AcuteCare Telemedicine Blog


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.



A Telehealth Summit: Transforming the Delivery of Healthcare

The third-annual Alabama Rural Health & Telehealth Summit is scheduled for October 15 through October 17, 2014 at the Embassy Suites in Birmingham, AL. The Summit is sponsored by the Alabama Partnership for Telehealth (APT) and is the only statewide gathering of telehealth advocates in Alabama. This year’s theme is “Transforming the Delivery of Healthcare” and will feature a diverse and experienced group of presenters who will discuss the value of telehealth technology and how it is revolutionizing the delivery of healthcare across rural and urban America.

The Summit is open to primary and specialty care physicians, advanced practice nurse practitioners, physician assistants, registered nurses, medical care facilities administrators and anyone who is interested in learning more about healthcare reform through the application of modern telecommunication technology. More than a dozen topics and forums will be available for attendees over the three day summit, featuring the foremost experts in telemedical services and technology. The Summit is a great opportunity to learn more about state, regional and international Telemedicine initiatives.

On Thursday, October 16, James Kiely, PhD, MD, Chief Information Officer, AcuteCare Telemedicine, will moderate and present a session titled “The Reality of Telestroke: Real People, Real Results.” Dr. Kiely will be joined in the presentation by Cecilia Land, Division Director, Rehab Services, Southeast Alabama Medical Center, and Steven L. Skeen, BSN, CNO, Mizell Memorial Hospital.

Dr. James Kiely is board certified in Neurology and Clinical Neurophysiology and is the medical director of the neurophysiology labs at both Northside and St. Joseph’s Hospitals, and a partner at Atlanta Neurology in Atlanta. He was recently named one of America’s Top Doctors by US News and World Report, as well as being named a “Top Doctor” in Atlanta by Atlanta Magazine for the past five years. Dr. Kiely also serves as the Chief Information Officer for AcuteCare Telemedicine, LLC, an Atlanta-based corporation advancing the opportunity for healthcare institutions to gain access to expert neurologists and telemedicine technologies for 24/7/365 emergent neurological care.

Registration is available online for all those who wish to attend. The Embassy Suites Birmingham-Hoover is located at 2660 John Hawkins Parkway, Birmingham, AL 35244. For additional information on the Summit, contact Samantha Haas, Alabama Partnership for TeleHealth, Inc.



AcuteCare Telemedicine and Coliseum Health System Partner To Improve Patient Access To Specialized Neurological Care

OCTOBER 2, 2014 – MACON, GA: AcuteCare Telemedicine (ACT) continues to expand its presence in the Southeastern region with the addition of two new client hospitals. Coliseum Medical Centers (CMC) and Coliseum Northside Hospital (CNH) of Macon, GA, have recently introduced ACT’s leading neurological specialists to their dedicated staff of medical professionals and patients. The two facilities are associated with the Nashville-based Hospital Corporation of America (HCA), the nation’s leading provider of healthcare services.

HCA is comprised of locally managed healthcare facilities that include about 165 hospitals and 115 freestanding surgery centers in 20 states and England. The more than 200,000 HCA medical professionals are committed to the delivery of high quality, cost effective healthcare in the communities they serve.

Coliseum Northside Hospital recently introduced a robot named TESS, or “Telestroke Station” to its staff and patients. TESS, an InTouch Health premium RP-Vita robot, can be stationed throughout the facility to remotely connect Coliseum’s dedicated medical team with ACT’s experienced neurological specialists 24 hours a day. Coliseum Northside Hospital’s sister facility, Coliseum Medical Centers, uses an identical robot named Bazinga meaning “an exclamation indicating a successful outcome”. Connecting hospital-based medical professionals with off-site specialists through the use of new telecommunication technologies is improving access of specialized care for patients in smaller, regional hospitals and medical centers. April Watson, Sepsis & Stroke Coordinator at Northside Hospital says, “The team of doctors at ACT are very professional and are great to work with. We look forward to teaming up with them to provide our patients the best in telestroke care.”

“Attracting and recruiting medical specialists is an ongoing challenge for smaller, regional hospitals who must balance the needs of their patients with the financial realities of healthcare in this demanding economy,” says Dr. Matthews Gwynn, director and founder of the Stroke Center of Northside Hospital and AcuteCare Telemedicine chief executive officer. “Having the ability to consult with a neurologist remotely for treatment of stroke and other neurological maladies is allowing these hospitals to meet the needs of the patients in the communities they serve. ACT is extremely proud to associate with Coliseum Medical Centers and Coliseum Northside Hospital.”

“ACT has been focused on providing the highest quality of care to our client hospitals and our patients. We are continuing to expand opportunities for acute stroke care to hospitals across nine states,” comments Gwynn. “We look forward to providing the most advanced telestroke care to more partners like Coliseum Medical Centers and Coliseum Northside Hospital who are also committed to advancements in telemedicine.” This announcement follows ACT’s recent partnerships with Emory John’s Creek and Colleton Medical Center (CMC) earlier this year.

 

About AcuteCare Telemedicine

Founded in 2009, AcuteCare Telemedicine is a limited liability corporation advancing the opportunity for healthcare institutions to gain access to highly-respected, expert neurologists and telemedicine technologies. AcuteCare offers a range of services including first-rate neurological emergency response care with around-the-clock support and hospital accreditation education. AcuteCare primarily provides remote emergency neurology consultation which fills staffing needs and reduces the costs associated with 24/7 neurologist availability. As a result, healthcare institutions provide full service emergency neurology care and can earn Joint Commission Certification as a Primary Stroke Center.

About Coliseum Health System

Owned by Hospital Corporation of America (HCA), Coliseum Health System is comprised of Coliseum Medical Centers and Coliseum Northside Hospital, two medical/surgical campuses with a total of 413 beds. The hospitals feature an expansive range of state-of-the-art services designed to meet the comprehensive medical needs of central Georgia. Both facilities include a 24-hour emergency room, inpatient and outpatient surgery options, rehabilitation programs, and diagnostic services. In addition, Coliseum Health System’s breadth of care options includes specialty facilities such as the Coliseum Heart Institute, an advanced cardiac center offering all services from non-invasive cardiology to open heart surgery, Coliseum Primary Stroke Center, Coliseum Orthopaedic & Spine Institute, Coliseum Cancer Institute, Coliseum Robotic Institute, Georgia Bariatric Center, Coliseum Diabetes Management Center, Coliseum Center for Pelvic Health, Coliseum Rehabilitation Center, and the Family Ties Birthing Center, which includes a level III neonatal nursery. The Coliseum Center for Behavioral Health provides treatment to adults with psychiatric and addiction issues through inpatient and outpatient programs, as well as, a specialty program for senior adults.   http://coliseumhealthsystem.com



New Rules for Telemedicine Providers in Georgia

The Georgia Composite Medical Board (GCMB) has approved new rules (360-3-.07) for healthcare providers who are practicing telemedicine in the state.

The new rules require doctors to be licensed in the state of Georgia and, in most cases, to have either seen the patient in person or have a referral from another physician, PA or APRN who has seen the patient in person prior to providing the electronic service. The ‘‘in person’’ rule allows exceptions in cases where a patient has been referred by certain types of providers and agencies, such as public school nurses, a community mental health center, the Department of Family and Children’s Services or law enforcement. The rule also includes a broad exception to the in-person encounter requirement if the care provider ‘‘is able to examine the patient using technology and peripherals that are equal or superior to an examination done personally by a provider within that provider’s standard of care.’’

The exceptions were a departure from previous rules that were under consideration by the GCMB. As reported in the Bloomberg BNA, the original provisions offered little in the way of exceptions to the in-person rule but language was altered on the advice of the Medical Association of Georgia (MAG) and other groups. Dr. Matthews Gwynn, an Atlanta area neurologist and board secretary for MAG, told Bloomberg BNA, ‘‘As a neurologist providing care for stroke patients in emergency situations, I’ve never seen these patients before, so I said you have to have a mechanism to allow us to see these patients de novo. This version of the rules does that.’’

The new rules were also prompted, in part, as a response to a growing abuse of online prescription pain medications by unscrupulous companies selling prescriptions on demand. Georgia instituted the Prescription Drug Monitoring Program in 2013 which allows pharmacists to check to see whether patients are getting prescriptions from more than one doctor or using several pharmacies. Georgia was the second to last state to implement a system to monitor and curb what has become a significant problem all across the country. The new GCMB telemedicine rules specifically exclude the prescription and distribution of controlled substances for the treatment of pain or chronic pain by electronic means.

The GCMB rule requiring telemedicine providers to have a Georgia state license is typical of other states’ requirements. The individual state license rule is often seen as a significant barrier to the accelerated expansion of telemedicine nationwide. Consumer groups traditionally advocate for more open telemedicine policies as a way to improve access to health care for residents of rural areas across the country and in Georgia, where doctors, particularly specialists, are scarce.



Telemedicine Contributes to the Education and Treatment of Autism

Using web-based technology to teach parents the strategies of applied behavior analysis (ABA) could offer big gains for kids with autism, new research suggests. In a small study of rural parents who participated in a series of online tutorials and videoconferencing sessions, researchers found that they could help moms and dads substantially increase their knowledge of ABA and apply the techniques without forcing the families to make long drives to a clinic. The finding could have particularly big implications for families living in remote communities that lack therapy offerings, researchers said.

“Autism spectrum disorders, now estimated to affect 1 in 68 children, are just as common in rural America, but ABA-trained professionals are rare,” said Linda Heitzman-Powell of the University of Kansas who worked on the study published in the journal Focus on Autism and Other Developmental Disabilities. Heitzman-Powell and her colleagues said the training method they developed, known as Online and Applied System for Intervention Skills (OASIS) helped parents increase their knowledge of ABA strategies by an average of 39 percent. What’s more, parents who took part in the training improved their implementation of the strategies by 41 percent overall, researchers said.

Four families with children on the spectrum participated in the study, each of whom completed a series of online tutorials and at least 13 videoconferencing sessions with a coach. Parents also used an online interface to report on their use of the strategies with their child. Since completing the initial study, researchers say they’ve further tested OASIS with nearly 40 families with similarly promising findings.

According to recent research, some 42 percent of U.S. hospitals have implemented telehealth platforms, with the highest levels of adoption occurring in rural areas. At Tift Regional Health System in Tifton, Ga., a telehealth frontrunner, they are operating several rural telehealth programs including programs providing telehealth at schools, an ADD and autism clinic, an emergency department stroke program, a program for patients undergoing kidney transplants, a geriatric psychiatric program and a program where patients can reach a provider 24 hours a day. “We believe in telehealth. We believe it’s the future,” says Jeff Robbins, director of the organization’s telehealth effort.

The ADD and autism clinic annually works for 600 children who often don’t have access to psychiatrists, endocrinologists, geneticists and other specialists. Some live more than three hours away, making monthly appointments challenging in terms of finding quality transportation and taking time off for caregivers. The program especially has impacted children from families with limited means, Robbins says.

On the eastern shore of Maryland, Atlantic General Hospital is the first hospital in the nation to partner with Kennedy Krieger Institute to provide telemedicine services to children with autism, ADD/ADHD, intellectual disabilities, and other developmental disorders living far from specialty care. Often a referral for specialty care means a trip to Baltimore and a six-hour round trip drive, with additional expenses for gas, food, parking and tolls. This can leave patients and their families exhausted before they even say hello to the doctor.

Dr. Deepa Menon, the assistant medical director at Kennedy Krieger’s Center for Autism and Related Disorders, and Dr. Paul Lipkin, the director of Kennedy Krieger’s Center for Development and Learning, are providing complete care, with initial evaluations and follow up visits, using encrypted telemedicine technology transmits both audio and video of the patient and doctor in real time. The physicians are able to interact with patients and their families in the same way they would in an actual exam room.

Children’s health care is a growing concern on a domestic and global scale among parents, specialists, and policymakers. Treating this special population, particularly among those living in rural communities, ignites continual challenges including insurance concerns, limited transportation, and the low number and availability of pediatric specialists. Telemedicine provides the best solution for providing much needed specialized treatment and education to those in need.



Telemedicine Increases tPA Use for Stroke Treatment

Presented at the annual American Academy of Neurology meeting in early May, a new study highlights the benefit of teleneurology care. The report indicates that a telemedicine program for patients with acute ischemic stroke increases the use of recombinant tissue plasminogen activator by as much as 13% in the year after the program’s implementation.

Stroke patients who receive the clot-busting drug tPA within 60 minutes of experiencing stroke symptoms have the best chance of avoiding brain damage or death. The administration of intravenous recombinant tissue-type plasminogen activator (tPA) and intra-arterial approaches, attempt to establish revascularization so that cells in the penumbra can be rescued before irreversible injury occurs, but restoring blood flow can mitigate the effects of ischemia only if performed quickly. “Most of the 13 hospitals in the study significantly increased their recombinant tissue plasminogen activator (tPA) use”, Dr. Jeffrey C. Wagner said at the annual meeting of the American Academy of Neurology.

The study population included patients aged 18 years and older who were admitted with a primary diagnosis of acute ischemic stroke. The hospitals represented a variety of patient demographics. About two-thirds were rural; approximately half were small, defined as fewer than 200 beds. The hospitals were located in the Northeastern, Southern, and Western portions of the United States.

Overall, tPA administration increased significantly, from 4.5% to 7.3% after a telemedicine program was introduced and the use of tPA in smaller hospitals increased from 1% to 7% after implementing a telemedicine program, compared with an increase from 5.4% to 7% in larger hospitals. Those results were similar when patients were stratified as inpatients or transferred patients.

The benefits of intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) are time dependent and guidelines recommend a door-to-needle (DTN) time of 60 minutes or less. However, studies have found that less than 30% of US patients are treated within this time window. Target: Stroke was designed as a national quality improvement initiative to improve DTN times for tPA administration in patients with AIS. Implementation of a national quality improvement initiative was associated with improved timeliness of tPA administration following AIS on a national scale, and this improvement was associated with lower in-hospital mortality and intracranial hemorrhage, along with an increase in the percentage of patients discharged home.

“Reducing DTN time is a primary goal when treating patients via telemedicine”, says Keith A. Sanders, Founder and Director of the Stroke Center of Emory St. Joseph’s Hospital and AcuteCare Telemedicine (ACT) COO. “ACT has seen dramatic improvements in the tPA administration rate and DTN times at our hospitals. We collect, review and distribute DTN times and other quality measures to our hospital partners. This report reaffirms the importance in administering tPA and its impact on patient outcomes.”



Recognizing the Symptoms of Stroke

While stroke awareness is a major concern for both men and women, a recent study concluded that women are less likely to recognize stroke symptoms. Only half of those surveyed know that sudden weakness or numbness on one side of the face, arms or legs is a warning sign of a stroke. 44 percent are aware that speech difficulty is a stroke sign while less than 1-in-4 could identify sudden severe headache, unexplained dizziness and sudden vision loss, or vision loss in one eye as the top symptoms of stroke. The study surveyed more than 1,200 women in the United States to assess their understanding of stroke’s warning signs.

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. As different parts of the brain control different parts of the body, your symptoms depend upon the part of the brain affected and the extent of the damage.

The main stroke symptoms can be remembered with the word F.A.S.T.: Face-Arms-Speech-Time.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 911 immediately if any of these signs or symptoms at the earliest onset of these symptoms

For those living with or who care for somebody in a high-risk group, such as someone who is elderly or has diabetes or high blood pressure, being aware of the symptoms is even more important.

The acronym “FAST” is also meant to underscore the importance of rapidly delivering treatment to stroke patients. If given in time, a clot-busting drug administered during a stroke can lead to better outcomes and a decrease in the likelihood that a patient will suffer long-term disability. A recent study examined the effectiveness of tissue plasminogen activator (tPA) relative to the delay in administering this clot busting drug. Researchers found that every minute tPA was delayed cost nearly 2 days of disability free survival. The researchers commented that their message is literally “Save a Minute, Save a Day.”

Although many Americans live relatively close to a hospital where emergency stroke treatment is available, few actually receive the recommended therapies. Researchers found that only 4 percent of the more than 370,000 Medicare patients who suffered a stroke in 2011 were treated with tPA. Most stroke victims fail to recognize the symptoms of stroke or call 911 early enough to receive the necessary treatment. tPA is most effective when administered within a 4 hour window of time.

Every minute counts for stroke patients. Remember to act F.A.S.T.!