NP Advocates to Know: Dr. Kelli Garber on Telehealth

An Advocate’s Journey in Telehealth

“When I started, there wasn’t much at all in the literature about telehealth,” Dr. Garber says. “I had to figure it out on my own, what worked and what didn’t. The more I learned about telehealth policy and best practices, the more I felt I needed to share it across the country. I started speaking at conferences and publishing papers. It’s been interesting to see the change from just nine years ago to where we are now. I’ve loved every minute of it.”

When Dr. Garber got started with telehealth advocacy, she encountered a lot of questions about whether telehealth was even viable as a concept. How could high-quality healthcare be delivered through a screen? 

A trial by fire during the Covid-19 pandemic proved just how much telehealth—and the healthcare system more broadly—could do when the circumstances required it. Telehealth proved to be far more than a stopgap measure. Questions around telehealth have evolved. The questions are no longer around feasibility but around maximizing benefits and reducing inefficiencies. 

Dr. Garber’s advocacy has taken many forms over the last nine years, from developing best practices to promoting patient and provider education to working on state legislation that enshrines an NP’s right to provide telehealth services. As the public health emergency draws to a close, advocacy has remained important in extending Covid-era barrier-reducing policies around prescribing via telehealth, too. And there’s still much more to do.

“Telehealth can extend the reach of healthcare beyond clinic walls,” Dr. Garber says. “But without adequate infrastructure regarding technology and access to the internet, as well as education and training for patients and providers, it may not be successful in overcoming health equity issues. To that end, I endeavor to equip and empower providers, NPs, and others to develop sustainable programs that not only enhance care but help achieve health equity and ensure that care continues to be provided.”

Challenges and Opportunities in Telehealth

Telehealth is not meant to replace in-person care, but it does require a rethinking of care. Telehealth can change what care looks like, who gets it, and where it occurs. Those changes bring new issues to the forefront, and one such issue is digital health equity. 

“One of the things that telehealth brought about during the pandemic was recognition of the healthcare deserts and the areas of our country with lack of access to internet, broadband, even cell service in some places,” Dr. Garber says. “If you don’t have access to those things, you can’t have access to telehealth. So it illuminated some of the existing disparities regarding technology and access.”

Patients need technology to access telehealth, but they also need to know how to use it, and additional patient education may be required to boost a patient population’s digital literacy. While a telehealth clinic visit can take place almost anywhere, that doesn’t mean it should take place anywhere, and helping patients set up the right parameters for a digital visit can boost the experience. Having an environment that’s quiet, private, and free of distraction makes a significant difference. 

Provider education is critical, too. Earlier this year, Dr. Garber and her colleagues at Old Dominion University published a paper in the Online Journal of Issues in Nursing that focused on telehealth etiquette and webside manner. Centered around a PEP framework (performance, environment, and privacy), it’s part of a push for more intentional and evidence-based provider education on conducting telehealth visits.

“We need education not only on how to conduct the visit from an etiquette standpoint but also how to maximize the care that’s provided and ensure that we are doing evidence-based care as we would do in person,” Dr. Garber says. “Because telehealth doesn’t change the standard of care. It’s the same standard of care we provide every day in person, just across distance, and not everyone has adequate training and education to understand that difference.”

Widening the community of patients one sees means cultural competency is at a premium. It also puts a renewed importance on the social determinants of health and the myriad of barriers patients may face in their healthcare journey. Calculating for these human variables is all part of the holistic approach that NPs are known for bringing to patient visits, whether digital or in-person: thinking outside the box to achieve better outcomes. 

“The primary benefit of telehealth is bringing that care to rural and underserved communities that may not otherwise have access to it,” Dr. Garber says. “So if we are in our own settings, in our in-person facility, dealing with a different patient population, we need to be sure we’re understanding the challenges faced by that new community. But not everyone instinctively thinks of that.”

The Power of NP Advocacy

Dr. Garber’s telehealth advocacy journey began when she received a call from the director of the Center for Telehealth about building a statewide school-based telehealth program. As a pediatric NP, she saw the program as a way to reach children in need and increase access for those who needed it most. The school-based telehealth program started in three schools and has now expanded to over 180. It serves as a national model. Dr. Garber and her colleagues have provided consultations to FQHCs, private practices, NPs, and physicians nationwide. 

“Advocacy is an inherent part of the nursing profession and advanced practice nursing,” Dr. Garber says. “It has so many different facets. I always tell my students to follow their passion, and often that leads to advocacy in a particular area.”

Telehealth has changed tremendously over the last nine years. After a peak during the pandemic, utilization has decreased slightly, but many experts expect it will remain between 20 and 30 percent of all healthcare going forward. For NPs and their patients, telehealth advocacy remains as important as ever. 

“Telehealth is here to stay,” Dr. Garber says. “It’s going to continue to be an integral part of our healthcare system going forward. In a perfect world, everyone would have access to high-quality healthcare through telehealth, and that means overcoming digital equity issues and making sure that we are providing culturally competent quality care. How long that will take, I don’t know. But that’s where we need to put our focus.”

Resources for NPs Interested in Telehealth

To learn more about how new and aspiring NPs can get involved in supporting, promoting, and practicing telehealth, check out some of the resources below.

• American Telemedicine Association (ATA): As an organization focused solely on advancing telehealth, the ATA offers several tools and resources that help advance telehealth’s role in the healthcare system and foster greater access to safe, affordable, and appropriate care. 
• Center for Connected Health Policy (CCHP): CCHP’s mission is to advance state and national telehealth policies that promote better systems of care and improved health outcomes and provide more equitable access to quality, affordable healthcare and services.
• Center for Telehealth Innovation Education and Research (C-TIER): C-TIER serves as a national leader in telehealth innovation, education, and research by preparing and arming students, providers, and health professions faculty with the knowledge, skills, and abilities necessary to become proficient in telehealth.
• National Consortium of Telehealth Resource Centers (NCTRC): A collaborative of 12 national resource centers and two national centers dedicated to supporting the development and implementation of telehealth programs for rural and underserved communities.