AcuteCare Telemedicine Blog

Privacy Issues Come to Light

Last month, the Veterans E-Health and Telemedicine Support (VETS) Act was introduced to Congress. The bill would “allow health professionals at the Department of Veterans Affairs (VA), as well as outside VA contractors, to practice telemedicine across state borders if they are qualified and practice within the scope of their authorized federal duties.” Unsurprisingly, the bill is casting a new light on issues of privacy and security in the growing telemedicine field.

Currently, different states have their own regulations around privacy rules that range from less to more severe than federal HIPAA laws. The VETS act has raised the question of what rules, state or federal, would apply in cases of doctor and patient being in different states and consulting via telemedicine.

Outside of the discussion on Capitol Hill, organizations like the American Telemedicine Association (ATA) have been working to override laws in those states inhibiting the growth of telemedicine across state lines. Most cases of doctors attempting to provide telemedicine services to other states serve to fill a need in areas where specialists like radiologists or neurologists are in short supply. Limiting the reach of these practitioners is manifestly detrimental to healthcare access. Doctors currently must obtain licensure in other states in order to provide telemedicine care to patients who reside outside their own state. The ATA approximates that only 20-25 percent of U.S. doctors have licenses in more than one state – national medical licensing is one proposed solution that would also cover the complications of the VETS bill.

Regardless of whether these issues of state vs. federal regulation are addressed sooner or later, more legal questions about the privacy of data in the practice of telemedicine are inevitably becoming part of the conversation. Everyone, not just regulators, but also practicing physicians and their patients must educate themselves about the potential for rubbing up against HIPAA as eHealth services continue to grow in popularity.

Healthcare in the Cloud

Cloud computing is a rapidly emerging trend, and for good reason. Storing data in the cloud (on an offsite data server location that can be accessed from anywhere via the web, as opposed to a personal computer or local server) has many advantages: it is cost effective, free of initial investment in and maintenance of hardware, convenient, and most importantly, flexible and easily accessible. Unfortunately, cloud computing is not too good to be true; there are also significant concerns, mostly related to issues of security and stability.

As technology and knowledge advance, doubts about moving towards a cloud-based system of storing healthcare related information, including electronic health records (EHRs) are being relieved, and adoption is speeding up.

According to a MarketsandMarkets report entitled “Healthcare Cloud Computing Market – Global Trends, Challenges, Opportunities & Forecasts,” the global healthcare cloud computing market is now projected to increase to a value of $5.4 billion by in the next five years. The report notes that the market is already using not only these kinds of cloud-based technologies, but other modern telemedicine techniques to find new solutions to problems that have troubled healthcare administrators for generations. The report’s authors estimate that the adoption cloud technology in the healthcare industry, measured in dollars, will grow at a compounded rate of as much as 20 percent or more in the coming decade.

This estimated growth can be attributed to increasing pressure on healthcare organizations (HCOs) to achieve more while simultaneously reducing costs. According to the report, many HCOs that have not yet turned to cloud computing do plan on converting to the new technology within five years. As healthcare moves toward the cloud, investment and innovation will undoubtedly continue to make dramatic impact on the industry as it strives to improve the quality of our nation’s healthcare.

Big Med Goes Back To School

In his most recent article in The New Yorker, contributor Dr. Atul Gawande demonstrates the value of quality-focused innovation in providing excellent service. Dr. Gawande nods to the Cheesecake Factory’s success in nimbly updating its large and varied menu as a potential model for healthcare innovation. Initially, he takes Big Med (as he calls organized American medicine) to task because, in his words, “good ideas still take an appallingly long time to trickle down,” but in the latter half of the article he provides examples of how the industry is getting things right.

Gawande’s own mother’s knee replacement surgery serves as his first example; by utilizing standardized protocols and equipment, his mother and her hospital achieved top results at a low cost. He then points to an innovative new way of managing patient data in real time that is serving to improve care: In Tele-ICU, nurses and doctors collect patient care data remotely from ICU patients and give direct feedback to the caregivers at the bedside. Using standardized treatment plans, Tele-ICU actually improves the quality of care while simultaneously lowering the costs associated with the sickest and traditionally most costly patients in the hospital.

As providers of teleneurology services, AcuteCare Telemedicine (ACT) wholeheartedly agrees with Dr. Gawande’s observations. Improving the quality of care in emergency neurology requires a standardized, quality-driven approach. Simply put, something done frequently becomes something done well. Traditionally, most neurologists who take ER calls don’t get much experience treating acute stroke patients, and neurology training focuses on diagnosing the problem rather than emphasizing treatment options and paradigms. The nuances of tPA inclusion and exclusion and the decisions about other stroke treatment options mandate that the neurologist treating stroke emergencies be familiar with the most up-to-date practices. Who would you rather have piloting your medical care: the team that flies sporadically, or the one that flies every day?


You May Already Be Acquainted

As futuristic or experimental as telemedicine may sometimes seem, patients from all demographics may unknowingly already have been engaging and reaping its benefits for years. At its core, telemedicine is interested in utilizing advances in technology to increase the speed and accuracy of communications either between patients and their physicians or among physicians in collaboration. The resulting drastic improvements in these areas that are afforded by telemedicine are what matter most, not the seemingly unorthodox techniques that facilitate them.

Following this idea, any health care protocol that leverages the internet is a practical application of telemedicine. Therefore, when a doctor retrieves lab work from the web, or a radiologist sends an electronic version of a scan to a colleague, telemedicine is already at work. For would-be telemedicine patients, videoconferencing is what is most unfamiliar. However, Americans are becoming more and more accustomed to communicating with one another via two-way video technologies; for many, platforms like Skype or Apple’s FaceTime are now commonplace. As these tools make their way into our everyday lives, more patients will grow comfortable with their powerful applications in healthcare.

According to the American Telemedicine Association, telemedicine technologies and practices has played a role in the care of as many as 10 million patients in the United States to date. With continued education and increased awareness, that number should be expected to rise exponentially as more hospitals adopt telehealth as a primary mode of monitoring patients and other individuals benefitting from remote supervision, such as the elderly or disabled. Several federal innovation grants resulting from the passage of the Affordable Care Act have also been awarded to telemedicine programs nationwide for their capability to reduce unnecessary hospitalizations.

There are obstacles, primarily related to patient and provider perceptions and fears about costs and reliance on new technologies, but telemedicine has often proved itself adaptable and efficient in the face of such doubts. Raising awareness and granting patients the confidence that they are already familiar with telemedicine’s advantages will be a major step in pushing healthcare forward.