AcuteCare Telemedicine Blog

What Can the Third World Teach Us About Telemedicine?

Telemedicine and mHealth solutions represent the most recent advances in medical history. As futuristic as a patient consulting a doctor from across the world via communications technology may seem, telemedicine is founded in addressing some fundamental challenges that are not unique to the 21st century.

Citizens of developing nations are a glance into the past of the modern world. Limited resources leave these countries facing 3 primary obstacles to proper care that telemedicine is working to overcome:

Lack of doctors: Lower education standards lead to fewer total doctors, leaving some large geographical areas with few or no doctors.

Lack of access: Citizens cannot get to doctors due to their sickness or difficulties with limited transportation options.

Lack of money:  Most citizens simply cannot afford to pay for healthcare.

Compare these points with realities for many Americans:

Lack of doctors: Currently, there are an estimated 954,000 total doctors in the U.S., and that number is projected to constitute a shortage of as many as 150,000 in 15 years. Certain specializations are particularly poorly represented; for example, there is currently roughly one geriatrician for every 2,620 Americans 75 or older, and is only getting worse as senior citizen numbers rise. This ratio could drop to as few as one geriatrician per 3,798 seniors by 2030.

Lack of access: The continental U.S. features many large rural regions, leaving hundreds of millions of citizens at a significant distance from an adequate acute care hospital.  Many people, particularly older citizens, require frequent visits to multiple doctors due to co-morbidity of diabetes, hypertension, and cardiovascular diseases. Transporting elderly or infirmed individuals to a physician is becoming increasingly demanding, with rising fuel costs. In addition, specialist doctor visits can often require weeks or months of wait time for schedule availability.

Lack of money: While average income is much higher in the U.S. than in developing nations, rising healthcare costs mean Americans spend a greater percentage of their earnings on healthcare, with healthcare expenditure constituting as much as 15% of GDP. This number is also expected to rise unless dramatic policy changes or significant shifts in healthcare protocol occur.

In reality, the challenges facing healthcare are unchanging. Unlike in the past, modern technology is now paving a path for healthcare providers to tackle the task of overcoming these obstacles. Best of all, as technology moves forward, the same telemedicine solutions that can solve problems in developed countries like the U.S. can eventually be extended to aid citizens of underdeveloped nations. Telemedicine is building a healthier, more connected world.


Christine Hale, M.D. Joins Acutecare Telemedicine Advisory Board

AcuteCare Telemedicine (ACT) announces the addition of Christine Hale, M.D. as a member of the ACT Board of Advisors. The partners of ACT believe Hale’s expertise and passion for improving healthcare delivery will aid the company in effectively extending the highest level of care to its client hospitals.

Hale’s impressive medical background includes receiving her M.D. from Johns Hopkins and completing her residency in Pediatrics at Duke University Medical Center. While at Duke, she also completed an M.B.A. with a concentration on Health Sector Management at the University’s Fuqua School of Business, giving her a unique skillset in approaching hospital operational issues with a medical perspective.

Presently working with McKinsey and Company in Atlanta, GA, Hale serves hospitals and hospital systems on a variety of organizational issues with an emphasis on strategic planning. She is a resource for numerous consultant teams interested in bettering healthcare delivery across the Southeast.

“Dr. Hale shares in ACT’s zeal and commitment to helping hospital facilities deliver higher quality care to patients in the most economically and operationally efficient means,” says James Kiely, M.D., Ph.D., Partner, ACT. “We are extremely pleased to have access to Dr. Hale’s knowledge and experience as a trusted, go-to resource in measuring our approach to providing the best possible services to client hospitals.”

US Government Stands Behind Telemedicine

The USDA has announced its renewed support for the development of telemedicine programs in rural areas. The latest round of funding is part of the agency’s Distance Learning and Telemedicine Loan and Grant Program (DLT), designed specifically to “meet the educational and health care needs of rural America.” Through loans, grants and loan/grant combinations, advanced telecommunications technologies such as those utilized in the practice of telemedicine provide enhanced learning and health care opportunities for rural residents.

The agency has long stood behind telehealth initiatives, touting the abilities of telemedicine to increase citizen access to quality healthcare while simultaneously opening lines of communication to enhance educational for hospitals and schools in underserved areas. Practitioners in the field of telemedicine share in the ideology that where a patient chooses to live should not affect the quality of care they can access.

The upgraded equipment and professional development that will result from the grants will help extend telemedicine services to a larger network of rural dwellers. As telemedicine networks grow, the benefits will continue to grow, both in terms of both improved patient outcomes and reduced healthcare costs.


Two Steps Forward, Two Steps Back

Sometimes, moving healthcare forward is achieved simply by looking back. The following article illustrates the latest example of the type of discoveries that fuel the constant evolution of medicine. Modern techniques, such as those utilized in telemedicine practices, often rely on the latest technical and innovative advances, but stepping back and evaluating standard procedures is a crucial step in ensuring the highest possible standards of care. As in the case of the findings featured here, discarding methods once thought to be best practices can improve both patient outcomes and cost-efficiency.

No Benefit to Patent Foramen Ovale (PFO) Closure in Ischemic Stroke or TIA

S. Andrew Josephson 

M.D., Department of Neurology, University of California San Francisco, San Francisco, USA

 Between 25% and 40% of ischemic strokes have no clear cause despite extensive investigation. These “cryptogenic” strokes may in some instances be due to an embolus traveling through a right-to-left shunt in the heart. A patent foramen ovale (PFO) is present in nearly one-quarter of patients in autopsy studies and is even more prevalent in young patients with cryptogenic stroke. Whether these PFOs should be treated with medical therapy or closure remains a point of much debate; Furlan and colleagues (2012) examined the benefit of a percutaneous closure device for preventing further cerebrovascular events in patients with cryptogenic stroke and transient ischemic attack (TIA).

The authors enrolled patients between the ages of 18 and 60 who had experienced a cryptogenic stroke or TIA within the previous 6 months and who were found to have a PFO documented by transesophageal echocardiography (TEE) with bubble study. These patients were randomly assigned either to percutaneous closure with the STARFlex device plus antiplatelet therapy or to medical therapy alone. Those assigned to closure were treated with clopidogrel for 6 months and aspirin for 2 years, whereas those assigned to medical therapy were treated with warfarin, aspirin, or both at the discretion of the site investigator. The primary outcome examined was a composite 2-year rate of stroke or TIA, death from any cause in the first 30 days, or death from a neurologic cause from 31 days to 2 years.

The authors enrolled 909 patients in the trial, and there were no significant differences in the baseline characteristics of the two groups. At 6 months, effective closure was confirmed by TEE in 86% of the closure group. The primary endpoint was reached in 5.5% of the closure group and 6.8% of the medical group (hazard ratio, 0.78; 95% confidence interval, 0.45–1.35; p = .37). There were no significant differences in stroke or TIA rates between the two groups, although the latter TIA endpoint (a “softer” endpoint, subject to patient reporting) was numerically higher in the medical therapy group. There were no differences in adverse events between the two groups. Atrial fibrillation more frequently developed in the closure group compared with the medical group (5.7% vs 0.7%; p < .001). A variety of subgroups were examined, including sex, the presence of an atrial septal aneurysm, shunt size, entry event (stroke vs TIA), and baseline medication; none was found to significantly favor percutaneous closure.

This well-done negative trial definitively demonstrates no benefit to PFO closure in patients with cryptogenic stroke and argues strongly that these patients should either be treated with medical therapy or be invited to participate in ongoing randomized trials of different devices. The slow recruitment in this trial, which began enrolling in 2003, was likely due in part to the fact that the device was available for use outside of the trial and many patients and their physicians chose to close PFOs rather than enrolling in the study. One limitation of this study may therefore have been a bias toward patients with characteristics thought by their physicians to warrant randomization, perhaps those at perceived at lower risk for stroke. Ideally, the definitive results of this trial will mean that percutaneous PFO closure no longer is practiced outside of these trials.

– Josephson, SA. No Benefit to Patent Foramen Ovale (PFO) Closure in Ischemic Stroke or TIA. Harrison’s Online, April 23, 2012.

Related to Chapter 370 Cerebrovascular Diseases in Harrison’s Principles of Internal Medicine, 18thedition, Dan L. Longo, Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Stephen L. Hauser, Joseph Loscalzo, Eds. McGraw-Hill, New York, 2012.


Furlan AJ et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 2012;366:991.

Understanding that even the most accepted methods of diagnosis and treatment are subject to scrutiny is a key tenet of the relentless pursuit of a better standard of care. The partners of AcuteCare Telemedicine agree with Dr. Furlan’s recommendation that device closure of PFOs should now be limited to patients enrolled in one of the ongoing trials.

Acutecare Telemedicine CEO Featured Speaker For American Heart Association’s Stroke Webinar Series

Dr. Matthews Gwynn, CEO of AcuteCare Telemedicine (ACT), appeared as the featured speaker for a webinar series produced by the southeast affiliate of the American Heart Association. The presentation, entitled “Extending Stroke Care through Telemedicine,” was delivered to several hundred hospital administrators and medical staff throughout the southeast and other areas of the U.S.

Dr. Gwynn’s webinar presentation, hosted by Mary Robicheaux, Vice-President of Quality Improvement for the American Heart Association southeast affiliate, focused on the advancement of teleneurology in the treatment of acute stroke patients. Dr. Gwynn discussed the positive effects that teleneurology continues to have on advancing stroke treatment, such as the increased use of the clot-disolving medication tPA (tissue plasminogen activator), as well more advanced neuro-interventional procedures known as thrombectomies, performed by neuro-interventionalists at such world-class facilities like Grady Hospital’s Marcus Stroke and Neuroscience Center in Atlanta, GA.

“Advanced treatments for acute stroke cases are becoming more and more prevalent with the advent of greater technology and treatment procedures,” stated Dr. Gwynn.  “The medical community observed this within the cardiology field over the past couple of decades, and now we are starting to see similar advancements in stroke care via neurocritical care and interventional neuroradiology.

In a continued effort to expand teleneurology in the southeast, Dr. Gwynn and the other neurologists of ACT serve as critical evaluators at partner hospitals of stroke cases that may require advanced interventions such as those discussed in the webinar.

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Helping Healthcare Go Green

Telemedicine has leveraged technology to help hospitals overcome challenges associated with staffing and transportation extend higher quality healthcare to patients, regardless of their location, while simultaneously reducing costs. Now, we are beginning to understand that telemedicine not only helps hospital facilities run leaner; it may also help them be greener.

Hospital facilities are traditionally located in areas of higher population, often far away from patients living in rural communities. The transfer of these remote patients to hospitals for inpatient treatment demands relatively high energy consumption. With a foreseeable increase in numbers of patients requiring care in the future, these costs can be expected to rise if left unaddressed.

Within the context of changing environmental policy, increased focus must be placed on reducing emissions and energy usage in healthcare policy. Telemedicine has demonstrated positive effects, creating a more environmentally sustainable process by improving inpatient treatment in local community hospitals and improving monitoring of complex diseases in outpatient settings, avoiding unnecessary hospital admissions.

Physicians have traditionally placed a priority patient care over any environmental responsibility, but telemedicine offers opportunities to minimize environmental impact while developing a higher standard of care across the country. By combating energy consumption, telemedicine is improving not only the health of patients, but also the planet.

Affordable Healthcare, On the Go

With the continually rising costs associated with healthcare in the U.S., two new reports suggest the market for telemedicine is poised to grow more than threefold within the next decade thanks to advances in wireless technologies in medical applications.

Mobile technology has paved the way for devices and infrastructure that are capable of mitigating healthcare costs by billions of dollars annually by reducing unnecessary hospitalizations and improving diagnostic and treatment efficiency. These telehealth solutions, many centered around wireless communications technologies, also help improve overall quality and timeliness of care administered, removing the traditional boundaries of distance and time in bringing patients and their doctors together over the web. Telemedicine ensures that patients receive the right care in the right setting to streamline the consultation process and fight excessive costs.

Telehealth has for some time now been proven as an effective means of delivering quality care, particularly to patients in underserved rural areas. Looking towards the future, practitioners are constantly gaining access to more powerful tools and increased mobility, reason to believe that telemedicine will extend more effective, more affordable healthcare to patients everywhere.

Already mobile technologies are steadily revolutionizing healthcare in a multitude of ways. In addition to patient consultation via communications platforms, the latest applications available to practitioners on smartphones, tablets, laptops, and other wireless devices can also help manage patient records, and encourage collaboration with other expert physicians.

Trends towards better technology and increased access to mobile platforms are fueling the rapid growth of telemedicine, which ultimately benefits both patients and providers. Just as mobile phones have given people the power to stay connected without the traditional landline, telemedicine is helping patients everywhere keep in touch with the quality care they deserve.