AcuteCare Telemedicine Blog


Will Mobile Technology Help Close The Digital Divide?

A recent study is revealing that patients using telemedicine are more likely to be urban and well educated. Based on data from 53,000 households collected by the Census Bureau in July 2011, the report found 8 percent of urban Internet users took part in telemedicine initiatives, compared with 4 percent in rural areas. That stands in contrast to telemedicine’s common selling point that it can more effectively and conveniently provide services to people in remote locations.

Participants were also found to be wealthier.  At income levels of $100,000 or more, 11 percent of Internet users took part in remote care, compared 4 percent from households in the under $25,000 bracket.  The 25-44 age group was found to be the most likely segment using online services for medical care and information.

As access to telemedicine opportunities continue to grow it is expected that the demographics will likely shift to include lower-income and less-educated patients.  One technology that may improve access to telehealth services is the mobile or smart phone devices which appear to be closing the digital divide among various demographic segments of the population. Mobile technology has become especially critical for low-income minorities who have no other technological means of connecting to the internet.

Survey results released in September by the Pew Research Center’s Internet & American Life Project indicate that African Americans and Hispanics are more likely than whites to own a smartphone, with 49 percent of Hispanics, 47 percent of African Americans, and 42 percent of whites owning these mobile devices.  For these groups, mHealth has the potential to be a powerful tool in promoting healthy living and preventive medicine, particularly in combating the high rates of diabetes in these populations.

Development of new and innovative health related mobile applications and growing the number of smart phones in the hands of the more economically challenged population promises to be an effective means to bridging the healthcare gap in America. Health and Human Services (HHS) has called on developers to create a mobile application to help educate minorities and women about cancer screenings and allow secure access to medical records.

Only time will reveal whether telemedicine’s promising benefits of increased access and lower cost of quality medical care will better attract and reach those who are most in need.



Medicare Recipients to Lose Telemedicine Services Benefits

Even though the availability of telemedicine has proven its value by lowering costs, increasing access and improving treatment and remote monitoring for chronic diseases, thousands of Medicare beneficiaries will soon lose access to telemedical services simply because of where they live, or more accurately stated, how government statistics identify where a patient lives.

Medicare patients from Hawaii to Puerto Rico to Minnesota will be redefined as living in “metropolitan” areas, precluding them from receiving Medicare coverage for video conferencing and other telehealth activities, even though 80% of beneficiaries live in urban counties such as those cut from the list.

“Congress has long overlooked the need for telemedicine services for residents of urban counties, despite the fact that they often suffer similar problems accessing healthcare.  Now, because of a statistical quirk, even more people will lose coverage of these services, reducing access and care,” said Jonathan Linkous, CEO of the American Telemedicine Association.

Originally, telemedicine technology demonstrated its most obvious benefits to rural communities, where specialized and chronic medical services and treatments were often not readily available without significant cost and inconvenience to patients.  However, the same cost/availability benefits have proven to be just as effective in urban areas and when chronic illness and extended, after hospital, care is encountered.

A study provided by the Commonwealth Fund shows that telehealth consultations are effective in reducing the amount of time patients spend in the hospital for care of chronic illnesses.  By examining data from large telehealth programs run by the Department of Veterans Affairs (VA), Partners HealthCare in Boston, and Centura Health, based in Colorado, researchers found that home monitoring programs can cut costs and raise patient satisfaction up to 85%.  Under the new guidelines, Medicare coverage will not be available for telemedicine visits to beneficiaries living in metropolitan areas–where over 80% of recipients live, resulting in cost reductions for the Medicare program.  Correcting this oversight will require an act of Congress, another incident of bureaucratic, regulatory interference with beneficial advancements in the delivery of healthcare to patients all around the country.

Given the increased involvement of government in the total delivery of health care in the coming years, this lack of insight does not bode well for reducing costs and improving availability to those who are most in need of the best in healthcare services.



AcuteCare Telemedicine and the American Telemedicine Association Team Up in Austin Texas

American Telemedicine Association (ATA) held their 18th Annual International Meeting and Trade Show On May 5-7 in Austin, Texas.  More than 6000 healthcare professionals and entrepreneurs in the telemedicine, telehealth and mhealth industries attended the premier forum on telemedical technology and health care services.

This year’s event offered more than 500 educational presentations and 300 exhibitors including AcuteCare Telemedicine (ACT), a leading practice-based Neurology provider of Telemedicine services. A day long video, a technical demonstration with GPT and InTouch and information on ACT telemedicine services was presented at the AcuteCare booth. ACT representatives sought out potential business opportunities throughout the conference with other vendors and service providers from markets in Mississippi, Arkansas, Florida and Latin America

Dr. Keith A. Sanders, from ACT, attended the “Telemedicine Venture Fair”, which featured industry experts from the Venture Capital community who shared their expertise and advice on strategic partnerships and venture financing with attending Telemedicine start-ups.  In addition, fellow ACT members attended multiple educational and business development presentations on neurology telemedicine. Speakers from UPMC in Pittsburgh, PA focused the discussions on topics concerning return on investment and business sustainability models.

During the three day event, The American Telemedicine Association named the winners of its prestigious annual awards and announced the election of two new members to the ATA College of Fellows. The winners of the 2013 ATA Awards represent the true innovators and best-of-the-best in our field,” said Stewart Ferguson, PhD, President of the American Telemedicine Association. “These individuals and organizations have proven that telemedicine is an invaluable tool in saving lives and improving healthcare, both here in the United States and around the world.  We are honored to recognize their great accomplishments.”

The American Telemedicine Association is the leading resource which advocates promoting the use of advanced remote medical technologies.  The diverse membership works to fully integrate telemedicine into healthcare systems in order to improve quality, equity and the affordability of healthcare to millions of people around the world.



Is There a Doctor in the House?

For those who can still remember the day when your family physician came to the house in response to a telephone call requesting medical service, the current debate over the acceptance of telemedical services in place of face-to-face visits with a doctor will bring back memories of a similar debate exorcised over the abandonment of house calls with in-office visits. Back then the vocal decry from opponents to the change suggested that patients would reject the idea and inconvenience of traveling to the doctor’s office to receive medical care and that somehow the process would have a negative effect on the quality of health care.

Few predict that the face-to-face, hands on, talk to me now visits with a physician is likely to go the way of the personal home visits anytime soon.  However, organizations resistant to changes with the current medical services delivery model and are unwilling to consider utilizing telecommunication technology will not be able to meet the growing demands of the patients and communities they serve.

A recent study by Cisco reveals that 74 percent of consumers are open to virtual doctor visits.  The results of the Global Customer Experience Report focused on health care, demonstrated a shift in consumer attitudes toward personal data, telemedicine and electronic access to medical information. The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.

The results indicated that 80 percent of American’s were comfortable with submitting personal medical and diagnostic information to the cloud to help ensure that all relevant personal medical information is readily available to receive treatment.  Perhaps the most interesting result was that the findings challenged the assumption that face-to-face interaction is always the preferred health care experience by consumers. While consumers still depend heavily on in person medical treatments, given a choice between virtual access to care and human contact three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician interaction.

The benefits of face-to-face visits to quality of care are valid and current telemedical service visits will not likely replace all physician/patient personal interactions anytime soon, nor should they.  But recurring studies are beginning to reveal that patient’s reluctance and suspicions of telemedicine is no longer a valid excuse for delaying the broader expansion of telemedical services.

Perhaps we shouldn’t be all that surprised that patient objections to a reduction in face-to-face doctor office visits are fading.  Consulting with your family health care practitioner, via telecommunication technology, in the comfort and convenience of your own home has a familiar ring.  House calls revisited? What goes around comes around?

 

 



ACT Collaborates with Southeastern Medical Center on Telestroke Network

AcuteCare Telemedicine (ACT), the Southeast region’s largest practice based telemedicine provider, participated at Southeastern Alabama Medical Center’s (SAMC) press conference, announcing SAMC’s new stroke care network.

SAMC’s service area covers over 60 miles in each direction.  With technology in place, SAMC looked at possible resources to staff the new 24X7 model.  Neurologists on staff at SAMC are responsible for patients after admittance to the hospital, and often following acute symptoms or neurological events.  To be able to provide 24X7 coverage would be impossible. SAMC selected AcuteCare Telemedicine as its clinical service provider.

With this hub-spoke stroke care model, SAMC will be able to add hospitals to its network, expanding coverage across its communities.  Patients have already started to receive care, including tPA.  The initial results show improved patient outcomes.   The goal of the stroke care network is to educate communities on the importance of wellness, to identify signs before a stroke and generate awareness for the new services offerings SAMC can provide.

“Telemedicine is such a new technology for our population. We had concerns about patient adoption and comfort with being diagnosed remotely,” comments Ceclia Land, Division Director, Rehabilitation Services, SAMC.  “However, ACT integrated seamlessly into our processes, working alongside our team, to insure only the highest level of care to our patients. All of the doctors at ACT have an incredible bedside manner and are engaging.  They have become an integral part of our team.”

ACT will be on hand to diagnose and treat acute care patients. ACT offers cost-effective solutions that deliver complete on-call coverage, improve patient outcomes that adhere to HIPAA / HITECH requirements and establish a sustainable financial model for patient care.  The ACT Team of Neurological specialists are in the business of creating relationships that will serve as the foundation for improving healthcare for communities across the Southeast and Nationwide.

“SAMC has really established the new standard of care, expanding access to specialty care in underserved communities,” comments Dr. Gwynn, CEO, Partner, ACT.  “We look forward to our continued involvement with SAMC and its patients.  We have the potential to improve the statistics for residents across these communities in the hopes of saving lives lost due to stroke.  If diagnosed in time, we are able to administer tissue plasminogen activator (tPA) decreasing patient deficits after the stroke.”



The Dollars and Sense of Telemedicine

With the anticipated “break out” of telemedicine services looming on the horizon, an important and significant obstacle still remains to be cleared away if wide-spread expansion and acceptance of medical treatment and services is to be realized.  As with the growth of any new industry it raises the question of who is going to provide the investment capital and who is ultimately going to pay for the services necessary to sustain the budding industry?

Even with the obvious benefits that telemedical services promises to bring to the traditional health care delivery model, change to the well-established and traditional minded payers of medical services continues to be a major detriment to the crack of the starter’s pistol that will unleash the race to expansion.  Currently there are five primary sources of funding for the $2.8 trillion healthcare markets in the United States, according to Jon Linkous, American Telemedicine Association (ATA) CEO.

Hospital and Healthcare Systems now permits providers the flexibility to pay for telemedicine services wherever warranted, over 100 million Americans are now covered and the number is growing rapidly.  This source remains the most fit of providers readily eager to set the pace.

Private and public employee insurers in the U.S. are expanding coverage of telemedicine but only 16 states currently mandate private insurance coverage.  This important source of funding continues to lag well behind the pace and is not likely to contribute seriously to a break-out soon.

Federal Medicare payments are currently approved for imaging and live consultations to patients in rural areas and Congress is expected to take up expansion of the payments in the coming year, but this is Congress an agency not known for leading or setting any records for implementing change.

State Medicaid coverage is available in 44 states at some level of reimbursement and three more states are considering full support in 2013.  In April, legislators in Arizona passed a law prohibiting insurers from denying payment for medical services solely because they are provided through telemedicine. The law is limited to providing payments in 13 specific rural areas and only for telemedicine treatment for seven specific conditions. The laws implementation was delayed until the end of 2014 to satisfy insurance industry concerns.  Such tentative, piecemeal advances’ provides little hope for a surge in Telemedical services being paid for by Medicaid provider’s in Arizona.  Apparently, as with justice, the wheels of bureaucratic change move slowly.

Direct federal healthcare agencies, such as the U.S. Veterans Administration, Department of Defense, Indian Health Service, federal and state and local corrections departments are active providers of remote health care.  This is rapidly expanding and increasingly relies on partnerships with non-governmental health providers.

Investment capital remains a concern for providers looking to aggressively enter the telemedical marketplace. While the mystery of how the new technology will generate returns on investment begin to fade in investors and venture capitalist minds, infrastructure funding sources are limited and somewhat timid in this hesitant economic environment.

The benefits of telemedicine to improve the access and quality of patient care is obvious, and makes perfect sense to providers, practitioners and patients alike, but the dollars portion of the “dollars and sense equation” is proving to be a more persistent challenge to expansion and sustainable growth of this new industry.



New Technologies Improving Health Care

Much has been said and written about technology and its effects on the practice of medicine regarding how telemedicine and telehealth promises positive economic availability of health care going forth into the future.  As the doctor shortage and increase in the costs of medical services continue to front and center the debate, medical technology companies focus their resources on providing less expensive, faster and more efficient patient care.

To speed up and simplify the approval process of new medical devices, the Federal Drug Administration (FDA) recently formed the Medical Device Innovation Consortium (MDIC).  The organization seeks input from industry, government, and other nonprofit organizations and will prioritize the regulatory science needs of the medical device community and fund projects to streamline the process.  “By sharing and leveraging resources, MDIC may help the industry to be better equipped to bring safe and effective medical devices to market more quickly and at a lower cost,” says Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

Every year industry observers and media select their favorite technology trends that propose to have the most favorable impact on overall medical care costs, patient care quality and safety.  Here are just five of this year’s technologies that fit the criteria.

The Optical Scanner

Melanoma, the most deadly form of skin cancer, has always been impossible to diagnosis without an invasive surgical biopsy.  The MelaFind optical scanner is not for definitive diagnosis but rather to provide additional information a doctor can use in determining whether or not to order a biopsy.  The new device is manufactured by MELA Sciences and uses missile navigation technologies originally developed by the Department of Defense and scans the surface of suspicious lesions.  The data is collected and processed using heavy-duty algorithms and matched against a registry of 10,000 digital images of melanoma and skin disease.

Electronic Aspirin

A reliable, long-lasting treatment for the most severe form of headache, chronic Cluster Headache (CH), is lacking. CH has long been associated with the sphenopalatine ganglion (SPG), a sensory nerve bundle in the head. Blocking pain directly at the SPG has been an elusive goal. A technology under clinical investigation at Autonomic Technologies, Inc., is a patient-powered tool for blocking SPG signals at the first sign of a headache.  The system involves the permanent implant of a small nerve stimulating device in the upper gum on the side of the head normally affected by CH.   The lead tip of the implant connects with the SPG bundle, and when a patient senses the onset of a headache, he or she places a handheld remote controller on the cheek nearest the implant. The resulting signals stimulate the SPG nerves and block the pain-causing neurotransmitters.

Needle-Free Diabetes Care

Anyone who suffers from Diabetes has to deal with the constant need to draw blood for glucose testing, the need for daily insulin shots and the heightened risk of infection from all that pricking and poking.  Echo Therapeutics is developing technologies that would replace the poke with a patch.  The transdermal biosensor reads blood analytes through the skin without drawing blood. The technology involves a handheld electric-toothbrush-like device that removes just enough top-layer skin cells to put the patient’s blood chemistry within signal range of a patch-borne biosensor. The sensor collects one reading per minute and sends the data wirelessly to a remote monitor, triggering audible alarms when levels go out of the patient’s optimal range and tracking glucose levels over time.

Autonomous Navigation Robots 

Telemedicine is well established as a tool for triage and assessment in emergencies, but new medical robots are taking the process one step further.  With the capability to patrol hospital hallways on more routine rounds, checking on patients in different rooms and managing their individual charts and vital signs without direct human intervention these new robotic devices are improving routine health care to hospitalized patients.  One of these new devices, the RP-VITA Remote Presence Robot produced jointly by iRobot Corp. and InTouch Health is the first such autonomous navigation remote-presence robot to receive FDA clearance for hospital use. The device is a mobile cart with a two-way video screen and medical monitoring equipment, programmed to maneuver through the busy halls of a hospital.

The Sapien Valve

The Sapien trans catheter aortic valve is a life-saving alternative to open-heart surgery for patients who need new a new valve but can’t endure the rigors of the operation. Manufactured by Edwards Life Sciences, the Sapien valve is now finding its first use in U.S. heart centers where it is being limited only to the frailest patients. The Sapien is guided through the femoral artery by catheter from a small incision near the grown or rib cage. The valve material, made of bovine tissue, is attached to a stainless-steel stent, which is expanded by inflating a small balloon when correctly placed in the valve space. This new device and simpler procedure promises dramatically shorter hospitalizations and is bound to have a positive effect on the cost of care.

Medical industry leaders agree that today’s most desirable technologies, whether telemedical communications or Sci-Fi-gadgets, strike a balance between reducing the overall cost of medical care while increasing safety and survival rates among patients.   While not immune from controversy and push-back from both health care providers and patients alike, new technologies hold the greatest promise to bringing higher quality and more efficient and affordable health care to millions of people around the world.



Telemedicine Increases Access to Critical Stroke Care

Researchers in studying the effectiveness of telemedicine programs in Oregon found that stroke coverage was pushed into previously uncovered less populated areas and expanded stroke coverage to rural areas. The results were found in a new study by researchers from the Perelman School of Medicine at the University of Pennsylvania studying telemedicine programs.

By employing telemedicine in concert with in-person care, nearly 80 percent of residents had access to expert stroke care within “the golden hour”.  Immediate access to high-quality emergency care is less common than one might think, leading to strokes being the fourth most common cause of death in the United States.  In-person stroke care is usually centered in large urban areas, and while telemedical stroke care is also available in urban centers, it is able to reach less populated areas that have low rates of uninsured patients.

The new study by researchers from the Perelman School of Medicine at the University of Pennsylvania was presented at the American Academy of Neurology’s 65th Annual Meeting in San Diego in March.  The study found that telemedicine programs in Oregon expanded coverage by approximately 40 percent.

“Telestroke programs can reach patients in smaller communities and provide time-critical treatment to previously unreached people,” said senior study author Brendan Carr, MD, MA, Assistant Professor of Emergency Medicine, Surgery, & Epidemiology in the Perelman School of Medicine at the University of Pennsylvania. “Increasing telestroke networks gives everyone a better chance of surviving a stroke.”

While many hospitals recognize the enormous benefits of providing immediate treatment to a patient using this technology, insurance plans are unlikely to cover the charges, and lack of financial support was cited by a third of hospitals as significantly limiting the growth of their programs.  Other factors, such as the absence of a robust, secure internet connection that can stream high-quality video, also prevent some hospitals from joining in regional programs.  Such inequities lead to disparities in access to health care.

Some supporters of the technology’s expansion argue that a combination of government and private initiatives will be necessary to ensure wide spread access to secure high-quality and high-speed bandwidth for telehealth applications.



AcuteCare Telemedicine and Ty Cobb Regional Medical Center Team Up to Improve Access to Immediate Stroke Care

Throughout Georgia and all around the country, Emergency Medical Services (EMS) responders are charged with reacting to emergency calls for assistance, providing emergency evaluation and treatment of a vast array of injuries and illnesses and delivery victims to emergency rooms for more advanced treatment.

The work requires split-second decisions that may affect the patient’s recovery.  Often the decision to bypass the nearest, more rural hospital for an urban medical center, known for its specialized treatment for such illnesses as stroke, can delay the patient’s arrival to that facility beyond the “golden hour”, the first sixty minutes after a patient begins to experience stroke symptoms and the critical window for providing care that can minimize long-term disabilities or prevent a stroke death.

At a recent conference at Ty Cobb Regional Medical Center (TCRMC) in Lavonia, GA, area EMS responders learned of a new program at the hospital that offers advanced critical, specialized care for victims of stroke. The goal was to educate emergency responders about its new telestroke program and how it can benefit the community, and TCRMC by capturing potential stroke patients that may have been otherwise bypassed by EMS personnel in the past.

The new teleneurology/telestroke program is a relationship between TCRMC and AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services for hospitals seeking advanced around-the-clock stroke and other urgent Neurological care.  Presenting the conference was Dr. David Stone, TCRMC Emergency Room Director and ACT’s CIO Dr. James M. Kiely, who is also partner at Atlanta Neurology, P.C. and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta.

Members of the Franklin County and Hart County EMS were on hand to receive information about the new service line and EMS’ role in triaging potential stroke patients.  “The goal of this new relationship with TCRMC is to build awareness in the area about ACT’s 24/7 stroke treatment coverage and to advance the area residence understanding of stroke, its symptoms and the importance of receiving immediate specialized treatment, said Dr. Kiely.”

Attending EMS personnel received information regarding strokes “golden hour”, and when it is appropriate to take patients directly to TY Cobb Regional Medical Center or when it is better indicated to take patients directly to an advanced tertiary treatment center.

Recent studies indicate that telestroke programs, like the one provided by AcuteCare Telemedicine, may improve access to immediate stroke care by 40 percent and bring advanced care within reach of millions of stroke victims now located outside the hour of critical care for the fourth most common cause of death in the United States.



Telemedicine, Bringing Improved Medical Care to India’s Rural Poor

In the United States, much has been said about how Telemedicine technologies are offering improved access and medical care to rural locations, particularly access to specialized medical care providers. But in many countries such as India, the opportunity to advance medical care to rural areas has a much more profound meaning to those in need of health care services.

India is administratively organized into state towns, district towns, block marketplaces, and then villages and healthcare, as such, is distributed along that supply chain with each level of infrastructure offering a lower standard of care.  Even in some of the fastest growing regions of India, as many as 85 percent of the 100 million residents only have access to healthcare that is at the bottom of the quality spectrum.  Private, better quality medical services may be located hundreds of miles away and take hours or days to reach by rural patients and are only available for those who have the money to pay.

Enter World Health Partners (WHP), an international nonprofit organization that provides health and reproductive health services in low-income countries by harnessing local market forces to work for the poor. Leveraging existing social and economic infrastructure, WHP utilizes the latest advances in communication, diagnostic and medical technology to build an ecosystem atop the existing private sector to bring improved medical services to even the most rural areas of India.

WHP is teaming up with out of the way, unlicensed, village health practitioners, or Quacks as they are known in India, to connect poor, rural patients with doctors located in Patna and Delhi.  For an investment of about $1000.00, each of the more than 433 quacks currently in WHP’s network of telemedicine practitioners can set up a Wifi network, laptop computer and the necessary equipment to make it all work, or at least work most of the time.  The system is not perfect and experiences frequent break downs but it saves time, money, and in some cases can save lives, for rural families that would otherwise have to travel hours to larger cities.

World Health Partners is working towards setting up 16,000, mostly privately owned and operated, telemedicine centers throughout India’s most rural provinces in hopes of bringing the convenience and benefits of telemedicine to the poorest of India’s population.  In addition, the concept is being scaled to be exported to countries and regions well beyond India, with hopes of reaching millions of world’s neediest populations.