AcuteCare Telemedicine Blog


Telehealth Pushed to the Forefront of Public Health Agendas

Governor Phil Bryant of Mississippi is standing up in support of telemedicine technology. In Mississippi, Gov. Bryant has introduced a new initiative “The Diabetes Telehealth Network”. Unveiled recently in his State of the State address, the Network is a partnership of University of Mississippi Medical Center (UMMC), North Sunflower Medical Center (NSMC), GE Healthcare, Intel-GE Care Innovations and CSpire. It’s designed to offer those with diabetes consistent and timely access to UMMC clinicians via telehealth technology.

Patients in the 18-month program will have a tablet with mobile broadband access to record vital signs like blood sugar levels and send that information to UMMC doctors, specialists, nurses and pharmacists. The results of those daily interactions will allow doctors to adjust treatment plans accordingly, said Dr. Kristi Henderson, UMMC’s director of telehealth.

The program’s base will be Ruleville’s North Sunflower Medical Center (RNSMC), which has an existing telehealth partnership with the UMMC. The program’s private partners will provide the technological infrastructure. The initiative resulted from a meeting more than a year ago at the Paris Air Show between state and GE officials. GE operates jet engine and component assembly facilities in Batesville and Ellisville.

Gov. Bryant said the program is centered at RNSMC because, “That was unfortunately the area where diabetes was most concentrated. It’s a rural area. Lack of transportation is a big issue, and that affects access to care.” But there are 372,000 people in the state diagnosed with diabetes, according to the Diabetes Foundation of Mississippi. More than 12 percent of adults in the Mississippi Delta were diagnosed in 2010 with type 2 diabetes, according to UMMC statistics. The American Diabetes Association, in a 2012 study, found Mississippians with the disease spent $2.7 billion on health care related to treating it.

If this initiative is successful, it can be scaled up and expanded to meet the needs of diabetic patients throughout the state of Mississippi. Supporting new telecommunication technologies to improve and expand specialized care for chronic disease sufferers is an example of how Mississippi and other state governments appear to be out in front of Congressional law makers when it comes to putting forth initiatives that remove barriers and implement new strategies that seek to modernize our established healthcare delivery model and improve access and quality of care to patients across the country.



Telemedicine Finding Support Among the Young and Affluent

According to a new RAND Corporation study, people who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help by talking to a doctor over the telephone. Patients who used the service suffered from a wide assortment of acute medical problems such as respiratory illnesses and skin problems, and researchers found little evidence of misdiagnosis or treatment failure among those who used the service.  The findings, published in the February edition of the journal Health Affairs, are from the first assessment of a telemedicine program offered to a large, diverse group of patients across the United States.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” said Lori Uscher-Pines, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing health care trend.”

Among patients studied, the most common problems treated during a visit were acute respiratory conditions, urinary tract infections and skin problems, which accounted for more than half the cases. Other frequent reasons for were abdominal pain, back and joint problems, viral illnesses, eye problems and ear infections. More than a third of the visits occurred on weekends or holidays. Interest has grown in telemedicine programs because of the shortage of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the Affordable Care Act. Telemedicine is one of the alternatives touted as a way to better provide primary health care without greatly expanding the number of doctors.

The implementation of the Patient Protection and Affordable Care Act is leading to increased demand that physicians interact with more patients, pointing to telemedicine as a potential solution. Most physicians believe that the quality of patient care is not compromised by telemedicine because it is delivered through different channels. Physicians can consult with more patients, and patients can meet with their physicians in a shorter time period. In terms of economic advantages, telemedicine can save a great deal of time for patients who otherwise would have to leave work, and it can reduce ER visits. According to Kenneth McConnochie, M.D., M.P.H., director of the Health-e-Access Telemedicine Program and professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y., parents with young children consider time and lower expenses to be valuable commodities. By increasing its use of telemedicine, the medical center reported a 22 percent reduction in ER visits among schoolchildren. McConnochie pointed out that the average telemedicine visit costs $75 compared with $750 for a typical ER visit.

“The people who are attracted to this type of telemedicine may be a more technologically savvy group that has less time to obtain medical care through traditional settings,” said Dr. Ateev Mehrotra, a RAND researcher, co-author and an associate professor at the Harvard Medical School. However, researchers caution that more research is necessary to further assess the quality and safety of telemedicine services and to more adequately address concerns that expanded use of this type of telemedicine may lead to fragmentation of care. Still, the general consensus among patients and parents who used the service appeared to indicate that they believed that accessing medical services via telemedicine technology was much more convenient, saving them time and money.  For these consumers the convenience factor dominated over other concerns.



Technology is Advancing the Practice of Telepsychiatry

Telepsychiatry and other long-distance options for providing mental health care can help overcome problems related to location and distribution of specialty mental health services but should not be seen as a panacea for delivering care to rural areas in the United States, reported a research and policy brief from the Maine Rural Health Research Center. “Telemental health” (yet another new term) once depended on heavy-duty audio and video technology based in fixed studios to initiate care. Despite this coarse beginning, advances in computer technology and its near-universal adoption have resulted in improved delivery of Telepsychiatry and made it more cost effective and available to a wider audience, however, some non-technical hurdles remain to be cleared.

Until recently, “Telemental health” services were most commonly provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners, but now a pilot project begun at one critical-access hospital in collaboration with a psychiatrist and specialty mental health staff at a community mental health center has expanded to five additional hospitals. This system provides round-the-clock crisis evaluation and support at the hospital emergency departments and some say that “Telemental health” enabled them to provide services to rural persons that otherwise would not be available, but some nontechnical barriers such as poor Medicaid and commercial reimbursement rates, recruitment and retention difficulties, high numbers of patients without insurance, and high no-show rates serve as a drag on expansion of current programs.

The barriers experienced with “Telemental health” expansion is shared by other medical service disciplines seeking to enter or expand the utilization of telecommunication technologies that promise to revolutionize the delivery of medical care in the United States and across the world.  While progress is being made to overcome many of the most significant structural road blocks to expansion and adoption of these new technologies, much remains to be done to clear the path to a new medical care delivery model.

Maintaining a consistent push to encourage state and congressional representatives and health insurance industry leaders to move forward and embrace the revolution in healthcare must continue until each barrier is removed or neutralized.  The promise of delivering better, less expensive and more available medical care to millions of patients across the country depends on these continued efforts progressing and succeeding.