AcuteCare Telemedicine Blog


Study Reveals Application of Telemedicine Delivers Positive Outcomes

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since the vast majority of research conducted to date has been conducted within old and possibly soon-to-be-outdated care delivery models.”

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

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



Managing Diabetes Remotely With Telemedicine

Diabetes afflicts more than 22 million Americans, or 7% of the total population, and the number of people diagnosed every year is skyrocketing. At a cost of $245 billion in 2012, the disease’s toll on the economy has increased by more than 40% since 2007, according to a recent report from the American Diabetes Association.

Mississippi, which ranks second after West Virginia in the percentage of residents affected by the chronic disease, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians. Early this year, Gov. Phil Bryant, the University of Mississippi Medical Center and three private technology partners announced a plan to help low-income residents manage their diabetes remotely through the use of telemedicine. The goal is to help them keep the disease in check and avoid unnecessary hospitalizations while remaining as active and productive as possible. To make the project possible, Bryant signed a first-of-its-kind law requiring private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care.

The new reimbursement law will also pave the way for similar telemedicine projects for other chronic diseases, said Dr. Kristi Henderson, the University of Mississippi Medical Center’s chief of telemedicine, who is heading the project. Initially the project, called the Diabetes Telehealth Network, will enlist 200 people with diabetes in one of the state’s poorest regions, the Mississippi Delta, who will be given Internet-capable computer tablets loaded with software that will enable medical professionals at the University of Mississippi and a hospital in the region, North Sunflower Medical Center, to remotely monitor patients’ test results and symptoms. A third technology partner will provide technical support for the wireless telecommunications services needed to transmit the medical data.

The price tag for Mississippi’s telemedicine project is about $1.6 million. But to expand the program or recreate it somewhere else, Henderson said, would cost much less because the groundwork would be done. “We want to prove a model and replicate it.”

Nationwide, one in every five health care dollars is spent caring for people with diabetes, according to the American Diabetes Association. Mississippi’s telemedicine law, said Gary Capistrant, public policy director at the American Telemedicine Association, goes further than any other state to remove what the telehealth industry considers its biggest impediment, lack of insurance reimbursement.

Numerous states and medical groups already have expressed an interest in the project, Henderson said. “If we can do it in Mississippi, where chronic disease is at its worst, where poverty is at its worst, and where transportation and workforce issue are at their worst, we can make it work anywhere.”



Knowledge: Can Too Much Be Just As Dangerous As Too Little

What does the “world’s first evidence-based mobile resilience program”, a 21-day personalized program to help wearers manage their stress and build mental resilience, and the “Shimmer3”, a slim-line sensor that can be strapped to an athlete’s arm in training to provide coaches with biophysical data, have in common? These are just two of the many hundreds new wearable electronic monitoring devices entering the crowded medical application market. Wearable monitoring devices are not new as healthcare providers have been utilizing devices to collect data on patients suffering from chronic diseases such as cardiac disease and diabetes.

To spur innovation, last year Qualcomm Life, a subsidiary of the chip maker Qualcomm and a big sponsor of wireless healthcare technology, announced a $10m prize for a Star Trek-style “tricorder” to be awarded to the first developer to succeed in designing a mobile platform capable of diagnosing a set of 15 conditions, including pneumonia, diabetes and sleep apnea, without recourse to a doctor or nurse. Don Jones, vice-president of Qualcomm Life, says, “Think of every way you have ever interacted with a medical professional or someone in a clinical setting – a doctor, a nurse, or your corner pharmacist – then think how that can be replicated digitally so that the process is both more convenient and faster,” he says. “The odds are that someone in Silicon Valley is already working on it.”

You can find high-tech wearable gadgets around the wrist, ankles and chests of just about every tech savvy enthusiast, leading some to champion their appearance as a means of keeping us all more in tune with our own health. Others are expressing cautious concern on how data is being interpreted by the less medically trained among us. What do we lose when healthcare becomes nothing more than a stream of digitalized physiological outputs, parsed and quantified by algorithms without the interpretation of experienced medical providers? The rise of digital medicine will have significant impact on the health and welfare of patients with the manner in which it is utilized determining whether this will be for better or for worse.

“Advancements in telemedicine allow us to provide acute stroke care quickly and efficiently, in situations where seconds matter,” comments Dr. James Kiely, partner, AcuteCare Telemedicine. “As technology reaches another inflection point with consumers, it’s important to educate users that data is more valuable in the hands of a board-certified medical practitioner.”



Telehealth Pushed to the Forefront of Public Health Agendas

Governor Phil Bryant of Mississippi is standing up in support of telemedicine technology. In Mississippi, Gov. Bryant has introduced a new initiative “The Diabetes Telehealth Network”. Unveiled recently in his State of the State address, the Network is a partnership of University of Mississippi Medical Center (UMMC), North Sunflower Medical Center (NSMC), GE Healthcare, Intel-GE Care Innovations and CSpire. It’s designed to offer those with diabetes consistent and timely access to UMMC clinicians via telehealth technology.

Patients in the 18-month program will have a tablet with mobile broadband access to record vital signs like blood sugar levels and send that information to UMMC doctors, specialists, nurses and pharmacists. The results of those daily interactions will allow doctors to adjust treatment plans accordingly, said Dr. Kristi Henderson, UMMC’s director of telehealth.

The program’s base will be Ruleville’s North Sunflower Medical Center (RNSMC), which has an existing telehealth partnership with the UMMC. The program’s private partners will provide the technological infrastructure. The initiative resulted from a meeting more than a year ago at the Paris Air Show between state and GE officials. GE operates jet engine and component assembly facilities in Batesville and Ellisville.

Gov. Bryant said the program is centered at RNSMC because, “That was unfortunately the area where diabetes was most concentrated. It’s a rural area. Lack of transportation is a big issue, and that affects access to care.” But there are 372,000 people in the state diagnosed with diabetes, according to the Diabetes Foundation of Mississippi. More than 12 percent of adults in the Mississippi Delta were diagnosed in 2010 with type 2 diabetes, according to UMMC statistics. The American Diabetes Association, in a 2012 study, found Mississippians with the disease spent $2.7 billion on health care related to treating it.

If this initiative is successful, it can be scaled up and expanded to meet the needs of diabetic patients throughout the state of Mississippi. Supporting new telecommunication technologies to improve and expand specialized care for chronic disease sufferers is an example of how Mississippi and other state governments appear to be out in front of Congressional law makers when it comes to putting forth initiatives that remove barriers and implement new strategies that seek to modernize our established healthcare delivery model and improve access and quality of care to patients across the 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.



Mobile Healthcare and Monitoring on the Brink of Revolution

Wireless in-home health monitoring is expected to increase six-fold in the next four years. A recent study by InMedica indicates that 308,000 patients were remotely monitored by their healthcare provider for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and mental health conditions worldwide in 2012. While congestive heart failure accounts for the majority of remote monitoring, it is expected that diabetes will supplant COPD with the second largest share of telehealth patients by 2017.  It is predicted that more than 1.8 million people worldwide will utilize mobile monitoring in the next four years.

Telemedicine is seen as a significant tool among healthcare providers for reducing hospital readmission rates, track patients chronic disease progression or provide advanced specialized medical treatment to patients in remote areas.  Four main factors are driving the demand for increased use of telemedicine and telehealth; Federal Readmission penalties introduced by the U.S. Center for Medicare and Medicaid Services (CMS);  healthcare providers desires to increase ties to patients and improve quality of care; insurance providers who are looking to increase their competitiveness and reduce in-patient pay-outs by working directly with telehealth suppliers to monitor their patient base; and an anticipation for future increased demand for telehealth services by patients.

Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic illnesses such as diabetes, heart disease, asthma and Alzheimer’s disease.  With rising costs and the anticipated shortage of physicians and healthcare providers over the next decade, utilizing the telemedicine technologies is becoming increasingly important to the routine delivery of medical services and monitoring of chronic diseases.

Even telepsychiatry, the use of secure Web-based video conferencing technology, and ambulatory patients, those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalized are expected to experience significant increased utilization of telemedicine among healthcare professionals in the next four years.  A plethora of emerging mobile technology, such as wearable wireless monitors to smartphone attachments will offer consumers the ability to track everything from core vital signs to impending heart attacks by discovering problems with heart tissue are on the horizon, offering a revolution in digital medical technology.

Speaking to those resisting the new mobile technology, Dr. Eric Topol, a professor of genomics at the Scripps Research Institute, recently encouraged the medical community to end paternal medicine, where only the physician has access to healthcare information, and to embark on a new beginning where patients own their data.  Dr. Topol compared the new mobile technology to the Gutenberg press and the way it revolutionized the way information was shared throughout the world.

We are embarking into a new era where patients have the mobile tools to better enable them to participate in their own medical diagnoses and treatment.