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.”



Solving the Physician Shortage: Should it be Left to an Act of Congress?

Since 1997, the number of physicians entering the workforce each year has essentially been capped, while the demand for everything from hip replacements to treatments for diabetes to angioplasties has soared with our growing and aging population. Now, the Obama administrations newly proposed budget seeks to spend an additional $5.23 billion over the next decade to manufacture new physicians. While this sounds like a lot of money, given the magnitude of the doctor shortage issue, it won’t be nearly enough to solve the shortage problem on its own merits. The proposal is designed to swell the ranks of primary care doctors, those family physicians, general internists, and pediatricians that constitute the healthcare workforce that is predicted to experience the greatest shortage of all the medical disciplines.

But primary care is not the only medical care discipline that is facing future short falls.  According to a study by the American Academy of Neurology (AAN), by 2025 the demand for neurologists will far outnumber the supply, creating a 19 percent disparity in the number of doctors needed to adequately care for all patients. Those who suffer with neurodegenerative diseases like multiple sclerosis (MS), Parkinson’s, and Alzheimer’s will have to wait longer to see a specialist.

“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. And graying doctors, nearly half the nation’s 830,000 physicians are over age 50, are seeing fewer patients than they did four years ago.

The flow of doctors entering the market each year is determined by the number of U.S. residency positions, chiefly in teaching hospitals. Those positions are funded primarily by the program that oversees Medicare and Medicaid. In 1997, the federal government essentially froze spending on residency slots, limiting the number to around 100,000 over three-to-four years, and in turn freezing the number of newly licensed physicians available for hire each year to around 26,000. Over the past 17 years, a few hospitals have established new residency programs for primary care doctors, raising the number to around 27,000, or a less than 4% increase. Meanwhile, the U.S. population has risen by 50 million, or almost 20%. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today.

The Affordable Care Act promises to magnify the problem but does attempt to address some of the issues to help stem its effect on the shortage by allocating an additional $1.5 billion in funding for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a more prevalent shortage. The law also puts more money toward training in hopes of increasing the primary care workforce and it offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015.

But many in the medical care industry do not see the solution reserved for government legislation alone. “Keep in mind the Affordable Care Act didn’t create this crisis,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “We’ve got an aging population that needs more care and a growing population.”

Many believe that new technologies will extend the reach of medicine in ways that will ameliorate the shortage 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. Creative new ways medicine is delivered, such as the use of “medical homes” and “accountable-care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. Telemedicine enhances productivity and outreach while cutting costs, it improves diagnosis and care management in remote areas, and it reduces unnecessary care. The technology also strengthens partnerships between community based hospitals and advanced regional care centers.

“I understand there is a sense of worry, and change can be scary, but our present system is broken,” Dr. Blackwelder said. “We pay twice as much for our health in this country and have worse outcomes than other countries. Looking to government to fix a problem often harbors complexity, inefficiencies and long-term implementation of solutions. Dr. Blackwelder’s opinion reflects that of many other medical industry professionals, “We will have to start coming up with creative solutions to this problem, ones that won’t have to wait for an act from Congress.”



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.



AcuteCare Telemedicine in 2013: Cutting Edge Neurological Care, Anywhere

Following a third consecutive year of growth in 2012, AcuteCare Telemedicine (ACT), an Atlanta-based partnership of 4 board-certified neurologists, is expanding its efforts to become the leading provider expert neurological care to rural and underserved areas throughout the Southeastern United States via cutting edge telemedicine technology.

Telemedicine, once regarded as an exciting new frontier, has now been fully realized as a part of the mainstream lexicon of medicine as we enter 2013. For a large number of hospital systems, telemedicine programs are now becoming a mandate as the nation faces a growing shortage of specialized physicians.

ACT has established itself as an innovator on the forefront of the industry, taking a unique approach to telemedicine by leveraging new technologies and techniques to enable personal neurology consultation when doctor and patient are in different locations. ACT offers a broad range of customizable services including 24/7 emergency neurological consultation and support programs for facilities seeking Joint Commission accreditation as a Primary Stroke Center, but primarily specializes in telestroke: the application of telemedicine to the treatment of the acute stroke patient. With the help of ACT’s powerful and personalized services, patients throughout the ‘Stroke Belt’ states of the Southeast have drastically improved access to the care they deserve, and medical facilities increase efficiency while reducing the costs associated with maintaining a traditional emergency neurology staff.

Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, ACT has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographical boundaries. Achieving this goal requires a certain level of investment in technology and trust in the people behind it. ACT is truly technology-agnostic.  This agility affords healthcare organizations with the ability to select the platform that meets budgetary and organizational parameters.

ACT provides access to the best 24X7 acute neurological care. Contact Michael Woodcock to hear how teleneurology can impact your business and patients in 2013.



What Can the Third World Teach Us About Telemedicine?

Telemedicine and mHealth solutions represent the most recent advances in medical history. As futuristic as a patient consulting a doctor from across the world via communications technology may seem, telemedicine is founded in addressing some fundamental challenges that are not unique to the 21st century.

Citizens of developing nations are a glance into the past of the modern world. Limited resources leave these countries facing 3 primary obstacles to proper care that telemedicine is working to overcome:

Lack of doctors: Lower education standards lead to fewer total doctors, leaving some large geographical areas with few or no doctors.

Lack of access: Citizens cannot get to doctors due to their sickness or difficulties with limited transportation options.

Lack of money:  Most citizens simply cannot afford to pay for healthcare.

Compare these points with realities for many Americans:

Lack of doctors: Currently, there are an estimated 954,000 total doctors in the U.S., and that number is projected to constitute a shortage of as many as 150,000 in 15 years. Certain specializations are particularly poorly represented; for example, there is currently roughly one geriatrician for every 2,620 Americans 75 or older, and is only getting worse as senior citizen numbers rise. This ratio could drop to as few as one geriatrician per 3,798 seniors by 2030.

Lack of access: The continental U.S. features many large rural regions, leaving hundreds of millions of citizens at a significant distance from an adequate acute care hospital.  Many people, particularly older citizens, require frequent visits to multiple doctors due to co-morbidity of diabetes, hypertension, and cardiovascular diseases. Transporting elderly or infirmed individuals to a physician is becoming increasingly demanding, with rising fuel costs. In addition, specialist doctor visits can often require weeks or months of wait time for schedule availability.

Lack of money: While average income is much higher in the U.S. than in developing nations, rising healthcare costs mean Americans spend a greater percentage of their earnings on healthcare, with healthcare expenditure constituting as much as 15% of GDP. This number is also expected to rise unless dramatic policy changes or significant shifts in healthcare protocol occur.

In reality, the challenges facing healthcare are unchanging. Unlike in the past, modern technology is now paving a path for healthcare providers to tackle the task of overcoming these obstacles. Best of all, as technology moves forward, the same telemedicine solutions that can solve problems in developed countries like the U.S. can eventually be extended to aid citizens of underdeveloped nations. Telemedicine is building a healthier, more connected world.