AcuteCare Telemedicine Blog


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.”



Removing Well Entrenched Impediments to Advancing Telemedicine Benefits

A recently published study in Telemedicine and e-Health found that despite numerous benefits to expanding telemedicine that there are three major barriers that remain to fully implementing the benefits of telehealth. Health care professionals agree that Telemedicine has and will continue to change care delivery and patient outcomes by expanding patient access, reducing service gaps, improving service quality, providing additional clinical support, delivering enhanced patient satisfaction and improved adherence to care standards.

Advances in powerful technology is transforming care facilitation, making real-time audiovisual communication more feasible and permitting physicians the ability to remotely consult with a patient via a robot and LCD screen.  Remote specialists and physicians can treat patients and save lives with the use of a broadband card, an internet connection from a cell phone tower and a laptop. This illustrates the amazing potential of telemedicine but the study found that serious human barriers to nationwide telemedicine still remain.

The study surveyed emergency and critical care remote presence telemedicine users from 53 healthcare institutions across North America and Ireland. One hundred-and-six surveys were completed. Sixty-eight percent of respondents were physicians, 17 percent nurses and nurse practitioners and 8 percent were administrators. The results indicated that three major human barriers for telemedicine in the areas of regulation and finance need eradication to fully implement the benefits of telemedicine.

     – Licensing for Physicians. A major benefit of telemedicine is the ability to consult remotely with physicians and patients across state boundaries, but today the current approach to medical licensing requires health providers to obtain multiple state licenses and adhere to diverse and sometimes conflicting state medical practice rules. The medical licensing process is not only complicated but also lengthy and expensive and it represents a major barrier to the expansion of telemedicine.

     – Credentialing. Credentialing can become very complicated especially for hospitals with hub and spoke models because physicians from each hospital have to have the credentials at every hospital.  The time it takes it to acquire all necessary documents and finish an application is time that could be used training medical staff to use telemedicine and bring the benefits of telemedicine to deserving patients. The current method for credentialing should be streamlined to facilitate easier credentialing at multiple facilities leading the way to wider telemedicine implementation and increased accessibility.

     – Reimbursement. A huge financial issue for telemedicine is the lack of reimbursement and capital expenditure for services. Similar to licensing issues, reimbursement models are different across the states with each having its own regulation for private payers with little or no consistency for telemedicine reimbursement.

Removing these impediments to the expansion of telemedicine remains a daunting task. Change never comes easy, particularly when it requires the cooperation of various bureaucratic agencies, multiple governing bodies and a wealth of well entrenched administrative procedures and regulations that were designed and implemented in a time when advanced communication technologies were little more than fantasy and science fiction. A continued focus on removing these barriers must intensify in order to bring the many proven benefits of telemedicine to patients throughout the country and the world.



Study Reveals Telemedicine Improves Patient Outcomes

Researchers at UC Davis Children’s Hospital have found that telemedicine consults improved pediatric patient outcomes for patients treated in rural pediatric emergency departments that lack pediatric specialists.  They also found a physician was more likely to adjust the patient’s diagnosis and course of treatment after a face-to-face video conference with a specialist.   Madan Dharmar, an assistant research professor in UC Davis’s pediatric telemedicine program and the study’s lead author said, “The shortage of physicians in rural communities isn’t going to be solved by increasing the number of physicians, but by increasing the number of physicians available over telemedicine.”  “Telemedicine is going to be the future.”

Researchers examined data collected from five rural California pediatric emergency departments from 2003 to 2007. The EDs were equipped with uniform telemedicine technology, which was met with some resistance at first.  “Some of the rural doctors [who] were old-school at first resisted using the technology but when their objections were overcome they used it and liked it.  To aid the adoption process, UC Davis doctors conducted periodic test calls to check in and help the rural doctors adjust to the technology.

The face-to-face communication was responsible for improved outcomes, according to James Marcin, director of the UC Davis Children’s Hospital Pediatric Telemedicine Program and the study’s senior author. “More time is spent on a video consult than a phone consult. Rural doctors asked more questions and UC doctors provided more recommendations when video conferencing. “The technology is readily available,” Marcin said. “There’s no excuse why it shouldn’t be used.”

Only 3% of pediatric critical care specialists live in rural areas, serving the 21% of U.S. children who live in those areas.  Expanding the availability of specialized care to these children should be a priority for all communities and healthcare providers. The benefits of telehealth are increasingly being recognized all around the country. A bill recently sponsored by state senator Arthenia Joyner will make Florida the 20th state to require private insurers to cover telehealth services.



Expanding tPA Stroke Treatment Through Telestroke Delivery Model

For years, the mantra of neurologists treating stroke victims has been “time equals brain.” That’s because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost. Established research has demonstrated that administering a tissue plasminogen activator (tPA) intravenously up to 4.5 hours, after the onset of a stroke, benefits patients with moderate to severe acute ischemic stroke. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain and it accounts for 87 percent of all stroke cases.

While the use of tPA significantly improves a patients recovery from stroke its administration requires the availability of neurologic expertise within this narrow window of time.  Specialized stroke care at large academic medical facilities is very effective in providing stroke care but access to these centers is limited to patients living in rural areas of the country.  Practiced-based telestroke services, staffed primarily by general neurologist, offer a streamlined organization that facilitates the dissemination of this vital emergency treatment but a comparative analysis of the data between the two delivery systems is a critical.

“Expanding Access to Intravenous Tissue-type Plasminogen Activator with a Practiced-based Telestroke System” was recently published by the Journal of Stroke and Cerebrovascular Diseases.  The study was prepared by 4 practiced-based neurologists at AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology in the southeast.  Summary findings included data gathered over a two year period at 7 hospitals on 202 emergency telemedicine consultations and treatment of 54 telestroke patients with IV tPA.  Patient demographics and outcome measures were not significantly different for patients treated by practiced–based or academic providers with the exception of lower age and shorter stay duration of the practiced-based treatment group.

The results indicate that emergency stroke care provided by the two delivery models can achieve similar patient outcomes and that a practiced-based telestroke system can expand the availability of IV tPA treatment with clinical outcomes no different from previously published studies.

“Meeting the requirement of providing rapid neurology care to all of the nation’s emergency rooms will necessitate a concerted effort of academic and practiced-based stroke systems”, said Dr. Keith A Sanders, ACT.  The technological, organizational and financial hurdles which currently limit telestroke use and expansion will likely be resolved as the benefits of telemedicine become more evident with its expanded use.

For more study details and the full article, contact info@acutecaretelemed.com



Will Telemedicine Reduce the Wait at Hospital Emergency Rooms?

Waiting times at hospital emergency rooms has long been a problem.  Originally established to treat patients with injuries and illnesses in cases of extreme emergency treatment needs, todays hospital emergency facilities are packed with patients seeking treatment for every ailment from the common flu, minor cuts, sprains, strains, to severe injuries and illnesses.  As a result anyone who has ever had the misfortune to need to visit a hospital emergency room is well experienced in the art of waiting for treatment, in some cases, many long hours.

For years hospitals have attempted to stem the unrelenting flow of patients by diverting them to physician’s offices and off-site medical clinics and triage centers, still others post estimated waiting times on billboards and electronic signage located outside the hospital entrances.  The waiting goes on unabated.

To address this issue, a pilot study has been launched at UC San Diego Health System’s Emergency Department (ED) to use telemedicine as a way to help address crowding and decrease patient wait times.  The study is the first of its kind in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.  The study, called Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), brings telemedicine doctors to patients when the ED becomes busy.  An offsite doctor is paged, who then remotely links to a telemedicine station to see patients.  With the aide of an ED nurse, these patients are seen based on arrival time and level of medical need.

“This telemedicine study will determine if we can decrease wait times while reducing the number of patients who leave the ED without being seen by a physician,” said David Guss, MD, principal investigator and chair of the department of emergency medicine at UC San Diego School of Medicine.  “If the use of a telemedicine evaluation can be shown to be safe and effective, it may shift how care in the emergency department is delivered.”

“ED overcrowding increases patient risk and decreases patient satisfaction with emergency services,” said Vaishal Tolia, MD, MPH, FACEP, emergency medicine physician at UC San Diego Health System.  “Implementing telemedicine in the emergency department setting may improve the overall experience for both patients and medical staff.”



Think of Your Brain!

It is without a doubt the most vital organ in the human body, but too often we neglect the importance of taking good care of our brain. The development and organization of the brain are incredibly complex, but the intricacies of this central body belie the simplicity of its proper day to day caretaking. We only get one – why not give some thought (pun intended) to it.

Prevention of traumatic head injuries is likely the most obvious consideration for avoiding significant damage to the brain. Unfortunately, we cannot always predict when an accident might occur, but we can take basic steps like fastening our seat belts while riding in automobiles and wearing helmets when engaging in physical activities carrying risk of trauma. Beneath the skull, we must be concerned with degenerative disorders of the brain affecting motor skills and cognition, such as Alzheimer’s Disease and Parkinson’s. Depression and anxiety also afflict millions of individuals across the country. It is important to remember that although our fast paced, high-stress lives can seem overwhelming, these conditions are chemical, and there are measures we can take to mitigate their negative effects.

Perhaps the most severe threat to the brain is stroke and other cardiovascular disease. The American lifestyle has taken a significant toll on the health of the blood vessels that deliver vital oxygen and nutrients to the brain. We have seen it most exaggerated throughout the southeastern US, a part of the country known as the ‘Stroke Belt,’ where residents face significantly higher rates of stroke morbidity and mortality.

The experts offering advice to citizens on how to minimize their risk of stroke sound like a veritable broken record; sleep more. Eat better. Exercise. Although stroke care has made huge advances in technology and technique over the course of the past decade, there is truthfully no more powerful plan of action than that of prevention. Telemedicine may soon be able to play a bigger role in opening lines communications between physicians and patients at risk of having a stroke, helping them take the necessary steps to avoid an emergency situation where the health of their brain and their life are in danger. As neurologists become more familiar with the advantages of new telemedicine technologies, they are realizing that the “ounce of prevention” is more readily available than ever before.