AcuteCare Telemedicine Blog


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.”



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.



AcuteCare Telemedicine Leading Acute Care Telemedicine

The effort to provide high-quality healthcare solutions to every patient, regardless of geographic location, while reducing delivery costs is at the foundation of industry leaders efforts to revolutionize the traditional healthcare delivery model. Telemedicine is becoming the cornerstone of the solutions. Advances in telecommunication technologies is providing increased opportunities to decrease complications for patients in areas of high acuity like the critical care unit, as well as provide assistance in time-sensitive treatment decisions for emergencies such as stroke care.

InTouch Health® is the leader in acute care remote presence telemedicine. The company through its network of clinical care providers delivers innovative healthcare solutions that extend a doctor’s ability to manage patient care remotely, thereby removing critical time and distance barriers. The InTouch Telemedicine System allows physicians and other healthcare providers to conduct highly reliable, real-time, remote consultations.

AcuteCare Telemedicine (ACT), the largest practiced based provider of acute stroke and neurological care is now linked as a preferred provider with InTouch Health. Acute care telemedicine is an approach to urgent healthcare delivery in which specialists are focused on providing comprehensive, end-to-end remote presence clinical services, enabling a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision and care plan. With their remote expertise available at a moment’s notice, ACT is able to increase the likelihood that patients will obtain necessary stroke care within the critical “golden hour” following stroke recognition. The importance of using acute care telemedicine in the advancement of emergency healthcare is supported by the efforts of InTouch Health.

The ACT team of expert Neurologists is being recognized for setting new standards for excellence in Telestroke and urgent Teleneurology care. As clinical partners with hospital based and emergency physicians, they are positioned to successfully deliver remote, live and interactive Telestroke and other Teleneurology solutions that deliver the highest quality, affordable services and superior clinical outcomes for hospitals all around the world.



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.



Honoring Our Veterans With Telemedical Technology

As we honor our American Veterans this month, it is fitting to examine how Telemedicine, the exchange of medical information via electronic communications, has vastly changed the way deployed soldiers receive access to health care and how the new communication system promises to offer better access to care for veterans in the future as well.

When Dr. Ronald Poropatich first joined the military 30 years ago, the digital cameras and web cams required for the use of telemedicine barely existed. Yet, during his career as the deputy director of the Telemedicine and Advanced Technology Research Center in the United States Army, Poropatich helped revolutionize health care for soldiers by bringing telemedicine technology to army bases and field hospitals around the world including in Somalia, Iraq and Afghanistan.

Today, soldiers in Iraq or Afghanistan can get second opinions on tricky medical situations from doctors located halfway around the world and can receive diagnoses from medical specialists, even when none are stationed at their base.  Telemedicine has advanced greatly, allowing soldiers to email photos of electrocardiograms (EKGs) or skin rashes back to physicians back in the U.S., and receive feedback within hours.

This technology has allowed the military to spot medical conditions that would have otherwise been missed or quickly garner second opinions on cases that have the potential to warrant costly evacuations. Telemedicine has also provided a way to treat soldiers for conditions like post-traumatic stress disorder, or depression, while preserving their privacy.

The survival rate, if you can get to a combat support hospital level 3 facility in Afghanistan, is a fantastic 90 percent, but that means a lot of guys and gals are surviving horrific wounds once thought to be fatal.  So providing a telemedicine lifeline to veterans once they are back home is imperative in order for veterans to communicate with health care providers outside of in-office visits.  Accessing their care through the use of a cellphone or webcam, recovering soldiers will be more likely to stick with rehabilitation programs and outpatient treatment, ultimately ensuring better mental and physical health outcomes in the long term.

Perhaps the best way to honor our veterans is to provide them the best of medical care through the use of Telemedical Technology.



Growth of Telemedicine is Global and Becoming Common Place

Though the United States has been dominating the global telemedicine market, Europe and developing nations are rapidly catching up. The global telemedicine market is expected to grow at a compound annual growth rate of 19 percent, driven mainly by growth opportunities in Europe, but the enthusiastic growth may be tempered by the lack of standardized classifications. However, the increase in remote monitoring of patients is expected to keep driving the market, which is also boosted by the increase in telesurgery. The shift is occurring mainly because of the increase in the number of patients with chronic diseases and the increasing availability of online healthcare services.

The remote delivery of healthcare services over the telecommunications infrastructure, or telemedicine, is a topic of interest to the vast majority of Italian general practitioners (GPs), with 73 percent stating that they are prepared to use the technology according to a study conducted by the Italian Family Doctor’s Association FIMMG. Over half of the doctors surveyed, 52 percent, are in favor of using these new technologies if they help to develop organizational aspects of the profession, while 30 percent state that telemedicine could even improve the doctor-patient relationship.

Global virtual doctor visits could become as common as face-to-face appointments because health insurers, hospital systems and employers view it as a way to clamp down on rising medical costs. They hope that by giving patients easy access to a primary care physician, it will discourage them from visiting a costly emergency room when they get sick. The trend in the US is expected to escalate as an influx of new patients, caused by the implementation of the Affordable Care Act (ACA), promises to put a strain on some doctors’ offices for treatment of routine illnesses.  Health giants UPMC and Highmark Inc. are rolling out new services that allow patients to video-conference with doctors through computers, tablets and smartphones.  “We think more and more people, as they become more familiar with telemedicine, will see this as something that is just going to be commonplace,” said Natasa Sokolovich, executive director of telemedicine at UPMC.  Convenience is the big selling point of telemedicine services to patients.  Rather than having to wait days or weeks to schedule an appointment at a doctor’s office, a video conference could be scheduled within minutes or hours, and the patient wouldn’t have to leave their home.

While such convenience is enticing to an increasingly busy society, some doctors and medical care providers are warning that an E-visit can’t entirely replace face-to-face consultations in a physician’s office environment. Nonverbal cues can be very important in accurately diagnosing patients, said Dr. Bruce MacLeod, president of the Pennsylvania Medical Society. “Some details could be missed in a video conference.”

But as the availability and quality of telemedicine advances globally, a increasing majority of patients are willing and eager to invite the technology into their relationship with their health care providers.  The desire to make medical care more accessible and less-costly is global. Whether E-visits replace face to face medical care completely or just become some relative portion of interaction between patients and physicians, the medical services delivery model is going to be altered dramatically for the future.  The rate of acceptance of communication technology in the medical care process will be driven more by necessary changes to the well-established regulations, licensing requirements, and cost reimbursement policies from within the health care community.