LEXINGTON, Ky. (Sept. 20, 2021) — Joneen Lowman, Ph.D., remembers how years ago, she received a federal grant to start an online master’s degree in communications sciences and disorders. At the time, the internet was a newer technology, but to her, it offered a window to the future.
While she directed the online master’s program and supervised students from a distance, she saw how technology could help deliver high-quality services.
“I was like, ‘I know this is where health care is going,’” said Lowman, an associate professor in the University of Kentucky College of Health Sciences’ Department of Communication Sciences and Disorders (CSD) and director of the Center for Telehealth Education, Research and Outreach.
She could never have known how right she was.
That was 10 years ago. Lowman had seen the first inklings of what would become known as telehealth, and she was fascinated — so much so that when she took a job at UK, she told her department chair that they needed to explore the “tele-thing,” or the idea of using technology to better deliver health care to patients.
Those around her agreed, and doggedly, Lowman began to align herself with others in the university who had been practicing a version of the new idea. She merged with UK HealthCare, where they piloted a program and applied for a U.S. Department of Education grant to train others. Soon, Lowman found herself at the forefront of telehealth education.
But it was still something that was not totally accepted — by patients or providers.
“There were only a few programs training in telehealth,” Lowman said. “But we felt we could do this. We were developing a scope and a curriculum.”
In 2016, she began training speech language pathologists (SLPs) to use telehealth to deliver their services with a focus on children in schools. The partnership made sense because schools always needed SLPs, so Lowman could train them to help children by using telehealth.
Then she wondered if they could expand their training services.
“We knew health care needed help,” Lowman said. “So we thought, ‘Let’s prepare them. Let’s open it up. Let’s train everybody!’”
This time, they reached out to their cohorts in CHS, namely those in the Physician Assistant and Physical Therapy programs and asked if they’d be interested in learning this new technique. They said yes.
And so, they began. Two years ago, CHS was awarded a certificate in telehealth.
Then, inexplicably, the world changed, and COVID-19 thrust everyone indoors. Suddenly, the need for delivering health services via technology became much more in demand.
When the World Changed
Tori Schaub remembers the exact moment when the world — and her life — changed.
It was January 2020, and Schaub, a 28-year-old speech pathologist at Associates in Pediatric Therapy in Louisville, was called to a meeting with her co-workers and their CEO. The message? That the new virus they’d heard about, COVID-19, could affect their business.
It could actually prove to change their entire model, as well as others in the medical community. And if it caused the kinds of problems they thought it could, then Associates in Pediatric Therapy would have to transition — quickly — to utilize more telehealth options, where the professionals could counsel and help their patients in a virtual format.
Immediately, Schaub was forced to become wise beyond her years. Fortunately in 2016, she’d found the telehealth topic interesting, so she studied it under Lowman. One of the topics? How to implement telehealth for your company.
“We were very lucky to have a foundation — I can’t imagine what it would’ve been like to try to start telehealth from scratch,” said Schaub, who graduated from UK in 2017 with a degree in communication sciences and disorders. “We had software and we had a training program that I developed from what I’d learned at UK. And even then, it was still a challenge to transition.”
Now, Schaub’s knowledge has become even more vital. As the COVID-19 pandemic raged over the past 18 months, she was able to help her business, as well as others, transition to telehealth. It’s become a huge part of her job — she even added the title of telehealth program developer — and she’s thankful for how UK prepared her for a world she could’ve never imagined.
“I knew (telehealth) was a (topic) that was growing, and so I thought it might be a good time to try something new,” she said. “And Dr. Lowman is really smart — I totally trust what she brings to the table. She was very forward-thinking in developing that program.”
“I don’t think anyone could have foreseen the pandemic,” Lowman said. “My colleagues and I always felt this was where health care was going and prior to the pandemic, people were doing it — people at UK were doing it — but we had all these regulatory barriers.”
She mentions things like how difficult it was to practice telehealth and be reimbursed by Medicaid and Medicare; the stringent rules on where providers and patients could be; and how physicians could do a lot more via telehealth as compared to people in say, physical therapy.
But when the pandemic came, it came quickly. Suddenly, providers and patients were buying in to the idea of learning how to get better via the computer.
“Before, the patients thought telehealth was ‘better than nothing,’ and that’s not our motto,” Lowman said. “Our motto is ‘As Good, or Better.’ That’s what we want to be. And that’s what we got to prove."
Not only did she get to keep teaching her students, Lowman had co-workers and those in the community contacting her, asking her for guidance and advice.
“It was a lot of sleepless nights,” she said. “A lot of everyone pulling together. Kudos to our faculty and students for being so patient. We had to keep educating our kids — but then we also had to help our clinical supervisors, plus develop policies and procedures to run a whole clinic. We were getting with Information Technology to help us develop all of it. There were a lot of parts that came together to help get it done.”
Now, the center is in its second year of offering the certificate. They graduated one cohort during a very challenging time, with students who represented six different health care disciplines. Their second cohort has students representing three different disciplines.
Students will tell you it’s important to get this certificate because telehealth is so much more than talking to someone through Zoom. It really is a science.
“It’s about establishing trust and relationships,” Lowman said. “And it’s about really getting to know your patient — their location, their abilities, the way they communicate. It’s about knowing your technology and your presentation. You have to have the right backgrounds and lighting and sound. You have to listen and pause when you’re talking so they can hear you. You have to look them in the eye.”
Lowman calls it tele-etiquette. But it’s more than that.
“It’s about doing what you can to make a connection,” she said. Within CHS, there is a lending library for those families who may need special technology. Once, Lowman drove over an hour to personally deliver a webcam to a family in need.
“We’re training these individuals to be experts,” she said. “We want them to be able to go out and start their own programs. They need to learn to be HIPAA compliant. They need to know how to work with a budget. They need to know how to put this all together into a comprehensive package — and that’s what we’re here to teach them.”
Lowman and her students are now being recognized across the country for their efforts, specifically by the American Speech-Language-Hearing Association.
This year, the editor-in-chief and editors of Perspectives of the ASHA Special Interest Groups selected the article, “Telepractice for Adult Speech-Language Pathology Services: A Systematic Review,” as the winner of the 2020 Editor’s Award, which is limited to the “most impactful works that meet the highest quality standards in research design and presentation,” the publication states. Written by Lowman and Kristen Weidner, a doctoral student in the rehabilitation sciences program, the pair conducted a systematic review of the literature regarding adult telepractice services from approximately 2014 to 2019, including screening, assessment and treatment. The idea began when Weidner got curious about older adults' perceptions and use of telehealth. Overall, results of the review continue to support the use of telepractice as an appropriate service delivery model in speech-language pathology for adults, Weidner explained. But further research needs to be conducted to determine the best ways to relay information.
“(Dr. Lowman) has made an impact,” Weidner said. “There was this ripple effect of the training that she's been doing. Prior to the pandemic, she had already been kind of laying the groundwork here in Kentucky, so we were a step ahead. Having her here, and the training that we’ve been able to do has really impacted people and their careers. We’ve been able to help people and deploy telehealth when it was needed.”
And, along the way, Weidner said she has found the environment to do exactly what she wanted.
“This has been a such a great place for doing research and working with other disciplines, getting help — there's so much support,” she said. “People are always willing to lend a hand and answer questions. If you, you have an idea, you can really carry it out to fruition, because of all the resources we have here.”
Choosing to Learn
The American Telemedicine Association has announced Sept. 19-25 as National Telehealth Week. “What we have been able to do over the course of the past two years in telehealth is nothing short of extraordinary,” said CHS Dean Scott Lephart, Ph.D. “Dr. Lowman, as well as all of our professors, staff and students working in the Center for Telehealth Education, Research and Outreach, should be commended. Their dedication helped — and is continuing to help — our department, university and community through a very challenging time.”
Now, Lowman said she wants to see telehealth become sustainable post-pandemic.
“How can we grow and keep educating?” she asked. “How are we going to make this sustainable in our own clinic?”
She said much will be determined by government regulations. Patients will also determine what they want to do. Some have favored a hybrid format, where they might come in once a month.
No matter what, those involved in telehealth say one thing is certain: Technology will always be here to stay. And you can choose to learn, or you can get left behind.
“Do you want to show you’re a cutting-edge provider?” Lowman asked. “Do you want to maximize access to your services and all that you’re learning? You need to do this certificate because using technology is here to stay. You don't want anything to be a barrier. And you want to do this so we can get health care to everybody, regardless of location, and actually be able to close this gap in inequities in health care services.”
Interested in applying for the telehealth certificate?
Learn more about Lowman's work in telehealth on "Behind the Blue."
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