AcuteCare Telemedicine Blog


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.



DR. MATTHEWS GWYNN RESPONDS TO WALL STREET JOURNAL ARTICLE

As telemedicine becomes a model for the delivery of healthcare, The Wall Street Journal recently published an article questioning if telemedicine could replace an ER visit. Read the full article included below as published in the Wall Street Journal on August 2, 2015 followed by Dr. Gwynn’s comments.

When a Doctor Is Always a Phone Call Away Many of the 136 million ER visits in 2011 could have been replaced with a $50 telemedicine consultation.

By

Richard Boxer

Aug. 2, 2015 5:30 p.m. ET 

A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room.

Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care.

When it comes to health care, “efficient” is a word that frightens people, calling to mind a soulless bureaucracy with an eye on the company’s bottom line. But it is inefficiency that is overburdening the medical system. Consider a woman with a urinary-tract infection who has to leave work to obtain a prescription from a doctor for a drug she already knows she needs. Or a man with a fever and hacking cough who has good health insurance, but who goes to the emergency room because his doctor’s office is closed.

Americans are struggling to obtain affordable, convenient care, and 103 million people in the U.S. live in areas with a shortage of primary health-care providers, according to the Health Resources and Services Administration. Yet the country is dependent on expensive, brick-and-mortar facilities that require time-consuming travel. 

Primary-care doctors tend to cluster in urban areas. If you get sick in rural Wyoming, even during the workweek, your only choice might be the emergency room. In 2011, the Centers for Disease Control and Prevention reports, 136 million people were seen in an ER; many of those visits could have been replaced with a $50 telemedicine consultation. Researchers at the University of Rochester found that 28% of the visits at one pediatric emergency room involved ailments such as ear infections or sore throats that could be diagnosed over the phone.

These problems are exacerbated by the increase in the elderly population, coupled with tens of millions of patients newly insured by the Affordable Care Act. A study in the Annals of Family Medicine projects that the U.S. will need 52,000 more primary-care doctors by 2025. Those positions aren’t filled easily. It takes 12 years and hundreds of thousands of public dollars to educate one primary-care doctor.

But there is an untapped resource: the many doctors leaving their practices, fed up with the regulations and other hassles, but who love their patients, and the older physicians eyeing retirement because they no longer want to maintain an office. Why not let these doctors offer their expertise to patients by smartphone?

Doctors who contract with a telemedicine company can opt for a specific block of time when they are “on call” to patients, picking up the phone and answering questions in 10- to 15-minute intervals. The doctor is paid and the patient gets a prompt and inexpensive answer to a concern.

Home care of individuals with major chronic conditions would also substantially benefit from telemedicine. Millions of houses have cable and satellite connections that can be used to monitor patients wearing wireless devices, allowing health professionals to intercede at the first sign of trouble. This can reduce rates of hospitalization by half or more, some studies suggest.

While there is worry about the quality of these interactions, telemedicine companies assess their doctors routinely and maintain strong quality-assurance programs. Every doctor is taught in medical school that 80% of diagnoses are obtained through a medical history and symptoms, and not by what a doctor sees, touches or tests.

Telemedicine will never completely supplant face-to-face visits, and most doctors naturally would prefer to treat a patient in person. The American Medical Association, for instance, has encouraged restriction of telemedicine to patients who have an established relationship with a doctor, and some state medical boards try to enforce that view.

But the perfect cannot be the enemy of the good—and by continuing to practice medicine as usual, we are making it so. Millions of Americans live in areas that are short of primary-care doctors, and millions more go to the emergency room when they have a sore throat. Entrepreneurs have responded by creating methods of connecting patients to doctors remotely, which reduces costs and satisfies patients.

There is no scenario for sustaining or improving health care in America without telemedicine. State and federal governments, as well as the medical establishment, should embrace the technology. For one thing, they should change Medicare and Medicaid to allow reimbursement for telemedicine consultations, most of which are currently not covered. Ask that truck driver if he thinks talking to a doctor over the phone has value: He is still alive and trucking.

Dr. Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via. 

Corrections & Amplifications

An earlier version of this article misstated the name of the journal that published a study of the need for 52,000 more primary-care doctors by 2025. It is the Annals of Family Medicine.

Dr. Matthews Gwynn, Partner, ACT, responds to the article saying, “One may argue plausibly whether a phone call, such as in Dr. Boxer’s example of the trucker, is adequate or not for general medical care, but there is no reasonable argument against audiovisual encounters combating emergency medical conditions such as stroke, provided remotely by experienced physicians to underserved urban, suburban and rural hospitals.”

Gwynn also comments, “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.”

Telemedicine is a critical part of the new healthcare delivery model. As healthcare organizations begin adopting new practices, the conversation around proper use, application, and the effect on patient outcomes will continue.



The Importance of Educating Legislators on Telehealth

Telemedicine legislation has been a frequent subject of much debate among healthcare professionals, Federal agencies, and State legislators. In recent news, the Governor of Delaware signed a new comprehensive telemedicine bill into law which requires healthcare companies to pay for telemedicine services at the same rate as in-person visits. Delaware joins 29 other states who have adopted similar requirements. U.S. Representative Mike Thompson is also actively working on the Medicare Telehealth Payment Parity Bill expanding the list of telehealth services available to Medicare patients.

In an effort to increase national attention on telehealth related issues, the American Telemedicine Association (ATA) is announcing The ATA Fall Forum, an event to educate members of Congress and push for important telemedicine policies. National Telehealth Lobby Day will be held on Capitol Hill in Washington DC. on September 16, 2015, and will be part of the event that includes training sessions on telehealth legislative priorities and expert tips on how telemedicine supporters can start discussions with Congressional leaders.

“Telemedicine has rapidly become the new standard of care,” comments Dr. Matthews Gwynn, Partner, AcuteCare Telemedicine. “In order to drive positive legislative change, we must educate legislators on the importance of access to telemedicine as well as the overall impact of telemedicine to patients and healthcare organizations.”

The Association leadership believes the best way to influence members of Congress is through face-to-face interactions with legislators. Federal and state legislation regarding physician licensing, care quality, scope of treatment and reimbursement of telemedicine is critical to expanding healthcare access and improving patient outcomes.

The ATA is the leading international resource and advocate for advanced remote medical technologies. Established in 1993, as a non-profit organization, the ATA membership works to fully integrate telemedicine into a transformed healthcare system to improve quality, equity and affordability of healthcare throughout the world. Their mission is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. The ATA Fall Forum in an opportunity to further this mission.

“As a leading practice-based provider of telestroke care, we support initiatives that open a dialogue with legislators, practitioners, and healthcare leaders with the intent on drafting smart legislation that will have a positive impact on our healthcare system,” said Dr. Keith Sanders, Partner, AcuteCare Telemedicine.



Rising Opportunities in Virtual Healthcare

While it may not be the .com bubble of the 90’s, telehealth and virtual healthcare initiatives are gaining popularity amidst investment communities across the globe. While some challenges still remain; individual state medical licensing reform, digital medical record keeping and some regional short-falls in technology infrastructure, a recent Wall Street Journal report on private equity firms investing in the health-care sector indicate increased investor interest in earlier stage opportunities. With the rising cost of healthcare, anticipated physician shortages and an increased demand for healthcare, virtual medical care is a way to solve the access and cost issues. Nirad Jain, a Bain partner and a co-author of Bain’s latest report on global health-care private equity, said “Health care is such an important part of the economy in the U.S. and globally, it impacts society in such a fundamental way that it is hard for a private equity firm of scale not to have some part of its portfolio in health care.” Private equity last year reached a three year high of $29.6 billion globally, nearly double the level recorded for 2013.

Telemedicine has been around for several decades but advances in digital infrastructure, software and the popularity of mobile devices by consumers is creating a tipping point for a budding virtual health industry. “Telemedicine is moving like lightning. We’re able to do so much more than before,” said Andrew Watson, Chief Medical Director of Telemedicine at University of Pittsburgh Medical Center.

Researchers at Mercom Capital Group estimated a 300% increase in funding flowing toward established and startup virtual-visit firms in 2014, and StartUp Health, a New York-based accelerator, and Rock Health, a San Francisco-based accelerator and seed fund, have independently reported that funding for new digital health ventures in the United States doubled last year. Rock Health estimates that $4.1 billion of new capital was invested in digital health in 2014, up from less than $1 billion in 2011.

“As practitioners in the telemedicine space, we’ve seen many technology platforms and telehealth delivery models enter the marketplace,” comments Dr. James Kiely, Partner, AcuteCare Telemedicine LLC.  “More consumers are embracing the convenience and lower costs of virtual visits and readily seeking routine and minor healthcare services through their smart phones, laptops and pads instead of face-to-face encounters with their doctors. As a result, healthcare organizations are moving quickly to implement telehealth initiatives across specialties such as neurology, cardiology, psychiatry, and other specialty programs.”

Whether or not virtual medicine and telehealth initiatives become the Facebook and Twitter of this decade remains to be seen. As investment dollars continue to rise, the future of telemedicine looks promising.



AcuteCare Telemedicine Announcing New Partnership with Bon Secours in Collaboration with InTouch Health

 

AcuteCare Telemedicine, the leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care, announces its newest collaborative partnership with Bon Secours Neuroscience Institute (BSNI), the neuroscience division at the not-for-profit Catholic health system sponsored by Bon Secours Ministries.

Bon Secours first established teleneurology initiatives 5 years ago at its smallest hospital, Richmond Community Hospital, with a goal to have all of its area hospitals joint commission certified. Patricia Lane, Bon Secours Richmond Administrative Director of Neurosciences says, “Working with the AcuteCare Telemedicine partners feels like an extension of the internal practice. They are truly in alignment with Bon Secours efforts to identify the right path to create continuity of care from the time the patient is admitted to our Emergency Room to the time they leave the hospital. AcuteCare is not just a provider, but invested team members who take pride in providing the best quality of neurological care to our patients.”

By utilizing innovative telecommunication technology, BSNI patients are able to undergo remote consultation with AcuteCare Telemedicine neurology specialists in Atlanta, Georgia. Dr. Matthews W. Gwynn, CEO AcuteCare Telemedicine says, “The neurologists of AcuteCare Telemedicine look forward to helping the Richmond and Kilmarnock areas achieve even greater quality in emergency care for their neurological patients through timely, professional medical consultations using the latest advanced communication technology with our partners at InTouch Health.”

AcuteCare Telemedicine is collaborating with InTouch Health to bring 24/7 extended teleneurology services to BSNI. InTouch Health provides technology enabled services to healthcare providers for the delivery of high-quality clinical care virtually anywhere, anytime. The InTouch® Telehealth Network enables healthcare systems to deploy telehealth applications across their enterprise. Patricia Lane comments, “I just love the technology and clinical solutions platform. It allows for continuity in communications from doctor to doctor and permits the real-time sharing of information between care-givers. Our ultimate goal is to provide a better treatment plan for each patient. AcuteCare Telemedicine and InTouch are the right solution to attain our goals and objectives with our teleneurology initiatives.”

Yulun Wang, Chairman & CEO, InTouch Health said, “We are honored to partner with the Bon Secours Health System to bring greater access to quality care at lower costs into the communities they serve.  InTouch Health’s enterprise-wide Telehealth Network, in combination with high-quality remote physician services, can touch more of Virginia’s population through Bon Secours’ extensive network of hospitals and ultimately into ambulatory care facilities, clinics, long term care and patients’ homes.”

AcuteCare Telemedicine continues to expand its geographic imprint in telestroke care, and is very excited for the opportunity to drive impact for Bon Secours as they continue to enhance their telestroke network. “The advancements in teleneurology not only allow us to access more patients in need of our specialized care, but also improves patient outcomes overall,” comments Dr. Keith Sanders, COO, AcuteCare Telemedicine. “The success of any program hinges on a seamless execution from door to needle. This collaboration is sure to have a significant impact on the patients and communities it serves.”

For more information on AcuteCare Telemedicine, visit www.acutecaretelemed.com.

 

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 Bon Secours Virginia Health System

Bon Secours Virginia provides good help to thousands of Virginians through a network of hospitals, primary and specialty care practices, ambulatory care sites and continuing care facilities across the Commonwealth. The not-for-profit health system employs more than 12,500 people, including nearly 800 providers as part of the Bon Secours Medical Group.

The fourth largest and only faith-based health system in Virginia, Bon Secours Virginia offers a full range of services including cardiac, women’s, children’s, orthopaedics, oncology, neurosciences and surgery at eight award-winning hospitals.

– Bon Secours Richmond is St. Mary’s Hospital, Memorial Regional Medical Center, Richmond Community Hospital, Rappahannock General Hospital and St. Francis Medical Center.

– Bon Secours Hampton Roads is Maryview Medical Center, DePaul Medical Center and Mary Immaculate Hospital. 

About Bon Secours Virginia Health Care Foundation

The Bon Secours Virginia Health Care Foundation raises charitable funds to help Bon Secours Virginia Health System address the community’s growing health care needs with compassion and excellence. Through charitable support, we are dedicated to helping create healthy communities, advancing clinical innovation and providing an extraordinary experience of care. For more information on giving, visit www.bsvaf.org. 

About InTouch Health

InTouch Health provides technology-enabled services to healthcare organizations for the delivery of high quality virtual care, anytime, anywhere.  InTouch Health has helped more than 100 healthcare systems deploy telehealth programs across their enterprise, and into other sites of care, quickly and seamlessly using its industry-leading combination of professionals, processes and practices.  The InTouch Telehealth Network provides users unmatched ease of use and diagnostic capabilities, proven reliability, FDA and HIPPA compliance, secure access control, and clinical and technical reporting.



Crossing the Point of No Return in the Delivery of Healthcare

For a number of years now, the prediction that telemedicine technology was on the verge of unabridged expansion has been as common as snow fall in the Rockies in January. But in reality expansion has always fallen short of the predictions.  At the beginning of each year loyal proponents touted that telemedicine would revolutionize the healthcare delivery model and change the way patients interface with their healthcare providers, only to encounter a number of stubborn road blocks that managed to slow the process of full utilization and implementation of the technology. This year, due to the convergence of more affordable technology and changing patient expectations, many industry leaders are once again claiming 2015 to be the long-awaited year of the break-out.

Telemedicine has been making significant progress in making specialized care, such as stroke and other neurological care, more accessible to patients who live in remote outlying areas not served by major urban medical centers. According to the American Telemedicine Association, more than half of all U.S. hospitals now use some form of telemedicine. But the full utilization and benefits of telemedical technology has been allusive.  Now there are several market and technological factors that could make 2015 the year that significant progress is achieved in the application of telehealth across all healthcare sectors.

With the predicted significant financial benefits and efficiencies for healthcare providers, insurance companies and ultimately the consumer, the global telehealth market is predicted to approach $27 billion by 2016. By 2018, it is expected that 65 percent of interactions with healthcare providers and organizations will be performed via virtual communication devises which will eventually be interconnected with an ever expanding array of mobile and wearable monitoring gadgets. Major healthcare players from pharmacy to health insurance companies and technology companies like Google are taking notice and making significant investments in telemedicine technology. Four factors that will insure expanded adoption in the coming year are beginning to come into focus:

Payment for telemedicine services. Government payers like Medicare and Medicaid as well as private healthcare insurers have broadened reimbursements for telemedical services. As payment barriers continue to be resolved utilization of telemedicine across the healthcare spectrum will advance more rapidly.

Market introduction of communication technology improvements. Advances in wearable technology will provide opportunities to interlink the monitoring devices with a comprehensive telemedicine communication system which will enhance remote diagnosis and virtual treatment in many cases. Long awaited improvements and increased adoption of electronic medical records (EMRs) will eventually benefit overall healthcare. By making patient medical history records easily and immediately available to virtual caregiver’s telemedicine services will have a greater opportunity to expand beyond the current limitations.

The consumerization of health care. Patient push-back over faceless physician encounters was once promoted as a formidable barrier to the implementation of telehealth. As patients became responsible for a larger share of their healthcare costs, tech user consumers began to embrace the convenience and lower cost provided by virtual remote care. From retail health insurance stores to health care kiosks in retail outlets, pharmacies and shopping malls, patients are embracing the concept of consumerization. The free market concepts that are already an established staple of other industry markets is turning the traditional delivery of healthcare into a business to consumer (B2C) model. Today’s healthcare consumers are increasingly setting the terms of service and expecting high-quality, personalized and convenient experiences from their healthcare encounters.

The state by state licensing of physicians has been a formidable barrier to multi-state expansion of telemedicine for years. “The morass of regulations and paperwork required by each state licensing board is a mountainous obstacle to efficient medical care throughout these United States. The recognition of multistate licensure would ease this restriction and improve access to experts for patients of all 50 states. I foresee the easing of these restrictions in the coming year,” says Dr. Matthews Gwynn, Director and Founder of the Stroke Center of Northside Hospital in Atlanta and AcuteCare Telemedicine CEO.

The long anticipated year of telemedicines break-out may finally be upon us. While many may find the new reality of healthcare delivery unsettling and disruptive, telemedicine may have finally crossed over the point of no return.



Expanding the Reach of Teleneurological Care

Thomas Hospital has been serving the communities of Baldwin County and Mobile Alabama for more than 50 years. A 150 bed hospital with a staff of more than 1300 dedicated medical professionals, Thomas Hospital has established a tradition for earning accolades for excellent service. In 2014 it was named among America’s 100 Best Hospitals for Patient Experience and a 2014 America’s Best Hospitals for Obstetrics by Women’s Choice Award. For four consecutive years the facility has been named among the Top 100 Cardiovascular Hospitals by Thomson Reuters and was named a Blue Distinction Center for Knee and Hip Replacement by Blue Cross Blue Shield of Alabama. With such an exemplary track record it is no surprise that it would seek to improve its neurological care services through the use of the latest communication technology.

In a time when medical specialist are in short supply and increasing financial pressures are common place among the nations smaller to mid-sized hospitals, many are turning to telemedicine to assure their patients have access to the finest quality care available. In an effort to complement their existing neurological care department, Thomas Hospital is partnering with AcuteCare Telemedicine and the Alabama Partnership for Telemedicine to provide virtual, 24 hour, seven days per week treatment for stroke and other neurological maladies. The service is scheduled to go into effect in early January, 2015 and will assist the dedicated caregivers at Thomas Hospital in providing the finest around the clock neurological treatment to the patients in their community.

AcuteCare Telemedicine (ACT) is the leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care. As the demand for Neurologists increases and new regulations impact hospitals, there is a growing shortage of experienced physicians available to provide continuous coverage. ACT offers cost-effective solutions that deliver complete on-call coverage to improve patient outcomes. “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 CEO. “We look forward to expanding our family of client partnerships throughout the region with the addition of Thomas Hospital.” Alabama Partnership for Telehealth will be providing the technical assistance and infrastructure for the project.

Alabama Partnership for TeleHealth (APT) is a charitable nonprofit corporation with a focus on increasing access to healthcare through the innovative use of technology. APT’s goal is to serve the citizens of Alabama by promoting and supporting new and existing telehealth programs across the state.

Thomas Hospital is an associate of Infirmary Health, Alabama’s largest non-government healthcare team, and is devoted to patient care through three acute-care hospitals, three rehabilitation hospitals, three outpatient facilities and 22 medical clinics which serve an 11-county area along the Gulf Coast of the state.