AcuteCare Telemedicine Blog

Philanthropy at Work

Aiming to improve the quality of healthcare delivery in a critical region of the United States, the Amerigroup Foundation, the philanthropic arm of Amerigroup Corp., is providing a $50,000 grant to improve access to care in rural areas of Georgia. The grant was presented to the Georgia Partnership for Telehealth (GPT), an organization working to provide specialized healthcare services in underserved parts of the state through the use of telemedicine.

Georgia is part of a group of states in the southeast US comprising what is known in neurology circles as the ‘Stroke Belt,’ or ‘Stroke Alley,’ named for citizens’ propensity toward higher risk and morbidity of stroke due to several lifestyle factors. One such factor for elevated risk is larger ‘desert’ areas where rural residents do not live within an acceptable distance of a facility where they can receive proper treatment in cases of stroke. Funding programs such as this most recent grant by the Amerigroup Foundation can mean tremendous strides toward building the awareness and infrastructure needed to correct these less-than-ideal conditions, including instating telemedicine programs to eliminate the obstacle of distance between patient and doctor.

Teleneurology brings technology and expertise that are incredibly powerful tools in the fight against stroke. With time so precious, telemedicine programs are saving the lives of rural dwellers who previously had extremely limited options. The partners of AcuteCare Telemedicine are pleased to see the patronage of organizations concerned with creating better, more accessible care being put to good use.


Ahead of the Curve

A recent PricewaterhouseCoopers Health Research Institute report suggested that medical costs are growing at a historically flat rate. The rate of growth is not only of interest to hospital facilities; it is also an extremely important factor in how commercial insurers and large employers set health insurance premiums, determining the changing cost of a health plan from year to year.

The report pointed to several factors combating rising cost trends; thanks to market pressure from a shifting public perception of the healthcare industry, medical supply and equipment costs are coming down and states are working towards greater transparency in disclosing true healthcare costs. A changing patent environment is leading to increased use of generic drugs over more costly name brands.

Perhaps the most influential change affecting the trends is the arrival of innovative new forms of care delivery. Although one helpful trend of reducing financial strain on hospitals by keeping non-emergency patients out of ERs can be accredited to the emerging market of retail clinics, telemedicine is truly the driving force of a broader revolution in the way patients interface with physicians. Whether physicians elect to conduct routine checkups through remote presence technologies or are able to diagnose and administer treatment in emergency cases, the benefit to not only the patient, but also to the healthcare ecosystem is immense.

Thanks to our desire to see the quality of healthcare increase and the system’s strain on the economy and environment decrease, the news that telemedicine is contributing to reducing the rate at which costs are rising is more than welcome to AcuteCare Telemedicine. Our dedication to combating these costs for both our client hospitals and our patients places us ahead of the curve.

Healthcare Reform and the Impact on Telemedicine

The recent announcement of the Supreme Court’s 5-4 ruling in favor of upholding the Patient Protection and Affordable Care Act (PPACA) has prompted widespread speculation among citizens of the US about the future of healthcare.  Notwithstanding the politics associated with the decision, the ruling carries significant impact for citizens in terms of access to preventive care and insurance coverage.

Telemedicine providers are heavily impacted by the ruling as well. The American Telemedicine Association (ATA) believes that it will positively impact the development of telemedicine, mHealth, and other remote technologies, citing 4 main reasons; the announcement reduces hesitation to invest in telemedicine technologies, protects existing investments in telemedicine, bolster’s telemedicine’s role in many healthcare programs, and strengthens telemedicine’s fundamental value proposition.

As healthcare enters its next era, telemedicine offers a model for streamlining care coordination and improving patient outcomes. In the period of time between healthcare reform being codified into law and the Supreme Court ruling to uphold it, there had been a great deal of uncertainty surrounding the healthcare industry implementing major changes in practice, as it would cause complications should the law be overturned, but the affirmation clears up many of the primary legal and cost concerns, opening the door for telemedicine to address logistical and financial pain points for both providers and patients.

Ultimately, telemedicine fits snugly into the PPACA. For ACO’s needing to include services unavailable in their area, a remote presence physician will be drastically most cost-effective than hiring a full time local MD. Telemedicine also helps alleviate costs for underinsured or completely uninsured patients as well as alleviating strain on the healthcare system caused by unnecessary emergency visits through improvements in preventive care. The court’s decision, while sparking some controversy on other fronts, is the latest step forward in the rapid evolution of telemedicine as a powerful solution for a multitude of healthcare issues facing Americans.

The Personal Side of Acute Stroke Intervention

Mr. Rigby was found unresponsive, gazing to the right and unable to move his left side. Just moments ago, his nurse had seen the 91 year old awake in his hospital bed preparing himself for discharge from the hospital. Though the hospital lacked a neurologist, it had invested in telemedicine services. Immediate assessment of his acute neurological deficits would determine whether treatment with tissue plasminogen activator (tPA), a clot-busting medication, or even thrombectomy (direct mechanical extraction of the clot) was appropriate. If performed within a very short time window, tPA or thrombectomy would open arteries and prevent progressive death of brain cells. However, it could also lead to hemorrhage, bleeding into the brain that could be devastating and even life-threatening. Thus, the teleneurologist was charged with not simply recognizing Mr. Rigby’s stroke symptoms, but also those factors which make the risk greater than the benefit.

As the AcuteCare Telemedicine physician on call, I was at the bedside within minutes via remote presence technology. The evidence; left hemiparesis, left visual field loss and inability to speak, made it clear; Mr. Rigby had sustained a large right hemisphere stroke. A large artery, the MCA, was blocked by clot. His nurse knew the exact time of symptom onset. Without treatment he may have survived, but it was likely he would not walk or talk. He met every inclusion criteria for tPA. Unfortunately, Mr. Rigby was not a good candidate. He had undergone a surgical procedure just the day before, his anticoagulation had been restarted that day and his platelets were very low. At the age of 91 years with these risk factors, the likelihood of serious hemorrhage was too great. As I informed the family members that had filled the hospital hallways, a look of desperation filled their eyes. His daughter stated, “This man is worth-saving.” Remembering my Hippocratic Oath, my immediate response in this case was, “I am certain he’s worth saving, but nobody is worth harming.”

Then I remembered this “case” was her father. I asked her to tell me more about Mr. Rigby. A picture of a family patriarch emerged. He was still vigorous, taking walks daily. He was driving. Indeed, he still routinely played 9 holes of golf. But what she told me next illustrated the shortcoming of using population-based inclusion and exclusion criteria as the sole determinant of risk-benefit for an individual. Mr. Rigby was the caretaker of his 89 year old disabled and blind wife. Without the ability to walk and speak not only Mr. Rigby would suffer. I made an immediate call to the Marcus Stroke Center at Grady Memorial Hospital in Atlanta. The Marcus Center stroke physician agreed the criteria for invasive intervention suggested a high risk, but Mr. Rigby would be given a chance because the potential for benefit was irrefutable. Within a few hours the clot was extracted. Mr. Rigby had an opened artery with full reperfusion. His symptoms improved with only residual left arm weakness. Though speaking slowly, his good humor was immediately apparent. A family had their patriarch back.

Patients Extremely Pleased with Telemedicine

Four months after launching a telemedicine pilot program in conjunction with technology provider Cisco Systems, St. Joseph Health System, a 14 facility hospital network in California, New Mexico, and Texas, has released a patient satisfaction survey that effectively outlines the advantages of telemedicine for patients.

Spokespeople for the partnership have reported that 95% of the patients seen using telemedicine technologies in the program claimed they were “completely satisfied” with their experience. Furthermore, 99% said they would use telehealth services again. Although just one case study, these numbers are a solid case study of the telemedicine patient experience.

So why is consultation via telemedicine technologies so popular with patients? Here are some of the most prominent pluses from the patient’s perspective:

-Telemedicine eliminates travel. Patients are able to connect with physicians from the comfort of their own home, or a facility closer to their home than the physician’s location. This helps both patient and physician avoid unnecessary travel, saving time and effort.

-Telemedicine permits a more flexible schedule. Whether for a simple checkup, continuous patient monitoring, or an emergency situation, scheduling a consultation becomes more flexible when a physician is instantly available. Frustrating long waiting room times are nonexistent in cyberspace.

-Telemedicine simplifies consultation without sacrificing quality. Close evaluation typically shows few or no medical disadvantages to patient consultation via telemedicine technology in most disciplines. Patients feel more relaxed in their own environment.

As practitioners, it is important to view the experience of telemedicine from the patient’s viewpoint. Fortunately, it is becoming clear that patients are on board with this revolutionary technology, facilitating better patient care across geographical borders.


AcuteCare Telemedicine Partners Earn Atlanta Magazine ‘Top Docs’ Honors

AcuteCare Telemedicine (ACT) partners James Kiely, MD, PhD, and Matthews Gwynn, MD were included in the 2012 edition of Atlanta Magazine’s annual ‘Top Docs’ list. The feature story of the magazine’s July issue highlights the best physicians in Atlanta, as voted upon by the doctors themselves. The list was compiled by Castle Connolly Medical Ltd., a New York-based healthcare research and information company.

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 also a member of the Epilepsy Foundation of Georgia and a past Chair of their Professional Advisory Board. Dr. Kiely is Board-certified in Neurology with added qualifications in Clinical Neurophysiology. He was also recently named one of ‘America’s Top Doctors’ by US News and World Report.

Dr. Gwynn is Founder and Director of the Stroke Center of Northside Hospital and recent Chairman of the Department of Internal Medicine. He is also a partner in Atlanta Neurology, P.C.; Co-Medical Director of Neurotrials Research, Inc.; the Chief of Neurology at St. Joseph’s Hospital of Atlanta; and served as the president of the Medical Association of Atlanta 2010-2011. Dr. Gwynn is Board-certified in Internal Medicine and Neurology and like Dr. Kiely, has also been named one of ‘America’s Top Doctors’ by US News and World Report.

“We are constantly working to deliver our client hospitals and our patients the highest standard of care and service possible at ACT as well as in our practice at Atlanta Neurology, P.C.,” commented Dr. Kiely. “Dr. Gwynn and I are thoroughly honored to have been recognized by our peers. We will continue to strive for excellence as ACT further extends its reach in 2012 and beyond.”

The July issue of Atlanta Magazine is currently available in print and digital formats. For more information about ACT, visit


About AcuteCare Telemedicine

Founded in 2009, AcuteCare Telemedicine is a limited liability corporation advancing the opportunity for healthcare institutions to gain access to highly-respected, expert neurologists and telemedicine technologies. AcuteCare offers a range of services including first-rate neurological emergency response care with around-the-clock support and hospital accreditation education. AcuteCare primarily provides remote emergency neurology consultation which fills staffing needs and reduces the costs associated with 24/7 neurologist availability. As a result, healthcare institutions provide full service emergency neurology care and can earn Joint Commission Certification as a Primary Stroke Center.