AcuteCare Telemedicine Blog


Extreme Telemedicine and the Urgency of Now

January and the New Year bring the Consumer Electronics Show, an exposition of tremendous scale where the newest and flashiest concepts and prototypes for technological marvel are put on display for the public. Innovation in medicine was a hot-button topic at this year’s show, as more and more attention has been focused on the state of the US healthcare system.

There is a new television commercial from a leading innovator in communications technology making its rounds. A segment of the ad shows a group of climbers on a snow covered mountain communicating with a doctor on a tablet computer. The doctor is explaining how to set the apparently broken leg of one of the members of the crew. This 5 second scene, interspersed with other vignettes displaying the company’s visions for the future of its technologies, is an intriguing and exciting flash forward into the vast potential that telemedicine holds for the future.

Of course, one could imagine countless such scenarios in which powerful telemedicine will eventually play a game-changing role. We are on the cusp of a huge revolution in medicine, fueled by relentless innovation like that on display at CES or in the television spot.

The fact of the matter is that telemedicine has already brought this future to our doorstep. While the ‘dreamers’ consider what capabilities advanced technology might ultimately unlock, many physicians are already working with very advanced tools to address issues that are urgent now. For AcuteCare Telemedicine, the focus remains on offering sustainable and highly effective resources to deal with the increasing prevalence of stroke and other neurological emergencies. Through means made possible by telemedicine, ACT is already hard at work shaping the future of the fight against this epidemic.

Allocating resources towards new and innovative technologies and practices is an important part of creating tomorrow’s healthcare culture equipped with the right tools to care for patients. But it is also imperative that until we achieve that goal, we concentrate on applying the amazing technology already available to us to focus on the task at hand. In solving today’s problems, we set the stage for a better understanding of where to go next.



AcuteCare Telemedicine in 2013: Cutting Edge Neurological Care, Anywhere

Following a third consecutive year of growth in 2012, AcuteCare Telemedicine (ACT), an Atlanta-based partnership of 4 board-certified neurologists, is expanding its efforts to become the leading provider expert neurological care to rural and underserved areas throughout the Southeastern United States via cutting edge telemedicine technology.

Telemedicine, once regarded as an exciting new frontier, has now been fully realized as a part of the mainstream lexicon of medicine as we enter 2013. For a large number of hospital systems, telemedicine programs are now becoming a mandate as the nation faces a growing shortage of specialized physicians.

ACT has established itself as an innovator on the forefront of the industry, taking a unique approach to telemedicine by leveraging new technologies and techniques to enable personal neurology consultation when doctor and patient are in different locations. ACT offers a broad range of customizable services including 24/7 emergency neurological consultation and support programs for facilities seeking Joint Commission accreditation as a Primary Stroke Center, but primarily specializes in telestroke: the application of telemedicine to the treatment of the acute stroke patient. With the help of ACT’s powerful and personalized services, patients throughout the ‘Stroke Belt’ states of the Southeast have drastically improved access to the care they deserve, and medical facilities increase efficiency while reducing the costs associated with maintaining a traditional emergency neurology staff.

Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, ACT has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographical boundaries. Achieving this goal requires a certain level of investment in technology and trust in the people behind it. ACT is truly technology-agnostic.  This agility affords healthcare organizations with the ability to select the platform that meets budgetary and organizational parameters.

ACT provides access to the best 24X7 acute neurological care. Contact Michael Woodcock to hear how teleneurology can impact your business and patients in 2013.



A Lens to View Technological Innovation in Healthcare

Keeping up with new technology feels like a sisyphean task. One way to think about technological innovation in healthcare is considering whether the innovation brings services to the patient or requires that the patient be brought to it. The former distributes care, while the latter centralizes it. Both have advantages; by distributing care, it is possible for many resources to contribute to care, and by centralizing care, treatment is focused at one site. Recognizing this technological dichotomy allows savvy hospitals to maximize their return on investment.

Dramatic improvements in radiology over the last 35 years exemplify centralizing care. New MRI and CT scanners dramatically improve our ability to diagnose complex conditions, but the machines’ bulk and expense mean that patients must be brought to them. The same rings true for the latest catheter-based therapies for heart and brain disease, requiring that the patient be brought to the specialized providers.

By contrast, telecommunications innovations distribute care, leading to improved patient outcomes regardless of locality. Translation services are a shining example: in the past, finding someone to translate a language like Amharic or Hmong was daunting, and in an emergency situation, it was simply unavailable. Thanks to new standards set by the Joint Commission, more attention will be paid to proper translation services. The Joint Commission standards reflect federal nondiscrimination laws regarding care of patients with limited English proficiency and recommend that patients be addressed in their preferred language. Now, thanks to successful providers such as CyraCom, dual handset phones can be brought to the bedside and certified translators in hundreds of languages are available in seconds

Telemedicine provides the best example of the power of distributive technological innovation. In stroke care, having experienced stroke neurologists readily available via telemedicine means that stroke patients have unlimited access to state of the art care. Being able to remotely conduct a video interview with the patient and family, examine the patient, and review the brain CT scan equates to faster and better care. AcuteCare Telemedicine’s stroke neurology experts, based in Atlanta, GA, contract with hospitals that need this type of coverage. By distributing care, these hospitals successfully avail their patients with top notch care and reduce treatment times, all while conserving a vital resource: the fossil fuel needed to physically bring the neurologist to the hospital.

 



Advances in Telemedicine and Technology Call for Changes in Standardization

Rudimentary forms of health care standardization in the United States can be traced back more than a century. The Joint Commission, for example, began its evolution with an elementary inception in 1910, when Dr. Ernest Codman proposed the “end result system of hospital standardization”. This system was designed to track patient care and outcomes to determine whether treatment was effective. In cases where treatment was unsuccessful, attempts were made to improve patient care. Three years later, the American College of Surgeons (ACS) was formed to promote this standards system, and in 1917, it developed the Minimum Standard for Hospitals. The following, year the ACS began on site hospital inspections, and of the 692 hospitals surveyed, only 89 met the standards set forth by the one page document. After the introduction of an 18 page manual in 1918, hospitals had increased incentive to meet these standards, and by 1950 standard of care had improved tremendously, with more than 3,200 hospitals approved by the ACS.

Needless to say, over the next 60 years, with countless advances in medicine and technology, there have been many changes to the ACA and its manual. The committee now known as The Joint Commission has expanded and upgraded standards in an effort to ensure that health care organizations are providing quality patient care. Although the Joint Commission is one of the most recognized and sought after accreditation programs, several other organizations such as Leapfrog, HealthGrades and Get With The Guidelines have also been formed in an attempt to foster improvement in quality of care throughout health care systems. The decision to seek accreditation by The Joint Commission or any other organization has always been voluntary, but because of its link to Medicare and Medicaid, Joint Commission accreditation has essentially become a default requirement. Because reputation, reimbursement and, most importantly, patient care may at minimum be presumed to be compromised without certification, a health care organization’s failure to achieve accreditation by the Joint Commission may be adversely perceived.

In 2003 The Joint Commission, in collaboration with the American Stroke Association, developed a Primary Stroke Center (PSC) Certification Program. This program was developed to recognize health care centers “that make exceptional efforts to foster better outcomes for stroke care”.  According to The Joint Commission, a PSC “is the best signal to your community that the quality care you provide is effectively managed to meet the unique and specialized care of stroke patients.” Demonstrating compliance with these national standards may help a facility obtain contracts from employers and purchasers concerned with controlling costs and improving productivity. Becoming a PSC has been shown, in one published study, to have increased the administration of IV- TPA to eligible patients 7 fold.

Unfortunately for many hospitals, this level of achievement in stroke care is not possible due to lack of availability of 24/7 neurology coverage. The reality is particularly challenging for smaller, rural hospitals. However, in 2011, the Brain Attack Coalition updated recommendations for PSCs, acknowledging the use of telemedicine as a means to provide remote diagnosis of acute stroke in facilities where this capability would otherwise be unavailable. Hospitals that do not have current PSC certification could use telemedicine services along with physicians that provide 24/7 expert care in acute stroke to become PSC certified or either transfer eligible patients to the closest PSC for IV- TPA administration. The Brain Attack Coalition has also recommended that EMS transport acute stroke patients to the nearest PSC facility, thereby potentially improving patient outcomes and increasing revenue at certified hospitals.

In 1997, The Joint Commission launched “ORYX: The Next Evolution in Accreditation” which incorporated the use of performance measures into the accreditation process. Under this initiative, hospitals had the flexibility to choose which performance measures they would submit for accreditation. This system posed problems in that there were no standard measurements across health care organizations. The Joint Commission has since put in place core measurement sets for which specific, standard accountability measures must be met in order to obtain and maintain accreditation. The initial core measurement sets were designated in 2003 and included Acute MI, Heart Failure and Community Acquired Pneumonia. As of 2011, Stroke has been added to the core measurement sets, giving facilities even more incentive to become Primary Stroke Centers.

Undoubtedly, the standards that have been initiated by the Joint Commission and other accreditation programs have lead to changes and improvement in health care outcomes for all specialties of medicine. Reaching a perfect level of standardization will always be a work in progress, particularly with the rapid advances in technology that have helped medicine evolve more quickly in recent years. As the landscape of medicine and technology continues to change and expand in the future, particularly regarding the management of acute stroke care, it is our expectation that hospitals will continue to strive to adapt to these changes in order to achieve the highest quality of patient care.



Certified Life Saving

For the last several years, the Joint Commission on Accreditation of Healthcare Organizations (The Joint Commission) has monitored hospitals’ specific performance measures in treatment of common diseases. In 2011, stroke care joined pneumonia, heart failure, and heart attack on the list of monitored core diseases. Hospitals must demonstrate to the Joint Commission, and to the public, that they are providing good emergency stroke care in order to receive certification as a Primary Stroke Center. For instances of stroke, the Joint Commission monitors if hospitals are administering tPA (the clot busting medication) to eligible stroke patients.

Despite this focus on a high standard of care, large areas of the country lack hospitals who have administered tPA to stroke patients.  Alabama, for example, has only 3 hospitals certified as stroke centers. A lack of certified stroke centers has been shown to correlate with the rate of death from stroke. A primary factor in the failure to meet established standards is the limited number of neurologists available for emergency stroke intervention. The expanded use of telemedicine is a practical solution. Rapid evaluation by a stroke specialist via the internet enables the use of tPA in otherwise underserved areas, leading to better care and outcomes.

Rapid access to quality emergency care underlies the public’s confidence in our healthcare system. With limited numbers of neurologists and vast numbers of needy hospitals, telemedicine makes sense for stroke care.



Proximity Matters in Stroke Care

A recent study published by the CDC discusses the importance of telemedicine for improving quality of stroke initiatives at hospitals in the Southeast.   The report identified deficiencies in timely access to Joint Commission Primary Stroke Centers (JCPSCs) in the tri-state area of North Carolina, South Carolina, and Georgia, part of a region known as the ‘Stroke Belt,’ recognized by public health authorities for having an unusually high incidence of stroke and other forms of cardiovascular disease.

Researchers categorize ease of access by measuring 30 and 60 minute drive times to JCPSCs. Not surprisingly, they reported a significant disparity: only 26% of people living in rural areas lived within a 30-minute drive time to a Stroke Center compared to 70% of those in urban areas. They next compared drive-times and stroke death rates within these states. Many of the counties with the highest stroke death rates were outside the 30-minute drive-time areas.

Stroke is a medical emergency. Rapid treatment is a defining factor in achieving better patient outcomes.  Many hospitals are looking to telemedicine, an alternative strategy to expand provision of quality acute stroke care in the region, particularly to underserved populations. Telestroke networks drastically reduce the time it takes for rural citizens to gain access to neurologists who can diagnose and treat the emergency.

Patients living outside of the 60-minute travel window from JCPSCs are still at increased risk.  However, Georgia continually expands the scope of its telestroke networks in an effort to afford proper emergency care access to all citizens statewide.