AcuteCare Telemedicine Blog


Telemedicine Creates Opportunities to Improve Access to Neurologists

Discussions over an impending shortage of doctors in America are nothing new. The debate and predictions of an increasing shortage of general practitioners, neurologists, radiologists and other medical specialties has raged for nearly a decade. A study by the Association of American Medical Colleges (AAMC), a lobby for medical schools and teaching hospitals, said “the doctor shortage is real” with total physician demand projected to grow by up to 17 percent as a population of baby boomers ages. The nation’s shortage of doctors may rise to between 46,000 and 90,000 by 2025. “The doctor shortage is worse than most people think,” says Steven Berk, M.D., dean of the School of Medicine at Texas Tech University. “The population is getting older, so there’s a greater need for physicians. At the same time, physicians are getting older, too, and they’re retiring earlier,” Berk says.

Neurology is one specialty impacted by the shortage. With stroke being the number four cause of death and a leading cause of disability in the United States, lack of access to neurologists who specialize in stroke care threatens to deprive many patients the best chance of surviving the effects of stroke. More than 800,000 strokes occur in the United States each year and the number of strokes is expected to grow significantly due to a growing elderly population. The need to encourage more young physicians to specialize in stroke is critical.

Dr. Harold P. Adams, Jr., of the University of Iowa Carver College of Medicine and Dr. Jose Biller, of Loyola University Chicago Stritch School of Medicine believes, “Unless the number of neurologists focusing their careers on the diagnosis and treatment of patients with cerebrovascular diseases increases, a professional void will develop, leaders of professional neurology associations “need to develop and vigorously support a broad range of initiatives to encourage residents to enter vascular neurology. These efforts need to be started immediately. Time is short.”

Other experts believe that new technologies may hasten the response to the pending crisis and may extend the reach of medicine in ways that will address the problem. Health care professionals can serve more people by using telemedicine technologies to examine, treat and monitor patients remotely as well as providing patients increased access to advanced stroke care. These technologies are already keeping patients out of hospitals and doctors’ offices and providing improved recovery results. Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services, has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographic boundaries. AcuteCare CEO, Dr. Matthews Gwynn says, “Increasing access to stroke specialists requires a certain level of investment in technology and trust in the people behind it. Technology affords healthcare organizations the ability to select a platform that meets budgetary and organizational parameters while extending the highest quality of neurological care to the patients they serve.”

Telestroke is one of the most adopted forms of telemedicine, providing solutions to healthcare providers looking for 24/7 neurology coverage for patients. “Telestroke is filling a gap in terms of the speed and accuracy of stroke diagnosis and start of critical therapy, says Lee Schwamm, vice chair of the Department of Neurology at Massachusetts General Hospital in Boston and director of the hospital’s Telestroke and Acute Stroke Services, “Telestroke is the poster child of telemedicine. It’s a really nice example of where the business case is so evident and the benefit to patients is well-documented.”

“The shortage of doctors is definitely impacting the future of medicine,” comments Gwynn. “In response, we remain focused on providing access to quality neurologists to small hospitals in underserved communities as well as to enterprise level healthcare organizations via telemedicine.”



The Building Momentum of Telehealth

Some proponents of telehealth are predicting that 2015 will be the year consumers will discover the convenience and cost benefits of accessing common health care through a virtual encounter. Telehealth has been reported to be on the precipice of rapid expansion for several years now, only to have the predictions fall short of expectations, mainly due to an established industry infrastructure that seemed to be well behind the present day technology curve. As service reimbursement, licensing and technical issues continue to fall-away many predict the time for a break-out in telehealth is upon the industry.

Entrepreneurs are taking the lead in providing opportunities for consumers to access common medical care services through virtual technology. More than 200 entities have entered the “doctor on call” market, connecting patients with a doctor for remedies for common every day ailments. In some parts of the country the service is becoming routine.This year more than 300,000 users will connect with a medical care provider over the internet, with that number predicted to grow to more than 7 million by 2018 as consumers discover the ease of use, convenience and lower costs. The initial concern that consumers would resist abandoning the traditional face-to-face office visit with their doctor has quickly dissipated as savvy; tech accepting consumers embraced the convenience of the new experience. The momentum continues to build, but is the other side of the doctor patient equation as prepared and eager to accept and embrace the new technological aspect of healthcare delivery?

For decades medical care has become increasingly industrialized and structured, primarily out of a need to control costs and manage available resources effectively and efficiently. The personal relationship between care giver and patient suffered as time was allocated to attending to increased numbers of patients. As primary care physicians integrate virtual encounters into their practice of care, the technology promises to provide new opportunities to once again place the relationship at the center of the care delivery. The addition of virtual encounters to the doctor/patient relationship promises many challenges to the largest and arguably the most important segment of the medical care industry, the general practitioner (GP), however, delegating the majority of follow-up or less critical visits to telecommunication may leave more time for developing the quality of the personal relationship through the face to face visit.

The clamor from the consumer is loud and clear but the growth rate of telehealth may be more dependent upon the medical professional’s willingness and preparedness to lead the way to the advancement of the new healthcare delivery model.

Your patients appear to be ready, are you?



A Telehealth Summit: Transforming the Delivery of Healthcare

The third-annual Alabama Rural Health & Telehealth Summit is scheduled for October 15 through October 17, 2014 at the Embassy Suites in Birmingham, AL. The Summit is sponsored by the Alabama Partnership for Telehealth (APT) and is the only statewide gathering of telehealth advocates in Alabama. This year’s theme is “Transforming the Delivery of Healthcare” and will feature a diverse and experienced group of presenters who will discuss the value of telehealth technology and how it is revolutionizing the delivery of healthcare across rural and urban America.

The Summit is open to primary and specialty care physicians, advanced practice nurse practitioners, physician assistants, registered nurses, medical care facilities administrators and anyone who is interested in learning more about healthcare reform through the application of modern telecommunication technology. More than a dozen topics and forums will be available for attendees over the three day summit, featuring the foremost experts in telemedical services and technology. The Summit is a great opportunity to learn more about state, regional and international Telemedicine initiatives.

On Thursday, October 16, James Kiely, PhD, MD, Chief Information Officer, AcuteCare Telemedicine, will moderate and present a session titled “The Reality of Telestroke: Real People, Real Results.” Dr. Kiely will be joined in the presentation by Cecilia Land, Division Director, Rehab Services, Southeast Alabama Medical Center, and Steven L. Skeen, BSN, CNO, Mizell Memorial Hospital.

Dr. James Kiely is board certified in Neurology and Clinical Neurophysiology and is the medical director of the neurophysiology labs at both Northside and St. Joseph’s Hospitals, and a partner at Atlanta Neurology in Atlanta. He was recently named one of America’s Top Doctors by US News and World Report, as well as being named a “Top Doctor” in Atlanta by Atlanta Magazine for the past five years. Dr. Kiely also serves as the Chief Information Officer for AcuteCare Telemedicine, LLC, an Atlanta-based corporation advancing the opportunity for healthcare institutions to gain access to expert neurologists and telemedicine technologies for 24/7/365 emergent neurological care.

Registration is available online for all those who wish to attend. The Embassy Suites Birmingham-Hoover is located at 2660 John Hawkins Parkway, Birmingham, AL 35244. For additional information on the Summit, contact Samantha Haas, Alabama Partnership for TeleHealth, Inc.



Recognizing the Symptoms of Stroke

While stroke awareness is a major concern for both men and women, a recent study concluded that women are less likely to recognize stroke symptoms. Only half of those surveyed know that sudden weakness or numbness on one side of the face, arms or legs is a warning sign of a stroke. 44 percent are aware that speech difficulty is a stroke sign while less than 1-in-4 could identify sudden severe headache, unexplained dizziness and sudden vision loss, or vision loss in one eye as the top symptoms of stroke. The study surveyed more than 1,200 women in the United States to assess their understanding of stroke’s warning signs.

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of the brain control different parts of the body, your symptoms depend upon the part of the brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word F.A.S.T.: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 911 immediately if any of these signs or symptoms at the earliest onset of these symptoms

For those living with or who care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

The acronym “FAST” is also meant to underscore the importance of rapidly delivering treatment to stroke patients. If given in time, a clot-busting drug administered during a stroke can lead to better outcomes and a decrease in the likelihood that a patient will suffer long-term disability. A recent study examined the effectiveness of tissue plasminogen activator (tPA) relative to the delay in administering this clot busting drug. Researchers found that every minute tPA was delayed cost nearly 2 days of disability free survival. The researchers commented that their message is literally “Save a Minute, Save a Day.”

Although many Americans live relatively close to a hospital where emergency stroke treatment is available, few actually receive the recommended therapies. Researchers found that only 4 percent of the more than 370,000 Medicare patients who suffered a stroke in 2011 were treated with tPA. Most stroke victims fail to recognize the symptoms of stroke or call 911 early enough to receive the necessary treatment. tPA is most effective when administered within a 4 hour window of time.

Every minute counts for stroke patients. Remember to act F.A.S.T.!



Leading Centers Aiming to Revolutionize Stroke Research

Georgia StrokeNet will be one of 25 U.S. regional coordinating centers to take aim at revolutionizing stroke research under a program funded by the National Institutes of Health (NIH). Georgia StrokeNet is the only regional coordinating center in Georgia that is participating in the project that is funded by a five-year, $2 million grant.

Those taking part in the collaboration include: Emory University’s School of Medicine, Grady Memorial Hospital’s Marcus Stroke and Neuroscience Center and other local partners. Emory neurology professor and Marcus Stroke and Neuroscience Center Director Dr. Michael Frankel will serve as Georgia StrokeNet’s principal investigator: Dr. Frankel says, “The new StrokeNet will be a conduit for clinical trials for patients to participate in, so we can answer those key questions about what is the best way to prevent a stroke, what the right blood pressure to try to prevent a stroke, what is the right treatment for a patient who has an acute stroke.”

Grady Hospital’s Marcus Stroke and Neuroscience Center has earned a top designation for stroke care by an independent accrediting agency for health care organizations. The Center has been designated an Advanced Comprehensive Stroke Center by the Joint Commission and is one of 50 U.S. stroke centers who have received the designation since it began. Emory University and Georgia Regents Medical Center in Augusta are the other two Georgia centers to receive the designation.

Dr. Keith A. Sanders, Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta, and partner in Atlanta Neurology, P.C., is looking forward to contributing to the stroke research at Georgia StrokeNet.  “The research is important because strokes and stroke-related deaths are prevalent in Georgia and the Southeast. It is hoped that this research will lead to more treatment options to reduce disability from stroke, commented Dr. Sanders.”



Study Reveals Telemedicine Improves Patient Outcomes

Researchers at UC Davis Children’s Hospital have found that telemedicine consults improved pediatric patient outcomes for patients treated in rural pediatric emergency departments that lack pediatric specialists.  They also found a physician was more likely to adjust the patient’s diagnosis and course of treatment after a face-to-face video conference with a specialist.   Madan Dharmar, an assistant research professor in UC Davis’s pediatric telemedicine program and the study’s lead author said, “The shortage of physicians in rural communities isn’t going to be solved by increasing the number of physicians, but by increasing the number of physicians available over telemedicine.”  “Telemedicine is going to be the future.”

Researchers examined data collected from five rural California pediatric emergency departments from 2003 to 2007. The EDs were equipped with uniform telemedicine technology, which was met with some resistance at first.  “Some of the rural doctors [who] were old-school at first resisted using the technology but when their objections were overcome they used it and liked it.  To aid the adoption process, UC Davis doctors conducted periodic test calls to check in and help the rural doctors adjust to the technology.

The face-to-face communication was responsible for improved outcomes, according to James Marcin, director of the UC Davis Children’s Hospital Pediatric Telemedicine Program and the study’s senior author. “More time is spent on a video consult than a phone consult. Rural doctors asked more questions and UC doctors provided more recommendations when video conferencing. “The technology is readily available,” Marcin said. “There’s no excuse why it shouldn’t be used.”

Only 3% of pediatric critical care specialists live in rural areas, serving the 21% of U.S. children who live in those areas.  Expanding the availability of specialized care to these children should be a priority for all communities and healthcare providers. The benefits of telehealth are increasingly being recognized all around the country. A bill recently sponsored by state senator Arthenia Joyner will make Florida the 20th state to require private insurers to cover telehealth services.



Expanding tPA Stroke Treatment Through Telestroke Delivery Model

For years, the mantra of neurologists treating stroke victims has been “time equals brain.” That’s because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost. Established research has demonstrated that administering a tissue plasminogen activator (tPA) intravenously up to 4.5 hours, after the onset of a stroke, benefits patients with moderate to severe acute ischemic stroke. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain and it accounts for 87 percent of all stroke cases.

While the use of tPA significantly improves a patients recovery from stroke its administration requires the availability of neurologic expertise within this narrow window of time.  Specialized stroke care at large academic medical facilities is very effective in providing stroke care but access to these centers is limited to patients living in rural areas of the country.  Practiced-based telestroke services, staffed primarily by general neurologist, offer a streamlined organization that facilitates the dissemination of this vital emergency treatment but a comparative analysis of the data between the two delivery systems is a critical.

“Expanding Access to Intravenous Tissue-type Plasminogen Activator with a Practiced-based Telestroke System” was recently published by the Journal of Stroke and Cerebrovascular Diseases.  The study was prepared by 4 practiced-based neurologists at AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology in the southeast.  Summary findings included data gathered over a two year period at 7 hospitals on 202 emergency telemedicine consultations and treatment of 54 telestroke patients with IV tPA.  Patient demographics and outcome measures were not significantly different for patients treated by practiced–based or academic providers with the exception of lower age and shorter stay duration of the practiced-based treatment group.

The results indicate that emergency stroke care provided by the two delivery models can achieve similar patient outcomes and that a practiced-based telestroke system can expand the availability of IV tPA treatment with clinical outcomes no different from previously published studies.

“Meeting the requirement of providing rapid neurology care to all of the nation’s emergency rooms will necessitate a concerted effort of academic and practiced-based stroke systems”, said Dr. Keith A Sanders, ACT.  The technological, organizational and financial hurdles which currently limit telestroke use and expansion will likely be resolved as the benefits of telemedicine become more evident with its expanded use.

For more study details and the full article, contact info@acutecaretelemed.com



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.