AcuteCare Telemedicine Blog


The Era of Resisting Telemedicine is Fleeing

Despite the promise of significant consumer benefits of access and costs and the overall growth of Telemedicine, many patients and physicians are slow to adopt new communication technologies in the delivery of healthcare. A recent article in Medical Economics News reported that “A HealthMine Survey of 500 consumers who use mobile/Internet-connected health applications finds that 39% still have not heard of telemedicine, and only one-third of respondents say their health plan offers telehealth as an option.” And while many patients have not yet signed on to telehealth services, nearly three quarters of patients are interested in using it in place of in-person medical appointments. Could it be that the slow progression of patient participation may be due to resistance and lack of participation from care providers?

One of the most prolific reasons many providers resist the technology is the concern that patients would be unwilling to replace traditional face-to-face physician encounters with a virtual relationship and that many consumers would be fearful of the technology, particularly those among the growing number of “Baby Boomer” patients. But in a recent Georgetown University study, the results indicated that more than half of the aging generation preferred to use this technology. And among those 34 years of age and under, 60 percent desired a virtual interaction with their physician.

Some of the complaints from cautious physicians revolve around the complexity and cost of technology hardware and software and the difficulties in merging new platforms into existing operations, particularly syncing virtual experiences with current EHR systems. Ongoing design improvements in the technology and simpler user interfaces are driving down cost and simplifying required functions. The reality today is that telemedicine improves the bottom line for most medical practices while reducing appointment management and patient flow issues.

As legislatures across the country continue to make progress on modifying existing regulatory barriers and concerns involving payment parity, payer participation and individual state licensing and credentialing, many early telemedicine supporters are beginning to see the light at the end of the increased adoption tunnel. For those providers who continue to resist the trends of virtual medical technology, the time is nearing to overcome the natural tendency to resist and fear change. The simple truth is patients prefer and want telehealth choices and the technology is here to stay.



Telemedical Technology: Creating a Healthcare World without Barriers

As with many other high tech gadgetry, revolutionary processes and scientific inventions telemedicine has its roots in the NASA space program. For those early adopters of telemedicine, the efficacy of the doctor/patient consultation and the ability to improve patient outcomes were on the top of the list for barriers to entry. Many thought that patients would be hesitant to trade personal face-to-face visits with their doctor for a consultation through a virtual robot. But as early adopters used the technology to bring specialized care to remote and distant rural areas, patients soon realized the convenience and cost savings of not having to travel long distances to receive the latest in specialized healthcare, and soon embraced the new experience in connecting with a doctor.

The process is now considered to be an ideal use of technology to monitor and connect healthcare professionals with patients over long distances. With the introduction and increasing popularity of wearable technology, the existing digital info-structure in many rural areas of the country limited the expansion of telehealth. With the recent introduction of ConnectAll, a new federal initiative aimed at building broadband parity across America, is expected to provide nearly 20 million more Americans with access to telemedicine. “The expansion of affordable Broadband will further solidify the rapidly growing telemedicine sector, which is transforming the healthcare paradigm,” said Jonathan Linkous, CEO, American Telemedicine Association (ATA). “This initiative helps to deliver the promise of more cost-effective healthcare delivery models, and promotes the expansion of telehealth services for all.”

With Medicare, Medicaid, and private health insurance carriers continually expanding the number of virtual services approved for reimbursement, a once formidable obstruction is disappearing all across the country and the world. A growing number of healthcare providers are now expanding their reach. “This is a world without boundaries, and that’s what we’re seeing,” said Andrew Watson, MD, chief medical information officer for University of Pittsburgh Medical Center’s (UPMC’s) International and Commercial Services Division, “The advent of telemedicine in a world without boundaries is no different than using Facebook or Skype around the world. We’re just seeing this technology impact medicine.”

But not all of the walls to expansion have been breached. Much remains to be done to remove existing impediments such as state by state licensing and credentialing requirements. The established healthcare regulatory system with its myriad of governing bodies, Boards, and legislatures continues to be a formidable foe when it comes to interjecting new technology into the traditional face-to-face experience between the healthcare provider and patient. “In-person visits will likely remain the mainstay for local care for those fortunate enough to be around many physicians, but when minutes count in emergencies experts can step in and make the decisions that will determine a lifetime of health instead of a lifetime of disability. Telemedicine isn’t a fad but rather a disruptive innovation that flows naturally out of technological advances and has already contributed immensely to our society’s health. It’s a perfect fit for our shrinking resources,” says Matthews W. Gwynn, M.D., Partner, ACT.

ACT has been on the forefront of the use of telecommunication technology for years, remotely delivering live and interactive telestroke and other teleneurology solutions anytime, anywhere to hospitals and emergency medical centers throughout the Southeast. Progress in reforming the massive healthcare regulatory system is occurring as dedicated industry leaders tackle the challenges of integrating advanced remote medical technologies into the existing mainstream healthcare delivery model.



Telemedicine is Closing the Gap Between Experts and Child Abuse Victims

Telemedicine’s entry into the healthcare process has been rather obvious over the past decade, particularly to those who have benefited from advanced stroke care, treatment for chronic diseases or convenient routine care for common illness. For those who live in areas away from advanced-care medical centers, telemedicine is closing the geographical gap to advanced, specialized treatment for stroke, diabetes and other coronary and neurologic disorders. As technology makes its way across the full spectrum of healthcare, providers are using the newest telemedicine technology to tackle one of their most difficult tasks: identifying a victim of child abuse or neglect.

Many cases of suspected child abuse arrive at hospital ERs, doctor’s offices or clinics where doctors and nurses can be less experienced in making a proper diagnosis. With the use of virtual technology the process of determining a proper diagnosis is enhanced, and the gap between child care experts and rural hospitals and advocacy centers closed. “We’ve saved lives, and we’ve saved families,” says Dr. Lori D. Frasier, division chief of child abuse pediatrics at Penn State Hershey Children’s Hospital.

The Department of Justice’s Office of Juvenile Justice and Delinquency Prevention and National Children’s Alliance provide financial support to more than 800 children’s advocacy centers across the country where treatment for victims of child abuse are benefiting from the use of telemedicine. It is also critical that a diagnosis of abuse be accurate. “The value is in the accuracy of the diagnosis,” says Patricia Goede, PhD, vice president of clinical informatics at XIFIN, “Over-interpreting something can be a huge cost to children and families.”

In Georgia, where much of the State’s populations reside in rural areas, the Children’s Healthcare of Atlanta Center for Safe and Healthy Children (CSHC) has used telemedicine since 2009. Jordan Greenbaum, M.D., Medical Director of Children’s CSHC says, “An evaluation utilizing telemedicine reduces parental anxiety and stress by providing prompt access to expert care and support. It also saves time and resources for authorities, who can lose a workday driving to and from Atlanta. And for rural medical providers, telemedicine relieves some of the burden of accurately identifying abuse and interpreting physical findings.”

In Florida a sharp increase in child abuse and a shortage of treatment specialist has exasperated an existing care differential between advanced care facilities and rural areas where child abuse rates are the highest. Providers in the state are working to expedite the development and initiation of telemedicine programs to address the growing problem. In the mid-west, at The Midwest Regional Children’s Advocacy Center at Children’s Minnesota, they’re utilizing the same platforms to share images and other tests and communicate with trained child abuse specialists.

Many formidable barriers to adoption and expansion of telemedicine remain, but as the utilization of the technology finds new and creative solutions across the range of medical services, closing the divide between specialized care and patients in need promises to remove many of the remaining, well-established opponents.



Healthcare Regulatory & Policy Environment Impacts Telehealth Adoption

For those who first thought telemedicine’s role would be limited to a supportive, “add-on” process focused on a narrow list of ailments and other procedures and treatments, today’s reality must be shocking, if not a bit frightening.

Unlike technology where advances are frequent and common, changes to industry governing regulations are often found at the other end of the spectrum, and perhaps rightfully so. While some may argue that the healthcare industry is overly regulated, others argue that well designed regulations and practice standards is the fundamental reason that our healthcare system is the envy of the world. The suspicious practices of past centuries of treating patients have been replaced by a complex set of regulations that are diverse across all fifty states but is universally founded on all responsible care givers guiding mantra, “First, do no harm”.

But no matter how well intentioned and successful, the massive healthcare regulatory system with its myriad of governing bodies, Boards, and legislatures is a formidable foe when it comes to interjecting new technology that promises to greatly improve and enhance the experience between healthcare provider and patient. The changes perhaps once thought to require mere tweaking around the edges of the regulatory giant are proving to be far more involved and are likely to require a restructuring of the healthcare regulatory environment, a process that will certainly slow the advancement and adoption of telehealth. Progress is occurring, at a disruptive but deliberate pace perhaps, as dedicated industry leaders tackle the challenges of integrating advanced remote medical technologies into the existing mainstream healthcare delivery model.

The American Telemedicine Association, the leading international resource and advocate promoting the use of advanced remote medical technologies is leading the way and monitoring the progress of change across all fifty states through two annual publications; The 50 State Telemedicine Gaps Analysis, Physician Practice Standards & Licensure and The State Telemedicine Gaps Analysis, Coverage & Reimbursement.

Ultimately, the future of telemedicine and its rate of adoption are dependent on reimbursement and regulatory policies at the industry, federal and state level. Jon Linkous, the CEO of the American Telemedicine Association, counts understanding healthcare’s regulatory and economic structure as one of his top To Do’s for companies active in the telehealth industry.



Technology & Telehealth At The Center of Healthcare Debate

Many industry pundits are predicting that 2016 will be the year that technology and healthcare will become the center of the healthcare industry. With advances being made to modify century old regulations and processes governing the established patient/doctor relationship, telehealth services are positioned to become main-stream in the delivery of care all across the country. Rapid adoption of technology driven health services is expected to accelerate as payment for services, interstate licensing and accreditation issues, currently complicating expansion, are resolved. “2016 is the time for telehealth,” said Nathaniel Lacktman, a partner at Foley & Lardner who specializes in telehealth. A major factor, he said, is that providers are taking on more financial risk for managing the health of enrolled populations. “What a provider can do on the front end is use telehealth to make the patient more likely to interact with a clinician,” he said.

As an increased number of states are allowing physicians to provide telehealth services across state lines through collaborative licensure arrangements, insurers across the industry are discovering the cost advantages of reimbursing for virtual care. However, a recently published survey conducted in 2014 by The American Academy of Family Physicians indicated that while 78 percent of respondents believed that telehealth would improve access to healthcare, only 15 percent actually used telemedicine during the year. The survey also pointed to other barriers to wider acceptance which include the need for additional training for caregivers, continued reimbursement issues, cost of the technology and potential liability issues. 

“Telehealth use is in the early stages of adoption,” states the paper. “Many of the barriers to wider adoption may be addressed by policy changes. Strategies to address the top two barriers identified by this survey include health care stakeholders offering new opportunities for training in the use of telehealth services and payers increasing awareness of their current reimbursement for telehealth services, as well as developing new ways to reimburse the services.”

On the consumer side, awareness appears to be a major factor in the level of use. While consumers are quick to buy into the benefits of a marriage between technology and their interactions with care givers, the mechanics of actually making a virtual connection, and when it is appropriate, has many potential users pausing at the first step. Providers will need to embark on a strategy to guide patients through the process of making that first connection and reinforcing the experience.

It’s safe to say that telehealth and technology will continue to dominate healthcare conversations in 2016.



Robots and Doctors Help Improve Stroke Treatment

The issue of delivering consistent medical care across all geographic areas from large populated urban centers to the outlying rural communities has been a critical area of focus for healthcare organizations. Typically smaller, financially stressed rural hospitals and clinics suffer from limited access to medical specialists, particularly in emergency situations involving stroke and other neurological and coronary events. These medical emergencies demanded quick and immediate treatment to save the affected patient from significant disability or death.

In the three years since the first telestroke robot was installed at Covenant Health Hospitals in East Tennessee, doctors at LeConte Medical Center (LMC) have used the technology on a weekly basis. Using the latest in virtual presence technology the dedicated medical professionals at LMC can connect immediately with a team of neurological specialists at AcuteCare Telemedicine in Atlanta, GA. “It’s an amazing thing that we have this expertise in a small rural hospital,” said Steve Dronen, M.D., Emergency Room at LeConte Medical Center. While the hospital has a well demonstrated history of providing quality care to stroke patients, the extra advantage of having highly trained and experienced neurological specialist available for consultation around the clock, 24/7 assures LMC patients the highest level of stroke care available anywhere in the country.

Dr. James Kiely, a partner in Atlanta Neurology, P.C. and AcuteCare Telemedicine said, “As Medical Director of the Neurophysiology Departments at St. Joseph’s Hospital of Atlanta I was aware of how fortunate our patients were to have the most immediate lifesaving treatment for stroke 24 hours a day, seven days a week.” The most effective stroke care requires that it be delivered to the patient within the “golden window” of stroke onset. With stroke being the number four cause of death and a leading cause of disability in the United States, lack of access to neurologists who specialize in stroke care threatens to deprive many patients the best chance of recovery after a stroke. “AcuteCare Telemedicine was created”, Dr. Kiely says, “to impact the well-being of patients with severe neurological emergencies who otherwise wouldn’t have rapid access to vital expertise simply because of where they live.”

The other major benefit of the technology, described by Dr. S. Arthur Moore, Medical Director of Stroke Program at Covenant Health’s Fort Sanders Regional Medical Center, is how quickly the tele-robot allows doctors to make life-saving decisions. “We can now do something about it. It doesn’t matter if you are in rural East Tennessee or in Knoxville, we can provide the same care,” said Dr. Moore. Doctors only have a small window of time to make a treatment decision before the damage from stroke becomes permanent. The new technology is helping to accelerate the treatment process.



Telehealth Can Play a Key Role in Saving Rural Hospitals

No matter the location, rural communities across America have one thing in common. Residents tend to be older and sicker than their fellow, “urbanites”. The introduction of the Affordable Care Act (ACA), designed to provide millions of previously uninsured or underinsured patients access to health insurance, accompanied by Medicare reimbursement cuts and other regulations is beginning to negatively impact rural hospitals. The trend has many pondering; “If you decide to live in a rural community, are you deciding to have a worse outcome if you have a stroke?” asked Dr. Jeff Feit, vice president of population health at the Valley Health system.

To date, 51 rural hospitals have closed in the US since 2010, according to the North Carolina Rural Health Research Program at the University of North Carolina at Chapel Hill. Southern states have been disproportionately affected by the increase in closing of rural facilities. Texas has seen 10 rural hospitals close, while Alabama and Georgia have each lost five just in the past five years. The National Rural Health Association has identified 283 more rural hospitals in danger of going out of business. Many rural hospitals “have been struggling on the cusp for a long time,” said Mark Holmes, director of the North Carolina Rural Health Research Program. The future of many rural hospitals is threatened by the ongoing cuts to Medicare and the failure of more than 20 states to expand Medicaid.

Maggie Elehwany, vice president of government affairs for the National Rural Health Association, says significant Medicaid cuts in the past few years have been suffocating rural hospitals. “The greatest crisis right now is the hospital closure issue,” she said. In Kansas, The Kansas Hospital Association has repeatedly told its lawmakers that failure to expand Medicaid will have dire consequences, leading some rural hospitals to shut down. Terry Hill, a senior policy adviser at the National Rural Health Resource Center has predicted, “You’re going to see a predominance of closures in the next year or so in those states that have not expanded their Medicaid eligibility.” Congress is attempting to respond to the crisis by initiating several bills to help rural hospitals recover, but they are receiving little attention by the majority of lawmakers.

In the interim, an increasing number of rural hospitals are looking to virtual healthcare options to remain financially viable and operationally relevant in a new, emerging healthcare delivery model. Telemedicine can provide many of them the means for resuscitating a community’s hospital by connecting rural patients to primary care and medical specialists as well as remote monitoring of many chronic diseases.

Establishing virtual healthcare solutions requires investment, but the investment will pay significant dividends for patients, providers and hospitals by creating broader access to healthcare networks, experts and outlying resources. While some small hospitals are debating whether they can afford to implement telemedicine, others are debating if the hospital can afford not to make the investment.