AcuteCare Telemedicine Blog


Making a Meaningful Difference to Lives around the World

It has been a little more than a year since Georgia Partnership for TeleHealth (GPT), the Louisiana State University Health Science Center (LSU) and Casa Para Ninos Aleluya (CASA) launched its first international telemedicine program. The mission of the collaboration is to deliver much needed primary and specialized medical care to the children of the CASA orphanage through the use of telemedicine technology.  The orphanage is home to over 400 abused, orphaned and mistreated children and is located just outside of Guatemala City. The medical needs of hundreds of the children at CASA are met daily through a few nurses that manage a clinic on-site.

Shortly after the Program got underway, Dr. James M. Kiely, a partner in Atlanta Neurology, P.C., AcuteCare Telemedicine (ACT) and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta was given the opportunity to demonstrate telemedicine capabilities at the orphanage and volunteered his time and talents to render virtual care to the youth of CASA.

Dr. Kiely remotely treated a 19 year old CASA patient with a history of intractable epilepsy. The young patient was on numerous medications but continued to experience recurring seizures. By using a high definition audio-visual connection provided by GPT, Dr. Kiely was able to interview the patient’s parents and examine the patient remotely. The imaging results, hemiparesis, and description of seizures allowed him to determine that the likely type and cause was attributed to porencephaly, the failure for one hemisphere of the brain to develop. Kiely was able to recommend appropriate medications to on-site doctors and to suggest additional steps to take if the patients epilepsy remained intractable. The process worked flawlessly and marked the beginning of a new relationship between the missions and medical providers across the region.

At a recent GPT Telehealth Summit this year in Florida, Dr. Kiely was brought up to date on the patient he first treated more than a year ago at the orphanage in Guatemala. A family member of the patient has recently received his Master’s Degree. He is now serving an internship with the Georgia Partnership for Telehealth who continue to provide ongoing support to the children of the Guatemala region through donated physician time. He had the opportunity to speak with Dr. Kiely and informed him that the young patient, his sister, is doing well.

Dr. James M. Kiely says, “I am so invigorated when I’m able help a patient and to make a meaningful difference in their future. Whether here at home, or around the world, it is extremely rewarding.”



Diligently Working To Formulate An Interstate Licensing Solution

Representatives of the country’s State Medical Boards are persistently working on drafting new legislation to revamp the process of the state by state licensing of physicians. Currently physicians are required to be licensed in each individual state in order to practice across state boundaries. The individual state licensing requirement is widely thought to be a major barrier to the expansion of telemedicine.

The proposed plan is thought to offer the most dramatic changes in medical licensing offered to date and, if enacted, could increase access to doctors and specialists for patients located in rural areas and permit people with complex illnesses or rare diseases to more easily consult experts. The proposed interstate compact would speed-up the process of licensing doctors in multiple states while preserving each state’s authority to regulate the practice of medicine within their respective borders.

Under the proposed compact, doctors who meet certain standards could avoid the longstanding requirement that they apply for licenses state by state. The compact would be administered and enforced by an interstate commission consisting of representatives from each participating state.

Mari E. Robinson, executive director of the Texas Medical Board said, “The compact would make it easier for physicians to get a license to practice in multiple states and would strengthen public protection because it would help states share disciplinary information that they cannot share now.”

While the compact proposal is the most aggressive model for change to interstate licensing to date, some feel as though the effort stops short of resolving all the issues. Jonathan Linkous, CEO of the American Telemedicine Association, believes the Federation’s proposition does not go far enough. “Their model is not a reciprocity model,” Linkous recently told MobiHealthNews. “The physician would still have to pay a fee to every state, probably (also) a processing fee, and have a third party handle the paperwork, which may or may not be a good thing. And we don’t know if all the states will adopt it.” The ATA estimates that doctors currently spend $200 million to $300 million a year for multiple state licensing, an expense that contributes to the rising cost of medical care nationwide.

Participation in the compact would be voluntary for both physicians and state medical boards and would only become effective and binding upon legislative enactment of the compact by at least seven states. If adopted by enough states it would be a first step in removing a formidable barrier to rapidly expanding the use of telemedicine nationwide.



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.”



Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



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.”



Telehealth: Impacting the Practice of Primary Care

Hundreds of employers of all sizes are contracting directly or through their insurers with telehealth providers to cut medical costs and give workers 24-hour access to doctors and nurse practitioners. Recently, Beth Ferrin’s 9-year-old son came home with a swollen throat and fever. It was after dinner, so she flipped open her laptop and dialed into LiveHealth Online, a service offered by her insurer, WellPoint, (WLP) that connects patients with doctors via video calls. After a quick diagnosis of strep infection, a prescription for an antibiotic was called in to a pharmacy near Ferrin’s home in Bellbrook, Ohio. Her other options would have been to see a doctor in the morning or risk a long wait at an urgent care facility. Beth’s willingness to seek treatment for her son via telecommunication technology counters some telemedicine critic’s prediction that patient insistence on face to face encounters with their physicians would be a significant barrier to remote medical care’s rapid expansion. Now it would appear that barrier was overstated and, in part, has been overcome. 

But some very legitimate concerns continue to exist among physicians about the safety and effectiveness of remote medical care. When asked about the throat infection treatment of Ferrin’s son, Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said: “The only way to diagnose strep is with a test. Best practices say you can’t just throw an antibiotic at somebody.” He says there’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication. But Telemedicine care works well for treating common conditions such as colds, flu, pink eye, and sprains, providers say. 

The widespread use of camera-equipped devices has made remote medical connections easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. The growth of Telemedicine has been spurred in part by the Affordable Care Act (ACA), which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed. 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. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently.

In response to concerns about the appropriateness of remote diagnosis and treatment, the American Telemedicine Association (ATA) is developing an accreditation program for telehealth providers and a bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telemedicine standards. Meanwhile, Telehealth companies are reporting double-digit revenue growth and attracting high-profile investors. MDLive CEO Randy Parker says. “Within the next few years, no consumer will even remember not being able to connect to their providers through telehealth.”



Stepping up and Getting Out in Front of the Revolution

Historically the healthcare industry has been notoriously slow to adopt innovation but one health insurance company is stepping out in front of their industry when it comes to demonstrating a willingness to pay for telemedicine services, recognizing the potential for cost savings and simplification of services.

At this year’s Connected Health Symposium in Boston, John Jesser, VP of Provider Engagement Services for WellPoint, explained that his company is partnering with American Well Systems, a telemedicine services vendor, to set up the program for its members. Before the program was set up, patients who needed to see a physician during off-hours had limited options: Visit the ER and spend about $600; see a physician in an urgent care center for about $150; or wait until the doctor is back in the office. WellPoint introduced a new choice for its members, which only costs about $49.

Patients are able to use a laptop computer, mobile device or tablet to connect with a primary care physician.  The encounter takes about 10 minutes to initiate, is HIPAA compliant and the service can be paid for with a credit card.  Medical history is available to the attending physician.  In addition to WellPoint, a number of other insurers including; Aetna, Highmark and Cigna are experimenting with similar programs for their member policy holders.  Following South Carolina’s State legislators recent introduction of SB 290 and HB 3779, requiring private insurers to cover telemedicine services, BlueCross BlueShield of South Carolina and Blue Choice HealthPlan of South Carolina announced that they would start paying for some telemedicine services.

But a recent tally from the American Telemedicine Association indicates that nationwide coverage will be a slow journey.  As of October 2013, there were only 20 states, and the District of Columbia, that required insurance companies to pay for some form of telemedicine services: Arizona, California, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, New Hampshire, New Mexico, Oklahoma, Oregon, Texas, Vermont, and Virginia.

Insurers and state lawmakers aren’t the only ones with reservations about telemedicine. Ron Dixon, MD, the Director of the Virtual Practice at Massachusetts General Hospital (MGH), says, “I’ve found trying to get telehealth moving at MGH has been impeded by the way insurers pay for things. It’s been a big barrier to get it rolled into the way physicians actually practice.” He also believes that doctors resist offering telemedicine care because they simply have too much to do. “If you are going to get doctors involved, there has to be a win for them, and the win is usually time. It’s not always about the money.”

Massachusetts General Hospital has built a tool that allows existing patients to get their follow-up care online. The hospital pays providers for the service, and while the fees they receive are less than what they get for in-person visits, it also takes them less time to see a patient online, so it tends to balance out.

If the full benefits of telemedicine services are to realized, more insurers and practitioners will need to step up and overcome their reluctance to technologies that promise to revolutionize the traditional healthcare delivery model.