AcuteCare Telemedicine Blog


Telestroke Is Proving to Be a Saver

Telestroke programs have been proving themselves very effective in bringing critical care to patients in rural areas throughout the country for a few years now and testimonials about patients who have benefitted from advanced, specialized treatment via telemedicine technology are becoming more common place. Receiving advanced stroke care faster is saving lives and resulting in less debilitating recoveries. Telemedicine programs help extend higher quality care to patients living in more rural areas, but some have questioned whether the cost to implement and maintain the technology and services has been thoroughly vetted and considered.

According to a new study by Mayo Clinic researchers, a telestroke program is leading to lower cost. Stroke patients living in rural areas who receive care via a telestroke network see, on average, nearly $1,500 in lower costs over their lifetime compared to stroke patients who do not receive telestroke care, researchers found. The savings are primarily attributed to reduced resource utilization, including nursing home care and inpatient rehabilitation. Researchers also estimate that, compared with no network, a modeled telestroke system consisting of a single hub and seven spoke hospitals may result in the appropriate use of more clot-busting drugs, more catheter based interventional procedures and other stroke therapies, with more stroke patients discharged home independently.

Despite the considerable upfront and maintenance expenses, the entire network of hospitals realizes a greater total cost savings, officials say. “This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, MD, director of the Mayo Clinic Telestroke Program, and lead investigator of the study, in a press statement. “We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained.”

“The results serve to inform government organizations, insurers, healthcare institutions, practitioners, patients and the general public that an upfront investment in telemedicine and stroke network personnel can be justified in our health system,” added Demaerschalk.

Today there are 10 million people utilizing telemedicine and the number will continue to rise as more state legislatures and medical insurance providers realize the benefits to providing payment and reimbursements for telestroke and telehealth services.



Taking It to the Patient

Gadget and device gurus are working hard to fill the need for advanced tools to help medical care providers in the field bring the best medical care to the patient even in the remotest corners of the world.  Remote Diagnostic Technologies (RDT) in the UK, with funding from ESA’s Advanced Research in Telecommunications Systems Program has developed a robust portable device for monitoring vital signs and providing communications for medics in the field. The Tempus Pro combines the diagnostic facilities found in standard hospital vital signs monitors with extensive two-way communications, packaged in a compact, rugged, highly portable unit that can be tailored to user needs. The key to the unit’s success is that it is a fully functional, hospital-grade vital signs monitor and takes less than an hour for an experienced medical professional to learn the basic functions.

In the United States, a University of Virginia Health System (UVA) team is working with local rescue squads to diagnose stroke patients before they reach the hospital, enabling more patients to receive lifesaving treatment and have a full recovery. UVA clinicians are raising $10,000 to equip two additional local ambulances with the iTREAT mobile telemedicine kit. The goal: Connect paramedics through a secure video link with UVA’s specially trained stroke neurologists and emergency medicine physicians, who can diagnose stroke patients while they’re in the ambulance and enable treatment to begin as soon as patients arrive at the hospital. Fast diagnosis and treatment is vital because the most effective treatment for acute ischemic stroke patients — the clot-busting drug tPA — is only safe and effective if delivered within three hours of when symptoms begin. Due to delays in reaching a hospital and receiving a diagnosis, less than 5 percent of all stroke patients receive tPA. Promising faster care for a variety of patients and treatments, The iTREAT technology is in the testing stage with local rescue squads, with the hope of using it to care for Central Virginia patients in early 2014.

A debate as to what or who spawned the revolution in using communication technology to advance a new medical care delivery model, the need or the gadget, is unimportant.  Teaming the hospital based life-savers and their dedicated field associates with savvy techies is creating an environment where patients are receiving better and faster advanced life support no matter where they are located. Telemedicine is taking to the patient!



Leading Centers Aiming to Revolutionize Stroke Research

Georgia StrokeNet will be one of 25 U.S. regional coordinating centers to take aim at revolutionizing stroke research under a program funded by the National Institutes of Health (NIH). Georgia StrokeNet is the only regional coordinating center in Georgia that is participating in the project that is funded by a five-year, $2 million grant.

Those taking part in the collaboration include: Emory University’s School of Medicine, Grady Memorial Hospital’s Marcus Stroke and Neuroscience Center and other local partners. Emory neurology professor and Marcus Stroke and Neuroscience Center Director Dr. Michael Frankel will serve as Georgia StrokeNet’s principal investigator: Dr. Frankel says, “The new StrokeNet will be a conduit for clinical trials for patients to participate in, so we can answer those key questions about what is the best way to prevent a stroke, what the right blood pressure to try to prevent a stroke, what is the right treatment for a patient who has an acute stroke.”

Grady Hospital’s Marcus Stroke and Neuroscience Center has earned a top designation for stroke care by an independent accrediting agency for health care organizations. The Center has been designated an Advanced Comprehensive Stroke Center by the Joint Commission and is one of 50 U.S. stroke centers who have received the designation since it began. Emory University and Georgia Regents Medical Center in Augusta are the other two Georgia centers to receive the designation.

Dr. Keith A. Sanders, Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta, and partner in Atlanta Neurology, P.C., is looking forward to contributing to the stroke research at Georgia StrokeNet.  “The research is important because strokes and stroke-related deaths are prevalent in Georgia and the Southeast. It is hoped that this research will lead to more treatment options to reduce disability from stroke, commented Dr. Sanders.”



Study Confirms Predictions Of Telemedicine Benefits for ICU’s

Supporters of telemedicine have long predicted that the application of telemedicine services in Intensive Care Units (ICU’S) would have a beneficial effect on costs and patient outcomes and the first large-scale multi-center study of the effects of use of telemedicine in the intensive care unit for adult care is indicating significant improvements in patient care and lower costs.

The results of the study were released in the CHEST Journal Online First, a publication of the American College of Chest Physicians. The study, “A Multi-center  Study of Telemedicine Reengineering of Adult Critical Care,” looked at the impact of the program on 118,990 critical care patients, across 56 ICUs, 32 hospitals and 19 health systems over a five-year period, and demonstrated reductions in both mortality and length of stay.

Among the key findings were that, compared to patients receiving conventional ICU care, patients using the telemedicine ICU program were:

  • 26 percent more likely to survive the ICU;
  • Discharged from the ICU 20 percent faster;
  • 16 percent more likely to survive hospitalization and be discharged; and
  • Discharged from the hospital 15 percent faster.

Craig Lilly, M.D., professor of medicine, anesthesiology and surgery at the University of Massachusetts Medical School and director of the eICU program at UMass Memorial Medical Center, said, “The study demonstrates that if you use really high-quality tools and motivated and talented people, that you can shift the paradigm; you can save lives and you can save money at the same time.” He added that the study is large enough, that it provides some insights as to ICU telemedicine works, and where its use makes sense. He noted that not everybody that implemented the ICU telemedicine tools did it in the same way. By using the validated survey instrument, the researchers were able to identify factors that made a difference in better patient care.

“Today, personnel accounts for 56 percent of the $2.8 trillion healthcare spend in the U.S., and coupled with the current shortage of clinicians, many hospitals are unable to offer on-site intensivist physicians, 24 hours a day, seven days a week,” said Brian Rosenfeld, Vice President and Chief Medical Officer, Philips Healthcare Telehealth. “This study provides further evidence that health systems employing coordinated telehealth in their care models will increase provider productivity, while improving outcomes and reducing costs.”



Stepping up and Getting Out in Front of the Revolution

Historically the healthcare industry has been notoriously slow to adopt innovation but one health insurance company is stepping out in front of their industry when it comes to demonstrating a willingness to pay for telemedicine services, recognizing the potential for cost savings and simplification of services.

At this year’s Connected Health Symposium in Boston, John Jesser, VP of Provider Engagement Services for WellPoint, explained that his company is partnering with American Well Systems, a telemedicine services vendor, to set up the program for its members. Before the program was set up, patients who needed to see a physician during off-hours had limited options: Visit the ER and spend about $600; see a physician in an urgent care center for about $150; or wait until the doctor is back in the office. WellPoint introduced a new choice for its members, which only costs about $49.

Patients are able to use a laptop computer, mobile device or tablet to connect with a primary care physician.  The encounter takes about 10 minutes to initiate, is HIPAA compliant and the service can be paid for with a credit card.  Medical history is available to the attending physician.  In addition to WellPoint, a number of other insurers including; Aetna, Highmark and Cigna are experimenting with similar programs for their member policy holders.  Following South Carolina’s State legislators recent introduction of SB 290 and HB 3779, requiring private insurers to cover telemedicine services, BlueCross BlueShield of South Carolina and Blue Choice HealthPlan of South Carolina announced that they would start paying for some telemedicine services.

But a recent tally from the American Telemedicine Association indicates that nationwide coverage will be a slow journey.  As of October 2013, there were only 20 states, and the District of Columbia, that required insurance companies to pay for some form of telemedicine services: Arizona, California, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, New Hampshire, New Mexico, Oklahoma, Oregon, Texas, Vermont, and Virginia.

Insurers and state lawmakers aren’t the only ones with reservations about telemedicine. Ron Dixon, MD, the Director of the Virtual Practice at Massachusetts General Hospital (MGH), says, “I’ve found trying to get telehealth moving at MGH has been impeded by the way insurers pay for things. It’s been a big barrier to get it rolled into the way physicians actually practice.” He also believes that doctors resist offering telemedicine care because they simply have too much to do. “If you are going to get doctors involved, there has to be a win for them, and the win is usually time. It’s not always about the money.”

Massachusetts General Hospital has built a tool that allows existing patients to get their follow-up care online. The hospital pays providers for the service, and while the fees they receive are less than what they get for in-person visits, it also takes them less time to see a patient online, so it tends to balance out.

If the full benefits of telemedicine services are to realized, more insurers and practitioners will need to step up and overcome their reluctance to technologies that promise to revolutionize the traditional healthcare delivery model.



SAMC Recognized For Outstanding Stroke Care

The Southern Alabama Medical Center (SAMC’s) Stroke Care Network was recently named “Partner of Year” at the Alabama Rural Stroke Award Health and Telehealth Summit.  The award was presented by the Alabama Partnership for Telehealth (APT) during the October summit in Prattville. Jason DeLeon, MD, Emergency Medicine; Cecilia Land, division director SAMC Rehabilitation Services and Levonne Outlaw, SAMC Stroke Network Coordinator accepted the award.

“This is an award that we give out to the partner who we feel has done the most outstanding job when it comes to not only using, but advancing telemedicine,” said Lloyd Sirmons, executive director of APT.  “SAMC has done a great job, not only building their program, but advancing telemedicine in the state of Alabama.”

AcuteCare Telemedicine (ACT), the Southeast region’s largest practice based telemedicine provider, joined in collaboration with SAMC earlier this year to remotely diagnose and treat acute care neurological patients and to offer advanced cost-effective solutions that deliver improved stroke patient outcomes throughout the expanded SAMC Network of participating hospitals.  The SAMC Stroke Care Network ensures that patients in surrounding rural communities have access to the most experienced stroke care available. “SAMC sets the standard in the state when it comes to providing stroke care in rural areas,” said Dr. DeLeon.

On hand to present the award were Matthews Gwynn, MD, Acute Care Telemedicine, SAMC TeleNeurology Providers; Lloyd Sirmons, Alabama Partnership for Telehealth; Ron Sparks, Alabama Department of Rural Development and David White, Alabama Governor’s Office.



New Partnerships Bring Telemedicine to Guatemala

Recently the Georgia Partnership for TeleHealth (GPT), the Louisiana State University Health Science Center (LSU) and Casa Para Ninos Aleluya (CASA) launched its first international telemedicine program. The new partnership was formed through an ongoing relationship with former Louisiana Senator and Family Medicine Practitioner, Dr. Donald Hines and GPT’s Chief Executive Officer, Paula Guy.

The mission of the collaboration is to deliver much needed primary and specialized medical care to the children of the CASA orphanage through the use of telemedicine technology.  The orphanage is home to over 400 abused, orphaned and mistreated children and is located just outside of Guatemala City.  Started in 1988 by missionaries Mike and Dottie Clark, CASA’s vision is for the kids they serve to have a chance in life by bringing pediatric specialty care to the clinic in order to change the futures of these children and so many more.  The medical needs of hundreds of the children at CASA are met daily through a few nurses that manage a clinic on-site.  The new technology will greatly aid the on-site care givers capabilities in providing quality medical care to the children. The new technology has become a magnet for other missions who are struggling to serve the estimated 200,000 orphaned children across Guatemala.

The clinic was up and online within 24 hours and the nursing staff at CASA was trained and certified as telemedicine presenters and will be supported by Georgia Partnership for TeleHealth as they continue to serve Cuidad de Los Ninos.

AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for hospitals in the southeast United States, recently donated their time and expertise to make telemedicine a reality at CASA.  Dr. James M. Kiely, a partner in Atlanta Neurology, P.C., ACT and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta recently demonstrated the benefits of telemedicine capabilities at the orphanage.

Dr. Kiely remotely treated a 19 year old CASA patient with a history of intractable epilepsy. The young patient was on numerous medications but continued to experience recurring seizures. By using a high definition audio-visual connection provided by GPT, Dr. Kiely was able to interview the patient’s parents and examine the patient remotely. The imaging results, hemiparesis, and description of seizures allowed him to determine that the likely type and cause was attributed to porencephaly, the failure for one hemisphere of the brain to develop. Kiely was able to recommend appropriate medications to on-site doctors and to suggest additional steps to take if the patients epilepsy remained intractable.  The process worked flawlessly and marked the beginning of a new relationship between the missions and medical providers across the region.

Georgia Partnership for TeleHealth has aligned its mission to serve domestically and internationally and is seeing lives change through getting access to care in these underserved areas. There are no limits in providing this kind of access worldwide using technology,” states Dr. Jeffrey Kesler, COO of GPT.  The Partnership’s experience in implementing Telemedicine includes nursing homes, school clinics, correction, specialty clinics, Emergency Department, ICU, stroke assessment, primary care, child advocacy, and continuing education.

GPT will be providing ongoing support to the children of the Guatemala region through donated physician time. Physicians, who are interested in investing time to serve at CASA Para Ninos Aleluya, are encouraged to contact Matt Jansen, Executive Director, Georgia Partnership for TeleHealth at matt.jansen@gatelehealth.org.