AcuteCare Telemedicine Blog


Telemedicine, the Future Venue for Healthcare

While many believe that telemedicine first made its debut just a little more than a decade ago, the practice of telemedicine can be traced back to the early years of the space program. The National Aeronautics and Space Administration (NASA) pioneered the remote use of physiological measurements of astronauts and telemetered the data back to earth from the spacecraft. These early efforts from the 1960’s enhanced the development of satellite technology which led to the development of telemedicine. The decades since have brought significant advances to the technology, lower costs of equipment and an expansion of the potential uses in the medical industry.

Advancements in the fidelity, mobility and affordability of technology is changing the landscape for healthcare delivery. As the digital gadgetry becomes smaller, more portable and easier to use patient/consumers are advancing their expectations of telemedicine as payers look to reduce the costs of routine medical care and shorten the length of hospitalization. There is a vast array of new technology being applied to healthcare that promises to give patients more responsibility and control over their health and fitness. Wearable technology and wellness devices enable users to continuously monitor their vital signs and track their progress towards their fitness goals.

Future wearable devises will focus on accuracy and data integration as well as visualization capabilities; virtual models that promote the patients understanding and significance of the all the wellness data generated by the wearable devise.

The newest digital health trend, nanotechnology, may have a significant impact on healthcare. Nanotechnology’s precision and accuracy can aid in designing new drugs to specifically match a patients needs or monitor the progress of cancerous tumors in a patient’s body. While still in its infancy, nanotechnology is expected to be a significant digital health trend in coming years. Artificial intelligence is another digital health trend that will help physicians track a patient’s health and identify danger signs before an onset of a heart attack or stroke. As the costs of genome sequencing continues to decline, integration of personal genetics and research will advance the practice of genomics in the next few years.

“Access, cost, and convenience are driving it (technology) forward, plus advancement in technological capabilities”, says John Jesser, vice president of engagement strategy at Anthem Blue Cross, an affiliate of the Indianapolis-based WellPoint. “Historically, telehealth meant expensive video conferencing equipment in a clinic at one location and expensive video conferencing in a hospital somewhere else. (The technology) now allows doctors to log in and log out easily at their convenience and it allows patients to seek care when they want it, from their iPhone or Android. That’s changed everything,”

As virtual health initiatives move forward, new and valuable trends and telehealth technology solutions will continue to emerge and be adopted as the traditional methods of delivering medical care are challenged and disrupted at medical facilities, physicians’ offices and hospitals. The venue of choice for patients seeking medical in the future will more likely be smartphones, laptops, and tablets. The preferred provider will have to be knowlegable and comfortable with this rapidly changing healthcare delivery landscape.



Making a Meaningful Difference to Lives around the World

It has been a little more than a year since Georgia Partnership for TeleHealth (GPT), the Louisiana State University Health Science Center (LSU) and Casa Para Ninos Aleluya (CASA) launched its first international telemedicine program. The mission of the collaboration is to deliver much needed primary and specialized medical care to the children of the CASA orphanage through the use of telemedicine technology.  The orphanage is home to over 400 abused, orphaned and mistreated children and is located just outside of Guatemala City. The medical needs of hundreds of the children at CASA are met daily through a few nurses that manage a clinic on-site.

Shortly after the Program got underway, Dr. James M. Kiely, a partner in Atlanta Neurology, P.C., AcuteCare Telemedicine (ACT) and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta was given the opportunity to demonstrate telemedicine capabilities at the orphanage and volunteered his time and talents to render virtual care to the youth of CASA.

Dr. Kiely remotely treated a 19 year old CASA patient with a history of intractable epilepsy. The young patient was on numerous medications but continued to experience recurring seizures. By using a high definition audio-visual connection provided by GPT, Dr. Kiely was able to interview the patient’s parents and examine the patient remotely. The imaging results, hemiparesis, and description of seizures allowed him to determine that the likely type and cause was attributed to porencephaly, the failure for one hemisphere of the brain to develop. Kiely was able to recommend appropriate medications to on-site doctors and to suggest additional steps to take if the patients epilepsy remained intractable. The process worked flawlessly and marked the beginning of a new relationship between the missions and medical providers across the region.

At a recent GPT Telehealth Summit this year in Florida, Dr. Kiely was brought up to date on the patient he first treated more than a year ago at the orphanage in Guatemala. A family member of the patient has recently received his Master’s Degree. He is now serving an internship with the Georgia Partnership for Telehealth who continue to provide ongoing support to the children of the Guatemala region through donated physician time. He had the opportunity to speak with Dr. Kiely and informed him that the young patient, his sister, is doing well.

Dr. James M. Kiely says, “I am so invigorated when I’m able help a patient and to make a meaningful difference in their future. Whether here at home, or around the world, it is extremely rewarding.”



Dr. Lisa Johnston, as CFO, finds AcuteCare experience to be priceless

Knowing how to analyze, organize and execute made her a star point guard on her undefeated high school basketball team, on Long Island, N.Y.

Those same qualities now in her professional life enable Lisa H. Johnston, M.D., to shine as the chief financial officer and founding partner of AcuteCare Telemedicine.

From Queens, N.Y., originally, it was at a young age that she decided to become a doctor. “I remember going to see my doctor at his house and thought, ‘Wow, he gets to work at home and make sick people feel better’,” Dr. Johnston says. “I remember looking through encyclopedias to figure out how old I would be when I graduated from medical school. Funny how it was so old then and so young now,” she laughs.

Initially, she wanted to become a physiatrist, but studying Neurology as an elective caused her to change course. “I remember seeing a man in a wheelchair whose left arm kept hanging out of the chair. I thought, ‘doesn’t he know it’s getting caught in the spokes,’” Johnston says, “and the resident said, ‘he had a stroke in his right parietal lobe. He has neglect and doesn’t know that’s HIS left arm.’ And that was it for me. I was completely sold after that.”

Dr. Johnston received her BA and MD degrees from Brown University and completed her initial post graduate training at Rush Presbyterian St. Luke’s Medical Center in Chicago. She was trained in Neurology at Emory University Hospital, where she also completed a fellowship in Sleep Medicine. Dr.  Johnston is a partner in Atlanta Neurology, P.C. and served as Medical Director of the Sleep Disorders Center at Northside Hospital. She is board certified in Neurology and Sleep Medicine.

Creating AcuteCare Telemedicine in 2009 was an easy decision for Dr. Johnston and her partners. “We had an opportunity as a group to provide telemedicine services at a community hospital nearby,” Dr. Johnston remembers. “We realized that we could provide the same service to other similarly situated hospitals; alas, ACT was born.”

Knowing the value of teamwork, Dr. Johnston says she and her colleagues share a work environment that is trusting, reliable, and cohesive. “We four partners of ACT are very fortunate that as physicians we have worked together for the past 15 years, sharing patient cases, new ideas and future goals. On call duty, in certain ways, can be a very solitude and at times daunting part of being a physician. There is comfort in knowing that there is always a partner that is willing and able to provide backup if needed.”

Dr. Johnston notes their commitment is multi-faceted. “Not only are we the physicians taking care of patients through ACT, we are the owners of ACT,” Dr. Johnston says. “We have a vested interest, not only in providing superior quality care of patients, we have an interest in making our company thrive. There is an all-around positive energy into everything we do – caring for our patients, and caring for our company. It’s a great environment to be a part of.”

She sees the healthcare environment for telemedicine as an increasingly expanding area. “Unfortunately there is an exodus of neurologists away from hospital work and on call duty. There is a particular lack of neurologists in many rural hospitals,” Dr. Johnston says. “As the trend continues, the need for telemedicine is only going to grow, especially in the field of Neurology, where assessing an acute stroke patient can be swiftly and completely performed via remote presence.”

Dr. Johnston finds her inspiration in the fast-paced, challenging work that emanates from remote presence. “You are talking about trying to intervene either to save someone’s life or improve their quality of life, within a limited period of time. You have to be there ‘now’ and you have to be on,” she says. “You have to decide whether to take the jumpshot or pass the ball inside … and the clock is ticking.”

Edward Herring’s relationship with his daughter is a pillar of Dr. Johnston’s success today. Her late father would have been 90 years old this year. “My dad (with mom’s support of course!) made tremendous sacrifices for me and my brother; some sacrifices that took me until adulthood to appreciate,” Dr. Johnston says. “His own dreams were deferred in order that ours could be realized. I know that he would not have had it any other way.”

In what spare time she gets, Dr. Johnston enjoys traveling, photography and spending time laughing and simply enjoying life with her husband and their teenage son.

For Dr. Johnston, being able to care for patients on an emergency basis through AcuteCare Telemedicine is invaluable. “I know that when ACT is called to see a patient for an acute stroke, there is no other neurologist at that time at that facility who is available to provide care and that’s what makes the work ACT does so impactful. We are providing care to patients that otherwise might be delayed or simply unavailable,” she says. “To me, to be able to serve in this manner, is priceless.”



Positive Patient Outcome Advances the Telemedicine Delivery Model

Recently a team of researchers from UCLA completed a major study on the use of tissue plasminogen activator, or tPA, on stroke victims within 4.5 hours after the stroke occurs. That study of more than 50,000 stroke patients, as reported in a recent issue of JAMA, The Journal of the American Medical Association, confirms that the sooner tPA is administered, the better chance of recovery.  In response to the study, AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology is making an aggressive push to help smaller hospitals and networks that don’t have immediate access to neurologists.

Their efforts have proven to be life saving for one Ozark, Alabama resident and recent stroke victim.  The collaboration between ACT and the Southeast Alabama Medical Center (SAMC) is having its desired effect for SAMC patients, providing once unavailable, advanced life saving treatments to stroke patients. The Stroke Care Network, established in Dothan, Ala., in collaboration with ACT, the Southeastern Alabama Medical Center Foundation and the Alabama Partnership for Telehealth provides stroke services for a 240-square-mile swath that includes southeast Alabama, southwest Georgia and the Florida Panhandle.

The collaboration was initiated when Cecilia Land, SAMC’s division director for rehabilitation services discovered an increase in the areas mortality and morbidity due to stroke. “We recognized an immediate need to establish a stroke care network, providing patients with access to 24×7 teleneurology,” said Land.  SAMC officials hope to add more “spokes” to the network, in the form of hospitals and clinics, and also want to use the network to educate communities on the importance of wellness and identifying precursors to a stroke.  Dr. Keith A. Sanders from AcuteCare Telemedicine hopes to extend ACT’s telemedicine platform to other specialties, such as telepsychology, and he expects more hospitals and health networks will buy into the system as executives see the benefits of sharing specialist services without having to house them on-site.

This most recent life-saving patient outcome from the collaboration between ACT and SAMC is proof that the new telemedicine health care model is an excellent vehicle to advancing the availability and quality of telestroke care to SAMC patients and to underserved patients all around the country.



CMS Expanding Telemedicine Coverage

The Centers for Medicare and Medicaid Services have proposed rules that would provide telemedicine services to nearly 1 million new Medicare beneficiaries.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services.

The first change would extend reimbursable telehealth services to “originating sites” serving nearly one million rural beneficiaries living in large metropolitan areas. Currently, Medicare uses a strict county-based classification to enforce its rural-only rule for telemedicine coverage. The new rule would create a more precise urban/rural distinction based on geographically smaller census tracts.

The second proposed change would increase coverage for transitional care management services under Current Procedural Terminology (CPT) codes 99495 and 99496, involving post-discharge communication with a patient and/or caregiver. Reimbursement of these services will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions.

Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association cautiously supports the change and in a statement said, “This is one small step in the right direction.  For 15 years the federal government has placed strict restraints on the use of telehealth while employers, private payers, states and many other nations have moved boldly forward, improving the quality and reducing the cost of care. It is time to unleash the power of modern technology and allow Medicare beneficiaries, regardless of whether they live in a rural area, underserved inner-city, in a clinic or at home to be eligible to receive the benefits of telehealth.”

The proposal is currently open for comment and ATA encourages all telemedicine advocates to express their support.  The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world.



States are Leading the Way on Telemedicine Expansion

The states of Missouri and Kentucky are the two most recent states that are making significant strides in increased implementation and utilization of telemedicine.  Effective Jan. 1, 2014, a Missouri law (House Bill 986) makes private insurers responsible for reimbursing providers offering telehealth services just as these payers are for in-person services.  The bill states that insurers “shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.”  While the new legislation benefits patients with private insurance payers, Missouri law still lacks provision for Medicaid beneficiaries.

In Kentucky, where state laws are in place for private and public payers, the legislators have expanded coverage of telemedicine services for Medicaid beneficiaries so long as these are delivered exclusively by way of interactive video-conferencing. The telehealth services covered by the law are extensive, ranging from mental health evaluations and care management to diabetes and physical therapy consultations.

These most recent events are indicative of individual state legislatures making the most aggressive progress towards removing regulations and passing legislation to accommodate the new technology’s use, while the federal government continues to focus on achieving a last place finish in the race for expansion.

American Telemedicine Association (ATA) CEO Jonathan Linkous said in a public statement recently. “The federal government places unnecessarily strict barriers and restraints on how Medicare patients are served when they deserve access to quality healthcare, regardless of geographic location and technology used.”

Kentucky and Missouri are joining a growing list of states that are realizing the benefit of telemedicine as a cost-effective delivery model for quality healthcare even though the two states have taken different approaches to expand access to telemedicine services. “This is a true win-win scenario,” said Jonathan Linkous, “First, it is a big victory for patients in Kentucky and Missouri, who now have greater access to the best-possible healthcare. It’s also a win for the treasury and taxpayers in those states, who will save significantly on public healthcare costs.”

With healthcare costs rising rapidly and access to specialized care diminishing for many Americans, it is well past a reasonable period of time for the top payer of medical services, the federal healthcare agencies and the U.S. Congress, to pick up the pace on making advances in passing and implementing legislation that will promote the advancement of telemedicine throughout the entire country.



Minority Communities May Benefit Most from mhealth Technology

Mobile Health (mHealth) is the newest entrant in the world of telemedicine.  Delivery of health services by way of mobile, smart phones is promising to be a quickly expanding healthcare delivery device and minority communities may be the segment of population that will benefit the most from the technology.  The Joint Center for Political and Economic Studies recently released a report entitled “Minorities, Mobile Broadband, and the Management of Chronic Diseases,” which evaluates the vast potential of mobile broadband technologies to help address our nation’s most pressing health concerns.

Diabetes, heart disease, cancer, arthritis, and obesity claim the lives of 7 out every 10 Americans each year and these chronic diseases affect minority communities disproportionately, with many individuals lacking the ability to effectively treat and monitor their health due to geographic, financial, cultural and linguistic barriers.  mHealth may be the answer to breaking down barriers to minorities receiving treatment for these chronic conditions.  With more than 63 percent of the minority population having access to mobile devices like smartphones and “pads”, equipping them with functionally relevant mobile applications can enhance the doctor-patient communication and empower patients to make informed healthcare decisions.

Some of the report’s policy recommendations include:

  • Ensure universal access to mobile broadband for households in both un-served and underserved areas.
  • Reform regulatory barriers that limit the use of non-traditional medical treatment.
  • Create incentives for physicians to use mobile broadband-enabled technologies for current and preventative care.
  • Avoid excessive and regressive taxation on wireless goods and services.

According to the latest industry data available, there are presently 31,000 health, fitness, and medical related apps on the market, and the rate of new introductions is growing rapidly. According to Washington, D.C.-based eHealth Initiative, the number of smart phone apps increased 120% during the past year alone and while there are hundreds of the apps that really work and are completely legitimate, the medical community has legitimate concern about many of the products safety and effectiveness.

Patients, physicians, and the vast mHealth community are profoundly optimistic about the future of health apps in bringing much needed medical care to those who suffer from chronic illnesses, not only in the minority communities but the increasingly aging population as well.