AcuteCare Telemedicine Blog

A Specialty Designed For Virtual Care

According to a recent article in the Scientific American, Alaska patients are more likely to find an astronaut than a geneticist. William Oefelein, who piloted the space shuttle Discovery, retired there, but the state of more than 700,000 people does not have a single medical geneticist to call its own. Instead, patients must wait until one flies in from Oregon around 4000 kilometers away. Six times a year a geneticist or two comes to Alaska and visits a few clinics, seeing about eight patients a day, diagnosing genetic causes for developmental delays such as fragile X syndrome or discussing hereditary cancer risk.

New advances in telecommunication technology are improving access to medical specialties for residents of regions well away from established urban centers, especially for specialties that do not always require hands-on interaction between a patient and a practitioner.  A virtual meeting with a geneticist is not as personable as a face to face encounter but those who are utilizing telemedicine to reach out to their patients from afar are reporting high satisfaction rates of among patients who are tapping such services. This may not be surprising to many because in an age when virtual chats are relatively commonplace, videoconferencing for genetic consultation, or telegenetics, is becoming a logical extension of what people already do with their Webcams and smartphones. The patients are already familiar with the technology and have racked up considerable experience socializing and shopping via the internet.

The lack of reasonable access to medical specialties is not limited to the state of Alaska. In nearly every state there are enclaves of population that are located five to six hours away from advanced or specialized medical centers, it is clear that the need is out there and the patients are willing and able to avail themselves of the convenience. The fact that more services like telegenetics are not more commonly available is not always due to usual obstacles like insurance reimbursements, licensing requirements or lack of necessary band width and supporting technology. To be successful, the programs require the willing participation of doctors and clinicians on the patients end in order to help facilitate a successful encounter. Even in this fast-paced, high-tech environment there are many healthcare practitioners that continue to be reluctant to treat patients in the virtual world. The problem would appear to be one of acceptance in some cultures.

Telemedical consultation by physicians in specialties in which there is little need for physical contact with patients is one area where new communication technologies would appear to be made to order. The obvious advantages of decreasing the costs and increasing the access to care are evident, even to the casual untrained observer.

Telemedicine Contributes to the Education and Treatment of Autism

Using web-based technology to teach parents the strategies of applied behavior analysis (ABA) could offer big gains for kids with autism, new research suggests. In a small study of rural parents who participated in a series of online tutorials and videoconferencing sessions, researchers found that they could help moms and dads substantially increase their knowledge of ABA and apply the techniques without forcing the families to make long drives to a clinic. The finding could have particularly big implications for families living in remote communities that lack therapy offerings, researchers said.

“Autism spectrum disorders, now estimated to affect 1 in 68 children, are just as common in rural America, but ABA-trained professionals are rare,” said Linda Heitzman-Powell of the University of Kansas who worked on the study published in the journal Focus on Autism and Other Developmental Disabilities. Heitzman-Powell and her colleagues said the training method they developed, known as Online and Applied System for Intervention Skills (OASIS) helped parents increase their knowledge of ABA strategies by an average of 39 percent. What’s more, parents who took part in the training improved their implementation of the strategies by 41 percent overall, researchers said.

Four families with children on the spectrum participated in the study, each of whom completed a series of online tutorials and at least 13 videoconferencing sessions with a coach. Parents also used an online interface to report on their use of the strategies with their child. Since completing the initial study, researchers say they’ve further tested OASIS with nearly 40 families with similarly promising findings.

According to recent research, some 42 percent of U.S. hospitals have implemented telehealth platforms, with the highest levels of adoption occurring in rural areas. At Tift Regional Health System in Tifton, Ga., a telehealth frontrunner, they are operating several rural telehealth programs including programs providing telehealth at schools, an ADD and autism clinic, an emergency department stroke program, a program for patients undergoing kidney transplants, a geriatric psychiatric program and a program where patients can reach a provider 24 hours a day. “We believe in telehealth. We believe it’s the future,” says Jeff Robbins, director of the organization’s telehealth effort.

The ADD and autism clinic annually works for 600 children who often don’t have access to psychiatrists, endocrinologists, geneticists and other specialists. Some live more than three hours away, making monthly appointments challenging in terms of finding quality transportation and taking time off for caregivers. The program especially has impacted children from families with limited means, Robbins says.

On the eastern shore of Maryland, Atlantic General Hospital is the first hospital in the nation to partner with Kennedy Krieger Institute to provide telemedicine services to children with autism, ADD/ADHD, intellectual disabilities, and other developmental disorders living far from specialty care. Often a referral for specialty care means a trip to Baltimore and a six-hour round trip drive, with additional expenses for gas, food, parking and tolls. This can leave patients and their families exhausted before they even say hello to the doctor.

Dr. Deepa Menon, the assistant medical director at Kennedy Krieger’s Center for Autism and Related Disorders, and Dr. Paul Lipkin, the director of Kennedy Krieger’s Center for Development and Learning, are providing complete care, with initial evaluations and follow up visits, using encrypted telemedicine technology transmits both audio and video of the patient and doctor in real time. The physicians are able to interact with patients and their families in the same way they would in an actual exam room.

Children’s health care is a growing concern on a domestic and global scale among parents, specialists, and policymakers. Treating this special population, particularly among those living in rural communities, ignites continual challenges including insurance concerns, limited transportation, and the low number and availability of pediatric specialists. Telemedicine provides the best solution for providing much needed specialized treatment and education to those in need.

Telemedicine Increases tPA Use for Stroke Treatment

Presented at the annual American Academy of Neurology meeting in early May, a new study highlights the benefit of teleneurology care. The report indicates that a telemedicine program for patients with acute ischemic stroke increases the use of recombinant tissue plasminogen activator by as much as 13% in the year after the program’s implementation.

Stroke patients who receive the clot-busting drug tPA within 60 minutes of experiencing stroke symptoms have the best chance of avoiding brain damage or death. The administration of intravenous recombinant tissue-type plasminogen activator (tPA) and intra-arterial approaches, attempt to establish revascularization so that cells in the penumbra can be rescued before irreversible injury occurs, but restoring blood flow can mitigate the effects of ischemia only if performed quickly. “Most of the 13 hospitals in the study significantly increased their recombinant tissue plasminogen activator (tPA) use”, Dr. Jeffrey C. Wagner said at the annual meeting of the American Academy of Neurology.

The study population included patients aged 18 years and older who were admitted with a primary diagnosis of acute ischemic stroke. The hospitals represented a variety of patient demographics. About two-thirds were rural; approximately half were small, defined as fewer than 200 beds. The hospitals were located in the Northeastern, Southern, and Western portions of the United States.

Overall, tPA administration increased significantly, from 4.5% to 7.3% after a telemedicine program was introduced and the use of tPA in smaller hospitals increased from 1% to 7% after implementing a telemedicine program, compared with an increase from 5.4% to 7% in larger hospitals. Those results were similar when patients were stratified as inpatients or transferred patients.

The benefits of intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) are time dependent and guidelines recommend a door-to-needle (DTN) time of 60 minutes or less. However, studies have found that less than 30% of US patients are treated within this time window. Target: Stroke was designed as a national quality improvement initiative to improve DTN times for tPA administration in patients with AIS. Implementation of a national quality improvement initiative was associated with improved timeliness of tPA administration following AIS on a national scale, and this improvement was associated with lower in-hospital mortality and intracranial hemorrhage, along with an increase in the percentage of patients discharged home.

“Reducing DTN time is a primary goal when treating patients via telemedicine”, says Keith A. Sanders, Founder and Director of the Stroke Center of Emory St. Joseph’s Hospital and AcuteCare Telemedicine (ACT) COO. “ACT has seen dramatic improvements in the tPA administration rate and DTN times at our hospitals. We collect, review and distribute DTN times and other quality measures to our hospital partners. This report reaffirms the importance in administering tPA and its impact on patient outcomes.”

Managing Diabetes Remotely With Telemedicine

Diabetes afflicts more than 22 million Americans, or 7% of the total population, and the number of people diagnosed every year is skyrocketing. At a cost of $245 billion in 2012, the disease’s toll on the economy has increased by more than 40% since 2007, according to a recent report from the American Diabetes Association.

Mississippi, which ranks second after West Virginia in the percentage of residents affected by the chronic disease, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians. Early this year, Gov. Phil Bryant, the University of Mississippi Medical Center and three private technology partners announced a plan to help low-income residents manage their diabetes remotely through the use of telemedicine. The goal is to help them keep the disease in check and avoid unnecessary hospitalizations while remaining as active and productive as possible. To make the project possible, Bryant signed a first-of-its-kind law requiring private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care.

The new reimbursement law will also pave the way for similar telemedicine projects for other chronic diseases, said Dr. Kristi Henderson, the University of Mississippi Medical Center’s chief of telemedicine, who is heading the project. Initially the project, called the Diabetes Telehealth Network, will enlist 200 people with diabetes in one of the state’s poorest regions, the Mississippi Delta, who will be given Internet-capable computer tablets loaded with software that will enable medical professionals at the University of Mississippi and a hospital in the region, North Sunflower Medical Center, to remotely monitor patients’ test results and symptoms. A third technology partner will provide technical support for the wireless telecommunications services needed to transmit the medical data.

The price tag for Mississippi’s telemedicine project is about $1.6 million. But to expand the program or recreate it somewhere else, Henderson said, would cost much less because the groundwork would be done. “We want to prove a model and replicate it.”

Nationwide, one in every five health care dollars is spent caring for people with diabetes, according to the American Diabetes Association. Mississippi’s telemedicine law, said Gary Capistrant, public policy director at the American Telemedicine Association, goes further than any other state to remove what the telehealth industry considers its biggest impediment, lack of insurance reimbursement.

Numerous states and medical groups already have expressed an interest in the project, Henderson said. “If we can do it in Mississippi, where chronic disease is at its worst, where poverty is at its worst, and where transportation and workforce issue are at their worst, we can make it work anywhere.”