules that regulate medical practice in Hawaii.

The HMB’s comprehensive guide deals with all the vital questions:

  1. Who can practice telemedicine?
  2. What constitutes a doctor-patient relationship?
  3. What is the necessary standard of care?
  4. How to prescribe medication
  5. How to keep medical records
  6. Are there any restrictions on locations?
  7. How to comply with data security and privacy rules

Who Is Eligible to Practice Telemedicine in Hawaii?

There are no restrictions on which healthcare providers can practice telehealth in Hawaii. The practitioner must possess a valid license for providing medical services in the State of Hawaii, even if they are not based there. For a Hawaiian physician who wants to treat patients from other states, the appropriate permits for practicing in those states are mandatory.

Licensing and all related issues proved to be a challenge for many practitioners because of the long procedures and limitations that may apply to telemedicine. Cutting through red tape would be easier if the state was a member of the Interstate Medical Licensure Compact. Hawaii is yet to join the program, which is extremely efficient in expediting medical licenses across state lines.

Physician-Patient Relationship in Telehealth

There is no doubt that telemedicine changed the doctor-patient relationship in many ways. The first point of contact must remain intact, according to HBM. An in-person meeting is required for the relationship to be established before a telemedicine session can take place. The only exception is when a practitioner who met with the patient in person refers them to a telehealth physician and provides all the necessary patient data.

The telemedicine practitioner must evaluate the patient and determine if telehealth services are an appropriate course of action. According to Hawaiian legislation, informed consent is not mandatory for the beginning of telemedicine treatment.

Standard of Care

The physician is responsible for determining whether telemedicine is sufficient and adequate for treating the patient’s condition

The continuity of care is essential. Telehealth providers must have emergency plans in check. They refer to situations in which the patient needs to be hospitalized. Providers should present the emergency protocols to patients and refer them to appropriate establishments on time.

Prescribing Medication in Telemedicine

Telehealth providers must follow the same prescribing policies that apply in traditional practice. A video conference call is enough for a provider to be able to prescribe medication to the patient. Online questionnaires and text messages will not suffice for prescribing drugs.

Providers are not allowed to prescribe opiates or cannabis for medicinal purposes via telemedicine platforms. The physician and the patient must have a traditional, in-person appointment before issuing such prescriptions

The doctor should not refer the patient to any specific pharmacies for drug purchase. HBM recommends the integration with e-Prescription systems to avoid errors and ensure safety.

Medical Records

Telehealth providers must keep updated, transparent, and accurate records on every patient they see. The standards must meet or exceed those that apply to in-person care. The records should be available to patients at all times.

The system you use should be able to integrate with your electronic health records (EHRs) as possible because it will eliminate manual or double entries. We at Curogram offer a solution that integrates with more than 700 EHRs, which enables the staff to focus on patients instead of administration.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

Location Restrictions

Hawaiian telehealth laws make a distinction between the “distant site” and “originating site.” The former is the location of the physician, while the latter refers to the location of the patient. The virtual appointment takes place at the originating site, and until recently, certain restrictions applied to what the patient’s location could be.

With recent updates, Hawaii is loosening the requirements about the originating site. The amendments allow the patient to receive telemedicine services at a location of their choosing. It is yet another way to make medical treatment more available and comfortable.

Data Security and Privacy

It is vital to be compliant with all federal and state laws when it comes to data security and patient privacy. The technology used for telemedicine services must ensure that sensitive patient information is safe from third parties. The doctor is allowed to share the patient’s information with their consent and for treatment purposes only. This means that the data can be forwarded to specialists for consultation on the patient’s condition.

Telehealth Reimbursement in Hawaii

Since amendments were added to telemedicine parity laws in 2016, private payers are obliged to reimburse for telehealth in the same way they do for traditional medical services. Fees that apply must not exceed those for comparable in-person services. Medicaid in Hawaii covers live video, remote patient monitoring, and store-and-forward telemedicine.

One of the biggest challenges at the moment is the capitation model used by some of the largest insurers in the state. It affects general physicians primarily. The model requires a lump payment per patient annually instead of the conventional per-visit payment. Many practitioners consider this to be a significant downgrade and advocate for returning to the previous system.

Potential Challenges with Hawaii Telehealth Practice

With medical professionals and the authorities promoting telemedicine as a way forward, practicing remote healthcare in the Aloha State seems to be easier than in some other parts of America.

This does not mean that there are no challenges that you should consider before setting up a telehealth practice. Hawaii’s geographic location makes certain practices difficult and expensive. Treating residents of remote islands with limited access can be demanding because the emergency protocols that apply to the continuity of care may be impossible to design.

The weather is yet another risk factor because certain parts of the state are often cut off from communication channels for days due to bad weather. Even in normal circumstances, the Internet connection can be problematic. That is why many Hawaiians give up on telehealth. Moving around the island trying to get a signal is an even bigger waste of time than making a doctor’s appointment on a neighboring island.

Useful Tips for Practicing Telemedicine in Hawaii

Any successful telemedicine practice equally depends on the expertise and dedication of medical professionals and the quality of the platform they use. The technology involved can make or break your business, so choose it wisely.

You should make sure that your website is appealing and easy to navigate. To avoid confusion on the patient side, make sure it states the following:

  • Available services
  • Fees and all additional costs
  • Credentials of the medical personnel
  • A section with the rights of the patient and the ways to exercise them

When it comes to the platform, it should allow for advanced two-way communication through video calls, texting, and chat. Encryption and password protection are mandatory to comply with strict HIPAA rules that apply to data security. At Curogram, we offer a reliable end-to-end solution that will support your practice and allow you to focus on what you do best—treat patients.

Why choose Curogram for telemedicine 

Integrates with over 700 EHRs

You don’t have to worry about manually entering data in your EHR. Save valuable time with full EHR integration and admit more patients daily.

Provides a two-way texting platform

Send appointment reminders to your patients via SMS. Patients can simply respond to your text message when they need to reschedule or inquire about your services.

Facilitates internal communications and file sharing

Curogram includes a secure messaging platform that allows your medical staff to communicate easily and share relevant medical information quickly.

Mimics in-person workflows

You can set up a virtual clinic with advanced waiting room tools. Medical assistants can prepare the patients before the appointment, and the doctor can initialize the video call whenever the patient is ready.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine, hawaii

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