AcuteCare Telemedicine Blog


Technology is Advancing the Practice of Telepsychiatry

Telepsychiatry and other long-distance options for providing mental health care can help overcome problems related to location and distribution of specialty mental health services but should not be seen as a panacea for delivering care to rural areas in the United States, reported a research and policy brief from the Maine Rural Health Research Center. “Telemental health” (yet another new term) once depended on heavy-duty audio and video technology based in fixed studios to initiate care. Despite this coarse beginning, advances in computer technology and its near-universal adoption have resulted in improved delivery of Telepsychiatry and made it more cost effective and available to a wider audience, however, some non-technical hurdles remain to be cleared.

Until recently, “Telemental health” services were most commonly provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners, but now a pilot project begun at one critical-access hospital in collaboration with a psychiatrist and specialty mental health staff at a community mental health center has expanded to five additional hospitals. This system provides round-the-clock crisis evaluation and support at the hospital emergency departments and some say that “Telemental health” enabled them to provide services to rural persons that otherwise would not be available, but some nontechnical barriers such as poor Medicaid and commercial reimbursement rates, recruitment and retention difficulties, high numbers of patients without insurance, and high no-show rates serve as a drag on expansion of current programs.

The barriers experienced with “Telemental health” expansion is shared by other medical service disciplines seeking to enter or expand the utilization of telecommunication technologies that promise to revolutionize the delivery of medical care in the United States and across the world.  While progress is being made to overcome many of the most significant structural road blocks to expansion and adoption of these new technologies, much remains to be done to clear the path to a new medical care delivery model.

Maintaining a consistent push to encourage state and congressional representatives and health insurance industry leaders to move forward and embrace the revolution in healthcare must continue until each barrier is removed or neutralized.  The promise of delivering better, less expensive and more available medical care to millions of patients across the country depends on these continued efforts progressing and succeeding.



Can We All to Come Together in the Interest of Progress?

According to a recently published report, telehealth is about to experience explosive growth. RNCOS Business Consultancy Services has just released a report predicting 18.5 percent annual growth in telehealth worldwide through 2018.  It is predicted that the U.S. will outpace the rest of the world with its share of the telehealth market expected to grow to $1.9 billion in 2018 from $240 million today, an annual growth rate of 56 percent. This projected explosive growth has gained the attention of the federal bureaucracy. In 2013, two bipartisan bills were introduced in Congress, designed to encourage telehealth expansion and growth:

  • HR 3077, the TELE-MED Act, would permit certain Medicare providers licensed in a state to provide telehealth services to Medicare beneficiaries in a different state.
  • HR 3750, the Telehealth Modernization Act, would promote the provision of telehealth by establishing a federal standard for telehealth, and inducing all states to adhere to the regulations.

The Health IT Now Coalition is pointing out that neither bill imposes a huge burden of federal control and that these two bills do not interfere with state sovereignty over the licensing of medical and allied health professionals. Traditional state licensing laws did not envision a physician in one state treating a patient in another state and the oversight and lack of inter-state licensing of physicians and other health professionals has long been an obstacle to TeleHealth rapid adoption.  Many in the medical community are concerned that Congressional overreach would have unintended consequences in situations that are better dealt with by individual states. Decentralized control at the state level ensures less likelihood of an inflexible and quickly dated regulatory regime, which often happens when Congress takes the lead.

The Federation of State Medical Boards has promised that it is very close to agreeing on language for an interstate compact for physician licensing, which has already been achieved for nurses. A compact is a constitutionally approved method for states to make treaty-like commitments to each other. It is a very appropriate tool to accommodate mutual recognition of professional licensing for the purpose of inter-state telehealth.

It is very encouraging that both advocates and governmental representatives are endorsing an approach that will allow providers, patients, and entrepreneurs to develop and adopt telehealth with minimal political interference.  It is all too common for politicians and their formidable federal and state machinery to reach out to “help” advance a promising, revolutionary movement only to over indulge the regulatory rule-making which ends up hindering real or untethered progress.

Technology promises to change much in the delivery of medical care in the coming years. Let’s hope that all parties to the process of change continue to work together to advance a common mission of providing improved quality and increased availability of affordable medical care to all Americans.



Will Mobile Technology Help Close The Digital Divide?

A recent study is revealing that patients using telemedicine are more likely to be urban and well educated. Based on data from 53,000 households collected by the Census Bureau in July 2011, the report found 8 percent of urban Internet users took part in telemedicine initiatives, compared with 4 percent in rural areas. That stands in contrast to telemedicine’s common selling point that it can more effectively and conveniently provide services to people in remote locations.

Participants were also found to be wealthier.  At income levels of $100,000 or more, 11 percent of Internet users took part in remote care, compared 4 percent from households in the under $25,000 bracket.  The 25-44 age group was found to be the most likely segment using online services for medical care and information.

As access to telemedicine opportunities continue to grow it is expected that the demographics will likely shift to include lower-income and less-educated patients.  One technology that may improve access to telehealth services is the mobile or smart phone devices which appear to be closing the digital divide among various demographic segments of the population. Mobile technology has become especially critical for low-income minorities who have no other technological means of connecting to the internet.

Survey results released in September by the Pew Research Center’s Internet & American Life Project indicate that African Americans and Hispanics are more likely than whites to own a smartphone, with 49 percent of Hispanics, 47 percent of African Americans, and 42 percent of whites owning these mobile devices.  For these groups, mHealth has the potential to be a powerful tool in promoting healthy living and preventive medicine, particularly in combating the high rates of diabetes in these populations.

Development of new and innovative health related mobile applications and growing the number of smart phones in the hands of the more economically challenged population promises to be an effective means to bridging the healthcare gap in America. Health and Human Services (HHS) has called on developers to create a mobile application to help educate minorities and women about cancer screenings and allow secure access to medical records.

Only time will reveal whether telemedicine’s promising benefits of increased access and lower cost of quality medical care will better attract and reach those who are most in need.



Is There a Doctor in the House?

For those who can still remember the day when your family physician came to the house in response to a telephone call requesting medical service, the current debate over the acceptance of telemedical services in place of face-to-face visits with a doctor will bring back memories of a similar debate exorcised over the abandonment of house calls with in-office visits. Back then the vocal decry from opponents to the change suggested that patients would reject the idea and inconvenience of traveling to the doctor’s office to receive medical care and that somehow the process would have a negative effect on the quality of health care.

Few predict that the face-to-face, hands on, talk to me now visits with a physician is likely to go the way of the personal home visits anytime soon.  However, organizations resistant to changes with the current medical services delivery model and are unwilling to consider utilizing telecommunication technology will not be able to meet the growing demands of the patients and communities they serve.

A recent study by Cisco reveals that 74 percent of consumers are open to virtual doctor visits.  The results of the Global Customer Experience Report focused on health care, demonstrated a shift in consumer attitudes toward personal data, telemedicine and electronic access to medical information. The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.

The results indicated that 80 percent of American’s were comfortable with submitting personal medical and diagnostic information to the cloud to help ensure that all relevant personal medical information is readily available to receive treatment.  Perhaps the most interesting result was that the findings challenged the assumption that face-to-face interaction is always the preferred health care experience by consumers. While consumers still depend heavily on in person medical treatments, given a choice between virtual access to care and human contact three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician interaction.

The benefits of face-to-face visits to quality of care are valid and current telemedical service visits will not likely replace all physician/patient personal interactions anytime soon, nor should they.  But recurring studies are beginning to reveal that patient’s reluctance and suspicions of telemedicine is no longer a valid excuse for delaying the broader expansion of telemedical services.

Perhaps we shouldn’t be all that surprised that patient objections to a reduction in face-to-face doctor office visits are fading.  Consulting with your family health care practitioner, via telecommunication technology, in the comfort and convenience of your own home has a familiar ring.  House calls revisited? What goes around comes around?

 

 



Telemedicine as Beneficial as In-Person visits for Parkinson’s Patients

A recent article in Fierce Health Information Technology reports on a study that indicates that Parkinson’s patients who received treatment via telemedicine did not show a decline in quality of life when compared to typical in-clinic patients.  The new research published in JAMA Neurology aims to address the problem of the prevalent burden of neurological disorders paired with limited access to care by testing home telemedicine for patients with Parkinson’s’ disease.

Skeptics have long argued that taking the face time out of the medical care experience between doctor and patient would result in a lesser quality of care being delivered to patients and some physicians remain adamant that healthcare by remote control is no substitute for in-person doctor visits, particularly when a patient needs care for a serious problem.  While there still remains significant and justifiable sentiments among medical professionals that in-person visits with a doctor plays a crucial role in the quality of health care, the evidence is beginning to indicate that the advantages of telemedicine is chipping away at the real impact these in-person visits have on the quality of care.

The study’s authors admitted that a larger trial would be needed to show if clinical benefits of telemedicine are comparable to in-person care.  They also reported that telemedicine patients, on average, were saved roughly 100 miles of travel and 3 hours of time.  Lead author Ray Dorsey, an associate professor of neurology at the Johns Hopkins University School of Medicine, said in the announcement. “If this proof-of-concept study is affirmed, the findings open the door to a new era where anyone anywhere can receive the care she or he needs. It appears we can use the same technology Grandma uses to chat with her grandson to provide her with valuable medical care in her home.”

There continues to remain many obstacles in the path of full blown acceptance of telemedicine as a quality health care delivery mechanism, but some long standing negative perceptions are beginning to fade away in response to increased successful utilization of the new technology.  With the promise of new, more accurate, comprehensive and sophisticated medical devices making their way into the market place, many more, well established opponents are sure to be challenged to defend their long standing positions and practices as it relates to delivering health care to their patients.



Telemedicine, Bringing Improved Medical Care to India’s Rural Poor

In the United States, much has been said about how Telemedicine technologies are offering improved access and medical care to rural locations, particularly access to specialized medical care providers. But in many countries such as India, the opportunity to advance medical care to rural areas has a much more profound meaning to those in need of health care services.

India is administratively organized into state towns, district towns, block marketplaces, and then villages and healthcare, as such, is distributed along that supply chain with each level of infrastructure offering a lower standard of care.  Even in some of the fastest growing regions of India, as many as 85 percent of the 100 million residents only have access to healthcare that is at the bottom of the quality spectrum.  Private, better quality medical services may be located hundreds of miles away and take hours or days to reach by rural patients and are only available for those who have the money to pay.

Enter World Health Partners (WHP), an international nonprofit organization that provides health and reproductive health services in low-income countries by harnessing local market forces to work for the poor. Leveraging existing social and economic infrastructure, WHP utilizes the latest advances in communication, diagnostic and medical technology to build an ecosystem atop the existing private sector to bring improved medical services to even the most rural areas of India.

WHP is teaming up with out of the way, unlicensed, village health practitioners, or Quacks as they are known in India, to connect poor, rural patients with doctors located in Patna and Delhi.  For an investment of about $1000.00, each of the more than 433 quacks currently in WHP’s network of telemedicine practitioners can set up a Wifi network, laptop computer and the necessary equipment to make it all work, or at least work most of the time.  The system is not perfect and experiences frequent break downs but it saves time, money, and in some cases can save lives, for rural families that would otherwise have to travel hours to larger cities.

World Health Partners is working towards setting up 16,000, mostly privately owned and operated, telemedicine centers throughout India’s most rural provinces in hopes of bringing the convenience and benefits of telemedicine to the poorest of India’s population.  In addition, the concept is being scaled to be exported to countries and regions well beyond India, with hopes of reaching millions of world’s neediest populations.