AcuteCare Telemedicine Blog


The VA Is Leading The Federal Charge On Advancing Telemedicine

Two California Congressmen have submitted a bill that would expand telehealth coverage to active-duty service members, their dependents, retirees and veterans.  The 21st Century Care for Military & Veterans Act (H.R. 3507) was submitted earlier this month by U.S. Reps. Mike Thompson (D-Calif.) and Scott Peters (D-Calif.). Co-sponsored by Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) and endorsed by the American Telemedicine Association, the bill would establish and expand current reimbursement policies for telehealth coverage under the Veterans’ Administration (VA) and The Defense Department’s TRICARE.

The VA has seen a 40 percent reduction in bed days and 87 percent reduction of annual per-patient costs when compared to home-based care programs, according to VA studies. Adam Darkins, MD, the VA’s chief consultant for telehealth services, anticipated that some 825,000 veterans would be served through telehealth by the end of 2013.

This new bill will offer members of the Armed Forces and their families the highest quality healthcare in a timely manner no matter where they live or how far away they are from the doctor they need to see. Technology can create a responsive and more efficient healthcare system that provides for better care and lower costs.

Earlier this year, U.S. Rep. Devin Nunes (R-Calif.) joined U.S. Rep. Frank Pallone (D-N.J.) in sponsoring the Telemedicine for Medicare (TELE-MED) Act (H.R. 3077), which would enable healthcare providers to treat Medicare patients in other states with telemedicine tools and services but without needing a different license for each state.

The VA, which launched telehealth services in 2003, appears to lead the way for the rest of the federal healthcare bureaucracy by eliminating many, still well-entrenched, barriers to the rapid expansion of telemedicine technology.  Given the history of the VA’s percieved poor performances in delivering much needed traditional healthcare services to our veterans, their leadership in advancing the use of telemedicine is a trend that is more than just a little encouraging.



Honoring Our Veterans With Telemedical Technology

As we honor our American Veterans this month, it is fitting to examine how Telemedicine, the exchange of medical information via electronic communications, has vastly changed the way deployed soldiers receive access to health care and how the new communication system promises to offer better access to care for veterans in the future as well.

When Dr. Ronald Poropatich first joined the military 30 years ago, the digital cameras and web cams required for the use of telemedicine barely existed. Yet, during his career as the deputy director of the Telemedicine and Advanced Technology Research Center in the United States Army, Poropatich helped revolutionize health care for soldiers by bringing telemedicine technology to army bases and field hospitals around the world including in Somalia, Iraq and Afghanistan.

Today, soldiers in Iraq or Afghanistan can get second opinions on tricky medical situations from doctors located halfway around the world and can receive diagnoses from medical specialists, even when none are stationed at their base.  Telemedicine has advanced greatly, allowing soldiers to email photos of electrocardiograms (EKGs) or skin rashes back to physicians back in the U.S., and receive feedback within hours.

This technology has allowed the military to spot medical conditions that would have otherwise been missed or quickly garner second opinions on cases that have the potential to warrant costly evacuations. Telemedicine has also provided a way to treat soldiers for conditions like post-traumatic stress disorder, or depression, while preserving their privacy.

The survival rate, if you can get to a combat support hospital level 3 facility in Afghanistan, is a fantastic 90 percent, but that means a lot of guys and gals are surviving horrific wounds once thought to be fatal.  So providing a telemedicine lifeline to veterans once they are back home is imperative in order for veterans to communicate with health care providers outside of in-office visits.  Accessing their care through the use of a cellphone or webcam, recovering soldiers will be more likely to stick with rehabilitation programs and outpatient treatment, ultimately ensuring better mental and physical health outcomes in the long term.

Perhaps the best way to honor our veterans is to provide them the best of medical care through the use of Telemedical Technology.



Growth of Telemedicine is Global and Becoming Common Place

Though the United States has been dominating the global telemedicine market, Europe and developing nations are rapidly catching up. The global telemedicine market is expected to grow at a compound annual growth rate of 19 percent, driven mainly by growth opportunities in Europe, but the enthusiastic growth may be tempered by the lack of standardized classifications. However, the increase in remote monitoring of patients is expected to keep driving the market, which is also boosted by the increase in telesurgery. The shift is occurring mainly because of the increase in the number of patients with chronic diseases and the increasing availability of online healthcare services.

The remote delivery of healthcare services over the telecommunications infrastructure, or telemedicine, is a topic of interest to the vast majority of Italian general practitioners (GPs), with 73 percent stating that they are prepared to use the technology according to a study conducted by the Italian Family Doctor’s Association FIMMG. Over half of the doctors surveyed, 52 percent, are in favor of using these new technologies if they help to develop organizational aspects of the profession, while 30 percent state that telemedicine could even improve the doctor-patient relationship.

Global virtual doctor visits could become as common as face-to-face appointments because health insurers, hospital systems and employers view it as a way to clamp down on rising medical costs. They hope that by giving patients easy access to a primary care physician, it will discourage them from visiting a costly emergency room when they get sick. The trend in the US is expected to escalate as an influx of new patients, caused by the implementation of the Affordable Care Act (ACA), promises to put a strain on some doctors’ offices for treatment of routine illnesses.  Health giants UPMC and Highmark Inc. are rolling out new services that allow patients to video-conference with doctors through computers, tablets and smartphones.  “We think more and more people, as they become more familiar with telemedicine, will see this as something that is just going to be commonplace,” said Natasa Sokolovich, executive director of telemedicine at UPMC.  Convenience is the big selling point of telemedicine services to patients.  Rather than having to wait days or weeks to schedule an appointment at a doctor’s office, a video conference could be scheduled within minutes or hours, and the patient wouldn’t have to leave their home.

While such convenience is enticing to an increasingly busy society, some doctors and medical care providers are warning that an E-visit can’t entirely replace face-to-face consultations in a physician’s office environment. Nonverbal cues can be very important in accurately diagnosing patients, said Dr. Bruce MacLeod, president of the Pennsylvania Medical Society. “Some details could be missed in a video conference.”

But as the availability and quality of telemedicine advances globally, a increasing majority of patients are willing and eager to invite the technology into their relationship with their health care providers.  The desire to make medical care more accessible and less-costly is global. Whether E-visits replace face to face medical care completely or just become some relative portion of interaction between patients and physicians, the medical services delivery model is going to be altered dramatically for the future.  The rate of acceptance of communication technology in the medical care process will be driven more by necessary changes to the well-established regulations, licensing requirements, and cost reimbursement policies from within the health care community. 



Advancing the Benefits of Telehealth and Telemedicine

Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. “You know what HD television looks like. You can actually see the pimples on the actors’ faces,” she says. “I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure.” A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.  The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.

The rural health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.

For many states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. Telehealth is the use of technology to deliver health care, health information or health education at a distance. Real time telehealth communications allows the patient and physician to connect and interact through video conferencing, telephone or video health monitoring device.  Store and forward telehealth refers to the transmission of data, images, sound and video from one care giver to another.

Forty-two states currently provide some form of Medicaid reimbursement for telehealth services and 17 states require private insurance companies to cover telehealth services. While individual states appear to be well out in front of the federal government on supporting telehealth innovation, the federal government is finally moving to catch-up with the recent introduction of “The Telehealth Enhancement Act of 2013 (H.R. 3306).”  The bill promises to strengthen Medicare and enhance Medicaid through expanded telemedicine coverage and calls for the adoption of payment innovations to include telehealth and to make other incremental improvements to existing telehealth coverage. Another Congressional bill, “TELE-MED Act of 2013” (H.R. 3077) would permit certain Medicare providers in a state to provide telemedicine services to Medicare beneficiaries in a different state.

The convergence of medical advances, health information technology, and a nationwide broadband network are transforming the delivery of health care by bringing the health care provider and patient together in a virtual world, especially those in disadvantaged areas. Telemedicine has the potential to improve health care access and quality to patients in urban and rural America alike, but a variety of barriers, such as reimbursement and licensing issues, continue to stand in the way of more aggressive, widespread adoption.

The recent progress by state and federal governing bodies to recognize the significant advantages of increased telehealth services for all Americans with the introduction of new and meaningful legislation to address and remove established barriers to expansion, is encouraging to those in the health care community whose fundamental goal is to provide the best quality medical care to their patients no matter where they live.