AcuteCare Telemedicine Blog


Study Reveals Application of Telemedicine Delivers Positive Outcomes

A recent study by The Agency for Healthcare Research and Quality (AHRQ) entitled Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews, indicates that that the application of telehealth delivers the most positive outcomes when used for remote patient monitoring, the treatment of several chronic health conditions and for psychotherapy as part of overall behavioral health. The leading chronic conditions, for telehealth success was cardiovascular and respiratory disease, according to the AHRQ study. The study’s authors also said that “research into practice-level implementation should be the next step, particularly since the vast majority of research conducted to date has been conducted within old and possibly soon-to-be-outdated care delivery models.”

The purpose of the study was to provide an overview of the large body of data about telehealth for use by healthcare decision makers. The approach used was to create an evidence map of systematic reviews published to date that assess the impact of telehealth on clinical outcomes. According to the report, the focus of future systematic reviews could include telehealth for consultation, uses in intensive care units and applications in maternal and child health. In addition, telemedicine for triage in urgent or primary care, management of serious pediatric conditions, patient outcomes for TeleDermatology, and the integration of behavioral and physical health were earmarked by AHRQ as ripe for analysis.

Healthcare remains a system where service is delivered primarily through in-person interactions, but many hospitals, physician groups and clinics as well as tech-savvy patient/consumers are turning to telemedicine to effectively and efficiently deliver and receive healthcare services regardless of their geographical location. The rise of utilization of telemedicine is one of the largest and most disruptive shifts in healthcare delivery over the last decade. With recent advances in telemedicine technology, an impending evolution in legislation governing the use of telehealth and falling regulatory barriers predicate that 2016 may be a turning point for the increased adoption of telemedical technology in the delivery of healthcare across a full spectrum of healthcare disciplines.



Continuity of Care in Telemedicine

Continuity of care is a fundamental factor in the delivery of quality healthcare and a bedrock principle of the patient-doctor relationship. It is understood to be a critical element in all health care systems and has shown to be responsible for reducing hospitalizations and lowering costs, particularly among chronically ill patients.

Traditionally, continuity of care is the delivery of a “seamless service through integration, coordination and the sharing of information between different providers.” The increasing complexity of healthcare delivery is complicating the assurance of continuity of care. Virtual interactions between patient and caregiver and a plethora of health related monitors, devises and mobile apps, has some believing the increasing complexity in healthcare delivery might impede the achievement of continuity of care. Even in a traditional face-to-face care relationship, it is common to have more than one care provider across the process of diagnosis and treatment. Add options like retail clinics, e-visit websites, smartphone apps, freestanding urgent care centers and kiosks and continuity of care could be compromised by all the disruptive innovation.

For this reason much debate about telemedicine and the effect it is imposing on healthcare delivery has been centered on the doctor/patient relationship and the adherence to maintaining a high standard of care, regardless of the method of interaction. While the importance of the patient and physician in the new electronic relationship is well understood, there is a third component essential to the successful integration of telemedicine. The ability to access patient’s medical information is critical to extending continuity of care for patients as well as improving transparency between telemedicine providers and healthcare organizations.

AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services for healthcare organizations for stroke and other neurological care, is providing technology enabled services to healthcare providers for the delivery of high-quality clinical care virtually anywhere, anytime. ACT has been on the forefront of the use of this technology for years, remotely delivering live and interactive Telestroke and other Teleneurology assessments to patients at hospitals and emergency medical centers throughout the nation. At Bon Secours Neuroscience Institute in Richmond, Virginia, Patricia Lane comments on their collaboration with ACT, “I just love the technology and clinical solutions platform. It allows for continuity in communications from doctor to doctor and permits the real-time sharing of information between care-givers. Our ultimate goal is to provide a better treatment plan for each patient.”

Integrating telemedicine connections into a secure electronic medical record system designed with familiar digital formats, functions and cutting edge security measures in order to ensure the highest level of patient confidentiality will be essential to insuring quality and continuity of care and answer much of the concern over the new disruptive healthcare delivery model.



The Marriage Between Technology and Telehealth Providers

Telemedicine is fast becoming the most promising break-through in the delivery of healthcare in the last century. While the promise has many championing the cause for expanded and universal use, some challenging hurdles remain in the way. Legislatures and medical boards are busy modifying regulations, payment structures, licensing and credentialing at various pace but one particular road block could derail the telehealth train if a workable connection is not soon found.

The video connection with the doctor is meeting the patient’s expectation for quick healthcare, but the process can often be overwhelming to providers who must sync the new service to their existing EHR platform. The key to a solution lies in creating a new virtual care environment within the providers existing EHR. James T. McElligott, MD, medical director for telehealth at the Medical University of South Carolina, is among a handful of health systems around the country that are pioneering virtual visits on a sustainable and scalable platform. “If you try to do something outside of that platform, there are downstream effects that end up making things very difficult” for the provider.

While some of the industry’s largest providers of EHR platforms have been slow to answer the call for a solution, smaller companies are making the connection happen for an increasingly larger number of provider clients. “We see time and again that workflow integration and ease of use are crucial factors to physician adoption of telehealth technologies,” Eran Westman, Vidyo CEO.

In a recent article by Eric Wicklund and published in mHealth Intelligence, titled “Virtual Care Within the EHR May Be a ‘Game-Changer”, the author reports on how some innovative companies are integrating creative solutions to the challenges presented when attempting to marry telemedicine services and existing electronic health records (EHR).

The idea of an electronic medical recording system was imposed upon an unprepared and often reluctant provider market several years ago. Many of the early glitches’ and bugs, that traditionally come with the roll-out of any new software system have been addressed, but the memory of the “fixing” process is fresh in the minds of many early users, leaving them less than enthusiastic about integrating still newer technologies into their daily routine.

It is becoming very clear to many in the healthcare industry that the once casual attitude towards telemedicine is changing as more and more applications for telecommunication technology in the delivery of healthcare become a reality. The disruption will continue. Telemedicine and EHR’s are not going to go away. Negotiating a workable union may indeed be the all-important game-changer for expanding telehealth.



The Era of Resisting Telemedicine is Fleeing

Despite the promise of significant consumer benefits of access and costs and the overall growth of Telemedicine, many patients and physicians are slow to adopt new communication technologies in the delivery of healthcare. A recent article in Medical Economics News reported that “A HealthMine Survey of 500 consumers who use mobile/Internet-connected health applications finds that 39% still have not heard of telemedicine, and only one-third of respondents say their health plan offers telehealth as an option.” And while many patients have not yet signed on to telehealth services, nearly three quarters of patients are interested in using it in place of in-person medical appointments. Could it be that the slow progression of patient participation may be due to resistance and lack of participation from care providers?

One of the most prolific reasons many providers resist the technology is the concern that patients would be unwilling to replace traditional face-to-face physician encounters with a virtual relationship and that many consumers would be fearful of the technology, particularly those among the growing number of “Baby Boomer” patients. But in a recent Georgetown University study, the results indicated that more than half of the aging generation preferred to use this technology. And among those 34 years of age and under, 60 percent desired a virtual interaction with their physician.

Some of the complaints from cautious physicians revolve around the complexity and cost of technology hardware and software and the difficulties in merging new platforms into existing operations, particularly syncing virtual experiences with current EHR systems. Ongoing design improvements in the technology and simpler user interfaces are driving down cost and simplifying required functions. The reality today is that telemedicine improves the bottom line for most medical practices while reducing appointment management and patient flow issues.

As legislatures across the country continue to make progress on modifying existing regulatory barriers and concerns involving payment parity, payer participation and individual state licensing and credentialing, many early telemedicine supporters are beginning to see the light at the end of the increased adoption tunnel. For those providers who continue to resist the trends of virtual medical technology, the time is nearing to overcome the natural tendency to resist and fear change. The simple truth is patients prefer and want telehealth choices and the technology is here to stay.



What’s In Your Digital Health Tool Box?

The early implementers of telemedicine faced resistance, skepticism, and predicted peril from an industry that has followed a standard of care, governed by regulations. Those initial trailblazers have prevailed in their efforts to improve access to specialized care for patients living afar from major medical centers, enhancing patient’s healthcare experiences and reducing the unnecessary cost of specialized treatment and ongoing chronic care. Their persistent efforts to merge the latest digital technologies in communication with modern medical care has spawned new terms to languages all around the world; Telepsychiatry, Telestroke, Telemedicine, TeleICU and Telehealth, just to name a few.

Technology is having a wider impact on how healthcare providers connect with their patients and dispense treatment. This connected health revolution is making everyone active participant’s in their healthcare through an ever expanding network of devices and platforms. But as is often the case, development of new technology can outpace the ability of an industry and their consumers to accept and engage the new methods.

Consumers have demonstrated an impressive demand and utilization of digital healthcare tools like activity trackers, smart watches and their accompanying health apps, but nearly half of the users complain that their caregiver is failing to integrate the data into a personalized healthcare plan. A survey, conducted by HealthMine, called “The State and Impact of Digital Health Tools,” found that “a significant amount of digital health data is not reaching doctors or health plans and that there appears to be a disconnect between where consumers would like their self-collected health data to go and how easy it is to share it.”

Many physicians articulate an understandable concern about the accuracy of many of these devices and the process of collecting and transferring the data. In a recent article Vaughn Kauffman, a global practice leader in PwC’s Health Industries Advisory, indicated that physicians have some apprehension around taking in data from mHealth devices and wearables. “Some providers are further down the road than others around utilizing these kinds of data for engagement. There’s the potential to extend the doctor-patient relationship to beyond the direct doctor visit interaction. And obviously, this would involve individuals opting in, as opposed to kind of a Big Brother phenomenon.”

While wearables continue to be popular, many once avid users are discontinuing their engagement with the technology. Some indicate their waning interest is due to not understanding how the data collection will benefit them or enhance their digital health plan. Education and better understanding of the technology and how it can benefit both providers and patients in improving the delivery of healthcare will solidify the acceptance and use of the technology. The early pioneers of telemedicine have opened the trail to a much larger spectrum of services but wider engagement is still dependent on the ability of technology to deliver on its promises.



Is That The Sound Of Ice Breaking?

Until recently, the state of Arkansas was ranked last among all states in a recent report by the American Telemedicine Association on telemedicine practice standards. Like many other states, Arkansas’s treatment of healthcare via telecommunication technologies included restrictions forbidding caregivers the opportunity to treat a patient remotely without first establishing a face to face relationship. While other regulations purposefully and effectively deal with commonly acceptable policies that hold virtual healthcare treatment to the same standards of care as traditional in-person encounters; control the prescription of certain drugs via telemedicine; require the responsible handling of medical recording; and doctor/patient transparency, the restrictions on non-pre service face to face encounters and the insistence on individual state licensing of physicians is arguably the two regulations which proponents of telemedicine feel are hindering the wider adoption of telemedical services across the country.

Recently issued proposed amendments to its existing regulations have been approved by the State Legislature. Arkansas Code 17-80-117, will allow a doctor to establish a valid relationship with a patient without the need for an in-person exam, if the doctor “performs a face to face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination.” The rule also requires the doctor to establish a face to face follow-up visit when and if it is medically necessary.

The sound one hears from this action may just be the noise regulatory ice makes when it is breaking under the pressure of consumer demand and the application technological common sense. While the proposed changes do nothing to alleviate the cost and inconvenience of individual state physicians licensing requirements, the removal of the face-to-face, pre-telemedicine service requirement could open up the virtual care landscape in states where the face-to-face regulation still exists.

The Arkansas Board held a public hearing involving the proposed amendment to Regulation 2.8 and new Regulation 38 in June and encouraged telemedicine companies and healthcare providers looking to offer telemedicine services in Arkansas to review the proposed regulations and consider submitting comments.

Adoption of the proposed changes to Arkansas rules governing telehealth services may be seen as a water-shed action for healthcare professionals who believe consumers will benefit from both increased healthcare access and reduced cost when telemedicine is permitted to more freely expand across state lines.



Telemedical Technology: Creating a Healthcare World without Barriers

As with many other high tech gadgetry, revolutionary processes and scientific inventions telemedicine has its roots in the NASA space program. For those early adopters of telemedicine, the efficacy of the doctor/patient consultation and the ability to improve patient outcomes were on the top of the list for barriers to entry. Many thought that patients would be hesitant to trade personal face-to-face visits with their doctor for a consultation through a virtual robot. But as early adopters used the technology to bring specialized care to remote and distant rural areas, patients soon realized the convenience and cost savings of not having to travel long distances to receive the latest in specialized healthcare, and soon embraced the new experience in connecting with a doctor.

The process is now considered to be an ideal use of technology to monitor and connect healthcare professionals with patients over long distances. With the introduction and increasing popularity of wearable technology, the existing digital info-structure in many rural areas of the country limited the expansion of telehealth. With the recent introduction of ConnectAll, a new federal initiative aimed at building broadband parity across America, is expected to provide nearly 20 million more Americans with access to telemedicine. “The expansion of affordable Broadband will further solidify the rapidly growing telemedicine sector, which is transforming the healthcare paradigm,” said Jonathan Linkous, CEO, American Telemedicine Association (ATA). “This initiative helps to deliver the promise of more cost-effective healthcare delivery models, and promotes the expansion of telehealth services for all.”

With Medicare, Medicaid, and private health insurance carriers continually expanding the number of virtual services approved for reimbursement, a once formidable obstruction is disappearing all across the country and the world. A growing number of healthcare providers are now expanding their reach. “This is a world without boundaries, and that’s what we’re seeing,” said Andrew Watson, MD, chief medical information officer for University of Pittsburgh Medical Center’s (UPMC’s) International and Commercial Services Division, “The advent of telemedicine in a world without boundaries is no different than using Facebook or Skype around the world. We’re just seeing this technology impact medicine.”

But not all of the walls to expansion have been breached. Much remains to be done to remove existing impediments such as state by state licensing and credentialing requirements. The established healthcare regulatory system with its myriad of governing bodies, Boards, and legislatures continues to be a formidable foe when it comes to interjecting new technology into the traditional face-to-face experience between the healthcare provider and patient. “In-person visits will likely remain the mainstay for local care for those fortunate enough to be around many physicians, but when minutes count in emergencies experts can step in and make the decisions that will determine a lifetime of health instead of a lifetime of disability. Telemedicine isn’t a fad but rather a disruptive innovation that flows naturally out of technological advances and has already contributed immensely to our society’s health. It’s a perfect fit for our shrinking resources,” says Matthews W. Gwynn, M.D., Partner, ACT.

ACT has been on the forefront of the use of telecommunication technology for years, remotely delivering live and interactive telestroke and other teleneurology solutions anytime, anywhere to hospitals and emergency medical centers throughout the Southeast. Progress in reforming the massive healthcare regulatory system is occurring as dedicated industry leaders tackle the challenges of integrating advanced remote medical technologies into the existing mainstream healthcare delivery model.