Speaking to health care leaders, providers, and medical students at Jump Trading Simulation & Education Center in Peoria, Illinois, Kyle Zebley, senior vice president of public policy for the American Telemedicine Association (ATA) and executive director of ATA Action, said the lapse wasn’t caused by technology or lack of provider readiness but by government dysfunction.

“On October 1st, patients across the country woke up to discover they had lost access to their doctors overnight,” Zebley said. “Not because of a technological failure or malpractice, but because of politics. That morning of October 1^st, Medicare telehealth flexibilities, the lifeline that millions of Americans had come to rely on, simply expired.”

The lapse affected Medicare fee-for-service beneficiaries and hospitals, including OSF HealthCare Saint Francis Medical Center in Peoria, participating in the federal Acute Hospital Care at Home program, after Congress failed to extend pandemic-era telehealth flexibilities. Although most private and Medicaid plans continued covering virtual visits, the sudden loss of federal authorization created confusion for providers and patients alike.

During the OSF OnCall Digital Health Symposium keynote speech, Zebley called the situation “a product of dysfunction, delay, and short-term thinking,” despite years of bipartisan support for telehealth across both the Trump and Biden administrations.

He stressed telehealth became collateral damage in a larger breakdown of governance.

On the 41st day of a record-long government shutdown, the U.S. Senate voted 60 to 40 to approve a continuing resolution to reopen the government. The measure would fund much of the government through January 30 and provide funding for some agencies through the end of next September. It also includes an extension of a waiver that allows for telehealth services for Medicare recipients.

Need a permanent fix

Zebley has been urging lawmakers to transform temporary extensions into permanent, digital-native health policy that provides stability for hospitals, clinicians, and patients. He argued that bipartisan goodwill alone is not enough. But Zebley is not convinced the rollercoaster ride is over.

“In the short term, it’s going to continue to threaten at least to be the rollercoaster that it has been in 2025. We have two political parties at total loggerheads – putting aside their agreement on the efficacy of telehealth and virtual care services – they disagree about almost everything it would seem.”

Zebley pointed out OSF HealthCare has been a leader in using digital technology and virtual care to transform health care.

“OSF has continued, through OnCall (its digital health arm), to really push the boundaries of their workforce and push the boundaries of increasing their capacity to do more good for more patients wherever those patients might be. He added, “They really are the gold standard in the use and deployment of technology.”

However, he argued health systems such as OSF can’t build business models around continuing resolutions. Clinicians can’t plan care around congressional calendars. Patients shouldn’t have to wonder whether their next therapy session or prescription refill depends on the latest vote count in Washington.

The future of telehealth

His vision for the future – a “digital-native, AI-enabled” health care system, where policy keeps pace with innovation and where care is continuous, data-driven, and equitable. The telehealth leader emphasized technology has advanced rapidly – from remote monitoring and hospital-at-home programs to AI-assisted diagnostics, but policy and regulation have lagged behind. Zebley stressed a permanent fix is needed.

“So that our fellow citizens, yourselves included, can lead healthier, better lives with more individualized care treatment that really is able to take advantage of the massive reams of data that our health care system can and does produce and come up with bespoke health care plans for them that meets them where they are.”

The lack of a permanent policy, he argued, doesn’t just slow innovation, it denies care.

The ATA and ATA Action are coordinating national coalitions to push for long-term reform, including the ATA Action Advocacy Council, the Virtual Foodcare Coalition, and the Advancing Digital Health Coalition, all aimed at ensuring that digital health access remains stable and bipartisan.

The ATA, through its Center of Digital Excellence is also continuing to collect data to provide additional evidence that telehealth is safe and that it is expanding access to care despite a shrinking workforce.

Regardless of the current lapse, Zebley is optimistic Congress will eventually make telehealth coverage permanent because he says it is one of the rare success stories of American health policy. He reminded those in the room in Peoria that data has already shown that telehealth is not only popular, but it is efficient, cost-effective and patient-centered.

Kyle Zebley

B-roll-OSF OnCall Digital Health Symposium

Digital health technologies have allowed people to access care where and when they want it because of computing platforms, software, sensors, and connectivity.  But, Sarasohn-Kahn says connectivity is a barrier for some who are experiencing gaps in care. 

“Because not everyone has connectivity. It costs money that a lot of people don’t have to spend. So, this is a limiting factor that we can address but we shouldn’t be pollyannish about this for everybody because not everybody can get online, and we learned that during the pandemic.” 

Connectivity, says Sarasohn-Kahn, is a social driver of health, much like transportation, food, housing and other social needs. She emphasized that partnerships with community and government organizations will be needed to create what she called “techquity”— tech equity. 

Universal access to innovations can help reduce inequities and remove barriers to care for underserved populations. Sarasohn-Kahn points out innovative health systems such as OSF HealthCare are investing in new technologies, providers, and data scientists to drive better health and prevent hospital admissions. Now, evidence is starting to show returns on that investment in better patient care and reduced treatment costs. 

Globally, she says for every $1 invested in telehealth, there is a $19 return to the economy in increased productivity and reduced health care costs. But trust is a major factor in driving consumer engagement in telehealth.

Sarasohn-Kahn says misinformation that began during the pandemic and that continues today is driving down trust in health care. 

 “Without trust, people will not engage with you as a health care provider. There has to be that sacred, and I use the word sacred because it’s real, it’s (a) deep bond of trust and it’s a precursor to health engagement.”

Technology is allowing the movement of more care to the home. Blood tests, labs, and imaging can increasingly be performed in the home or remotely. Sarasohn-Kahn says the growth of digital health apps, digital therapeutics and increased use of sensors integrated with smartphones that can passively monitor patient metrics is advancing convenient care. Plus, there's been increasing expansion of videoconferencing for virtual visits from anywhere. 

She emphasized that health systems can take a lesson from OSF and embrace collaboration to boost trust, access and equity. For example, trusted community organizations can be partners to help build one-on-one relationships with people who don’t trust health care. Once patients engage and have a great experience with a virtual visit or using a platform for health monitoring or other technology, Sarasohn-Kahn suggests they will help others get on board.

“Once you start that process, people will engage, ask more questions and then they become your evangelists in the community. She shared, “I’ve seen this over and over. It takes a lot to get (trust) up, but once you get that relationship going, it can be a beautiful thing.”

Faster computing power and use of generative AI will also transform health care.

Artificial intelligence will be embedded in so many aspects of our lives, including health care. And, with proper governance and ethical use, Sarasohn-Kahn says it can make the most of a shrinking and increasingly burned-out workforce. She outlined several practical applications.

“In research trials, marketing personalization; same way it will have in health care decision making, productivity – not to replace jobs but to enhance people’s ability to do more and have the lower, easy low-hanging-fruit stuff done so that you can concentrate and work at the top of your license whoever you are and not just for clinicians but for all workers to work at the good stuff.”

From her research and personal experience Sarasohn-Kahn says its clear health consumers have mixed feelings about AI and data privacy. But, she says many are willing to share their data if they see the value in doing so. For consumers, she advises making sure to use apps that are HIPPA compliant (legislation that protects personal health information).

Finally, what is also needed to drive more engagement with telehealth? Sarasohn-Kahn says a federal data privacy law that mirrors what is in place in Europe, based on the premise that all consumers should have complete control over their own personal data.

Video clips with Jane Sarasohn-Kahn

B-roll for digital health symposium

More than 1.5 million rural Illinois residents face significant health care access barriers due to a lack of resources and limited infrastructure. OSF HealthCare serves many rural communities in Illinois and Michigan and leaders are looking at telehealth and digital health tools and platforms to bridge those gaps.

Part of the strategy involves collaborating with academic partners such as Illinois State University in Normal. A team made up of faculty at ISU and clinicians from OSF is working on a project to educate the future workforce on using a telehealth platform that can allow real-time assessments, consultations, diagnosis and creation of care plans, along with providing health education for people with chronic conditions in rural, medically underserved communities with aging populations.

The project called STARTED – Simulation to Address Rural Telehealth Education Development is funded by a joint OSF-ISU Connected Communities grant as part of an ongoing collaboration.

Associate Dean for Academics, Susie Watkins, PhD, RN, Mennonite College of Nursing at Illinois State says the platform will allow nurses to hold pop up clinics in homeless shelters or other community sites.

“This would help us provide some care in a community like that where they don't otherwise have access to health care, and that could potentially avoid them having to use the emergency room for things like ear infections and strep throat,” Watkins says. 

The platform also has attachments that can be used for physical exams performed by a nurse. Data and video from the exam could then be sent back to a provider at a distant hospital or clinic to review and offer a diagnosis and treatment recommendations, including prescriptions or referrals to a specialist.

Watkins holds up attachments as she explains, “It has an attachable otoscope that would record a full ear exam to determine if the ears are inflamed, and then also has an oral tongue depressor feature that one could examine the back of the throat for potential tonsillitis. 

There are other devices that can connect to the platform to provide assessments on heartbeat, lung sounds, blood pressure and other tests such as blood glucose levels that can be sent to the off-site provider via the platform.

The Director of Interprofessional Education at Jump Simulation, Ann Willemsen-Dunlap, CRNA, PhD, is co-lead on the collaboration for the first year of training 120 Bachelor of Science in Nursing (BSN) and 24 Family Nurse Practitioner (FNP) graduate students. She’s supporting the development of web-based learning modules that use patient scenarios, video vignettes and telehealth simulations using standardized participants.

Trained actors will be used

Standardized participants are specially trained actors who portray patients from rural communities with various health challenges. The actors also provide an assessment with standardized metrics that measure competency in various areas including wellness screening, disease specific illness-related triage, disease self-management support using motivational interviewing and person-centered goal planning techniques. Willemsen-Dunlap says the standardized participants also give verbal feedback once the simulation is over.

“They’re going to be talking with their learners about how the interaction made them, as patients, feel from a first-person perspective.” 

Willemsen-Dunlap says eventually community health workers, as trusted advisors, can be trained to go into homes within medically underserved communities to help patients get comfortable with the portable technology that allow for in-home exams, rather than requiring patients to travel long distances for care.

“I think that having a community health worker present in the home to facilitate the interaction and nurses who are skilled and comfortable working in the digital environment, as well as providers who had similar training is going to be the key to success,” Willemsen-Dunlap stresses. 

Other funding sources are being sought from governmental or non-governmental organizations to support additional work to implement a rural health mobile clinic that uses this training and technology to deliver exams and health-related care within underserved communities.

In areas of so-called connectivity deserts, where the internet is not available or is unreliable, OSF OnCall, the health system’s digital care arm, could use an OSF OnCall Connect On the Go van for exams using the enhanced virtual platform and on-site connectivity.

Watkins says one-third of older adults in rural communities have two or more chronic diseases so its important patients continue to stay on track in managing them.  

“This technology would allow nurses to connect with patients on an ongoing basis between provider visits and do that condition specific assessment and also the self-care assessment and make sure that the patient is staying on target with their goals and all of the treatment recommendations made by their provider at the previous visit.” 

In the future, training could also involve behavioral health or dietary students who could be brought in on a telehealth visit to receive training on how to address additional concerns that are influencing a patient’s overall health and wellbeing.

Video clips with Susie Watkins

Video clips with Ann Willemsen-Dunlap

B-roll of robust telehealth platform

Telemedicine – seeing a provider by video from home – is a common and useful part of today’s health care landscape. But as Amer Alshekhlee, MD, points out, it’s sometimes not fast. A person will commonly book a virtual appointment days or weeks out.

So how can telemedicine play a critical role when millions of brain cells are at stake in a matter of minutes?

Enter telestroke. It’s a concept in use throughout OSF HealthCare. At OSF HealthCare Saint Anthony’s Health Center in Alton, Illinois, the strategic affiliation between OSF and SSM Health allows telestroke to be seamless. Dr. Alshekhlee, the stroke program director at DePaul Hospital in nearby Bridgeton, Missouri, is one of the doctors who sees people virtually when they come to the OSF Saint Anthony’s Emergency Department with a suspected stroke.

“We see patients quickly. We triage them from hospital to hospital. That provides very quick treatment,” Dr. Alshekhlee says.

“We’ll have a video encounter,” he adds. “We examine the patient. Talk to them and their family. Make a decision on what kind of treatment and where.”

Providers will ask about when symptoms started and their severity. They will likely have the patient demonstrate the BEFAST acronym, a standard way to spot stroke symptoms. Providers will look for problems or abnormalities in balance, eyes, face, arms and speech. The “T” in BEFAST stands for time. In other words, if there is evidence of issues in B through S, it’s “time” to take quick action.

“We have a scale. We score the person, and for example, say ‘these stroke symptoms look very bad’. Then we have to really act on that patient.”

That could mean a transfer to a hospital better equipped to treat stroke. Again, providers will tell you time is of the essence. For example, if you start treatment at the Emergency Department within 4½ hours of the onset of symptoms, you may be able to take Tenecteplase, a blood clot-busting agent that experts say could become the gold standard for stroke care.

On the flip side, for each minute a stroke goes untreated, the brain loses around 2 million cells it cannot recover. Strokes can also have life-altering consequences like vision, walking and swallowing difficulties. They can take years off your life and put you at risk of another stroke.

Learn more about stroke care on the OSF HealthCare website.

Related stories

Strokes are more common in older adults

Anxiety. Depression. Bipolar disorder. Schizophrenia.

They’re daunting diagnoses, but necessary to think about for many people.

And experts say those concerns don’t magically go away when a person reaches age 60 and beyond. Rather, older adults need to keep mental health care in mind and know the resources available to help with concerns unique to that age group.

Ari Lakritz, PsyD, is a clinical psychologist at OSF HealthCare who has taken a keen interest in this area.

“As individuals grow older, they start to prioritize their emotional needs over their professional, financial or more mundane needs,” Dr. Lakritz says. “So you may be surprised when you work with an individual who’s older at how quickly they want to work on the problems in their life and how solution-focused they are as compared to their younger cohorts.”

Dr. Lakritz has seen plenty of examples of this research-backed idea as he’s conducted counseling sessions. For example, an older adult may want to dive right into talking about death or family disputes that have been festering for years.

How does a mental health professional achieve results with this age group? Dr. Lakritz points to a concept called interpersonal therapy, which focuses on a person’s relationships and their overall place in the world.

“That is really what older adults have on their mind at this stage of their life. Many of them are retired. For many of them, financial issues or their professional climbing of the ladder have kind of taken a backseat,” Dr. Lakritz reiterates. “They are focused on their remaining relationships and making them as good as possible.”

A therapy session for an older adult may be structured the same as a younger person’s visit. But a psychologist would need to keep in mind the person’s needs. If the patient has mobility issues, for example, the office should be easy to get in and out of. If the person is homebound, a home visit or virtual visit would be necessary.

Those telemedicine appointments, Dr. Lakritz says, took on extra importance during the pandemic. Some older adults were already isolated, and COVID fears or government mandates to stay home separated them further from visiting their loved ones and practicing social or coping skills. Card games were replaced with phone calls. A trip to the community theater was scuttled in favor of watching the show on DVD.

“On the plus side, I think everyone saw and was pleasantly surprised at how quickly older adults managed to understand technology,” Dr. Lakritz says.  “[They] understand remote meetings and how to participate almost as fast as younger adults who also had to adjust very quickly.

“That was a big game changer in the field that is not going away anytime soon,” Dr. Lakritz says.

Not to mention the sense of pride from an old dog learning new tricks, as the saying goes.

“It’s very much emphasized, even in old age, to continue to pick up new skills. To acquire new knowledge,” Dr. Lakritz says. “That does lead to a great deal of self-esteem. And cognitive stimulation, learning new things, reasoning and being intellectually challenged are some of the biggest protective factors against dementia.”

One last thing Dr. Lakritz says clinicians should keep in mind when serving older adults: confronting biases or falsehoods about that generation.

For example: older adults are slower workers. The data say that’s more folklore than fact, Dr. Lakritz says.

“Many people have this misconception that working with older adults is something that is fundamentally different than working with younger people,” Dr. Lakritz says. “[Many think] you need specific, specialized training or you need to be an older adult yourself to work with older adults. And that serves as a barrier to older adults’ treatment.”

The OSF HealthCare website outlines mental health resources. Taking a look, then broaching the topic with your older friend or family member is a good first step. A necessary one, too, for some older adults who grew up in a time when “self-care” wasn’t a common term.

“If you’re a trusted person in that older adult’s life, and they trust you with more mundane concerns such as helping them get around the house and giving them rides,” Dr. Lakritz explains, “then, I think there’s a good chance they would trust you if you said, ‘I see you’re dealing with this. You’ve been dealing with it for a very long time. You haven’t been able to talk with anyone about it. There is someone we can go to’.”

And make those check-ins with your parents, grandparents and older friends a habit. They’ll be happy you did.

Interview clips

Related stories

Caring for someone with dementia
Mental health care starts with a first step