AcuteCare Telemedicine Blog


Advancing Availability and Quality of Stroke Care to the Underserved

The recent collaboration between AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for hospitals in the southeast United States, and the Southeast Alabama Medical Center (SAMC) is having its desired effect for SAMC patients, providing once unavailable, advanced life saving treatments to stroke patients. The Stroke Care Network, established in Dothan, Ala., in collaboration with ACT, the Southeastern Alabama Medical Center Foundation and the Alabama Partnership for Telehealth provides stroke services for a 240-square-mile swath and includes five “spoke” hospitals located throughout southeast Alabama, southwest Georgia and the Florida Panhandle.  The efforts have proven to be critical for stroke victim patients who were once underserved by the latest in life-saving technology.

The adoption and expansion of Telestroke, other acute Teleneurology support and Telemedicine applications has a significant beneficial impact for healthcare organizations, clinicians and patients alike.  Timely access to specialty Neurological consultations via Telemedicine, help many patients avoid the debilitating effects of strokes and other Neurological emergencies due to late diagnosis or delayed administration of “clot-busting” drugs.

Dr. Gwynn, ACT, Director and Founder of the Stroke Center of Northside Hospital and recent Chairman of the Department of Internal Medicine, says, “The new telemedicine health care model is an excellent vehicle to advance the availability and quality of telestroke care to patients who remain underserved throughout the region and all around the country.” In response to their success AcuteCare Telemedicine is making an aggressive push to help other hospitals and networks that don’t have immediate access to neurologists and other specialties.

Dr. Keith A. Sanders from AcuteCare Telemedicine and Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta, says, “We are planning on extending our successful telemedicine platform to an additional two hospitals before the end of 2013 and to an additional 3 hospitals during the first quarter of 2014 as more hospitals and health networks recognize the benefits of sharing specialist services without having to house them on-site.”



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.



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.”



AcuteCare Telemedicine and Ty Cobb Regional Medical Center Team Up to Improve Access to Immediate Stroke Care

Throughout Georgia and all around the country, Emergency Medical Services (EMS) responders are charged with reacting to emergency calls for assistance, providing emergency evaluation and treatment of a vast array of injuries and illnesses and delivery victims to emergency rooms for more advanced treatment.

The work requires split-second decisions that may affect the patient’s recovery.  Often the decision to bypass the nearest, more rural hospital for an urban medical center, known for its specialized treatment for such illnesses as stroke, can delay the patient’s arrival to that facility beyond the “golden hour”, the first sixty minutes after a patient begins to experience stroke symptoms and the critical window for providing care that can minimize long-term disabilities or prevent a stroke death.

At a recent conference at Ty Cobb Regional Medical Center (TCRMC) in Lavonia, GA, area EMS responders learned of a new program at the hospital that offers advanced critical, specialized care for victims of stroke. The goal was to educate emergency responders about its new telestroke program and how it can benefit the community, and TCRMC by capturing potential stroke patients that may have been otherwise bypassed by EMS personnel in the past.

The new teleneurology/telestroke program is a relationship between TCRMC and AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services for hospitals seeking advanced around-the-clock stroke and other urgent Neurological care.  Presenting the conference was Dr. David Stone, TCRMC Emergency Room Director and ACT’s CIO Dr. James M. Kiely, who is also partner at Atlanta Neurology, P.C. and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta.

Members of the Franklin County and Hart County EMS were on hand to receive information about the new service line and EMS’ role in triaging potential stroke patients.  “The goal of this new relationship with TCRMC is to build awareness in the area about ACT’s 24/7 stroke treatment coverage and to advance the area residence understanding of stroke, its symptoms and the importance of receiving immediate specialized treatment, said Dr. Kiely.”

Attending EMS personnel received information regarding strokes “golden hour”, and when it is appropriate to take patients directly to TY Cobb Regional Medical Center or when it is better indicated to take patients directly to an advanced tertiary treatment center.

Recent studies indicate that telestroke programs, like the one provided by AcuteCare Telemedicine, may improve access to immediate stroke care by 40 percent and bring advanced care within reach of millions of stroke victims now located outside the hour of critical care for the fourth most common cause of death in the United States.



Not Yet Out of the Woods

As most Americans celebrated the New Year, our elected representatives met in Washington to approve legislation narrowly avoiding the ‘fiscal cliff.’ As part of its extensive provisions, the new legislation saved Medicare providers from an impending 2% payment reduction that would have gone into effect on January 1 and postponed spending cuts to Medicare, but only for two months. Within the terms of the agreement, negotiations on ways to cut spending are expected to resume after this period, meaning hospitals are still facing the risk of cuts triggered by uncertainty and further harm if the reduction does eventually takes effect.

While overall Medicare spending may not be affected now, hospitals are still face a long-term decrease in payments. The compromise legislation includes the “doc fix,” which negates a 26.5% decrease in Medicare payments to physicians, with hospitals bearing the brunt of financing it. The tally will come to about $15 billion over 10 years, or roughly half the total cost of the one-year fix. On top of those made by the passage of major healthcare reform in 2010, the new cuts include decreases in payout from both projected Medicare payment increases for inpatient or overnight stays and Medicaid disproportionate share payments, as well as reducing risk-adjusted payments to Medicare Advantage plans.

The kind of last-minute action taken by Congress is a reminder of the severe need to address the provider payment formula for Medicare reimbursement with a long-term solution. Short-term fixes ultimately result in a reduction of important healthcare services detrimental to both patient and provider. Until a solution is reached, hospitals simply cannot afford to cover the difference.



Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.



Investing in People

Telemedicine has garnered more attention as of late as a truly game-changing emerging field on the cutting edge of healthcare. Perceptions of the field have become increasingly favorable, but there is still a long road ahead to becoming part of the mainstream lexicon of medicine for patients and providers.

Presently, one of the most significant barriers to entry for new companies in telemedicine is the level of investment required on the part of potential client facilities. Revolutionary technology does not typically come cheap, and as healthcare spending continues to swell (albeit at a slower rate than previously), most facilities are working diligently to combat rising costs rather than add new programs to already bloated budgets.

The good news is that practical new technologies, regardless of how disruptive or expensive at the outset, have a habit of eventually finding their way into adoption. A common adage proclaims that every few years, the power of technology doubles and its price tag is halved. This implies that facilities which have temporarily chosen to forego the extensive advantages that telemedicine programs offer based upon steep startup costs will ultimately find the same solutions to be far more cost effective in the not-too-distant future. However, late adopters of telemedicine services do run the risk of losing their competitive edge. This is especially true in light of the rapid changes ahead in the healthcare landscape; the integration of telemedicine can make a hospital more independent of, or attractive to, consolidation by larger healthcare systems, depending on the goals of the client.

When considering teleneurology as a discipline in particular, hospitals must recognize that an investment in telemedicine is far more than an investment in the newest, best equipment; it is the foundation of a relationship with physicians who are among the most knowledgeable and experiences practitioners in their field. AcuteCare Telemedicine is truly technology- agnostic, meaning that regardless of the price tag of the machines that we leverage to connect with a facility’s patients or staff, a partnership with our physicians means that behind the machinery is the expertise needed to drastically improve the quality of care a patient can receive. We place value in finding quality tools to accomplish our mission, but our accessibility is by no means restricted by them.

Many healthcare leaders are still hesitant to make the investment in something new, but the time has come that the highest level of expert care be available to everyone, everywhere. It is our vision that hospital facilities will share in our agnosticism towards technology and invest in the people who will improve healthcare’s next generation.