AcuteCare Telemedicine Blog


Continuity of Care in Telemedicine

Continuity of care is a fundamental factor in the delivery of quality healthcare and a bedrock principle of the patient-doctor relationship. It is understood to be a critical element in all health care systems and has shown to be responsible for reducing hospitalizations and lowering costs, particularly among chronically ill patients.

Traditionally, continuity of care is the delivery of a “seamless service through integration, coordination and the sharing of information between different providers.” The increasing complexity of healthcare delivery is complicating the assurance of continuity of care. Virtual interactions between patient and caregiver and a plethora of health related monitors, devises and mobile apps, has some believing the increasing complexity in healthcare delivery might impede the achievement of continuity of care. Even in a traditional face-to-face care relationship, it is common to have more than one care provider across the process of diagnosis and treatment. Add options like retail clinics, e-visit websites, smartphone apps, freestanding urgent care centers and kiosks and continuity of care could be compromised by all the disruptive innovation.

For this reason much debate about telemedicine and the effect it is imposing on healthcare delivery has been centered on the doctor/patient relationship and the adherence to maintaining a high standard of care, regardless of the method of interaction. While the importance of the patient and physician in the new electronic relationship is well understood, there is a third component essential to the successful integration of telemedicine. The ability to access patient’s medical information is critical to extending continuity of care for patients as well as improving transparency between telemedicine providers and healthcare organizations.

AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services for healthcare organizations for stroke and other neurological care, is providing technology enabled services to healthcare providers for the delivery of high-quality clinical care virtually anywhere, anytime. ACT has been on the forefront of the use of this technology for years, remotely delivering live and interactive Telestroke and other Teleneurology assessments to patients at hospitals and emergency medical centers throughout the nation. At Bon Secours Neuroscience Institute in Richmond, Virginia, Patricia Lane comments on their collaboration with ACT, “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.”

Integrating telemedicine connections into a secure electronic medical record system designed with familiar digital formats, functions and cutting edge security measures in order to ensure the highest level of patient confidentiality will be essential to insuring quality and continuity of care and answer much of the concern over the new disruptive healthcare delivery model.



Telemedicine Achieves Its Potential for Parkinson’s Patients

Ask any patient suffering from chronic disease and they often will tell a story of isolation, uncertainty and frustration over the debilitating effects of their disease. Many times the focus of their complaints is not being afforded easy access to specialized care and consultation with caregivers. While significant inroads have been made in the treatment options for chronic maladies like Diabetes and Parkinson’s disease, gaining routine, daily access to those ground breaking discoveries is out of the reach of many sufferers.

Researchers are looking at how modern communication technology, coupled with the latest techniques in treating Parkinson disease, can revolutionize the quality of care for sufferers of the chronic neurological disorder. “We are looking at quality of life, quality of care and reducing the burden on healthcare providers”, says Dr. Ray Dorsey, co-director of the Center for Human Experimental Therapeutics at the University of Rochester (N.Y.) Medical Center. “Imagine if you thought there was a possibility you had Parkinson’s disease, but you lived 100 miles or more from the nearest medical center with a qualified neurologist. You’re faced with at least a couple of hours of driving, of navigating an unfamiliar urban environment, of parking and walking—and that’s assuming you’re able to find a neurologist within driving distance to begin with. Now think about how easy it is to buy a book or a pair of shoes online. The two should not be so different.”

Preliminary results of the Connect.Parkinson project, the nation’s first randomized clinical trial of remote treatment of Parkinson’s disease, indicate the benefits of virtual treatment for patients and caregivers alike. A recent report on the initial results of the 18-state, Connect.Parkinson project reported that 95 percent of Parkinson’s patients completing telehealth visits have experienced an increased proportion of the time with a healthcare professional of 89 percent; up from 25 percent for those opting for traditional in-person encounters.

The National Parkinson Foundation is committed to supporting efforts to demonstrate how telemedicine can enhance the delivery of care to people with Parkinson’s. Studies are indicating that telemedicine care, often delivered in the patients home, is just as good as care received at a brick and motor medical center. The fact that diagnosing and monitoring the progression of Parkinson’s disease and other movement disorders is based almost entirely on visual observation makes Parkinson uniquely suited for virtual care technologies. Christopher Goetz, MD, a leading expert on movement disorders and director of the Parkinson’s Disease and Movement Disorders Center at Rush University Medical Center says, “Ninety-five percent of the information I gather is visual. Thus, with telemedicine visits where I can see and hear my patient right in front of me on the computer screen, there is no decline in the quality of information I gather.”

Rush is located in the state of Illinois which is among those states not yet mandating payers to provide payments for telemedical services. But according to Dr. Brian Patty, Rush’s chief medical information office and chairman of Rush’s Telemedicine Steering Committee, the Medical Center has several telemedicine pilot projects underway that can likely have significant impact on Parkinson patients.

In New York, researchers at The Rochester Center for Human Experimental Therapeutics, are developing and testing mobile apps that will help Parkinson’s patients track metrics such as dexterity, balance, gait, voice patterns and cognition, then send readings to researchers.

After decades of promises, telemedicine is delivering on its promise to increase access to quality, specialty care to improve patient outcomes.



Paying for the Promises of Telemedicine

Telemedicine is living up to its hype on revolutionizing the healthcare delivery model. With many of the most formidable barriers to increased expansion being overcome, virtual technology is quickly becoming a preferred method for patients when connecting with their care provider. New advances in hardware and software coupled with faster digital info structure, is driving more and more healthcare professionals to electronic communications. Patients are warming-up to using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions in the comfort of their home.

Healthcare providers, payers and governmen supported healthcare programs are recognizing the potential cost savings of telemedicine technologies. However, payment policies for telehealth services, while expanding quickly, continue to be inconsistent and are discouraging the progress towards realizing the full potential of virtual healthcare. Providers are eager to embrace telehealth. A survey of more than 1,500 family physicians conducted for Anthem and the American Academy of Family Physicians (AAFP) found that “almost 90% of respondents would use telehealth to help treat their patients—if they were compensated for that care.” Richard Bakalar, MD, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence says, “Healthcare providers need to figure out how to become more efficient and the technology behind telemedicine allows caregivers to connect with patients remotely, efficiently and effectively.”

Currently payments for telehealth services are as far flung as the 50 states landscape. New rules for Medicaid managed care and MACRA are becoming telehealth-friendly, but Medicare and Medicaid reimbursements are spotty, with Medicaid payment varying greatly from state to state. Today, 48 states and the District of Columbia provide some form of Medicaid payment for telehealth services, according to the National Conference of State Legislatures. Commercial insurers seem to be embracing telehealth but consistency of payment policy remains elusive. In just over half of the states and the District of Columbia, private insurers are answering the call of parity laws that require them to pay for telehealth services. Payment parity is important for providers because it protects them against arbitrary cuts in reimbursement for telehealth services as compared to services provided in-person.

While expansion of virtual technology continues to progress at a steady pace, solutions to resolving remaining barriers like payment for services, multistate licensing, credentialing, and regulation are evolving at a deliberate pace.



The Marriage Between Technology and Telehealth Providers

Telemedicine is fast becoming the most promising break-through in the delivery of healthcare in the last century. While the promise has many championing the cause for expanded and universal use, some challenging hurdles remain in the way. Legislatures and medical boards are busy modifying regulations, payment structures, licensing and credentialing at various pace but one particular road block could derail the telehealth train if a workable connection is not soon found.

The video connection with the doctor is meeting the patient’s expectation for quick healthcare, but the process can often be overwhelming to providers who must sync the new service to their existing EHR platform. The key to a solution lies in creating a new virtual care environment within the providers existing EHR. James T. McElligott, MD, medical director for telehealth at the Medical University of South Carolina, is among a handful of health systems around the country that are pioneering virtual visits on a sustainable and scalable platform. “If you try to do something outside of that platform, there are downstream effects that end up making things very difficult” for the provider.

While some of the industry’s largest providers of EHR platforms have been slow to answer the call for a solution, smaller companies are making the connection happen for an increasingly larger number of provider clients. “We see time and again that workflow integration and ease of use are crucial factors to physician adoption of telehealth technologies,” Eran Westman, Vidyo CEO.

In a recent article by Eric Wicklund and published in mHealth Intelligence, titled “Virtual Care Within the EHR May Be a ‘Game-Changer”, the author reports on how some innovative companies are integrating creative solutions to the challenges presented when attempting to marry telemedicine services and existing electronic health records (EHR).

The idea of an electronic medical recording system was imposed upon an unprepared and often reluctant provider market several years ago. Many of the early glitches’ and bugs, that traditionally come with the roll-out of any new software system have been addressed, but the memory of the “fixing” process is fresh in the minds of many early users, leaving them less than enthusiastic about integrating still newer technologies into their daily routine.

It is becoming very clear to many in the healthcare industry that the once casual attitude towards telemedicine is changing as more and more applications for telecommunication technology in the delivery of healthcare become a reality. The disruption will continue. Telemedicine and EHR’s are not going to go away. Negotiating a workable union may indeed be the all-important game-changer for expanding telehealth.



What’s In Your Digital Health Tool Box?

The early implementers of telemedicine faced resistance, skepticism, and predicted peril from an industry that has followed a standard of care, governed by regulations. Those initial trailblazers have prevailed in their efforts to improve access to specialized care for patients living afar from major medical centers, enhancing patient’s healthcare experiences and reducing the unnecessary cost of specialized treatment and ongoing chronic care. Their persistent efforts to merge the latest digital technologies in communication with modern medical care has spawned new terms to languages all around the world; Telepsychiatry, Telestroke, Telemedicine, TeleICU and Telehealth, just to name a few.

Technology is having a wider impact on how healthcare providers connect with their patients and dispense treatment. This connected health revolution is making everyone active participant’s in their healthcare through an ever expanding network of devices and platforms. But as is often the case, development of new technology can outpace the ability of an industry and their consumers to accept and engage the new methods.

Consumers have demonstrated an impressive demand and utilization of digital healthcare tools like activity trackers, smart watches and their accompanying health apps, but nearly half of the users complain that their caregiver is failing to integrate the data into a personalized healthcare plan. A survey, conducted by HealthMine, called “The State and Impact of Digital Health Tools,” found that “a significant amount of digital health data is not reaching doctors or health plans and that there appears to be a disconnect between where consumers would like their self-collected health data to go and how easy it is to share it.”

Many physicians articulate an understandable concern about the accuracy of many of these devices and the process of collecting and transferring the data. In a recent article Vaughn Kauffman, a global practice leader in PwC’s Health Industries Advisory, indicated that physicians have some apprehension around taking in data from mHealth devices and wearables. “Some providers are further down the road than others around utilizing these kinds of data for engagement. There’s the potential to extend the doctor-patient relationship to beyond the direct doctor visit interaction. And obviously, this would involve individuals opting in, as opposed to kind of a Big Brother phenomenon.”

While wearables continue to be popular, many once avid users are discontinuing their engagement with the technology. Some indicate their waning interest is due to not understanding how the data collection will benefit them or enhance their digital health plan. Education and better understanding of the technology and how it can benefit both providers and patients in improving the delivery of healthcare will solidify the acceptance and use of the technology. The early pioneers of telemedicine have opened the trail to a much larger spectrum of services but wider engagement is still dependent on the ability of technology to deliver on its promises.



Telemedicine is Closing the Gap Between Experts and Child Abuse Victims

Telemedicine’s entry into the healthcare process has been rather obvious over the past decade, particularly to those who have benefited from advanced stroke care, treatment for chronic diseases or convenient routine care for common illness. For those who live in areas away from advanced-care medical centers, telemedicine is closing the geographical gap to advanced, specialized treatment for stroke, diabetes and other coronary and neurologic disorders. As technology makes its way across the full spectrum of healthcare, providers are using the newest telemedicine technology to tackle one of their most difficult tasks: identifying a victim of child abuse or neglect.

Many cases of suspected child abuse arrive at hospital ERs, doctor’s offices or clinics where doctors and nurses can be less experienced in making a proper diagnosis. With the use of virtual technology the process of determining a proper diagnosis is enhanced, and the gap between child care experts and rural hospitals and advocacy centers closed. “We’ve saved lives, and we’ve saved families,” says Dr. Lori D. Frasier, division chief of child abuse pediatrics at Penn State Hershey Children’s Hospital.

The Department of Justice’s Office of Juvenile Justice and Delinquency Prevention and National Children’s Alliance provide financial support to more than 800 children’s advocacy centers across the country where treatment for victims of child abuse are benefiting from the use of telemedicine. It is also critical that a diagnosis of abuse be accurate. “The value is in the accuracy of the diagnosis,” says Patricia Goede, PhD, vice president of clinical informatics at XIFIN, “Over-interpreting something can be a huge cost to children and families.”

In Georgia, where much of the State’s populations reside in rural areas, the Children’s Healthcare of Atlanta Center for Safe and Healthy Children (CSHC) has used telemedicine since 2009. Jordan Greenbaum, M.D., Medical Director of Children’s CSHC says, “An evaluation utilizing telemedicine reduces parental anxiety and stress by providing prompt access to expert care and support. It also saves time and resources for authorities, who can lose a workday driving to and from Atlanta. And for rural medical providers, telemedicine relieves some of the burden of accurately identifying abuse and interpreting physical findings.”

In Florida a sharp increase in child abuse and a shortage of treatment specialist has exasperated an existing care differential between advanced care facilities and rural areas where child abuse rates are the highest. Providers in the state are working to expedite the development and initiation of telemedicine programs to address the growing problem. In the mid-west, at The Midwest Regional Children’s Advocacy Center at Children’s Minnesota, they’re utilizing the same platforms to share images and other tests and communicate with trained child abuse specialists.

Many formidable barriers to adoption and expansion of telemedicine remain, but as the utilization of the technology finds new and creative solutions across the range of medical services, closing the divide between specialized care and patients in need promises to remove many of the remaining, well-established opponents.



The Importance of Measuring Performance

Telestroke, the use of communication technology to remotely treat victims of acute stroke, continues to grow and has entered the mainstream of care in an ever evolving and increasingly disruptive healthcare delivery model. Like all medical innovations, telestroke must demonstrate successful outcomes to achieve sustained growth and acceptance. Merely asserting that telemedicine is faster, employs the latest technology, or promotes a better use of limited re-sources is laudable but insufficient.

AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care, understands the importance of evaluating and documenting telestroke performance. In their recently published study “Improving Telestroke Treatment Times in an Expanding Network of Hospitals” the authors reveal that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency.

“Success in our business isn’t just about adding new healthcare organizations to our client portfolio,’ says Dr. Matthews Gwynn, co-author and ACT partner. “As clinicians, we measure our success on consistently providing the highest level of stroke care and improving patient outcomes. This study is representative of our ongoing commitment to serve as a leader in telestroke care, establishing a standard of care and a model that supports the positive growth of telestroke programs across the country.”

As virtual health initiatives continue to move forward, new and valuable trends and telehealth technology solutions will continue to emerge. Traditional methods of delivering medical care will be challenged and disrupted at medical facilities, physicians’ offices and hospitals. Dr. Keith Sanders, ACT Partner and co-author comments, “It is critical to prove that our business is able to create telestroke programs that are not only effective but sustainable.”

For more information on how AcuteCare Telemedicine can assist you with acute stroke care, contact us!