AcuteCare Telemedicine Blog

AcuteCare Telemedicine Adds Dr. Richard David Franco to Board of Advisors

AcuteCare Telemedicine (ACT) announces the addition of Dr. Richard David Franco to its advisory board. Dr. Franco is a partner emeritus of Atlanta Neurology,  and has worked closely with the physicians of ACT. Board certified in Internal Medicine and Neurology, Dr. Franco also serves as Clinical Professor of Neurology at Emory University. With more than 35 years in practice, Dr. Franco is one of the city’s most sought-after doctors.

Dr. Franco’s recognition of the value of technology in neurological care is of immense value to ACT. His early advocacy for technology led to the acquisition of Georgia’s first CT scanner in 1975. Throughout his extensive career of hospital and faculty appointments, he has remained on medicine’s cutting edge, understanding that innovation is a significant force behind the improvement of patient care.

His knowledge and approach share commonality with the philosophy and mission of ACT. “Dr. Franco has long been a trusted colleague and close friend of the partners of ACT,” remarks Dr. Lisa Johnston, Partner, ACT. “His expertise and passion for improving the quality of care we deliver as physicians will keep the direction of our business aligned with our values of authenticity, accountability, and integrity.

Dr. Franco has served on the Board of Trustees for MedShare International, a nonprofit dedicated to improving healthcare through the recovery and redistribution of surplus medical supplies to those in need, making him a capable veteran in his new role with ACT. “ACT is determined to extend our reach in 2012, and Dr. Franco’s guidance will ensure that our standards are maintained as we grow our business,” says Dr. Matthews Gwynn, Partner, ACT. “We are fortunate to be able to consult with someone as experienced and dedicated as Dr. Franco along the way.”

Looking Backwards to See Ahead – Part 1: Strategic Planning

The New Year is a natural time to reflect on what has been learned during the previous year. For AcuteCare Telemedicine (ACT) specifically, notice of the upcoming 2012 ATA meeting in San Jose prompts recall of last year’s meeting in Tampa, Florida, where we were exposed to facts, opinions, and new experiences that informed our actions in 2011. Over the coming months, lessons and insights gained from the 2011 ATA meeting will be discussed, grouped into related areas including accountability, relationships, sustainability, technology, coding, advertising and competition.

ACT marked a year of significant growth in 2011. However, with that growth came expected growing pains. In hindsight, ACT realizes that our strategic planning must be reactive and adaptive in order to achieve continued success in 2012.

While the annual ATA meeting offered courses on developing telemedicine “programs,” it was clearly aimed at members of universities and government agencies as opposed to “business development” within the private sector. As an autonomous entity, ACT has the distinct competitive advantage of not needing institutional support to succeed. ACT is not burdened by the bureaucratic infrastructure of academic and government institutions whose healthcare vision we nonetheless share. In turn, this advantage is responsible in part for the 300% growth ACT has enjoyed over the past year.

However, the aforementioned institutions do have their own advantages; for example, access to highly trained interventionists in academic centers and monetary support in the form of grants in government agencies. As such, the highest yield strategy moving forward will likely be a partnership among these groups. Already ACT works closely with Emory University-affiliated interventionists at the Marcus Stroke Center at Grady Hospital in Atlanta, GA. ACT is also a provider for the Georgia Partnership for Telehealth. ACT understands telemedicine and its application in the “real world.” Telemedicine is integral to improving access to healthcare and reducing its costs. Thus, the model ACT developed at its inception stands to serve it well in the foreseeable future.

Certified Life Saving

For the last several years, the Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission) has monitored hospitals’ specific performance measures in treatment of common diseases. In 2011, stroke care joined pneumonia, heart failure, and heart attack on the list of monitored core diseases. Hospitals must demonstrate to the Joint Commission, and to the public, that they are providing good emergency stroke care in order to receive certification as a Primary Stroke Center. For instances of stroke, the Joint Commission monitors if hospitals are administering tPA (the clot busting medication) to eligible stroke patients.

Despite this focus on a high standard of care, large areas of the country lack hospitals who have administered tPA to stroke patients.  Alabama, for example, has only 3 hospitals certified as stroke centers. A lack of certified stroke centers has been shown to correlate with the rate of death from stroke. A primary factor in the failure to meet established standards is the limited number of neurologists available for emergency stroke intervention. The expanded use of telemedicine is a practical solution. Rapid evaluation by a stroke specialist via the internet enables the use of tPA in otherwise underserved areas, leading to better care and outcomes.

Rapid access to quality emergency care underlies the public’s confidence in our healthcare system. With limited numbers of neurologists and vast numbers of needy hospitals, telemedicine makes sense for stroke care.

Lewis Massey Joins AcuteCare Telemedicine Board of Advisors

AcuteCare Telemedicine (ACT) announces the addition of Lewis A. Massey as a member for the ACT Board of Advisors. Massey’s experience as a lawyer and as an executive with growth stage companies lends is invaluable to the partners at ACT and the business.

Massey, a native of Gainesville, GA, is presently a partner in Massey, Bowers & Hembree LLC, a firm specializing in public affairs counsel. He has held a number of prolific positions, including serving as CEO of Directo, Inc., a financial services management company, President and CEO of SciTrek, a science and technology center for children, Vice President of Bank South Securities, and Chief of Staff for Georgia Lt. Governor Pierre Howard.

Most notably, Massey was appointed by Georgia Governor Zell Miller as Secretary of State in 1996. During his two year tenure in this position, Massey established a strong record as an advocate for Georgia citizens, cracking down on telemarketing fraud, reducing agency spending, assisting with the collection of back child support, and implementing new customer service technologies. He did not run for reelection in 1998.

Massey has served on the Board of Directors of both the Georgia Special Olympics and Prevent Child Abuse Georgia. He currently serves on the Board of Hands on Georgia, appointed by Governor Sonny Perdue in 2005.

He has been named University of Georgia Business School Outstanding Young Alumnus, and cited as one of the 100 Most Influential Georgians by Georgia Trend Magazine.

“Mr. Massey brings an immense wealth of unique knowledge earned throughout his impressive career and his track record includes significant contribution as a key advisor to other strong initiatives,” says Keith Sanders, M.D., Partner, ACT. “The breadth of his experience will be essential to AcuteCare Telemedicine as we work towards our goals in 2012 and beyond.”

Healthcare, Anywhere

For rapid access to information from anywhere at anytime, nothing beats a smartphone or other mobile device. The widespread use of these devices sets the stage for rapid growth in mobile health (mHealth) applications to improve patient care.  In 2011, smartphones accounted for more than half of all phone sales in the United States, and there are now over 12,000 health-related apps on the iTunes store alone. There is immense theoretical value, but how is mHealth being used by patients and physicians in the real world?

The first generation apps available now provide rapid access to information previously available from far more specific resources. Common conditions like hypertension, diabetes and headache have apps that allow patients to conveniently collect and trend data about their condition. iHeadache and Seizure Log allow patients to look for triggers to these events; Seizure Log can even embed videos of events. Neuro Toolkit provides key protocols and scales that neurologists use routinely in the hospital, frequently saving them a trip to the library or internet. Practical mHealth apps do not necessarily need to be brilliant to be helpful. The value is in the unparalleled level of accessibility that they offer.

In her speech at the annual mHealth summit in December, Health and Human Services Secretary Kathleen Sebelius described mHealth as “opening up new lines of communications between patients and their doctors, among health care providers trying to stay on the same page and even among communities of patients.”  She mentioned iTriage, an app that helps patients document their symptoms and find a nearby emergency room.

Of course, apps that aid patients and doctors alike are a very positive force in healthcare, but must continue to be improved. iTriage, for example, would benefit by including which hospitals are certified for acute stroke and heart attack treatment by the Joint Commission. If a patient does need emergency treatment for one of these or other conditions, the chance of getting the fastest and most complete care are increased at the most capable facility.

The next generation of apps will move beyond data collection and collation.  Smartphone trends for 2012 include larger screens, faster processing and more apps, all of which bode well for more robust medical applications. With the advances, mHealth is likely to continue to revolutionize access for patients and physicians.

Telemedicine: Modern Breakthrough or Timeless Concept?

Telemedicine is the practice of medicine at a distance; interaction that occurs remotely with the physician removed from direct contact with either the patient or other physicians. Telemedicine can include all phases of the physician-patient relationship, from evaluation (including pathology) to diagnosis and treatment. Although  recent breakthroughs in telecommunications technologies have accelerated the advancement of telemedicine, the desire to seek medical counsel regardless of the proximity of the healthcare provider is a common thread throughout medical history. The mechanism has changed, but medicine has long worked to remove the barriers of distance and time.

As early as the Middle Ages, “telepathology” was employed in the form of sending urine samples over distance to physicians for analysis. Prescriptions were carried over miles to patients before the advent of postal services. With the postal service came written letters describing symptoms to physicians, who would reply with diagnoses and treatment plans. These are all examples distinctly foreshadowing the emails and blog centered care that is now gaining a foothold.

Eventually, a milestone was reached when the telegraph allowed transmission of x-ray images. By the late 1800’s, telephony allowed direct 2-way communication between physicians. Still, a physical connection was required, and physicians at sea or without telephone access were at a loss. The radio broke that barrier by the 1920’s, and by the middle of the century, television technology brought real time images into the equation.

Near the end of the last century the most rapid, indeed explosive, growth of telemedicine utilization resulted from the symbiosis of computer technology, wireless communication networks and the internet. The ease of access to telemedicine that modern communication technology provides has broadened the scope of services. “Telehealth,” the utilization of remote presence to monitor health conditions, rather than responding to acute emergencies, is essentially commonplace. Moreover, well-care and health education have benefitted as well.

Today, we do not think twice about calling patients or colleagues on a phone, logging onto a computer for laboratory results, or reviewing radiology images on a TV screen. Soon, electronic health records (EHR’s) will be the norm. There are even technologies on the horizon which will become a partner with the doctor in establishing a diagnosis. The question for our future is when does new remote presence technology become standard of care? Inevitably, we will lose the “tele” and acknowledge that we are completely free of distance as an obstacle to patient care.

Giant Steps

This is a photo of the first MRI scanner in the world. It is presently on display as an artifact at the London Science Museum in the Wellcome History of Medicine exhibit, but the scanner only dates back to 1971. The first images it produced were extremely coarse and only showed rough shadows of what the brain really looked like. It is incredible to think that just 40 years later, we are able to see the brain and other organs as substantially clearer three-dimensional images. With the immensely improved technology, we can even see the circulation of blood in the brain and its metabolic activity as it is being used. There are other fascinating exhibits at the museum, including devices used in attempts to ameliorate the human condition dating from long before the MRI scanner came about.

Besides the usual trephining tools used to burr holes in the skull and buckets to catch the blood from ‘therapeutic’ lobotomies, there is this; an early 19th century EMG machine used to measure nerve conductions in diagnosis of peripheral nervous system disorders:

It seems that one would place a limb at the bottom of this arc and the weights would be dropped onto them, causing a reflex which was recorded by the machine. The time and distance of the nerve impulse was measured giving the speed at which the impulse moved down a nerve.  It sounds painful, but compared to the advances of the MRI scan, the nerve conduction studies we do today are relatively similar to what this machine did.

With the advent of the Internet and the rise of telemedicine, our skills as physicians are undergoing another paradigm shift. The magnitude of the change brought on by telemedicine technologies is closer to that of the leaps made by the MRI scan than those of the EMG. For the first time, physicians can see patients in real-time from hundreds of miles away, markedly increasing the efficiency and productivity of our field. Perhaps one day, this same exhibit will include one of our current devices, denoted as an “early robot,” and serve as a curiosity to the lines of people that pass by. Whatever the result, we will probably always look back on the strides we are making today and the people behind them as the next great pioneers in the history of medicine.