AcuteCare Telemedicine Blog


Knowledge: Can Too Much Be Just As Dangerous As Too Little

What does the “world’s first evidence-based mobile resilience program”, a 21-day personalized program to help wearers manage their stress and build mental resilience, and the “Shimmer3”, a slim-line sensor that can be strapped to an athlete’s arm in training to provide coaches with biophysical data, have in common? These are just two of the many hundreds new wearable electronic monitoring devices entering the crowded medical application market. Wearable monitoring devices are not new as healthcare providers have been utilizing devices to collect data on patients suffering from chronic diseases such as cardiac disease and diabetes.

To spur innovation, last year Qualcomm Life, a subsidiary of the chip maker Qualcomm and a big sponsor of wireless healthcare technology, announced a $10m prize for a Star Trek-style “tricorder” to be awarded to the first developer to succeed in designing a mobile platform capable of diagnosing a set of 15 conditions, including pneumonia, diabetes and sleep apnea, without recourse to a doctor or nurse. Don Jones, vice-president of Qualcomm Life, says, “Think of every way you have ever interacted with a medical professional or someone in a clinical setting – a doctor, a nurse, or your corner pharmacist – then think how that can be replicated digitally so that the process is both more convenient and faster,” he says. “The odds are that someone in Silicon Valley is already working on it.”

You can find high-tech wearable gadgets around the wrist, ankles and chests of just about every tech savvy enthusiast, leading some to champion their appearance as a means of keeping us all more in tune with our own health. Others are expressing cautious concern on how data is being interpreted by the less medically trained among us. What do we lose when healthcare becomes nothing more than a stream of digitalized physiological outputs, parsed and quantified by algorithms without the interpretation of experienced medical providers? The rise of digital medicine will have significant impact on the health and welfare of patients with the manner in which it is utilized determining whether this will be for better or for worse.

“Advancements in telemedicine allow us to provide acute stroke care quickly and efficiently, in situations where seconds matter,” comments Dr. James Kiely, partner, AcuteCare Telemedicine. “As technology reaches another inflection point with consumers, it’s important to educate users that data is more valuable in the hands of a board-certified medical practitioner.”



Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



Recognizing the Symptoms of Stroke

While stroke awareness is a major concern for both men and women, a recent study concluded that women are less likely to recognize stroke symptoms. Only half of those surveyed know that sudden weakness or numbness on one side of the face, arms or legs is a warning sign of a stroke. 44 percent are aware that speech difficulty is a stroke sign while less than 1-in-4 could identify sudden severe headache, unexplained dizziness and sudden vision loss, or vision loss in one eye as the top symptoms of stroke. The study surveyed more than 1,200 women in the United States to assess their understanding of stroke’s warning signs.

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of the brain control different parts of the body, your symptoms depend upon the part of the brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word F.A.S.T.: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 911 immediately if any of these signs or symptoms at the earliest onset of these symptoms

For those living with or who care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

The acronym “FAST” is also meant to underscore the importance of rapidly delivering treatment to stroke patients. If given in time, a clot-busting drug administered during a stroke can lead to better outcomes and a decrease in the likelihood that a patient will suffer long-term disability. A recent study examined the effectiveness of tissue plasminogen activator (tPA) relative to the delay in administering this clot busting drug. Researchers found that every minute tPA was delayed cost nearly 2 days of disability free survival. The researchers commented that their message is literally “Save a Minute, Save a Day.”

Although many Americans live relatively close to a hospital where emergency stroke treatment is available, few actually receive the recommended therapies. Researchers found that only 4 percent of the more than 370,000 Medicare patients who suffered a stroke in 2011 were treated with tPA. Most stroke victims fail to recognize the symptoms of stroke or call 911 early enough to receive the necessary treatment. tPA is most effective when administered within a 4 hour window of time.

Every minute counts for stroke patients. Remember to act F.A.S.T.!



A Better Model of Delivery Realized

We buy groceries, trade stocks, and chat with friends, surf and cultivate new relationships around the country and the world all without leaving our home or office. Yet seeing a doctor remains an old-fashioned routine: minutes of medical attention can cost hours spent in transit or in a waiting room, only to have a face-to-face with a doctor. The familiar choreography dates back several generations, virtually unchanged since treatment from your family physician moved from your home to his or her office, where the newest diagnostic equipment of the day and the best trained supporting staff could more efficiently provide the most up to date medical care for the time. The technology revolution has brought amazing new diagnostic equipment, treatments and medications over the past several decades, but until now the process of visiting the doctor has remained nearly the same.

Telemedicine involves locating available doctors over the Internet and connecting with them, at a moment’s notice. It lets a patient see a doctor whenever and wherever you want, freeing them to choose a doctor based on merit rather than location. It can also improve the quality of medical care and reduce costs and it works well for urgent care, ongoing diagnostic monitoring and illnesses that can be diagnosed and treated without personal contact with a care giver. Telestroke, the practice of providing emergency stroke care through telemedical technology has brought lifesaving care to patients who were once located outside of the golden hour of treatment and chronically ill patients who were accustomed to spending many hours of travel time to receive treatment for a variety of illnesses and injuries have realized a new level of convenience and quality of healthcare.

In 2010, telemedicine and telehealth appeared to be on the verge of an acceptance break though. Recognizing an oncoming shortage of physicians and escalating medical care costs, the healthcare community recognized how the technology could significantly impact the future medical care costs and streamline the delivery of a broad array of healthcare services. The benefits of a new technological healthcare delivery model faced some rather significant hurdles on its way to acceptance and meaningful implementation. Much of the healthcare infrastructure, fiscal processes and protective regulations, many in place for nearly a century, needed to be revised to take advantage of the promised benefits of telemedicine. Policymakers, politicians and those early doubters within the medical community are warming to the new model and once formidable barriers to the advancement of telemedicine are beginning to tumble. Removing process barriers may be the easy part of bringing the benefits of telehealth to the everyday life of patients, changing life-long rituals and perceptions associated with traditional medical care delivery may take a bit longer. Simply recognizing the benefits of telemedicine isn’t enough; patients must embrace the concept, understand how the features benefit them and motivate them to use it.

Some say that there is no substitute for the human touch and a healing bedside manner. Consumers will always insist on traditional, face to face encounters with their doctor. Yet the advantages, convenience in particular, of new technologies and cutting edge devices are being accepted and utilized by virtually all generations. Social interactions are now ongoing connections and rarely limited to special occasion or planned encounters. Acceptance and utilization of technology in medicine will advance as the options and variety of healthcare services, accessible and the benefits of convenience and costs are realized by more and more patients.

Regardless of the methods of delivery, those who choose to enter the practice of healthcare will still be motivated to do so by the desire to help others in need, to provide treatments to those who suffer the fates of life’s many malady’s and to save lives. Having to adjust their bedside manner to accommodate the medium of delivery will do little to deter their aspirations to heal others.

In the words of Thomas Nesbitt, the Associate Vice-chancellor for Technology at the University of California Davis Health System, “A lot of people think it’s about the technology, but it’s really about a new model of care that the technology facilitates.”