AcuteCare Telemedicine Blog


Telestroke Is Proving to Be a Saver

Telestroke programs have been proving themselves very effective in bringing critical care to patients in rural areas throughout the country for a few years now and testimonials about patients who have benefitted from advanced, specialized treatment via telemedicine technology are becoming more common place. Receiving advanced stroke care faster is saving lives and resulting in less debilitating recoveries. Telemedicine programs help extend higher quality care to patients living in more rural areas, but some have questioned whether the cost to implement and maintain the technology and services has been thoroughly vetted and considered.

According to a new study by Mayo Clinic researchers, a telestroke program is leading to lower cost. Stroke patients living in rural areas who receive care via a telestroke network see, on average, nearly $1,500 in lower costs over their lifetime compared to stroke patients who do not receive telestroke care, researchers found. The savings are primarily attributed to reduced resource utilization, including nursing home care and inpatient rehabilitation. Researchers also estimate that, compared with no network, a modeled telestroke system consisting of a single hub and seven spoke hospitals may result in the appropriate use of more clot-busting drugs, more catheter based interventional procedures and other stroke therapies, with more stroke patients discharged home independently.

Despite the considerable upfront and maintenance expenses, the entire network of hospitals realizes a greater total cost savings, officials say. “This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, MD, director of the Mayo Clinic Telestroke Program, and lead investigator of the study, in a press statement. “We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained.”

“The results serve to inform government organizations, insurers, healthcare institutions, practitioners, patients and the general public that an upfront investment in telemedicine and stroke network personnel can be justified in our health system,” added Demaerschalk.

Today there are 10 million people utilizing telemedicine and the number will continue to rise as more state legislatures and medical insurance providers realize the benefits to providing payment and reimbursements for telestroke and telehealth services.



Taking It to the Patient

Gadget and device gurus are working hard to fill the need for advanced tools to help medical care providers in the field bring the best medical care to the patient even in the remotest corners of the world.  Remote Diagnostic Technologies (RDT) in the UK, with funding from ESA’s Advanced Research in Telecommunications Systems Program has developed a robust portable device for monitoring vital signs and providing communications for medics in the field. The Tempus Pro combines the diagnostic facilities found in standard hospital vital signs monitors with extensive two-way communications, packaged in a compact, rugged, highly portable unit that can be tailored to user needs. The key to the unit’s success is that it is a fully functional, hospital-grade vital signs monitor and takes less than an hour for an experienced medical professional to learn the basic functions.

In the United States, a University of Virginia Health System (UVA) team is working with local rescue squads to diagnose stroke patients before they reach the hospital, enabling more patients to receive lifesaving treatment and have a full recovery. UVA clinicians are raising $10,000 to equip two additional local ambulances with the iTREAT mobile telemedicine kit. The goal: Connect paramedics through a secure video link with UVA’s specially trained stroke neurologists and emergency medicine physicians, who can diagnose stroke patients while they’re in the ambulance and enable treatment to begin as soon as patients arrive at the hospital. Fast diagnosis and treatment is vital because the most effective treatment for acute ischemic stroke patients — the clot-busting drug tPA — is only safe and effective if delivered within three hours of when symptoms begin. Due to delays in reaching a hospital and receiving a diagnosis, less than 5 percent of all stroke patients receive tPA. Promising faster care for a variety of patients and treatments, The iTREAT technology is in the testing stage with local rescue squads, with the hope of using it to care for Central Virginia patients in early 2014.

A debate as to what or who spawned the revolution in using communication technology to advance a new medical care delivery model, the need or the gadget, is unimportant.  Teaming the hospital based life-savers and their dedicated field associates with savvy techies is creating an environment where patients are receiving better and faster advanced life support no matter where they are located. Telemedicine is taking to the patient!



Leading Centers Aiming to Revolutionize Stroke Research

Georgia StrokeNet will be one of 25 U.S. regional coordinating centers to take aim at revolutionizing stroke research under a program funded by the National Institutes of Health (NIH). Georgia StrokeNet is the only regional coordinating center in Georgia that is participating in the project that is funded by a five-year, $2 million grant.

Those taking part in the collaboration include: Emory University’s School of Medicine, Grady Memorial Hospital’s Marcus Stroke and Neuroscience Center and other local partners. Emory neurology professor and Marcus Stroke and Neuroscience Center Director Dr. Michael Frankel will serve as Georgia StrokeNet’s principal investigator: Dr. Frankel says, “The new StrokeNet will be a conduit for clinical trials for patients to participate in, so we can answer those key questions about what is the best way to prevent a stroke, what the right blood pressure to try to prevent a stroke, what is the right treatment for a patient who has an acute stroke.”

Grady Hospital’s Marcus Stroke and Neuroscience Center has earned a top designation for stroke care by an independent accrediting agency for health care organizations. The Center has been designated an Advanced Comprehensive Stroke Center by the Joint Commission and is one of 50 U.S. stroke centers who have received the designation since it began. Emory University and Georgia Regents Medical Center in Augusta are the other two Georgia centers to receive the designation.

Dr. Keith A. Sanders, Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta, and partner in Atlanta Neurology, P.C., is looking forward to contributing to the stroke research at Georgia StrokeNet.  “The research is important because strokes and stroke-related deaths are prevalent in Georgia and the Southeast. It is hoped that this research will lead to more treatment options to reduce disability from stroke, commented Dr. Sanders.”



Can We All to Come Together in the Interest of Progress?

According to a recently published report, telehealth is about to experience explosive growth. RNCOS Business Consultancy Services has just released a report predicting 18.5 percent annual growth in telehealth worldwide through 2018.  It is predicted that the U.S. will outpace the rest of the world with its share of the telehealth market expected to grow to $1.9 billion in 2018 from $240 million today, an annual growth rate of 56 percent. This projected explosive growth has gained the attention of the federal bureaucracy. In 2013, two bipartisan bills were introduced in Congress, designed to encourage telehealth expansion and growth:

  • HR 3077, the TELE-MED Act, would permit certain Medicare providers licensed in a state to provide telehealth services to Medicare beneficiaries in a different state.
  • HR 3750, the Telehealth Modernization Act, would promote the provision of telehealth by establishing a federal standard for telehealth, and inducing all states to adhere to the regulations.

The Health IT Now Coalition is pointing out that neither bill imposes a huge burden of federal control and that these two bills do not interfere with state sovereignty over the licensing of medical and allied health professionals. Traditional state licensing laws did not envision a physician in one state treating a patient in another state and the oversight and lack of inter-state licensing of physicians and other health professionals has long been an obstacle to TeleHealth rapid adoption.  Many in the medical community are concerned that Congressional overreach would have unintended consequences in situations that are better dealt with by individual states. Decentralized control at the state level ensures less likelihood of an inflexible and quickly dated regulatory regime, which often happens when Congress takes the lead.

The Federation of State Medical Boards has promised that it is very close to agreeing on language for an interstate compact for physician licensing, which has already been achieved for nurses. A compact is a constitutionally approved method for states to make treaty-like commitments to each other. It is a very appropriate tool to accommodate mutual recognition of professional licensing for the purpose of inter-state telehealth.

It is very encouraging that both advocates and governmental representatives are endorsing an approach that will allow providers, patients, and entrepreneurs to develop and adopt telehealth with minimal political interference.  It is all too common for politicians and their formidable federal and state machinery to reach out to “help” advance a promising, revolutionary movement only to over indulge the regulatory rule-making which ends up hindering real or untethered progress.

Technology promises to change much in the delivery of medical care in the coming years. Let’s hope that all parties to the process of change continue to work together to advance a common mission of providing improved quality and increased availability of affordable medical care to all Americans.



Telemedicine In Europe: Another Euro Disney Experience?

It seemed like a “no-brainer. Take the most successful family entertainment experience (Disney World), clone an exact copy, pack it all up, and implant it to the center of European culture and voila, another mega Disney entertainment success story!  Well, not exactly. It seems as though the European culture frowns on fast food, long lines and many other conveniences and inconveniences that Americans have become accustomed to enjoying and enduring.  The initial Disney experience required many millions of dollars and years of tweaking and modification to the American Disney World model before it became anything nearly as successful. It forever set-forth another example as to how Europeans differ in their perceptions and customs relative to other world societies.  So where does entertainment and telemedicine have commonality?

Decade’s after Disney’s surprising experience significant advances in telecommunications technologies have brought about vast improvements to societies all around the world, across all industries, commerce, media, personal communication and even to the well-established healthcare delivery model.  And while some resistance to changes in healthcare delivery, brought on by the telemedicine and telehealth revolution, have been experienced the vast majority of cultures around the world are envisioning and welcoming significant benefits to the quality and availability of medical services derived from the revolution.  Even deeply traditional governmental regulation and policy barriers are falling aside, albeit slowly in some cases, giving way to a new era of medical care delivery.  But in Old Europe, as telemedicine revolutionizes medical care around the rest of the world, Germans are happier paying a visit to the doctor, and those who could benefit most from the technology will just have to wait.

By international standards, Germans have plenty of doctors: 3.84 for every 1,000 patients. In the US, the number is 2.46. But such statistics shed little light on how doctors are distributed throughout a country. “In some rural regions, we have a situation where a consultation might require a day’s travel for the patient,” says Wolfgang Loos, chairman of the German Society for Telemedicine. One of the solutions, he says, is that a doctor could consult patients via live video streams to the patient’s home. Digital medicine is taking hold in the field of stroke prevention and care, small hospitals and care clinics are networked and can consult specialists through video conferencing whenever they have questions. Patients with chronic heart issues can access a different form of telemedicine: some measuring instruments are connected to centralized medical networks, and if a patient’s value suddenly worsens, a nearby doctor is alerted. But telemedicine faces a number of particularly German hurdles.

Doctors in Germany, as stipulated in the “prohibition of remote treatment” (a German physician’s code of conduct), doctors are not allowed to diagnose a patient remotely without having dealt with that patient before, at least once in person.

Beyond code of conduct restrictions, patients in Germany are accustomed to, and expect, a direct line of personal contact with their general practitioner and specialist. And while most German physicians recognize huge potential in the field of telemedicine, they continue to view “direct contact between doctor and patient as indispensable.” A custom many early detractors of telemedicine in America promoted, only to be rebuffed by patients once the convenience of virtual consultations was experienced.

There are also technical barriers that inhibit telemedicine in Germany. In many regions, high-speed Internet access is lagging, making video conferencing or the transmission of large patient data files nearly impossible. The areas lacking broadband access are often the same rural regions, say its advocates, which would benefit most from telemedicine.

It appears that cloning even the most advantageous of instruments and practices of technology will need some tweaking and modification in order to be universally accepted and successful.