AcuteCare Telemedicine Blog


Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



Recognizing the Symptoms of Stroke

While stroke awareness is a major concern for both men and women, a recent study concluded that women are less likely to recognize stroke symptoms. Only half of those surveyed know that sudden weakness or numbness on one side of the face, arms or legs is a warning sign of a stroke. 44 percent are aware that speech difficulty is a stroke sign while less than 1-in-4 could identify sudden severe headache, unexplained dizziness and sudden vision loss, or vision loss in one eye as the top symptoms of stroke. The study surveyed more than 1,200 women in the United States to assess their understanding of stroke’s warning signs.

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of the brain control different parts of the body, your symptoms depend upon the part of the brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word F.A.S.T.: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 911 immediately if any of these signs or symptoms at the earliest onset of these symptoms

For those living with or who care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

The acronym “FAST” is also meant to underscore the importance of rapidly delivering treatment to stroke patients. If given in time, a clot-busting drug administered during a stroke can lead to better outcomes and a decrease in the likelihood that a patient will suffer long-term disability. A recent study examined the effectiveness of tissue plasminogen activator (tPA) relative to the delay in administering this clot busting drug. Researchers found that every minute tPA was delayed cost nearly 2 days of disability free survival. The researchers commented that their message is literally “Save a Minute, Save a Day.”

Although many Americans live relatively close to a hospital where emergency stroke treatment is available, few actually receive the recommended therapies. Researchers found that only 4 percent of the more than 370,000 Medicare patients who suffered a stroke in 2011 were treated with tPA. Most stroke victims fail to recognize the symptoms of stroke or call 911 early enough to receive the necessary treatment. tPA is most effective when administered within a 4 hour window of time.

Every minute counts for stroke patients. Remember to act F.A.S.T.!



A Better Model of Delivery Realized

We buy groceries, trade stocks, and chat with friends, surf and cultivate new relationships around the country and the world all without leaving our home or office. Yet seeing a doctor remains an old-fashioned routine: minutes of medical attention can cost hours spent in transit or in a waiting room, only to have a face-to-face with a doctor. The familiar choreography dates back several generations, virtually unchanged since treatment from your family physician moved from your home to his or her office, where the newest diagnostic equipment of the day and the best trained supporting staff could more efficiently provide the most up to date medical care for the time. The technology revolution has brought amazing new diagnostic equipment, treatments and medications over the past several decades, but until now the process of visiting the doctor has remained nearly the same.

Telemedicine involves locating available doctors over the Internet and connecting with them, at a moment’s notice. It lets a patient see a doctor whenever and wherever you want, freeing them to choose a doctor based on merit rather than location. It can also improve the quality of medical care and reduce costs and it works well for urgent care, ongoing diagnostic monitoring and illnesses that can be diagnosed and treated without personal contact with a care giver. Telestroke, the practice of providing emergency stroke care through telemedical technology has brought lifesaving care to patients who were once located outside of the golden hour of treatment and chronically ill patients who were accustomed to spending many hours of travel time to receive treatment for a variety of illnesses and injuries have realized a new level of convenience and quality of healthcare.

In 2010, telemedicine and telehealth appeared to be on the verge of an acceptance break though. Recognizing an oncoming shortage of physicians and escalating medical care costs, the healthcare community recognized how the technology could significantly impact the future medical care costs and streamline the delivery of a broad array of healthcare services. The benefits of a new technological healthcare delivery model faced some rather significant hurdles on its way to acceptance and meaningful implementation. Much of the healthcare infrastructure, fiscal processes and protective regulations, many in place for nearly a century, needed to be revised to take advantage of the promised benefits of telemedicine. Policymakers, politicians and those early doubters within the medical community are warming to the new model and once formidable barriers to the advancement of telemedicine are beginning to tumble. Removing process barriers may be the easy part of bringing the benefits of telehealth to the everyday life of patients, changing life-long rituals and perceptions associated with traditional medical care delivery may take a bit longer. Simply recognizing the benefits of telemedicine isn’t enough; patients must embrace the concept, understand how the features benefit them and motivate them to use it.

Some say that there is no substitute for the human touch and a healing bedside manner. Consumers will always insist on traditional, face to face encounters with their doctor. Yet the advantages, convenience in particular, of new technologies and cutting edge devices are being accepted and utilized by virtually all generations. Social interactions are now ongoing connections and rarely limited to special occasion or planned encounters. Acceptance and utilization of technology in medicine will advance as the options and variety of healthcare services, accessible and the benefits of convenience and costs are realized by more and more patients.

Regardless of the methods of delivery, those who choose to enter the practice of healthcare will still be motivated to do so by the desire to help others in need, to provide treatments to those who suffer the fates of life’s many malady’s and to save lives. Having to adjust their bedside manner to accommodate the medium of delivery will do little to deter their aspirations to heal others.

In the words of Thomas Nesbitt, the Associate Vice-chancellor for Technology at the University of California Davis Health System, “A lot of people think it’s about the technology, but it’s really about a new model of care that the technology facilitates.”



Solving the Physician Shortage: Should it be Left to an Act of Congress?

Since 1997, the number of physicians entering the workforce each year has essentially been capped, while the demand for everything from hip replacements to treatments for diabetes to angioplasties has soared with our growing and aging population. Now, the Obama administrations newly proposed budget seeks to spend an additional $5.23 billion over the next decade to manufacture new physicians. While this sounds like a lot of money, given the magnitude of the doctor shortage issue, it won’t be nearly enough to solve the shortage problem on its own merits. The proposal is designed to swell the ranks of primary care doctors, those family physicians, general internists, and pediatricians that constitute the healthcare workforce that is predicted to experience the greatest shortage of all the medical disciplines.

But primary care is not the only medical care discipline that is facing future short falls.  According to a study by the American Academy of Neurology (AAN), by 2025 the demand for neurologists will far outnumber the supply, creating a 19 percent disparity in the number of doctors needed to adequately care for all patients. Those who suffer with neurodegenerative diseases like multiple sclerosis (MS), Parkinson’s, and Alzheimer’s will have to wait longer to see a specialist.

“The doctor shortage is worse than most people think,” says Steven Berk, M.D., dean of the School of Medicine at Texas Tech University. “The population is getting older, so there’s a greater need for physicians. At the same time, physicians are getting older, too, and they’re retiring earlier,” Berk says. And graying doctors, nearly half the nation’s 830,000 physicians are over age 50, are seeing fewer patients than they did four years ago.

The flow of doctors entering the market each year is determined by the number of U.S. residency positions, chiefly in teaching hospitals. Those positions are funded primarily by the program that oversees Medicare and Medicaid. In 1997, the federal government essentially froze spending on residency slots, limiting the number to around 100,000 over three-to-four years, and in turn freezing the number of newly licensed physicians available for hire each year to around 26,000. Over the past 17 years, a few hospitals have established new residency programs for primary care doctors, raising the number to around 27,000, or a less than 4% increase. Meanwhile, the U.S. population has risen by 50 million, or almost 20%. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today.

The Affordable Care Act promises to magnify the problem but does attempt to address some of the issues to help stem its effect on the shortage by allocating an additional $1.5 billion in funding for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a more prevalent shortage. The law also puts more money toward training in hopes of increasing the primary care workforce and it offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015.

But many in the medical care industry do not see the solution reserved for government legislation alone. “Keep in mind the Affordable Care Act didn’t create this crisis,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “We’ve got an aging population that needs more care and a growing population.”

Many believe that new technologies will extend the reach of medicine in ways that will ameliorate the shortage problem. Health care professionals can serve more people by using telemedicine technologies to examine, treat and monitor patients remotely as well as providing patients increased access to advanced stroke care. These technologies are already keeping patients out of hospitals and doctors’ offices and providing improved recovery results. Creative new ways medicine is delivered, such as the use of “medical homes” and “accountable-care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. Telemedicine enhances productivity and outreach while cutting costs, it improves diagnosis and care management in remote areas, and it reduces unnecessary care. The technology also strengthens partnerships between community based hospitals and advanced regional care centers.

“I understand there is a sense of worry, and change can be scary, but our present system is broken,” Dr. Blackwelder said. “We pay twice as much for our health in this country and have worse outcomes than other countries. Looking to government to fix a problem often harbors complexity, inefficiencies and long-term implementation of solutions. Dr. Blackwelder’s opinion reflects that of many other medical industry professionals, “We will have to start coming up with creative solutions to this problem, ones that won’t have to wait for an act from Congress.”



Removing Well Entrenched Impediments to Advancing Telemedicine Benefits

A recently published study in Telemedicine and e-Health found that despite numerous benefits to expanding telemedicine that there are three major barriers that remain to fully implementing the benefits of telehealth. Health care professionals agree that Telemedicine has and will continue to change care delivery and patient outcomes by expanding patient access, reducing service gaps, improving service quality, providing additional clinical support, delivering enhanced patient satisfaction and improved adherence to care standards.

Advances in powerful technology is transforming care facilitation, making real-time audiovisual communication more feasible and permitting physicians the ability to remotely consult with a patient via a robot and LCD screen.  Remote specialists and physicians can treat patients and save lives with the use of a broadband card, an internet connection from a cell phone tower and a laptop. This illustrates the amazing potential of telemedicine but the study found that serious human barriers to nationwide telemedicine still remain.

The study surveyed emergency and critical care remote presence telemedicine users from 53 healthcare institutions across North America and Ireland. One hundred-and-six surveys were completed. Sixty-eight percent of respondents were physicians, 17 percent nurses and nurse practitioners and 8 percent were administrators. The results indicated that three major human barriers for telemedicine in the areas of regulation and finance need eradication to fully implement the benefits of telemedicine.

     - Licensing for Physicians. A major benefit of telemedicine is the ability to consult remotely with physicians and patients across state boundaries, but today the current approach to medical licensing requires health providers to obtain multiple state licenses and adhere to diverse and sometimes conflicting state medical practice rules. The medical licensing process is not only complicated but also lengthy and expensive and it represents a major barrier to the expansion of telemedicine.

     - Credentialing. Credentialing can become very complicated especially for hospitals with hub and spoke models because physicians from each hospital have to have the credentials at every hospital.  The time it takes it to acquire all necessary documents and finish an application is time that could be used training medical staff to use telemedicine and bring the benefits of telemedicine to deserving patients. The current method for credentialing should be streamlined to facilitate easier credentialing at multiple facilities leading the way to wider telemedicine implementation and increased accessibility.

     - Reimbursement. A huge financial issue for telemedicine is the lack of reimbursement and capital expenditure for services. Similar to licensing issues, reimbursement models are different across the states with each having its own regulation for private payers with little or no consistency for telemedicine reimbursement.

Removing these impediments to the expansion of telemedicine remains a daunting task. Change never comes easy, particularly when it requires the cooperation of various bureaucratic agencies, multiple governing bodies and a wealth of well entrenched administrative procedures and regulations that were designed and implemented in a time when advanced communication technologies were little more than fantasy and science fiction. A continued focus on removing these barriers must intensify in order to bring the many proven benefits of telemedicine to patients throughout the country and the world.



Telehealth: Impacting the Practice of Primary Care

Hundreds of employers of all sizes are contracting directly or through their insurers with telehealth providers to cut medical costs and give workers 24-hour access to doctors and nurse practitioners. Recently, Beth Ferrin’s 9-year-old son came home with a swollen throat and fever. It was after dinner, so she flipped open her laptop and dialed into LiveHealth Online, a service offered by her insurer, WellPoint, (WLP) that connects patients with doctors via video calls. After a quick diagnosis of strep infection, a prescription for an antibiotic was called in to a pharmacy near Ferrin’s home in Bellbrook, Ohio. Her other options would have been to see a doctor in the morning or risk a long wait at an urgent care facility. Beth’s willingness to seek treatment for her son via telecommunication technology counters some telemedicine critic’s prediction that patient insistence on face to face encounters with their physicians would be a significant barrier to remote medical care’s rapid expansion. Now it would appear that barrier was overstated and, in part, has been overcome. 

But some very legitimate concerns continue to exist among physicians about the safety and effectiveness of remote medical care. When asked about the throat infection treatment of Ferrin’s son, Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said: “The only way to diagnose strep is with a test. Best practices say you can’t just throw an antibiotic at somebody.” He says there’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication. But Telemedicine care works well for treating common conditions such as colds, flu, pink eye, and sprains, providers say. 

The widespread use of camera-equipped devices has made remote medical connections easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. The growth of Telemedicine has been spurred in part by the Affordable Care Act (ACA), which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently.

In response to concerns about the appropriateness of remote diagnosis and treatment, the American Telemedicine Association (ATA) is developing an accreditation program for telehealth providers and a bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telemedicine standards. Meanwhile, Telehealth companies are reporting double-digit revenue growth and attracting high-profile investors. MDLive CEO Randy Parker says. “Within the next few years, no consumer will even remember not being able to connect to their providers through telehealth.”



AcuteCare Telemedicine Leading Acute Care Telemedicine

The effort to provide high-quality healthcare solutions to every patient, regardless of geographic location, while reducing delivery costs is at the foundation of industry leaders efforts to revolutionize the traditional healthcare delivery model. Telemedicine is becoming the cornerstone of the solutions. Advances in telecommunication technologies is providing increased opportunities to decrease complications for patients in areas of high acuity like the critical care unit, as well as provide assistance in time-sensitive treatment decisions for emergencies such as stroke care.

InTouch Health® is the leader in acute care remote presence telemedicine. The company through its network of clinical care providers delivers innovative healthcare solutions that extend a doctor’s ability to manage patient care remotely, thereby removing critical time and distance barriers. The InTouch Telemedicine System allows physicians and other healthcare providers to conduct highly reliable, real-time, remote consultations.

AcuteCare Telemedicine (ACT), the largest practiced based provider of acute stroke and neurological care is now linked as a preferred provider with InTouch Health. Acute care telemedicine is an approach to urgent healthcare delivery in which specialists are focused on providing comprehensive, end-to-end remote presence clinical services, enabling a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision and care plan. With their remote expertise available at a moment’s notice, ACT is able to increase the likelihood that patients will obtain necessary stroke care within the critical “golden hour” following stroke recognition. The importance of using acute care telemedicine in the advancement of emergency healthcare is supported by the efforts of InTouch Health.

The ACT team of expert Neurologists is being recognized for setting new standards for excellence in Telestroke and urgent Teleneurology care. As clinical partners with hospital based and emergency physicians, they are positioned to successfully deliver remote, live and interactive Telestroke and other Teleneurology solutions that deliver the highest quality, affordable services and superior clinical outcomes for hospitals all around the world.




Follow

Get every new post delivered to your Inbox.

Join 3,246 other followers