AcuteCare Telemedicine Blog


Elements Essential to Establishing a Successful Telemedicine Program

Several studies in recent years have indicated that the use of telecommunication technologies in the delivery of health care will rise dramatically as new technology is improved and its utilization perfected. Patients seeking healthcare through the use of fixed and mobile digital devices will reach 7 million by the year 2018. This predicted high demand for mHealth has existing providers scrambling to design an effective, high quality delivery model that meets the requirements of increasingly savvy consumers/patients. The projected increase in users of telemedicine services is also attracting a new wave of investor-supported entrepreneurs, eager to embark into the practice of virtual medical care. These new technologies make it possible for healthcare providers to monitor, measure, and interface with patients remotely while making it easier for patients to manage their own healthcare.

As healthcare companies and providers seek to implement telehealth solutions, it requires certain critical, essential elements necessary to the successful engagement of a connected-care-telemedicine practice:

Devices – The popularity and utilization of personal computing came about only after the deliberate evolution of devices that were simple and easy to use by inexperienced consumers. A telemedicine practice must use remote presence devices that are easy to use for the patient and promote a high level of confidence in the exchange of information with their physician.

Platform – Utilizing a platform that integrates telemedicine connections into a secure electronic medical record system will be essential to insuring quality and continuity of care. A software platform should be easily accessed by users and consistent with familiar digital formats and functions, but include cutting edge security measures in order to ensure the highest level of patient confidentiality.

Expert Practitioners – Telemedicine is not a new or different type of healthcare, but a different method of delivering the same quality of healthcare.  The physicians and care-givers must be equally skilled and proficient, not just in medicine, but also in technology.

Process Improvement – A successful telemedicine practice must establish key performance indicators that can be monitored and measured.  As the system is monitored and measured, telemedicine providers are able to make continual improvements to ensure the highest level of care.

The growth of telemedicine has become one of the most disruptive events in the delivery of healthcare in more than a century. Applying the technology to a well-established and confident system of care will come with certain challenges in its implementation. The impact will be derived, not by the technology or its devices, but rather from the healthcare professionals who incorporate these essential elements.



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.



Telemedicine Legislation is Moving; In All Directions

The use of telemedicine and telehealth is increasing becoming the subject of debate in state legislatures all across the country, making the delivery of medical care via telecommunication technology a priority legislative issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming are moving legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

Ron Bachman, a foremost expert on health care consumerism, consumer-centric Medicaid and Medicare, the uninsured population and mental health, predicts an estimated half a billion smartphone users worldwide will be using a health care app to connect to a healthcare giver by the end of 2015. An emerging, technology-using generation is becoming increasingly comfortable with using mobile devises to access their medical care through smartphones, tablets and laptops. Entrusted with an increased responsibility for paying the rising costs of healthcare, these new consumers are embracing disruptive technologies to command lower cost, more convenient, higher quality, consumer oriented medical care. “It is impossible to stop a mega-trend,” says Bachman. “Telehealth is the cutting-edge future of health care worldwide. Telehealth, in its various forms, will provide convenient medical services because consumers will demand it.”

In another recent Harris survey, more than half of Americans indicated that they want to use telemedicine to connect with a physician, and they also think it should cost less than an in-person visit. It is an indication that consumers identify telemedicine as a different means by which to deliver care not a different type of healthcare. Data consistently indicates that telemedicine can deliver quality healthcare outcomes comparable to in person office visits while lowering consumer costs for routine care. Emergency Room (ER) treatment tops the list as the most expensive, least efficient and most frequently utilized way to provide non-emergent care, with an ER visits costing from $1,500 to $3,000 on average. Visits to a Primary Care Physician (PCP) can coast from $130 to $190. A telemedicine visit can cost as little as $40. With the popularity among voting consumers growing there is little wonder why state lawmakers are aggressively marching telehealth legislation forward.

In a recent Forbes article entitled, “Telemedicine Is a Game-Changer for Patients, The System,” contributor Bill Frist points out that there are multiple barriers to the widespread uptake of telemedicine with the most prohibitive being regulatory policies at the state level. The laws in many states either severely limit or completely ban the practice of telemedicine. In Frist’s opinion, for consumers to gain the most benefits from telemedical technology legislation must address four persistent barriers to complete telehealth adoption:

The legislation needs to provide payment parity by requiring insurers to reimburse licensed health care providers for services delivered remotely at the same rate they would pay if the visit were in-person. This assures there would be no financial incentive to favor face to face care over telemedical services. The caveat that it cost the same acknowledges the value of the telephysicians expertise and the indirect costs of providing this service. Cost savings would still be realized through a reduction in lost workforce productivity and less reliance on emergency medical services.

For quality assurance, any legislation should establish that the same standard of practice applies whether the services are delivered in person or remotely.

Proposed legislation should prevent the use of additional rules requiring in person visits before or after telemedicine encounters or the presence of care facilitators during an encounter. Such restrictions effectively eliminate the possibility of most telemedicine models from operating.

State licensure requirements should allow exemptions for telemedicine.

The legislation that is passing through some states is attempting to encompass many of these points. The Arkansas House of Representatives was able to pass a new bill (SB133) that is more restrictive than one that had been previously voted down. While the bill does not meet all goals of an open telemedicine market for consumers and provider alike, it will allow telemedicine practitioners to be licensed as doctors in Arkansas, waives the requirement for a pre-existing, in-person relationship with the patient in cases of emergency and demands that telemedicine be reimbursed by Medicaid and private health plans.  Arkansas lawmakers, like those of many states, are finally willing to open the door to a new healthcare delivery model by way of modern technology, if only a little.

Other states have also passed or are considering telemedicine legislation that would expand telemedicine within their states. There appears to be little consistency in the various offerings except for a tendency towards over-regulation and complexity. Telehealth is exactly the type of innovation that can solve many of the challenges currently facing the healthcare system. Elected representatives must move more vigorously to craft legislation that serves to promote this innovation while limiting litigiousness and overregulation.



Telehealth Legislation Continues to Evolve

Things are heating up in state and federal legislatures when it comes to advancing legislation that will help accelerate the spread of telehealth across America. The American Telemedicine Association (ATA) is working with congressional representatives to move forward on what is known as, “21st Century Cures”. The ATA is recommending that Congress take immediate action to improve coverage for telehealth services under Medicare payment innovations in a number of areas from fee-for-services to Accountable Care Organizations to bundled payment programs. The House and Energy Commerce Committee recently released a draft bill that will, in part, direct the Centers for Medicare and Medicaid Services (CMS) to implement a methodology for coverage of telehealth services.

Outside of Washington and all across the country, State legislatures are making telemedicine a priority issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming have introduced legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

In the state of Florida the battle to find acceptable legislative action to help increase access to health care in their rural communities is on-going. A bipartisan group of House and Senate leaders are confident they will reach agreement this year on how to boost the use of telemedicine in their state. “It’s abundantly important that we get it done and get it done right,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said during a news conference at the state Capitol in Tallahassee. As with several other states, law makers continue to struggle to pass legislation that satisfies legislators’ and healthcare industry concerns for the safety of patients and maintain the fiduciary responsibility of state government.

Lawmakers during the past few years have filed telemedicine bills that would allow for the use of modern telecommunication technology in the delivery of healthcare but the Florida House and Senate have not been able to reach an agreement. This year legislative leaders are expressing confidence that they can resolve their differences on regulatory issues. One of the points of disagreement in Florida and other states is the issue of individual state licensing and whether out-of-state physicians should be allowed to provide telemedical care to patients in their state. The current requirement and process of requiring a physician to be licensed in each state where treatment is rendered continues to be a significant stumbling block to the unabridged expansion of the practice of telehealth across state boundaries.

If the year 2015 is to become the predicted tipping point for expanding the benefits of technology driven medical care, state legislatures in Florida, and other states around the country, will need to do more than just debate and negotiate over the future of regulations that were relevant to times past.



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.



The Building Momentum of Telehealth

Some proponents of telehealth are predicting that 2015 will be the year consumers will discover the convenience and cost benefits of accessing common health care through a virtual encounter. Telehealth has been reported to be on the precipice of rapid expansion for several years now, only to have the predictions fall short of expectations, mainly due to an established industry infrastructure that seemed to be well behind the present day technology curve. As service reimbursement, licensing and technical issues continue to fall-away many predict the time for a break-out in telehealth is upon the industry.

Entrepreneurs are taking the lead in providing opportunities for consumers to access common medical care services through virtual technology. More than 200 entities have entered the “doctor on call” market, connecting patients with a doctor for remedies for common every day ailments. In some parts of the country the service is becoming routine.This year more than 300,000 users will connect with a medical care provider over the internet, with that number predicted to grow to more than 7 million by 2018 as consumers discover the ease of use, convenience and lower costs. The initial concern that consumers would resist abandoning the traditional face-to-face office visit with their doctor has quickly dissipated as savvy; tech accepting consumers embraced the convenience of the new experience. The momentum continues to build, but is the other side of the doctor patient equation as prepared and eager to accept and embrace the new technological aspect of healthcare delivery?

For decades medical care has become increasingly industrialized and structured, primarily out of a need to control costs and manage available resources effectively and efficiently. The personal relationship between care giver and patient suffered as time was allocated to attending to increased numbers of patients. As primary care physicians integrate virtual encounters into their practice of care, the technology promises to provide new opportunities to once again place the relationship at the center of the care delivery. The addition of virtual encounters to the doctor/patient relationship promises many challenges to the largest and arguably the most important segment of the medical care industry, the general practitioner (GP), however, delegating the majority of follow-up or less critical visits to telecommunication may leave more time for developing the quality of the personal relationship through the face to face visit.

The clamor from the consumer is loud and clear but the growth rate of telehealth may be more dependent upon the medical professional’s willingness and preparedness to lead the way to the advancement of the new healthcare delivery model.

Your patients appear to be ready, are you?



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



Does The FSMB ‘Compact’ Go Far Enough?

A new bill was introduced to Congress earlier this month that is designed to remove what many are calling a significant barrier to the expansion of telemedical services throughout the US. The “Telemedicine for Medicare Act,” or HR 3077, was introduced Sept. 10, in the House by Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J.

In introducing the bill, Rep. Nunes said, “By reducing bureaucratic and legal barriers between Medicare patients and their doctors, it expands medical access and choice for America’s seniors and the disabled.” For doctors who treat Medicare patients, the bill will remove the state-by-state licensing requirement which has existed since the very formation of the states. Presently, each state requires a physician to be licensed in the state where the medical care is being performed, making it difficult and unnecessarily expensive for doctors to practice telemedicine across state lines.

“Keeping medical licensure within the states’ domain maximizes surveillance of physician quality while fostering diversity by preventing potentially unreasonable control by Federal agencies,” says AcuteCare Telemedicine Chief Executive Officer Matthews Gwynn, M.D. “The efforts by regional state groups to streamline licensure is a good solution.”

Joel White, the Health IT Now coalition executive director says, “Congress has already had success in implementing a national telemedicine framework for members of the Department of Defense (DOD) and Veterans Administration (VA), this Nunes-Pallone bill does the same thing for Medicare beneficiaries.”

As if taking a cue from the bill sponsoring congressmen, the Federation of State Medical Boards (FSMB) has just released model legislation which would create a multistate “compact” system, where member states will experience a streamlined interstate licensing process. While the proposed compact promises to expedite the path to individual licensing requirements within those member states, it appears that it will not sufficiently address the costs associated with fees charged for each license or with the process as a whole in non-member states. The model legislation calls for at least seven states to participate in the compact.

Many industry leaders feel that if more states sign-on to the compact it will head-off the federalization of medical licensing. But at first read, the FSMB compact model would complement many of the same negative, bureaucratic, bells, whistles and hoops that would most likely come with a national licensing system, leading others to see the proposed FSMB legislation as a means to preserve the centuries-old influence of state medical boards’ authority over the authorizing of physicians’ practices.

With the Congress already demonstrating a respectable performance in providing a successful framework for telemedicine to flourish, through the DOD and the VA, the present actions and efforts by FSMB and their supporters to bring the entrenched state licensing process into the 21st century, and avoid federal intervention, may be an example of too little, too late.



Universally Consistent Telemedicine Guidelines Still Out Of Reach

Recognizing the strong growth and innovative approach in telemedicine practices, the American Medical Association (AMA) enacted a set of guidelines for care provided by telecommunications earlier this year. The guiding principles seek to address the concerns and issues within the medical community relative to the development and implementation of telemedicine programs. The AMA guidelines support the “use of telecommunications in the delivery of healthcare while ensuring favorable standards of care; patient safety; quality and continuity of care; transparency; and the responsible handling of patient medical records and privacy.”

The action by the AMA appears to address the many valid concerns among the medical community while providing much needed flexibility, if telemedicine is to fulfill its many promises to increase availability of specialized medical services to rural communities, reduce costs of medical care and have a positive impact on the anticipated future shortage of physicians.

More recently, the Georgia Composite Medical Board enacted a new regulation governing the standards for telemedicine practice for physicians practicing in the state of Georgia. Much like the AMA guidelines, the regulations establish consistent standards of practice for providing treatment and consultation through the use of telecommunication technologies. The regulations were enacted after more than two years of evaluation and discussions by the state Board. The requirements, like those of the AMA, appear to successfully address many of the same concerns and issues.

The Georgia regulations require that all providers of telemedicine services, which include physicians, physician assistants (PAs) and advanced practice registered nurses (APRNs), hold a valid Georgia state license. However, one area of inconsistency between other proposed individual states requirements and the AMA guidelines is the requirement relative to prior in-person examination.

The AMA prefers not to specify whether the prior face-to-face examination requirement, before rendering treatment via telecommunication, must be performed in person or by a video encounter. The Georgia regulation specifically requires an in-person relationship prior to the any telemedicine service, but enumerates several exceptions and qualifiers which defer the requirement in specific instances. In many other states, including Tennessee, a much more defined requirement of pre-telemedical care relationship is mandated.

Perhaps the most prevalent impact of technology on our society is its effect on breaking down pre-existing divisions, both geographical and social. State lines, geographic hurdles and physical market limiting factors are obliterated by advances in telecommunications. If the full benefits of telemedicine are to be realized, consistency and clarity in regulations and guidelines must prevail.

Few in the healthcare community advocate for blanket federalization of regulations. The industry can do more to enact a core set of standards and practices that successfully address the bulk of concerns and issues of each entity while assuring every patient, regardless of where they reside, receives the best quality and most efficient medical care available.



Eagle Scout, AcuteCare CEO Dr. Matthews Gwynn Does His Best To Help Others

Being a good scout has carried Dr. Matthews W. Gwynn through life, to the post of chief executive officer of AcuteCare Telemedicine, and consistently as one of America’s Top Doctors, according to U.S. News and World Report.

An Eagle Scout’s life lessons are a solid foundation for Dr. Gwynn, now 55, as he strives, on his honor, to do his best to help others. “It teaches you to do the right thing if you take it seriously,” he says of Scouting’s influence.  “In my blood I always try to do the right thing. I believe there is something to be said for society that, if you simply follow the Scout law and motto and think like that, it sounds hokey, really hokey, but the world is a better place.”

Dr. Gwynn was born in Baltimore, Md., then moved around in his early years, to Cincinnati, Ohio, Raleigh, N.C., and Reston, Va.

With his father’s encouragement, he grew into the idea of becoming a doctor. As a chemistry major with a liberal arts education, it was his love of science and problem solving, plus his maternal grandmother, that cleared the path for Dr. Gwynn’s career. In his teenage years, he helped take care of his grandmother after she’d suffered a stroke. “I came to understand the frailties of people,” he remembers. “I realized I could make a living at it and also help people get better.”

He is a graduate of the College of William and Mary and the University of Virginia Medical School. He completed an Internal Medicine residency at the University of Alabama in Birmingham, and then returned to the University of Virginia for his Neurology residency. He is also a partner in Atlanta Neurology.

The challenges and riddles of Neurology are what eventually drew Dr. Gwynn in. “I loved the fact that it was a puzzle and the diseases were highly interesting and very challenging,” he says. “Not particularly easy and not everybody could do it. It required a very formal thought process to come to the right answer.” He says he was discouraged at first, “that there was nothing to do for people” he adds. “It was the old saying ‘diagnose and adios’ in neurology.” So he went into general medicine residency to find something to help people get better. But he changed his mind and realized he was fascinated by Neurology, just as the field was developing quickly.

Dr. Gwynn realized that telemedicine was a rising frontier in the field of Neurology. “The current economics in medicine is unfavorable for many neurologists to stay in hospitals. Almost all liability comes from there, and it is very disruptive to your primary income source, which is your private practice,” he says.  This exodus creates a real void. “Telemedicine is not a fad. It’s a demand that is growing,” the chief of Neurology at St. Joseph’s Hospital in Atlanta adds. “We are trying to use this opportunity to fill the gap.”

The CEO sees the professionals at AcuteCare Telemedicine as “competent, punctual and engaging.” He says they embody the “Three A’s of Medicine”: ability; availability; and affability. “They are competent and have a wide breadth of clinical neurology experience and knowledge and are leaders in their field,” Dr. Gwynn adds. “They are engaged. We are people-people. We provide expert advice and with patients we are able to empathize and help them really well; better than most of our colleagues.”

Dr. Gwynn is also director and founder of the Stroke Center of Northside Hospital and recent chairman of the Department of Internal Medicine. He says the ability to connect with people is crucial in telemedicine. “It’s amazing how well that works,” he says. “Within five seconds I can gain the trust of the patient as much as if I were in the room by greeting them with a smiling face and respect.

We all find commonality very quickly with our patients,” the husband of 27 years and father of two says assuringly. “A lot of people are very frightened when they have neurological symptoms, because it is so foreign to them. It’s an enigma. So we’re there to try to put them at ease and figure out how to help them.”

Dr. Gwynn has also become a national expert leader in using botulinum toxin for medical treatment of chronic migraine, movement disorders, spasticity, and other disorders, and he trains other physicians to use it in their own practices.

The doctor enjoys a round of golf in what little spare time he gets. He also likes to cycle and backpack and enjoys classical music.

The Eagle Scout in a white coat gets his inspiration within each new day. “I love that every day is different and that I am going to see interesting people,” Dr. Gwynn says. “That people are going to come to me asking for my advice and wanting me to help them and make them better. I can’t help everybody but I can listen to everybody and ameliorate their suffering.”

He is also fond of the direction AcuteCare Telemedicine is taking. “By the end of next month we’re going to be in six states and many different ERs,” Dr. Gwynn says, “and I can reach anyone from anywhere. I can even have an influence on someone’s care 2,000 miles away in Arizona. That’s very cool.”