AcuteCare Telemedicine Blog

Telemedicine Delivering Advanced Pediatric Care To The World’s Children

Telemedicine was originally trumpeted as a technological tool capable of delivering specialized medical care and treatment to patients living in rural areas of America. But the technology, which helped connect stroke patients, diabetics and the chronically ill to medical specialists located at urban medical centers, is now helping to effectively deliver quality specialized healthcare to children all around the world.

Doctors in Latin America believe that telemedicine has improved the outcomes for young patients in those countries. A new study just released by researchers at Children’s Hospital of Pittsburgh (Children’s) at UPMC has shown that physicians in Latin American countries were very satisfied with services offered by Children’s. The results were gleaned from more than 1,000 pediatric consultations between physicians at CHP and doctors in Latin America.

“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Ricardo A. Muñoz, M.D., FAAP, FCCM, FACC, of Children’s Hospital. He is chief of the Cardiac Intensive Care Division and led the study. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education.” But Pittsburgh is not the only city reaching out to the world’s children.

The Cincinnati Children’s Hospital Medical Center, in Ohio, has a new telemedicine program that is diagnosing and treating sick children located in the Dominican Republic, using virtual technology. Physicians at the Center for Telehealth at Cincinnati Children’s are able to share medical information about patients, video and audio without the costly and inconvenient aspects of long-distance travel. Specialists in pediatric cardiology, neurology, psychiatry, cancer, blood disease and urology are available in Cincinnati for international consultation.

Physicians and patients in the country of Ukraine are connecting with specialists and subspecialists at the Miami Children’s Hospital’s (MCH), through telemedical technology, for individualized medical consultations, electrocardiograms, ultrasound, endoscopy and audiology exams and treatment. Through their partnership with Ukraine-based Boris Clinic, the MCH program is helping support the treatment of Ukrainian children.

Even when children are sailing on the Seas of the world, telemedicine is ensuring that the best in medical care is not far away. MSC Cruises is initiating new technology across its entire fleet of passenger ships to enable the long distance care of children with onshore support from specialists located at The Giannina Gaslini Institute in Genoa, Italy. The world-class pediatric medical center will enable onboard doctors to confirm their diagnoses and treatments using a cutting-edge system of remote image and data transmission. Virtual consultations with pediatric specialists, radiology and health monitoring will be available to the ship’s young passengers 24/7.

In the past, providing quality medical care to sick children living in hard-to-reach areas of the world required extensive travel and complicated logistical solutions for caregivers and patients alike. Technology, especially telemedicine, is rapidly improving the delivery of quality medical care to children living not only in rural America but throughout the world.



Patients May Get A Dose Of Regulations When Reaching For Telehealth
July 24, 2014, 9:14 am
Filed under: Industry Standards, Telemedicine | Tags: , , ,

John Williams was feeling poorly after a long day of meetings with clients. He had traveled to Los Angeles for a series of presentations for a prospective client and was scheduled to meet with the decision-makers the following day. It was vital that he be at the top of his game, but he was feeling terrible and knew that he needed to see a doctor.

His customary sinus infection was keeping him from preparing for the important meetings.  Away from home, and after regular business hours, John decided to try a new service the hotel bellman had told him about. It would connect him with a doctor via a smartphone application. After downloading the app, John was connected with a board-certified doctor. Fifteen minutes after that, he had a prescription to address his troublesome symptoms and a list of things he could do to help fight-off future infections. He readily paid the $40 fee for the service and went on to complete his mission successfully the following day.

John’s story is becoming more common throughout the country as consumers look for more convenient appointments with healthcare providers. For a relatively reasonable fee, patients are connecting with a licensed physician via their tablet or computer when they are unable to see a doctor through more traditional methods.

The most common treatments available through telehealth include routine respiratory illness, fever, ear and urinary tract infections and skin or eye problems. In many states across the country consumers and physicians alike are enthusiastically embracing telemedicine when it comes to routine medical consultation and treatment for patients that don’t require intensive medical intervention. Online medical exams promise to be more convenient, lower-cost, and are generally offered for a fixed price. But perhaps more importantly, for many time-strapped patients, the usual long wait at a primary-care office or busy emergency room is avoided. The virtual experience is being offered in many states that have established telemedicine rules supportive of expanded virtual healthcare services.

Rules recently proposed by the Federation of State Medical Boards (FSMB) and several state legislatures are likely to hinder the expansion of virtual doctor-patient relationships, like John’s. While the FSMB guidelines simply require that the same standard of care for both in-person and telemedicine services be met for the formation of a valid patient-physician relationship, the proposed regulations in Tennessee will require that a patient-physician face-to-face meeting take place prior to the first virtual experience. Furthermore, additional in-person doctor-patient appointments are required at regular intervals in order to continue future telehealth encounters. While the need for such rules may be founded in legitimate concerns for patient safety, the practicality of such state-by-state restrictions is being debated.

In an era where state boundaries are being blurred by a push toward a more consistent and accessible national healthcare delivery model, consumers are eager to utilize their electronic devices, even for maintaining and monitoring their healthcare. It seems unlikely that restrictive rules, like those contemplated by Tennessee officials, will be able to stand the test of consumers looking for better access and more convenient and cost effective healthcare services offered through telecommunication technology, particularly when such unrestricted access may routinely be available in an adjacent state.

It may be too late for prudent and well-meaning state legislatures and bureaucracies to impose their rules on the new healthcare delivery model.  The more consumers recognize the choices and benefits virtual healthcare has to offer them, the more they are likely to exercise their influence over the regulatory process. Severely restricting or over-regulating virtual healthcare will be like putting the genie back in the bottle.


Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.

Diligently Working To Formulate An Interstate Licensing Solution

Representatives of the country’s State Medical Boards are persistently working on drafting new legislation to revamp the process of the state by state licensing of physicians. Currently physicians are required to be licensed in each individual state in order to practice across state boundaries. The individual state licensing requirement is widely thought to be a major barrier to the expansion of telemedicine.

The proposed plan is thought to offer the most dramatic changes in medical licensing offered to date and, if enacted, could increase access to doctors and specialists for patients located in rural areas and permit people with complex illnesses or rare diseases to more easily consult experts. The proposed interstate compact would speed-up the process of licensing doctors in multiple states while preserving each state’s authority to regulate the practice of medicine within their respective borders.

Under the proposed compact, doctors who meet certain standards could avoid the longstanding requirement that they apply for licenses state by state. The compact would be administered and enforced by an interstate commission consisting of representatives from each participating state.

Mari E. Robinson, executive director of the Texas Medical Board said, “The compact would make it easier for physicians to get a license to practice in multiple states and would strengthen public protection because it would help states share disciplinary information that they cannot share now.”

While the compact proposal is the most aggressive model for change to interstate licensing to date, some feel as though the effort stops short of resolving all the issues. Jonathan Linkous, CEO of the American Telemedicine Association, believes the Federation’s proposition does not go far enough. “Their model is not a reciprocity model,” Linkous recently told MobiHealthNews. “The physician would still have to pay a fee to every state, probably (also) a processing fee, and have a third party handle the paperwork, which may or may not be a good thing. And we don’t know if all the states will adopt it.” The ATA estimates that doctors currently spend $200 million to $300 million a year for multiple state licensing, an expense that contributes to the rising cost of medical care nationwide.

Participation in the compact would be voluntary for both physicians and state medical boards and would only become effective and binding upon legislative enactment of the compact by at least seven states. If adopted by enough states it would be a first step in removing a formidable barrier to rapidly expanding the use of telemedicine nationwide.

Restrictive Rules On Use Of Telemedicine – Is It To Protect Or To Preserve?

The Tennessee Board of Medical Examiners (TBME) recently issued proposed changes to regulations governing the delivery of medical care through telemedicine technology. Patients in that state who seek care through telemedicine may soon be faced with new, complicated and restrictive regulations. Proponents argue the new rules are necessary to ensure that every patient in Tennessee has a primary care physician.

One of the most controversial rules mandates that patients have a face-to-face visit with a primary care doctor prior to receiving telemedical treatment. In addition, the new rule requires the patient to receive an in-person appointment with a physician annually or on the fourth consecutive time the patient receives care. Vaughn Frigon, chief medical officer for TennCare, the state’s Medicaid program, explains, “We want every patient in the state to say, ‘I have a primary care doctor,’ and that their initial access is through the primary care provider.”

In a time when general practice or specialized care physicians are in short supply, particularly in a state with large rural communities whose residents often do not have access to much needed healthcare, it is difficult for telemedicine advocates to understand how such restrictive regulations will provide rural Tennesseans with better or easier access to either general or specialized healthcare. It is as if the residents of geographically challenged rural areas had the opportunity to utilize a new state-of-the-art super highway to deliver better, less expensive life sustaining benefits offered by the outside world, only to have new restrictions levied to frustrate its use.

Applying the TBME logic to this scenario would mandate that anyone using the new improved highway would first be required to take the old path, slowly winding through the mountains on the old, more dangerous narrow roads so as to ensure the traveler has the opportunity to have the appreciation for the longer travel time and the abundance of beautiful scenery. To be certain that no one misses the experience, once each year, or every fourth trip, each traveler must repeat the more difficult journey.

This analogy may be over-simplified due to the fact that face-to-face medical care is important and will always have an important role in the delivery of quality patient care, but the comparison emphasizes that telemedicine is not a different or a lesser valued form of healthcare, only a different, and in most cases, less expensive and efficient means of delivering healthcare that improves access and availability to patients in rural and outlying communities.

Meaningful regulation across all industries is necessary to ensure the safety and protection of all people and communities. But excessive, though well-meaning, regulations often counter the promises of new technology to improve our lives. Expanding access to efficient, quality healthcare to all people is a worthy goal.