AcuteCare Telemedicine Blog


Researchers Use Telemedicine to Identify Patients for Clinical Trials

Using telecommunication technology to advance the delivery of healthcare is nothing new. Each day telestroke programs are demonstrating their value to patients who suffer acute ischemic stroke, particularly for those patients who live their daily lives beyond the easy reach of advanced urban healthcare centers. Well-developed “spoke and hub” telestroke programs at small to mid-sized hospitals throughout rural areas are providing advanced life-saving and quality of life benefits to thousands of stroke victims who once were just too far removed from medical specialists to benefit from the most specialized treatment. Advancements in telecommunication technology and its application to delivery medical treatment (telemedicine) are revolutionizing the healthcare delivery model by bringing the care-givers and the treatment to the patient no matter where they reside.

But a major new step in the approach to conducting clinical trials has been taken at the University of Texas Health Science Center at Houston (UTHealth). By utilizing telemedicine to remotely enroll patients with acute stroke in a new study being conducted at different hospitals, researchers are now bringing the research and clinical trials to the patients. The virtual enrollment of patient participants by a group of researchers at Baptist Beaumont Hospital and Memorial Hermann Southwest Hospital will help overcome limitations in the scientific process of testing therapies. The results of the study entitled “Telemedicine-Guided Remote Enrollment of Patients into an Acute Stroke Trial” were recently published in the journal of the American Neurological Association, Annals of Clinical and Translational Neurology. The research team identified 10 candidates and remotely enrolled six of them in a randomized, phase III study.

“One of the main drawbacks of conducting clinical trials for stroke is that we traditionally are limited to patients who arrive at large stroke centers that have the expertise to treat stroke quickly to minimize damage to the brain,” explained the first author of the study and director of the Telemedicine Program, Tzu-Ching Wu, MD. The trial was led by the associate professor of neurology at UTHealth and senior author of the study, Andew Barreto, MD. Patients were identified, screened, enrolled and randomized remotely. “Instead of the patients having to be taken to the mother ship, we brought the study to the patient. The implications are enormous,” Dr. Wu said. “This opens the doors to clinical trials for everyone and helps move science along. Because of the amount of stroke trials that are conducted, it’s hard to find enough participants. This allows us to widen the pool.”

Research and prevention efforts over the past decade have contributed to the decline in the mortality rates for stroke, but the disease still impacts approximately 800,000 people each year and remains the fourth leading cause of death in America. With the aging of the population, stroke research and clinical trials remain a vital determent to the upward progression of the disease. Telemedicine promises to have a significant impact on acute ischemic stroke and is likely to result in further declines in stroke mortality. Using telemedicine technology to assist researchers in broadening access to stroke patients for research purposes may lead to more opportunities to unlock new and beneficial treatments for the disease.



AcuteCare Telemedicine Advancing Stroke Care

A little more than a decade ago, telestroke and teleneurology were words that where not even part of our language but today are synonymous with the delivery of life-saving treatments for stroke. In a time when medical specialist are in short supply  among the nations smaller to mid-sized hospitals and increasing financial pressures make maintaining a neurology service difficult even at larger hospitals, many are turning to telestroke programs to assure their patients have access to the finest quality care available.  “Attracting and recruiting medical specialists is an ongoing challenge for smaller, regional hospitals who must balance the needs of their patients with the financial realities of healthcare in this demanding economy,” says Dr. Matthews Gwynn, Director and Founder of the Stroke Center of Northside Hospital in Atlanta and AcuteCare Telemedicine CEO. The combination of improving patient care, a growing shortage of neurology specialist and concerns over rising healthcare cost have converged to produce a significant increase in the utilization of communication technologies in the delivery of advanced stroke care

In a recent study, telestroke units helped increase the number of rural stroke patients treated and delivered treatment faster. In the 10-year evaluation of telestroke programs the study, published in the journal Stroke, found that the number of patients receiving the clot-busting drug tissue plasminogen activator (tPA) for ischemic stroke rose from 2.6 percent to 15.5 percent and the median time between a patient’s arrival at a regional hospital until tPA was administered fell from 80 minutes to 40 minutes. In addition, the median time between onset of stroke symptoms and receiving tPA fell from 150 minutes to 120 minutes. During the same decade, the number of patients transferred from regional hospitals to stroke centers declined from 11.5 percent to 7 percent.

Telemedicine continues to make significant progress in providing quality, specialized care for stroke and other neurological ailments and is improving access to this care for patients who live in remote outlying areas not served by major urban medical centers. According to the American Telemedicine Association, more than half of all U.S. hospitals now use some form of telemedicine.

According to a new study by Mayo Clinic researchers, telestroke programs are leading to lower cost. Stroke patients living in rural areas who receive care via a telestroke network experience, on average, nearly $1,500 in lower costs over their lifetime compared to stroke patients who do not receive telestroke care. The savings are primarily attributed to reduced resource utilization, including nursing home care and inpatient rehabilitation. The researchers evaluated a particular kind of telestroke care, with the healthcare provider acting as a hub that connects with a network of multiple hospitals, or spokes. They determined that when a telestroke system connects a hub with seven spokes it’s effective and cost-friendly for the patient. “This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, MD, director of the Mayo Clinic Telestroke Program, and lead investigator of the study.

Thomas Hospital has been serving the communities of Baldwin County and Mobile Alabama for more than 50 years. A 150 bed hospital with a staff of more than 1300 dedicated medical professionals, Thomas Hospital has established a tradition for earning accolades for excellent service. Recently, in an effort to complement their existing neurological care department, the Hospital partnered with AcuteCare Telemedicine (ACT) and the Alabama Partnership for Telemedicine to provide virtual, 24 hour, seven days per week treatment for stroke and other neurological maladies. With its exemplary track record for providing outstanding care it is no surprise that it would seek to improve its neurological care services through the use of the latest communication technology. Dr. James M. Kiely, says “When you engage with AcuteCare Telemedicine you are engaging in more than a technical solution. You are gaining quality individuals to augment your medical staff.  Patients are able to engage with neurologists who are invested in their care.”

ACT has established itself as an innovator on the forefront of the industry, taking a unique approach to telemedicine by leveraging new technologies and techniques to enable personal neurology consultation when doctor and patient are in different locations. “The interaction between patients and families and us with the two-way, secure videoconferencing system that we have, it’s the same as being there,” says Dr. Keith A. Sanders, AcuteCare COO. “The Neurologic exam for stroke and emergency Neurology can be as safely and reliably done remotely as it is in person, I don’t think we miss anything by not being there.” With the help of ACT’s powerful and personalized services, patients throughout the ‘Stroke Belt’ states of the Southeast have drastically improved access to the care they deserve, and medical facilities increase efficiency while reducing the costs associated with maintaining a traditional emergency neurology staff. Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, ACT has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographical boundaries. Achieving this goal requires a certain level of investment in technology and trust in the people behind it. ACT is truly technology-agnostic.  This agility affords healthcare organizations with the ability to select the platform that meets budgetary and organizational parameters.

At Dodge County Hospital ACT partners with InTouch Health (InTouch), a leading developer and provider of remote presence devices and software, to bring remote telestroke care to its client hospitals. InTouch and ACT closely collaborate with their hospitals to easily integrate and improve the efficiency of the new remote service workflow processes as well as improve clinical performance and cost containment.  The client hospitals dedicated staff of medical professionals receive important, on-site training in the operation of the telecommunication robots and its software and form critical consultative relationships with ACT neurologist to ensure the highest quality patient care. “Having the ability to consult with a neurologist remotely for treatment of stroke and other neurological maladies is allowing these hospitals to meet the needs of the patients in the communities they serve,” says Dr. Gwynn. “We look forward to expanding our family of client partnerships throughout the region.

Hospitals all across America are finding the cost of telemedicine an affordable solution to ensuring improved accessibility of critical care and specialized treatment for their patients no matter where they live. Dr. Lisa Johnson, AcuteCare CFO, sees the healthcare environment for telemedicine as an increasingly expanding area. “Unfortunately there is an exodus of neurologists away from hospital work and on call duty. There is a particular lack of neurologists in many rural hospitals,” as the trend continues, the need for telemedicine is only going to grow, especially in the field of Neurology, where assessing an acute stroke patient can be swiftly and completely performed via remote presence.”

If your hospital or hospital system is looking to establish a stroke center to offer the best in telestroke care, AcuteCare Telemedicine, as a practice-based provider, is the best solution. For more information, please contact ACT at info@acutecaretelemedicine.com.



The Georgia Partnership for Telehealth Spring Conference

The Georgia Partnership for TeleHealth (GPT) was founded on the advances in the continually evolving telecommunications technologies. Since its formation in 2008, GPT has grown to become one of the most robust, comprehensive telehealth networks in the nation. The hallmark of GPT is the Georgia Telemedicine Program, an Open Access Network, which is a web of statewide access points based on strategicGPT Image partnerships with successful existing Telemedicine programs, and the creation of new Telemedicine locations, to maximize opportunities for timely specialty services. When fully realized, the Program will enable all rural Georgians to access specialty care within 30 miles of their homes. GPT’s services and support can provide state of the art telehealth solutions for all Georgians.

On March 25, 2015 GPT will be sponsoring their 6th Annual Spring Conference in Savannah, GA. The conference is a great opportunity for healthcare professionals from all medical disciplines and specialties to learn how the most up-to-date telecommunications technologies are impacting the delivery of stroke care and other healthcare services. Attendees will experience telemedicine in an applied framework, build network relationships and gain exposure to the latest in telehealth hardware and software technology. The conference will include a Grant Writing Workshop and will feature presentations from foremost experts in teleneurology.

Dr. Keith A. Sanders will be presenting a talk at the conference entitled “Outcome Analysis Demonstrates the Value of Telestroke”. Dr. Sanders is Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta and former Chairman of the Ethics Resource Committee and a partner in Atlanta Neurology, P.C. and AcuteCare Telemedicine (ACT). “As medical practitioners, we are expected to apply the latest techniques and technologies to the treatment of our patients. However, it is incumbent upon us to analyze the outcomes to gauge whether there are meaningful benefits and share that knowledge with the greater medical community. Indeed, state-of-the-art telemedicine technology is advancing stroke care and saving lives,” says Dr. Sanders. “I’m looking forward to sharing my experiences improving outcomes and expanding access to quality, advanced stroke care with my fellow Conference attendees.”

The GPT Spring Conference will begin on March 25, 2015 and run through March 27, at the Hyatt Regency-Savannah at 2 West Bay Street, Savannah GA 31401. Online registration is now open. An array of exhibitor opportunities is now available. Additional information is available by contacting Samantha Haas at samantha.wainright@gatelehealth.org.



Major Advance in Chronic Stroke Treatment

For those who dedicate their professional careers to providing medical care to patients suffering from persistent and chronic disease, treatments that reduce disability and save lives do not come along often enough. And when they do come along, promising new technology and treatments all too often do not deliver on their initial promises after being subjected to critical clinical trials. But stroke experts are reporting a major advance in the treatment of chronic stroke which, after numerous clinic studies and trials, appears to be living up to the initial promises.

Stents similar to the ones used to open clogged heart arteries can now be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled. Most of the 800,000 strokes in the U.S. each year are caused by a blood clot lodged in the brain. Now an Endovascular device, a metal mesh cage called stent, can be inserted thorough a blocked blood vessel to more quickly retrieve and remove a clog. At a recent American Heart Association (AHA) International Stroke Conference in Nashville, TN doctors reported that patients treated with these brain stents were far more likely to be alive and able to live independently three months after their stroke. The treatment was so successful that three studies testing it were stopped early, so it could be offered to more patients. One study also found the death rate was cut almost in half for those given the treatment.

“This is a once-in-a-generation advance in stroke care,” said the head of one study, Dr. Jeffrey Saver, stroke chief at the University of California, Los Angeles. Early endovascular clot removal is improving stroke outcomes beyond those patients who received treatment with thrombolytics alone. “This is a real breakthrough,” agreed Patrick Lyden, MD, director of the stroke program at Cedars-Sinai in Los Angeles, “There’ve been very few people as critical as me about this procedure, but even I have to take a look at the data and say we have to believe this.”

The results shown from the three trials is a major verification of the treatments previously promised benefits. An independent expert, Dr. Lee Schwamm of Massachusetts General Hospital, called it “a real turning point in the field.” For those many patients who can be offered this treatment, “This is the difference between returning home and not returning home.”

The procedure could be offered to patients regardless of whether they’re a candidate for clot-dissolving medicine called tissue plasminogen activator (tPA), but the evidence supports the patient getting both treatments if eligible. Stroke care “needs to be completely changed” to make the treatment more widely available, said Dr. Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke. “This has taken stroke therapy to the same place that heart attack therapy is now,” he said.

Stent treatment of stroke has a narrow time window for use and is less effective for those who seek help too late. The key to surviving a stroke is recognizing the warning signs including; numbness or weakness on one side, confusion or trouble speaking, visual changes, and trouble walking, and then getting help within three to four hours after the onset of any of these symptoms.



AcuteCare Telemedicine Selected as Gator 100 Honoree

When the University Of Florida (UF) sought to recognize and celebrate the achievements of university alumni, they reached out to their Warrington College of Business Administration (WCBA) and the Center for Entrepreneurship & Innovation (CEI). The collaboration produced the Gator 100, an annual programGator100_HonoreeBadge_CMYK designed to recognize and rank the fastest growing, Gator alumni-owned or led businesses from around the world each year. Candidates are nominated from all graduates of the University of Florida. “CEI is excited to honor top Gator alumni entrepreneurs from schools and colleges across the UF campus,” said Nola Miyasaki, Director of Gator StartUps. “The Gator100 exemplifies one of CEI’s core values of contributing to a vibrant culture of entrepreneurship across our campus and the Gator Nation.”

To qualify for inclusion in the Gator 100, candidate companies must be in operation for five years or more and have verifiable revenues in excess of $100,000. A University of Florida alumnus or group of alumni must have owned 50% or more of the company; must have served as the Company’s CEO, President or Managing Partner. In addition, the alumnus must have founded the company and been active as a member of the most senior management team. “The Gator100 is an important initiative that recognizes entrepreneurial excellence,” explains Dr. Michael Morris, the Academic Director of the entrepreneurship program at UF. “It is open to any and all companies founded or run by Gator alumni, and recognizes those who are achieving growth, innovating, and making a difference in their communities.”

At the Gator 100’s inaugural event this month, Dr. James M. Kiely, a graduate of University of Florida’s College of Liberal Arts & Sciences (CLAS), accepted University recognition for his partnership in AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for stroke and AcuteCare Gator 100 Trophyemergency neurological care. Founded in 2009, ACT allows hospitals to access highly-respected expert Neurologists and Telemedicine technologies twenty four hours a day through the application of the latest telecommunication technology. ACT ranked as the 16th fastest growing Gator-led business.

Dr. Kiely is a partner in Atlanta Neurology, P.C. and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta. He is a member of the Epilepsy Foundation of Georgia and a past Chair of their Professional Advisory Board. After graduating with Honors from the University of Florida, he received a M.D. from Emory University and earned a Ph.D. from the Emory Department of Pharmacology for a thesis on nervous system control of blood pressure. He completed a Neurology residency at the University of Virginia, with fellowship training in Epilepsy and Intensive Monitoring. During this tenure, he was the recipient of national awards for epilepsy research. Dr. Kiely is Board-certified in Neurology with added qualifications in Clinical Neurophysiology. He was recently named one of America’s Top Doctors by US News and World Report.

Congratulations to AcuteCare Telemedicine on being selected to the 2015 Gator 100!



Telehealth Legislation Continues to Evolve

Things are heating up in state and federal legislatures when it comes to advancing legislation that will help accelerate the spread of telehealth across America. The American Telemedicine Association (ATA) is working with congressional representatives to move forward on what is known as, “21st Century Cures”. The ATA is recommending that Congress take immediate action to improve coverage for telehealth services under Medicare payment innovations in a number of areas from fee-for-services to Accountable Care Organizations to bundled payment programs. The House and Energy Commerce Committee recently released a draft bill that will, in part, direct the Centers for Medicare and Medicaid Services (CMS) to implement a methodology for coverage of telehealth services.

Outside of Washington and all across the country, State legislatures are making telemedicine a priority issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming have introduced legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

In the state of Florida the battle to find acceptable legislative action to help increase access to health care in their rural communities is on-going. A bipartisan group of House and Senate leaders are confident they will reach agreement this year on how to boost the use of telemedicine in their state. “It’s abundantly important that we get it done and get it done right,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said during a news conference at the state Capitol in Tallahassee. As with several other states, law makers continue to struggle to pass legislation that satisfies legislators’ and healthcare industry concerns for the safety of patients and maintain the fiduciary responsibility of state government.

Lawmakers during the past few years have filed telemedicine bills that would allow for the use of modern telecommunication technology in the delivery of healthcare but the Florida House and Senate have not been able to reach an agreement. This year legislative leaders are expressing confidence that they can resolve their differences on regulatory issues. One of the points of disagreement in Florida and other states is the issue of individual state licensing and whether out-of-state physicians should be allowed to provide telemedical care to patients in their state. The current requirement and process of requiring a physician to be licensed in each state where treatment is rendered continues to be a significant stumbling block to the unabridged expansion of the practice of telehealth across state boundaries.

If the year 2015 is to become the predicted tipping point for expanding the benefits of technology driven medical care, state legislatures in Florida, and other states around the country, will need to do more than just debate and negotiate over the future of regulations that were relevant to times past.



Sharing Experience and Knowledge on Cerebrovascular Diseases

It is even a busier time than usual for medical professionals who are focused and dedicated to fighting cardiovascular diseases and stroke. The American Heart Association (AHA) will be sponsoring The International Stroke Conference, “Connecting the World to Stroke Science,” on February 11-15 at the Music City Center in Downtown Nashville. It is the world’s largest meeting of medical professionals dedicated to the science and treatment of cerebrovascular disease and will attract more than 4,000 cerebrovascular experts from around the world including neurological specialist from AcuteCare Telemedicine (ACT). The leading practice-based provider of telemedicine services for hospitals seeking around-the-clock stroke and other urgent neurological care will be an exhibitor at this premier AHA event.

On March 25, 2015 the Georgia Partnership for Telehealth will be conducting their 6th Annual Spring Conference in Savannah, GA. The conference is a great opportunity for Primary Care Providers, specialty physicians, advanced practice nurse practitioners, Physician Assistants, Registered Nurses and medical facilities administrators to learn how the most up-to-date telecommunications technologies are impacting the delivery of stroke care and other healthcare services. Attendees will experience telemedicine in an applied framework, build network relationships and gain exposure to the latest in telehealth hardware and software technology. The conference will include a Grant Writing Workshop and will feature presentations from foremost experts in teleneurology.

Dr. Keith A. Sanders will be presenting a talk at the conference entitled “Outcome Analysis Demonstrates the Value of Telestroke”. Dr. Sanders is Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta and former Chairman of the Ethics Resource Committee and a partner in Atlanta Neurology, P.C. and AcuteCare Telemedicine (ACA). “As medical practitioners, it is incumbent upon us to not only apply the latest techniques and technologies to the treatment of our patients but to share our experiences and knowledge with the greater medical care community on how state-of-the-art telestroke technology is advancing cardiovascular care and saving lives,” says Dr. Sanders. “It is a privilege to have the opportunity to share my experiences on improving and expanding access to quality, advanced cardiovascular care to patients no matter where they live.”

The GPT Spring Conference will begin on March 25, 2015 and run through March 27, at the Hyatt Regency-Savannah at 2 West Bay Street, Savannah GA 31401. Online registration is now open. An array of exhibitor opportunities is now available. Additional information is available by contacting Samantha Haas at samantha.wainright@gatelehealth.org.




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