AcuteCare Telemedicine Blog


Preparing for the New Reality of Telehealth

A little more than a decade ago, telestroke and teleneurology were words that where not even part of our language but today are synonymous with the delivery of remote life-saving treatment for stroke and other neurological maladies. Telemedicine has provided vast improvements in medical care for our nation’s troops and veterans who are deployed in remote areas across the country and around the world, and is now poised to expand to a much larger telehealth initiative which promises to bring virtual, routine medical care to the home, workplace and public facilities of millions of patients throughout the country. With this expansion, telehealth will not only change the method of delivery of healthcare but proposes to alter the dynamics of the traditional caregiver/patient relationship. Yesterday’s patients are today and tomorrows consumers.

A new study from consulting company Oliver Wyman titled “The Patient to Consumer Revolution,” is revealing how empowered-consumers and outside industry innovators are influencing important changes to a centuries-old healthcare delivery model. “Empowering the consumer is what’s toppled many markets,” says Tom Main, partner at Oliver Wyman and co-author of the report. Companies like Walgreen’s, CVS, Google and Apple are beginning to enter what was traditionally an industry driven market. These new influencers are consumer experienced and able to successfully initiate telemedical products and services to a more aware and influential consumer.

In order to adjust to the new reality of virtual care delivery; hospitals, physicians and healthcare professionals across the care giving spectrum will need to alter not only their hard technology skills but learn new methods of personal interaction with their patients. Practitioners accustomed to performing good bedside manners will need to add “laptop manners” to their set of skills.

Relating to patients in person requires a much different approach than interacting with them virtually. Randy Parker, CEO of MDLIVE, a Florida-based telehealth provider says, “There’s a whole comfort level and professionalism involved (in telehealth) that many doctors don’t get, there’s even a dress code, and a way you present yourself” in a video encounter.” The new skills are not yet taught in medical school and few practitioners have yet had the opportunity to develop and fine-tune them in practice.

Peter Antall, medical director of the Online Care Group, says “Online doctors face two unique challenges that they don’t encounter in the exam room. First, they should have a familiarization with the technology they’re using, in case the patient on the other end of the encounter isn’t tech-savvy and needs help. Second, they have to learn “how to evaluate patients without the ability to examine by touch. Developing these skills requires a physician to be open minded and willing to learn and grow.”

It could be safe to say that very few healthcare professionals envisioned the disruptive effects the arrival of the internet, social media, wearable devices and mobile technology would have on the delivery of healthcare in the 21st century.



Telemedicine Joins the Fight against Ebola

As news outlets report the increased number of healthcare workers becoming infected with Ebola while treating patients with the deadly disease, concern for the welfare of healthcare workers around the globe is mounting. Ebola is an extremely infectious and deadly virus which is spread through the exchange of bodily fluids. Doctor and nurses who treat patients are highly prone to becoming infected while administering treatment to Ebola patients. More than 320 health workers who have treated Ebola patients have died of the disease and several others have been infected and survived.

Telemedicine is becoming a very effective weapon in treating Ebola patients while protecting care givers from being infected. From the evaluation of a potentially infected person to the routine communication of treatment, telemedicine can be a remote vehicle used to administer treatment while the patient is in isolation. Medical staff or specialists located anywhere around the globe can be consulted and participate in providing the best and latest care. Many healthcare providers will be spared the time, expense and inconvenience of relocating to areas where the disease poses the greatest risk. Telemedical technology can be useful to containment efforts at points of entry such as airports, emergency rooms, border crossings, schools and military installations.

In the military and Veterans Administration the benefits of telemedicine to the treatment of infectious diseases is not new. Telemedicine has been used to care for U.S. troops dispersed throughout the world and to veterans at home for nearly a decade. According to the Association of Military Surgeons, infectious disease tele-consults ranked second in the total number of online consults, and a study of the infectious disease tele-consultation service found the service to be providing beneficial and relevant recommendations for treatment in a timely fashion.

Telemedicine has become very successful in the private sector as well; improving access to specialized care to rural communities throughout the United States and remote areas of the world. Advanced treatments for stoke and other neurological diseases are now readily available remotely to patients, who were once too far removed from urban medical centers to benefit from time-sensitive treatment, improving recovery prospects and saving lives.

Defenders against contagious diseases can learn important lessons from these successful experiences and gain vital insights as to how telemedicine can improve care for patients and healthcare workers alike.



AcuteCare Chief Operating Officer Dr. Keith A. Sanders Providing Quality Care In His Hometown

0924 Dr Sanders

For Dr. Keith A. Sanders, it is a pleasure to care for patients locally and worldwide, from his hometown of Atlanta, GA.

“One patient recently told me, ‘The last time I saw you, you were up at Lake Lanier in your father’s arms’,” Dr. Sanders says. “It’s a small world and Atlanta has grown a lot. But it’s nice to have a connection with people like that.”

The homegrown physician is President of Atlanta Neurology and Chief Operating Officer of AcuteCare Telemedicine.

Healing others is part of Dr. Sanders’ heritage. His uncle was a general surgeon and his grandfather and other uncle were dentists. “My grandfather got me summer jobs at Crawford Long Hospital in Atlanta, working in the operating room,” Dr. Sanders remembers. For him, medicine was a natural career choice, “and I’m glad I made it.”

Dr. Sanders graduated cum laude from the University of Pennsylvania, and went on to medical school at Emory University. He completed his Neurology residency at Columbia-Presbyterian Medical Center in New York City. His fellowship in Neuromuscular Disease was at California Pacific Medical Center in San Francisco. He is board-certified in Neurology, Electro Diagnostic Medicine, and has subspecialty certification in Vascular Neurology. He is director and founder of the Stroke Center of St. Joseph’s Hospital in Atlanta and former chairman of the Ethics Resource Committee.

“I was drawn to the brain and nervous system,” Dr. Sanders says of his choosing Neurology. “There was a lot of fertile ground there. A lot of enigmas and curiosity to pursue.”

Dr. Sanders and wife, Theresa, a nurse and a cardiology research coordinator at Emory University Hospital, have had robust discussions, “about which organ is more important – the heart or the brain,” he says. “We’ve decided they are both important.”

They have a daughter and son in college, and two Jack Russell terriers. In what spare time he finds, Dr. Sanders enjoys walking, swimming, hiking and traveling. On his bucket list is a long overdue return trip to the Caribbean Islands.

He is still inspired by mentors like Dr. Richard Frank, a family friend, now retired. “Dr. Franco was a great humanist,” Dr. Sanders says. He admires Dr. Frank’s approach to, “Identifying the patient who has the disease, not just the disease the patient has.”

According to Dr. Sanders, gravitating to providing telemedicine services was a gradual process for AcuteCare’s four founding partners. “We asked ‘What is telemedicine,’ and at that point the four of us were curious enough and we saw potential in this new technology. So we took the ball and ran with it,” Dr. Sanders says. “We’ve been able to find our way in the business world. It’s a learning adventure and the beauty of it is, we’re really practicing Neurology on a broader scale. It’s the same as our other business (Atlanta Neurology), practicing neurology, just a different way of doing it.”

Technology bridges the distance between remote telemedicine and patients and families in an Emergency Room. “The interaction between patients and families and us with the two-way, secure videoconferencing system that we have, it’s the same as being there,” Dr. Sanders says. “The Neurologic exam for stroke and emergency Neurology can be as safely and reliably done remotely as it is in person,” he adds. “I don’t think we miss anything by not being there.”

For the doctors of AcuteCare Telemedicine, time is of the essence. “When we see these patients it’s in an emergency setting and we have to quickly evaluate if they are eligible for the new stroke treatments,” Dr. Sanders says. “You know the mantra, ‘time is brain.’ For every minute that the brain is deprived of blood supply, one million nerve cells are dying.” Establishing a doctor-patient relationship is critical. “It’s an immediate and intense rapport that you establish and they are looking to us as a specialist, and they are very trusting and we’re very honest with them. It’s very gratifying to be able to help people in that immediate situation.”

Dr. Sanders describes the atmosphere with his partners at AcuteCare as one of collegiality, information-sharing, and cooperation. “We promote a practice-based telemedicine service. We share the responsibility to the patients at the hospitals that we provide the service to. Just like we share our practices in person,” he says. “It provides a better quality of care than a staffing based model where the telemedicine Neurologist one day may be in Texas; the next shift he’s going to be in Florida; and the next shift in New Jersey.”

Dr. Sanders is fortunate to find his motivation in the fact that, “I still enjoy what I do,” he says. “Find a job that you enjoy – never work a day in your life. My partners are critical. Providing a high level of care to our patients, there’s intellectual stimulation to be able to use our specialized knowledge to help people.”



A Better Model of Delivery Realized

We buy groceries, trade stocks, and chat with friends, surf and cultivate new relationships around the country and the world all without leaving our home or office. Yet seeing a doctor remains an old-fashioned routine: minutes of medical attention can cost hours spent in transit or in a waiting room, only to have a face-to-face with a doctor. The familiar choreography dates back several generations, virtually unchanged since treatment from your family physician moved from your home to his or her office, where the newest diagnostic equipment of the day and the best trained supporting staff could more efficiently provide the most up to date medical care for the time. The technology revolution has brought amazing new diagnostic equipment, treatments and medications over the past several decades, but until now the process of visiting the doctor has remained nearly the same.

Telemedicine involves locating available doctors over the Internet and connecting with them, at a moment’s notice. It lets a patient see a doctor whenever and wherever you want, freeing them to choose a doctor based on merit rather than location. It can also improve the quality of medical care and reduce costs and it works well for urgent care, ongoing diagnostic monitoring and illnesses that can be diagnosed and treated without personal contact with a care giver. Telestroke, the practice of providing emergency stroke care through telemedical technology has brought lifesaving care to patients who were once located outside of the golden hour of treatment and chronically ill patients who were accustomed to spending many hours of travel time to receive treatment for a variety of illnesses and injuries have realized a new level of convenience and quality of healthcare.

In 2010, telemedicine and telehealth appeared to be on the verge of an acceptance break though. Recognizing an oncoming shortage of physicians and escalating medical care costs, the healthcare community recognized how the technology could significantly impact the future medical care costs and streamline the delivery of a broad array of healthcare services. The benefits of a new technological healthcare delivery model faced some rather significant hurdles on its way to acceptance and meaningful implementation. Much of the healthcare infrastructure, fiscal processes and protective regulations, many in place for nearly a century, needed to be revised to take advantage of the promised benefits of telemedicine. Policymakers, politicians and those early doubters within the medical community are warming to the new model and once formidable barriers to the advancement of telemedicine are beginning to tumble. Removing process barriers may be the easy part of bringing the benefits of telehealth to the everyday life of patients, changing life-long rituals and perceptions associated with traditional medical care delivery may take a bit longer. Simply recognizing the benefits of telemedicine isn’t enough; patients must embrace the concept, understand how the features benefit them and motivate them to use it.

Some say that there is no substitute for the human touch and a healing bedside manner. Consumers will always insist on traditional, face to face encounters with their doctor. Yet the advantages, convenience in particular, of new technologies and cutting edge devices are being accepted and utilized by virtually all generations. Social interactions are now ongoing connections and rarely limited to special occasion or planned encounters. Acceptance and utilization of technology in medicine will advance as the options and variety of healthcare services, accessible and the benefits of convenience and costs are realized by more and more patients.

Regardless of the methods of delivery, those who choose to enter the practice of healthcare will still be motivated to do so by the desire to help others in need, to provide treatments to those who suffer the fates of life’s many malady’s and to save lives. Having to adjust their bedside manner to accommodate the medium of delivery will do little to deter their aspirations to heal others.

In the words of Thomas Nesbitt, the Associate Vice-chancellor for Technology at the University of California Davis Health System, “A lot of people think it’s about the technology, but it’s really about a new model of care that the technology facilitates.”



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.”



Telemedicine Finding Support Among the Young and Affluent

According to a new RAND Corporation study, people who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help by talking to a doctor over the telephone. Patients who used the service suffered from a wide assortment of acute medical problems such as respiratory illnesses and skin problems, and researchers found little evidence of misdiagnosis or treatment failure among those who used the service.  The findings, published in the February edition of the journal Health Affairs, are from the first assessment of a telemedicine program offered to a large, diverse group of patients across the United States.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” said Lori Uscher-Pines, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing health care trend.”

Among patients studied, the most common problems treated during a visit were acute respiratory conditions, urinary tract infections and skin problems, which accounted for more than half the cases. Other frequent reasons for were abdominal pain, back and joint problems, viral illnesses, eye problems and ear infections. More than a third of the visits occurred on weekends or holidays. Interest has grown in telemedicine programs because of the shortage of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the Affordable Care Act. Telemedicine is one of the alternatives touted as a way to better provide primary health care without greatly expanding the number of doctors.

The implementation of the Patient Protection and Affordable Care Act is leading to increased demand that physicians interact with more patients, pointing to telemedicine as a potential solution. Most physicians believe that the quality of patient care is not compromised by telemedicine because it is delivered through different channels. Physicians can consult with more patients, and patients can meet with their physicians in a shorter time period. In terms of economic advantages, telemedicine can save a great deal of time for patients who otherwise would have to leave work, and it can reduce ER visits. According to Kenneth McConnochie, M.D., M.P.H., director of the Health-e-Access Telemedicine Program and professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y., parents with young children consider time and lower expenses to be valuable commodities. By increasing its use of telemedicine, the medical center reported a 22 percent reduction in ER visits among schoolchildren. McConnochie pointed out that the average telemedicine visit costs $75 compared with $750 for a typical ER visit.

“The people who are attracted to this type of telemedicine may be a more technologically savvy group that has less time to obtain medical care through traditional settings,” said Dr. Ateev Mehrotra, a RAND researcher, co-author and an associate professor at the Harvard Medical School. However, researchers caution that more research is necessary to further assess the quality and safety of telemedicine services and to more adequately address concerns that expanded use of this type of telemedicine may lead to fragmentation of care. Still, the general consensus among patients and parents who used the service appeared to indicate that they believed that accessing medical services via telemedicine technology was much more convenient, saving them time and money.  For these consumers the convenience factor dominated over other concerns.



Telemedicine In Europe: Another Euro Disney Experience?

It seemed like a “no-brainer. Take the most successful family entertainment experience (Disney World), clone an exact copy, pack it all up, and implant it to the center of European culture and voila, another mega Disney entertainment success story!  Well, not exactly. It seems as though the European culture frowns on fast food, long lines and many other conveniences and inconveniences that Americans have become accustomed to enjoying and enduring.  The initial Disney experience required many millions of dollars and years of tweaking and modification to the American Disney World model before it became anything nearly as successful. It forever set-forth another example as to how Europeans differ in their perceptions and customs relative to other world societies.  So where does entertainment and telemedicine have commonality?

Decade’s after Disney’s surprising experience significant advances in telecommunications technologies have brought about vast improvements to societies all around the world, across all industries, commerce, media, personal communication and even to the well-established healthcare delivery model.  And while some resistance to changes in healthcare delivery, brought on by the telemedicine and telehealth revolution, have been experienced the vast majority of cultures around the world are envisioning and welcoming significant benefits to the quality and availability of medical services derived from the revolution.  Even deeply traditional governmental regulation and policy barriers are falling aside, albeit slowly in some cases, giving way to a new era of medical care delivery.  But in Old Europe, as telemedicine revolutionizes medical care around the rest of the world, Germans are happier paying a visit to the doctor, and those who could benefit most from the technology will just have to wait.

By international standards, Germans have plenty of doctors: 3.84 for every 1,000 patients. In the US, the number is 2.46. But such statistics shed little light on how doctors are distributed throughout a country. “In some rural regions, we have a situation where a consultation might require a day’s travel for the patient,” says Wolfgang Loos, chairman of the German Society for Telemedicine. One of the solutions, he says, is that a doctor could consult patients via live video streams to the patient’s home. Digital medicine is taking hold in the field of stroke prevention and care, small hospitals and care clinics are networked and can consult specialists through video conferencing whenever they have questions. Patients with chronic heart issues can access a different form of telemedicine: some measuring instruments are connected to centralized medical networks, and if a patient’s value suddenly worsens, a nearby doctor is alerted. But telemedicine faces a number of particularly German hurdles.

Doctors in Germany, as stipulated in the “prohibition of remote treatment” (a German physician’s code of conduct), doctors are not allowed to diagnose a patient remotely without having dealt with that patient before, at least once in person.

Beyond code of conduct restrictions, patients in Germany are accustomed to, and expect, a direct line of personal contact with their general practitioner and specialist. And while most German physicians recognize huge potential in the field of telemedicine, they continue to view “direct contact between doctor and patient as indispensable.” A custom many early detractors of telemedicine in America promoted, only to be rebuffed by patients once the convenience of virtual consultations was experienced.

There are also technical barriers that inhibit telemedicine in Germany. In many regions, high-speed Internet access is lagging, making video conferencing or the transmission of large patient data files nearly impossible. The areas lacking broadband access are often the same rural regions, say its advocates, which would benefit most from telemedicine.

It appears that cloning even the most advantageous of instruments and practices of technology will need some tweaking and modification in order to be universally accepted and successful.