AcuteCare Telemedicine Blog


AcuteCare Telemedicine Partners With Emory Saint Joseph’s

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EMORY Health Sciences News

Emory Saint Joseph’s Hospital launches Telestroke program

ATLANTA—Emory Saint Joseph’s Hospital is improving treatment for stroke patients with the launch of a Telestroke program, which allows neurologists to remotely evaluate patients around the clock through real-time conferencing with a Telerobot monitor.

AcuteCare Telemedicine (ACT) and InTouch Health have partnered with Emory Saint Joseph’s to bring these extended teleneurology services to the hospital. This virtual, high-tech clinical care includes a camera, microphone and speaker in order for the physicians to communicate directly with patients and provide a rapid diagnosis.

The faster a patient receives the proper treatment for stroke, the better the chances for recovery. With this new telemedicine program at Emory Saint Joseph’s, patients may avoid the debilitating effects of stroke that occur due to late diagnosis or delayed administration of clot-busting drugs.

“The advancements in teleneurology not only allow us to access more patients in need of our specialized care, but improves patient outcomes overall,” says Keith Sanders, MD, medical director of Emory Saint Joseph’s Primary Stroke Center. “This new collaboration with Emory Saint Joseph’s is sure to have a significant impact on the patients and communities we serve.”

Patients arriving in the emergency room exhibiting signs of stroke such as numbness or weakness in the face, arm or leg, trouble speaking and walking or other symptoms, will have the Telerobot placed at the foot of their bed, so the physician has the ability to assess their condition and communicate treatment recommendations immediately.

Along with Sanders, fellow AcuteCare Telemedicine physicians Matthews Gwynn, MD, Lisa Johnston, MD and James Kiely, MD are on-call 24/7 to work with the Primary Stroke Center Team at the hospital. During the evaluation, the physician asks the patients if they have had any difficulties with speaking and movement, and then encourages them to perform basic tasks, such as lifting their arms and legs and touching their fingers to their nose.

Once the evaluation is complete, the physician makes a diagnosis and communicates treatment recommendations to emergency medicine doctors and the Primary Stroke team members.

“Time is brain,” says Regina Minter, RN, Quality Management Specialist for Emory Saint Joseph’s Primary Stroke Center team, stressing the importance of a rapid stroke diagnosis and treatment. “The Telestroke program will enable us to give tPA in a quicker amount of time for the benefit of our patients,” she says about the FDA-approved medicine that works by dissolving the clot and improving blood flow to the part of the brain being deprived. If administered within the first three hours, tPA may improve the chances of recovering from a stroke.

Emory Saint Joseph’s treats more than 400 stroke patients a year, and joins Emory Johns Creek Hospital as the second hospital within Emory Healthcare to offer the Telestroke program. Since 2009, Emory Saint Joseph’s has been certified as a Primary Stroke Center, and is designed to provide emergent and acute stroke care. The multidisciplinary team includes ancillary, emergency and neurovascular services, a clinical decision unit, neurovascular units and a designated ICU.

Emory Saint Joseph’s has been recognized on the “Target: Stroke Honor Roll” by the American Heart Association/American Stroke Association (AHA/ASA), meaning 50 percent of ischemic stroke patients arriving at the hospital received tPA (door-to-needle time) within 60 minutes of arriving. The AHA/ASA also recognized Emory Saint Joseph’s with the “Get with the Guidelines-Stroke” Gold Plus Quality Achievement Award for treating stroke patients with 85 percent or higher adherence to all “Get with the Guidelines-Stroke” achievement indicators for two or more consecutive 12-month periods.

Stroke is the number five cause of death and a leading cause of adult disability in the United States, according to the American Heart Association/American Stroke Association. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

Since the inception of the Telestroke program at Emory Saint Joseph’s, patients have already benefitted from the rapid response of the neurologist, which takes an average of four minutes. “The first day we launched the Telestroke program, a patient was admitted with acute symptoms of stroke. After careful assessment, we were able to administer tPA immediately with great success,” Sanders says.

About Emory Saint Joseph’s

Emory Saint Joseph’s Hospital was founded by the Sisters of Mercy in 1880, and is Atlanta’s longest serving hospital. The 410-bed acute-care hospital is recognized as one of the leading specialty-referral hospitals in the Southeast. As one of only three hospitals in the world to earn a fifth consecutive Magnet designation for nursing excellence from the American Nurses Credentialing Center, Emory Saint Joseph’s is also a leading provider of progressive and innovative medical care in a range of specialties from oncology and orthopedics to cardiology.

Emory Saint Joseph’s Hospital is a member of Emory Healthcare, the largest, most comprehensive health system in Georgia.

Media Contact: Mary Beth Spence, Marybeth.spence@emoryhealthcare.org, 678-843-5850



The Personal Side of Acute Stroke Intervention

Mr. Rigby was found unresponsive, gazing to the right and unable to move his left side. Just moments ago, his nurse had seen the 91 year old awake in his hospital bed preparing himself for discharge from the hospital. Though the hospital lacked a neurologist, it had invested in telemedicine services. Immediate assessment of his acute neurological deficits would determine whether treatment with tissue plasminogen activator (tPA), a clot-busting medication, or even thrombectomy (direct mechanical extraction of the clot) was appropriate. If performed within a very short time window, tPA or thrombectomy would open arteries and prevent progressive death of brain cells. However, it could also lead to hemorrhage, bleeding into the brain that could be devastating and even life-threatening. Thus, the teleneurologist was charged with not simply recognizing Mr. Rigby’s stroke symptoms, but also those factors which make the risk greater than the benefit.

As the AcuteCare Telemedicine physician on call, I was at the bedside within minutes via remote presence technology. The evidence; left hemiparesis, left visual field loss and inability to speak, made it clear; Mr. Rigby had sustained a large right hemisphere stroke. A large artery, the MCA, was blocked by clot. His nurse knew the exact time of symptom onset. Without treatment he may have survived, but it was likely he would not walk or talk. He met every inclusion criteria for tPA. Unfortunately, Mr. Rigby was not a good candidate. He had undergone a surgical procedure just the day before, his anticoagulation had been restarted that day and his platelets were very low. At the age of 91 years with these risk factors, the likelihood of serious hemorrhage was too great. As I informed the family members that had filled the hospital hallways, a look of desperation filled their eyes. His daughter stated, “This man is worth-saving.” Remembering my Hippocratic Oath, my immediate response in this case was, “I am certain he’s worth saving, but nobody is worth harming.”

Then I remembered this “case” was her father. I asked her to tell me more about Mr. Rigby. A picture of a family patriarch emerged. He was still vigorous, taking walks daily. He was driving. Indeed, he still routinely played 9 holes of golf. But what she told me next illustrated the shortcoming of using population-based inclusion and exclusion criteria as the sole determinant of risk-benefit for an individual. Mr. Rigby was the caretaker of his 89 year old disabled and blind wife. Without the ability to walk and speak not only Mr. Rigby would suffer. I made an immediate call to the Marcus Stroke Center at Grady Memorial Hospital in Atlanta. The Marcus Center stroke physician agreed the criteria for invasive intervention suggested a high risk, but Mr. Rigby would be given a chance because the potential for benefit was irrefutable. Within a few hours the clot was extracted. Mr. Rigby had an opened artery with full reperfusion. His symptoms improved with only residual left arm weakness. Though speaking slowly, his good humor was immediately apparent. A family had their patriarch back.



Helping Healthcare Go Green

Telemedicine has leveraged technology to help hospitals overcome challenges associated with staffing and transportation extend higher quality healthcare to patients, regardless of their location, while simultaneously reducing costs. Now, we are beginning to understand that telemedicine not only helps hospital facilities run leaner; it may also help them be greener.

Hospital facilities are traditionally located in areas of higher population, often far away from patients living in rural communities. The transfer of these remote patients to hospitals for inpatient treatment demands relatively high energy consumption. With a foreseeable increase in numbers of patients requiring care in the future, these costs can be expected to rise if left unaddressed.

Within the context of changing environmental policy, increased focus must be placed on reducing emissions and energy usage in healthcare policy. Telemedicine has demonstrated positive effects, creating a more environmentally sustainable process by improving inpatient treatment in local community hospitals and improving monitoring of complex diseases in outpatient settings, avoiding unnecessary hospital admissions.

Physicians have traditionally placed a priority patient care over any environmental responsibility, but telemedicine offers opportunities to minimize environmental impact while developing a higher standard of care across the country. By combating energy consumption, telemedicine is improving not only the health of patients, but also the planet.



Beyond TPA: Teleneurology for the Current Decade

Before the advent of therapeutic interventions in the field, the old joke about neurology was “diagnose and adios.” Neurologists were known for our abilities to locate exactly where in the nervous system a problem existed, communicate information to patients and physicians, and then move on. The lack of options for intervention was a vexing and frustrating problem.

Congress declared that the 1990s would be the “Decade of the Brain.” Perhaps because of this – or maybe in spite of it – the 90’s did see huge advances in treatments of many of brain diseases. Early on, the first effective therapy for multiple sclerosis was introduced, followed by several others. Suddenly, a once untreatable disease could be controlled in many cases. Likewise, the treatment of migraine was revolutionized by the development of triptans such as sumatriptan and rizatriptan that effectively aborted the headache without the terrible side effects of nausea or sedation common with previous medications. New seizure drugs arrived on the market that were more effective than their predecessors, with fewer side effects. Botulinum toxin proved to be a significant advance for many patients with movement disorders. More recently, the same treatment is effectively used for chronic headache.

In 1995, tissue plasminogen activator (TPA) was approved for the treatment of stroke. Finally, one of the most devastating neurological diseases could be addressed in a meaningful way with real outcome improvements. Thanks to the same medication used by cardiologists for many years for the treatment of heart attacks, hundreds of thousands of patients can now have improved outcomes after suffering a stroke.

Nevertheless, many patients with stroke don’t improve significantly after receiving this medication, in part because the clot inside an artery did not truly dissolve once the medication was given in the vein. To help solve this conundrum, the TPA could be given directly into the blocked artery by a catheter. Unfortunately, this all too frequently was either ineffective or resulted in life-threatening hemorrhages into the brain..

In cardiology, this same problem was essentially made moot by the technique of angioplasty, in which a balloon is inserted into the blocked artery and expanded, pushing open the artery. When the same technique is used in the brain, however, the artery often bursts, in part because the brain arteries lack the tough outer layer that helps ensure such rupture does not happen as often in the heart. Also, a surgeon can come behind a cardiologist and rescue the patient with an open-heart procedure – no such thing can be done in the brain. And so, approaching the new century, neurology was still, as it always had been, about 10 to 15 years behind cardiology. What to do?

The answer came in the form of a slightly different technique. The procedure still opens up the artery, but rather than pushing the artery open with a balloon, neurologiststake a similar catheter and simplyeither suck the thrombus (clot) up the tube, or snare it with a small cage and pull it out. Either method opens the artery to blood flow without actually having to press on it or traumatize it. This is called thrombectomy and is the newest and best treatment for severe strokes. Furthermore, it can be combined with intravenous TPA treatment at the outset, and together, the two achieve much better outcomes than IV TPA alone.

In order to do this procedure, the patient has to be seen at a state-of-the-art hospital with the appropriate equipment and personnel. Since there is a critical shortage of neurologists nationwide, the same problems facing patients who require TPA – little or no neurology consultation available in rural or underserved hospitals – are amplified; even fewer hospitals have the resources to provide both treatments in tandem.Once again, teleneurology can come to the rescue. Through teleneurology consultation, experienced neurologists can determine which patients are appropriate to transfer to an advanced stroke center. AcuteCare Telemedicine has been doing this successfully. Furthermore, as more neurologists graduate with training in the latest and most effective procedures, more patients will not only survive their strokes, but will be far less disabled from them. By the end of this decade, cardiology and neurology will stand on roughly equal footing in the treatment of heart and brain.

 



Looking Backwards to See Ahead – Part 3: Revenue & Sustainability

This is another in a series of blogs chronicling the development of AcuteCare Telemedicine (ACT). Much of this reflection involves lessons learned at 2011’s Annual Meeting of the American Telemedicine Association (ATA). What follows is an amalgam of facts, experience and opinions culled from that fantastic symposium and honed by hindsight. Today’s blog will focus on telemedicine revenue and sustainability.

The business of medicine is a unique challenge for physicians used to focusing on clinical practice. Fee for service is now a relic in the changing healthcare landscape;  the days of physicians hanging up their “shingle” and watching patients flock to their doorstep are waning. An entrepreneurial spirit is required and is certainly not taught in medical school. A telemedicine startup may be costly in many ways. Besides “sweat equity,” it demands a large time investment dedicated to learning the marketplace, self-initiated marketing & sales, and direct client interaction. For doctors used to years of medical school, long residencies and fellowships, and 24+ hours of emergency call, this may be a natural investment. However, for long term sustainability, that patience must shift to the financial burden of expanding staff. An executive director, a sales force and marketing support are required, yet may not immediately lead to increased revenue. Balancing long term sustainability with short term revenue generation is the challenge.

Before taking the leap into the realm of venture capitalism, one must take a very critical look at economic realities. Healthcare delivery is changing, and ventures that offer reduced costs and improved outcomes, such as telestroke, are poised to grow exponentially – exactly what an investor is looking for. However, accepting capital early in business development may severely limit income if profit margins are small. That is, venture capitalists will expect a return on their investment regardless of your income. In contrast, investors may provide the guidance and experience not readily garnered from a career in medicine. Ultimately, pursuit of venture capital must meet a specific goal towards sustainability that is otherwise unattainable.

Other sources of revenue are available and should be investigated. Grants or other government funding help rural or safety net patients gain access to best possible care. For example, the state of California provided a $200 million grant to create a statewide broadband network resulting in an “eHealth Community.” They used telemedicine as a means towards a bigger goal of improved access, quality, and efficiency in underserved areas. Georgia Bill 144; The Distance Learning and Telemedicine Act of 1992, was the first mandate by any state for telemedicine. It led to development of the Georgia Partnership for Telehealth, a not-for-profit web of statewide access points based on strategic partnerships with successful existing telemedicine programs. Partnering with government and not-for-profits reduces overhead and increases client base for a telemedicine startup. In turn, the startup becomes their reliable source of clinical expertise and business acumen. In this case, it is important that businesses advocate for the common goal rather than simply for business success, and be prepared to give credit to all those involved.

Many remote presence technology companies are also working diligently to improve patient access to healthcare. By externalizing the technology component, a telemedicine startup significantly reduces overhead while giving their clients increased options for technology to meet their needs and budgets. This avoids the requirement of significant venture capital at the outset, and also ensures that the technology is handled by remote presence experts, allowing telemedicine practitioners to focus on providing cutting edge healthcare service.

Sustainability is inextricably linked to a company’s financial stability, but also derives from integration with the marketplace. While the aforementioned partnerships have obvious financial incentives, they also help make one relevant in the market. That relevance is not measured strictly in size or profit, but in the reputation of the level of service.

Goods and services can be obtained through a variety of outlets, from boutiques to so-called “superstores.” Finding one’s niche in the market will result in both profitability and sustainability.



AcuteCare Telemedicine Discusses the Future of Teleneurology at GPT Conference

Dr. Matthews Gwynn, Partner, AcuteCare Telemedicine (ACT) will speak during the 2012 Georgia Partnership for Telehealth (GPT) Conference at the Ritz-Carlton, Reynolds Plantation in Lake Oconee, GA on Thursday, March 15th. The annual conference brings together physicians, nurses, and other industry figures to address a wide variety of topics related to telehealth, including recent innovations, advocacy and education, policies and regulations, and case studies.

Dr. Gwynn will discuss the potential of teleneurology in this decade. ACT is a leader in teleneurology services, dedicated to bringing high quality neurological care to underserved areas through the use of telemedicine technologies.

“Significant advances in technology are presently writing the next chapter of medical history. As futurists who see the possibilities and value of telemedicine, specifically teleneurology, ACT is truly on the forefront of this movement,” said Gwynn. “The GPT Conference is a fantastic opportunity to exchange knowledge with other industry leaders who share the same vision. Events such as this move us closer to a future where patients have access to the best possible care, regardless of their location.”

More information about GPT and the 2012 Conference can be accessed at http://www.gatelehealth.org/index.php/2011-conference/2012-conference/.



Daniel H. Bauer Joins AcuteCare Telemedicine Advisory Board

AcuteCare Telemedicine (ACT) announces the addition of Daniel H. Bauer as a member for the ACT Board of Advisors. Bauer’s extensive C-level experience as a CFO with a diverse portfolio of companies and status as a Certified Public Accountant will guide the business with sound advice.

Bauer, a graduate of the University of Tennessee and Emory University, is presently serving as Chief Financial Officer of CardioMEMS, a medical device company that has developed and is commercializing a proprietary wireless sensing and communication technology for the human body.

After beginning his career in public accounting at Price Waterhouse, Bauer also previously served as the Chief Financial Officer for Industriaplex, Granite City Food and Brewery (NASDAQ: GCFB), and Church’s Chicken, the largest division of AFC Enterprises (NASDAQ: AFCE), which was acquired by Arcapita.

Bauer is currently a board member of the Association for Corporate Growth and a member of the advisory board of Emerge Scholarships. He was a recipient of a Delaney Consulting 2011 excellence in Finance and Accounting Award and a finalist for the Atlanta Business Chronicle CFO of the year in 2010.

“Mr. Bauer’s track record is indicative of his knowledge and commitment to building strong businesses,” says Matthews Gwynn M.D., Partner, ACT. “We are fortunate to have the luxury of Mr. Bauer’s perspective when weighing important decisions. The scope of his experience will be invaluable to keeping AcuteCare Telemedicine on track as we continue to grow the business in 2012.”