Welcome to a Virtual View. Today I'm joined by Dr. Amna Anwar, the new director of the Upper Midwest Telehealth Resource Center. Thank you so much for joining us today.

Thank you so much for having.

could you tell us a little bit about.

I've been with Indiana Rural Health Association for the past six years, starting the seventh year in September. And strangely enough, when I started with IRHA, I started with the Upper Midwest Telehealth Resource Center. At that time my role was program evaluation and a little bit of coordination. Eventually I stayed with U M P RRC for a year and then moved on other program. My work in the past five, six years has mostly focused on substance use disorder and mental health in rural Indiana. I've served in the program director capacity for Indiana Rural Opioid Consortium. That was a program that was funded through the Rural Health Opioid Program and the Rural Community's Opioid Program through its phase one and phase two which just ended on August 31st, 2022. Currently I also serve as the program director for the Community Paramedicine Program for Maternal and Child Health. And now I'm the program director for Upper Midwest Telehealth Resource Center. In addition to these programs, I also wear the hat of a senior director at Indiana Rural Health Association, where I supervise a team of six staff members. And I also lead the data team at IRHA in addition to my work at IRHA, I also work as a research associate for various different programs at the Polish Center at IUPUI. And I also teach the MHA program, some of the classes at Purdue University. Prior to my work with IRHA, I was a journal surgeon by training. I worked as a journal surgeon back in Pakistan. I've been in Indiana for the past 10 years. And that's, I have lived my past few years in my career as well as a professional life.

Welcome back to the UMTRC. We're glad to have you.

Oh, thank you. Glad to be back.

So with your medical background, what is your experience with telehealth like? Is that something you've only engaged with recently or is that something you have a longer history with?

My first introduction to telehealth was when I joined Upper Midwest Telehealth Resource Center back in 2016, and after I moved into the other programs with substance use disorder and mental health, I helped in planning and implementation of Telebehavioral Health programs in rural Indiana. I've also worked with recovery community organizations in the implementation of virtual peer recovery hubs. And then when Covid 19 hit, a lot of the work was involved in providing the necessary assistance and expertise when it came to convincing providers to deliver the medication assisted treatment through telehealth, the induction, as well as the other support. Behavioral health therapies, which are needed and deliver that via telehealth. So not as much as from the clinical side, but mostly from the, from helping clinic clinicians implement that program in their communities and in their practices.

Gotcha. You touched on it briefly about how the pandemic really did affect the utilization of telehealth, but have you seen any changes in how the TRCs the telehealth resource centers operate now versus pre.

Oh yeah, it's, the difference is day, night, and day. Because when I start started back in 2016, and like I said, my role was as that of an evaluator. So I was really looking at the data about the technical assistance requests that were coming in to UMTRC and also representing the program at various different events and conferences. And if I recall correctly, most of the technical assistance questions that were directed towards the TRCs were based mostly on like the basics of telehealth how to implement telehealth. There were some questions about the technologies or the platforms that were available, HIPAA constraints, but mostly it was about reimbursement, like what was reimbursable and what was not reimbursable throughout the pandemic. Like I mentioned, I worked mostly in the substance use disorder and the behavioral health realm. I saw a huge shift, obviously when the world shut down overnight. Providers were finding ways and unique ideas in order to deliver the healthcare services that they could not do in person. And telehealth was already there. It was just a matter of implementing it in their practices. And even though I was not directly a part of a Midwest telehealth resource center at that time, I was yielding a lot of the questions that were coming my way on how to adapt the services, mental health services, Especially like the treatment and the medication for opioid use disorder, how to deliver those via telehealth. And at that time I realized that not only the providers were more open, but the patient patients who were receiving those services were also more open, probably because this was the only venue available to them to get the services that they needed. But at the same time, what I saw, The increased uptake and then the role of TRCs has changed from just providing the technical assistance when it comes to how do we start telehealth to now that we have telehealth, how do we cater it to our specific specialty? How do we do. The primary care visits via telehealth. How do we do the dermatology visits via telehealth? How do we actually assess the patient who is coming in for the induction of medication for opioid use disorder. We are telehealth, so all of those. All of that has changed. And in addition to this, I think the increased adoption was because of the waivers that were set in place due to the public health emergency. And now that I have taken over the stroll in the past 10, 12 days that I've been with the program, most of the questions are regarding the public health emergency and the waivers. If they're going away, which will, what will stay. Has a chances of being extended beyond a public health emergency. So there's a lot of that piece that is coming into when the telehealth resource centers are providing the technical assistance to not only the providers now, but also the consumers.

And I do think it's interesting that you point out that before that a lot of. questions that we had were more very general about what is telehealth? But now it's okay. Everybody knows about telehealth. How do we apply it to our specialty beyond just behavioral health? We're doing all sorts of things in telehealth now.

yes. That is true. And then it also just shows that people have embraced telehealth, like it is a part of our, of every person's everyday life now. Because through these two years, at least once every one of us has utilized telehealth for, we use different purposes. It's not like it is an alien or it is something that only specific people would reach out to. utilize it's a part of our life and probably will continue to do so and expand as we move forward.

So what are your priorities as the new director of UMTRC?

I think every new director who comes in wants to take the program to the next level. That's what my priority is. I think the previous program directors delivered an excellent program at the time and which met the needs of the region that we are in, which includes Michigan, Illinois, Ohio and Indiana Obviously. But my priority when I come in at this point is also to expand upon the success that they had already re re achieved through the work that they had done. Like I mentioned, that UMTRC had created a lot of resources pertaining to the basic. Information about Telehealth in the past few years. But what we are going to do with our team is to expand those resources and make them cater them towards specific specialties and also specifically for the states that we serve, so that whoever is reaching out to us, we have those created. Products that we can actually direct them towards in terms of both the principal resources as well as if we can have recorded trainings and all of that is available. And obviously it'll also depend upon the technical assistance request that comes into TRCs to be better able to assess what is the need out there, what is the need of the time when the public health emergency ends, and how people can then, Modify their service delivery or modify their workflows at their practices depending upon the new reimbursement and the new rules, which will again, become effective after the public health emergency ends.

So why is it an important thing to have telehealth resource centers like the UMTRC freely available?

like I mentioned earlier, telehealth is here to stay and the technology is changing every day. There are new. Tools and gadgets available. There are new policy changes as policy makers are becoming more educated. NRCS have a role to play in that as well, providing that education. When it comes to policy makers, the things will change. Technology will innovate and people will adapt more to telehealth. Some of the providers who have not adapted it to the full extent, may move in that direction, and what Telehealth resource centers provide is. Expertise that the people who are looking into either expanding their practices or patients who are looking into trying to find a telehealth provider are the health systems who want to add on more services as a result of the telehealth resource centers are there. To provide that expertise in every aspect of telehealth healthcare delivery. It ranges from providing technical assistance to reimbursement, to policy updates, to information about the new gadgets of the tools that are available. So the need. For that, just like people turn to Google to find stuff or information that they don't know about TRCs or telehealth. Resource centers are like that when it comes to anything and everything pertaining to telehealth.

Yeah, it's a lot easier to have one central resource you can go to instead of having to Google a hundred different questions that probably will lead you to the same place in the end.

That is true. And then the telehealth resource centers also work as a part of the National Telehealth Resource Center consortium. So if there is something that our resource center does not have readily available, there are 12 other regional telehealth resource centers with experts having different. Areas of expertise, even within telehealth that we can reach out to immediately and can provide that information to the person who's seeking that are, or the healthcare entity who's seeking that. So not only is our staff at the upper Midwest Telehealth resource center at their fingertips, we're reaching out to TRCs, but they, by reaching out to even one trc, they have access to 12 other TRCs and the two national t.

Yeah, that collaboration is so important cuz it gets you not just a couple of subject matter experts. It gets you a whole country full of them.

That is correct.

Yeah. So before we hop off for the day, I did wanna ask you what do you think the future of telehealth in this country might look?

No one can predict the future. So if we, if somebody had asked two years back, what would be the telehealth adoption in the us we would not have guessed what it is right now. But if you look at our everyday life, just about everything that we do has been adapted to be done virtually. We do shopping online. We order food from our res, our favorite restaurants online. We play. Games and talk, and there are servers that people get on to talk and play with people all around the world. So we are living in a time where virtual connection is becoming even more readily available and people are adapting to that as compared to the in-person connection or Meetings when it comes to any aspect of our life, healthcare is just another aspect of our life where I think the virtual connection is just going to grow stronger. There is a whole new generation, which is comfortable sitting behind a camera and talking with other people even. Including their healthcare provider as compared to actually driving up and going up to their appointments, especially in the tele behavior health realm. So when we're talking about the future, I think it's only going to expand. It's going to expand and innovate because of the innovation and technology as well as the new enlightenment I guess, that the policy makers have had through the pandemic, that this is something which can actually save costs. Provide almost the same type of the healthcare services that are available in person. And obviously it is becoming more and more user friendly which also provides access to populations which would not otherwise have access to certain healthcare services, especially if you're talking about distant rural areas as well as the tribal areas. It is. I foresee it expanding. Now, how fast it moves post con post pandemic is a question that we'll just have to see, like how people will continue to do that when the waivers are removed. How are we going to modify some of the services that are being delivered? But it's going to continue to.

I for one. I'm very excited to see how it all sh shakes out and where we go with telehealth in the future. So

am I.

Okay. Thank you so much for joining us. I'm glad that we could have this chat and we're really excited to have you as part of the

Thank you so much for your time and this opportunity.

Yeah, thanks so much.