AcuteCare Telemedicine Blog


Is Telemedicine and Telehealth the Future of Healthcare Delivery?

With the global telemedicine market predicted to soar past the $30 billion mark by 2020 it is becoming increasingly difficult to overestimate the impact telemedicine, or it’s broader application telehealth, is about to have on the broader healthcare delivery model. Much of the considerable focus of discussions thus far has been about the effects of virtual technology on the safety and quality of service to patients, the creation of new methods of payment for virtual services rendered and massaging the concerns of the industries evaluators and licensors. But the ongoing advance of mobility and affordability of communication technology is opening up vast new opportunities to apply telemedical technology to a much larger spectrum of healthcare delivery.

It is true that even if the whole of telemedicine’s promise were to be fully realized, it is likely never to completely replace the face to face relationship between the healer and the afflicted. But with the rising cost of healthcare, anticipated physician shortages and a general increase in demand for healthcare, virtual medical care is attracting a much wider audience of support across the medical care industry. In a recent Wall Street Journal report on private equity firms, investors are increasingly interested in investing in the health-care sector, creating a tipping point for a newer early stage virtual healthcare industry. Until recently the technology, devices, applications, operating platforms and processes have been the elements receiving most of the attention, but with the increasing appearance of virtual telehealth centers at shopping malls and big box retailers, it may be time to expand our thinking on just how dramatic the disruption on the industry will be.

Some well-established healthcare systems are now facing a decision on where to most effectively invest their capital. Should it be in traditional brick and mortar facilities or in the newest telehealth information technology? While advancement of diagnostic technology and ground breaking progress in treatment options has been common in the industry for decades, the “hard” methods of engaging patients by the healer has seen little change since the “industrialization” period of healthcare more than a half-century ago. As mobile health monitoring devices become more reliable and capable, patients with chronic diseases are being monitored, evaluated and often treated without leaving the confines of their home or work areas, reducing the usefulness of centralized physical structures used to connect and treat patients with chronic diseases. Advances in surgical robotics, techniques and technology has resulted in less invasive surgeries being “off-loaded” from heavily supported hospital based surgical suites into less costly outpatient surgical facilities.

Telemedicine has made significant changes in delivery models for clinical and acute care in the last 5 years and is certain to provide expanded application and creative solutions for meeting challenges across the whole of the healthcare delivery spectrum. It’s time to expand our vision for utilizing communication technology in the delivery of healthcare. Telemedicine and telehealth is the future of healthcare delivery.



Telemedicine Creates Opportunities to Improve Access to Neurologists

Discussions over an impending shortage of doctors in America are nothing new. The debate and predictions of an increasing shortage of general practitioners, neurologists, radiologists and other medical specialties has raged for nearly a decade. A study by the Association of American Medical Colleges (AAMC), a lobby for medical schools and teaching hospitals, said “the doctor shortage is real” with total physician demand projected to grow by up to 17 percent as a population of baby boomers ages. The nation’s shortage of doctors may rise to between 46,000 and 90,000 by 2025. “The doctor shortage is worse than most people think,” says Steven Berk, M.D., dean of the School of Medicine at Texas Tech University. “The population is getting older, so there’s a greater need for physicians. At the same time, physicians are getting older, too, and they’re retiring earlier,” Berk says.

Neurology is one specialty impacted by the shortage. With stroke being the number four cause of death and a leading cause of disability in the United States, lack of access to neurologists who specialize in stroke care threatens to deprive many patients the best chance of surviving the effects of stroke. More than 800,000 strokes occur in the United States each year and the number of strokes is expected to grow significantly due to a growing elderly population. The need to encourage more young physicians to specialize in stroke is critical.

Dr. Harold P. Adams, Jr., of the University of Iowa Carver College of Medicine and Dr. Jose Biller, of Loyola University Chicago Stritch School of Medicine believes, “Unless the number of neurologists focusing their careers on the diagnosis and treatment of patients with cerebrovascular diseases increases, a professional void will develop, leaders of professional neurology associations “need to develop and vigorously support a broad range of initiatives to encourage residents to enter vascular neurology. These efforts need to be started immediately. Time is short.”

Other experts believe that new technologies may hasten the response to the pending crisis and may extend the reach of medicine in ways that will address the problem. Health care professionals can serve more people by using telemedicine technologies to examine, treat and monitor patients remotely as well as providing patients increased access to advanced stroke care. These technologies are already keeping patients out of hospitals and doctors’ offices and providing improved recovery results. Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services, has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographic boundaries. AcuteCare CEO, Dr. Matthews Gwynn says, “Increasing access to stroke specialists requires a certain level of investment in technology and trust in the people behind it. Technology affords healthcare organizations the ability to select a platform that meets budgetary and organizational parameters while extending the highest quality of neurological care to the patients they serve.”

Telestroke is one of the most adopted forms of telemedicine, providing solutions to healthcare providers looking for 24/7 neurology coverage for patients. “Telestroke is filling a gap in terms of the speed and accuracy of stroke diagnosis and start of critical therapy, says Lee Schwamm, vice chair of the Department of Neurology at Massachusetts General Hospital in Boston and director of the hospital’s Telestroke and Acute Stroke Services, “Telestroke is the poster child of telemedicine. It’s a really nice example of where the business case is so evident and the benefit to patients is well-documented.”

“The shortage of doctors is definitely impacting the future of medicine,” comments Gwynn. “In response, we remain focused on providing access to quality neurologists to small hospitals in underserved communities as well as to enterprise level healthcare organizations via telemedicine.”



Best Integrated Campaign for Stroke Month Awarded to Bon Secours Richmond

ACT Blog Bonsecour Award

From Left to Right: Bob Silverstein, Enterprise Executive Sales Director, ACT; Dionne Henderson Director of Community & Multi-Cultural Initiatives at American Heart Association, American Stroke Association; Patricia C. Lane MBA, SCRN|Bon Secours Richmond Administrative Director Neurosciences, Bon Secours Richmond Health System; Dr. Stacey Epps, Executive Medical Director Bon Secours Virginia Neuroscience Institute.

The American Heart Association/American Stroke Association recognizes American Stroke Month by focusing on efforts to teach family, friends and coworkers how to recognize the signs of stroke.

This year The American Heart Association awarded Bon Secours Richmond Health System the Best Integrated Campaign Award for 2015. The fourth largest and only faith-based health system in Virginia, Bon Secours Virginia provides full range of services to thousands of Virginians through a network of hospitals, primary and specialty care practices, ambulatory care sites and continuing care facilities across the Commonwealth.

Bon Secours is accustomed to taking a leadership role in Neurological care, having established teleneurology initiatives more than five years ago with a goal to have all of its area hospitals joint commission certified. AcuteCare Telemedicine, the leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care is collaborating with Bon Secours Neuroscience Institute (BSNI), the neuroscience division at the not-for-profit Catholic health system sponsored by Bon Secours Ministries.

Dr. Keith Sanders, Partner, AcuteCare Telemedicine, comments, “ACT is aligned with Bon Secours and its ongoing commitment to utilizing the finest and latest technology for the treatment of stroke. This award is evidence of their outstanding efforts to promote a fully integrated stroke program that improves awareness of the dangers of stroke and provides the best in acute stroke care to the communities we serve.”



Telehealth Market Expected to Reach $17 Billion by 2020

Growth within the telemedicine marketplace continues to reach a fever pitch. Fueled by the shortage of physicians, increasing aged population, rising healthcare costs and expanding health insurance coverage for virtual healthcare, the emerging telemedicine market is set to soar in the coming decade. While some experts attribute telemedicine’s popularity to the to rise in smartphone use and consistent demand for quality virtual services, many healthcare systems are trying to reduce both the number of hospital visits and the length of stay in hospitals.

A new report entitled, “The Global Telemedicine Market Outlook 2020, studied the complete telemedicine industry which includes hardware, software and services. The telemedicine technologies market is anticipated to grow 8.4% and surpass $30 billion by 2020. “The report is a detailed study on the geographical distribution of telemedicine with the market sizes of North America, Europe and Asia-Pacific and provides an insight into different telemedicine applications.” North America is the largest market globally, accounting for more than 40 percent of the global market size.

Telemedicine, and the broader and increasingly more favorable term telehealth, includes medical services which use electronic information and telecommunications technologies to support long-distance clinical healthcare. The relationship between telemedicine and health IT is recognized as complementary by the reports researchers.

Another report from information and analytics firm HIS predicts video consultations will jump to nearly 27 million in the U.S. market, a doubling of virtual video consultations between primary health care providers and their patients, in the next five years. The IHS report projects a cumulative annual growth of nearly 25% a year to 5.4 million video consultations by 2020. Healthcare payers are recognizing telehealth as a way for patients to get high quality care from a physician and to avoid a more expensive trip to a hospital emergency room. “We’ve seen growth in reimbursement,” Roeen Roashan, medical technology analyst with IHS said in a recent interview. “Specialty consultations are projected to jump from 14.5 million to 21.5 million.”

As the industry reaches new heights, the pace of growth will continue to be moderated by tepid physician support, outdated reimbursement models, technology costs, and legal and governmental regulations regarding telehealth practices. The industry has made significant changes in delivery models for clinical and acute care in the last 5 years. Telemedicine and telehealth programs are certainly proving to be the future of healthcare.



Telemedicine, the Future Venue for Healthcare

While many believe that telemedicine first made its debut just a little more than a decade ago, the practice of telemedicine can be traced back to the early years of the space program. The National Aeronautics and Space Administration (NASA) pioneered the remote use of physiological measurements of astronauts and telemetered the data back to earth from the spacecraft. These early efforts from the 1960’s enhanced the development of satellite technology which led to the development of telemedicine. The decades since have brought significant advances to the technology, lower costs of equipment and an expansion of the potential uses in the medical industry.

Advancements in the fidelity, mobility and affordability of technology is changing the landscape for healthcare delivery. As the digital gadgetry becomes smaller, more portable and easier to use patient/consumers are advancing their expectations of telemedicine as payers look to reduce the costs of routine medical care and shorten the length of hospitalization. There is a vast array of new technology being applied to healthcare that promises to give patients more responsibility and control over their health and fitness. Wearable technology and wellness devices enable users to continuously monitor their vital signs and track their progress towards their fitness goals.

Future wearable devises will focus on accuracy and data integration as well as visualization capabilities; virtual models that promote the patients understanding and significance of the all the wellness data generated by the wearable devise.

The newest digital health trend, nanotechnology, may have a significant impact on healthcare. Nanotechnology’s precision and accuracy can aid in designing new drugs to specifically match a patients needs or monitor the progress of cancerous tumors in a patient’s body. While still in its infancy, nanotechnology is expected to be a significant digital health trend in coming years. Artificial intelligence is another digital health trend that will help physicians track a patient’s health and identify danger signs before an onset of a heart attack or stroke. As the costs of genome sequencing continues to decline, integration of personal genetics and research will advance the practice of genomics in the next few years.

“Access, cost, and convenience are driving it (technology) forward, plus advancement in technological capabilities”, says John Jesser, vice president of engagement strategy at Anthem Blue Cross, an affiliate of the Indianapolis-based WellPoint. “Historically, telehealth meant expensive video conferencing equipment in a clinic at one location and expensive video conferencing in a hospital somewhere else. (The technology) now allows doctors to log in and log out easily at their convenience and it allows patients to seek care when they want it, from their iPhone or Android. That’s changed everything,”

As virtual health initiatives move forward, new and valuable trends and telehealth technology solutions will continue to emerge and be adopted as the traditional methods of delivering medical care are challenged and disrupted at medical facilities, physicians’ offices and hospitals. The venue of choice for patients seeking medical in the future will more likely be smartphones, laptops, and tablets. The preferred provider will have to be knowlegable and comfortable with this rapidly changing healthcare delivery landscape.



AcuteCare Telemedicine (ACT) Exceeds Mid-Year Projections

AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services for healthcare organizations seeking around-the-clock stroke and other neurological care, exceeds mid-year projections, adding to its previous 5 years of successive growth.

“As we expand our geographic footprint, ACT has been able to attract enterprise level healthcare systems looking for acute stroke care to support a network of hospitals,” comments Dr. Matthews Gwynn, Partner, ACT.  “Our practice-base model enables us to seamlessly integrate with our client hospitals.”

In March, ACT announced a collaborative partnership with Bon Secours Neuroscience Institute (BSNI), the neuroscience division at the not-for-profit Catholic health system sponsored by Bon Secours Ministries. 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.”

The American Academy of Neurology reports that stroke is the No. 4 cause of death in the United States and is also a leading cause of disability, creating a shortage of neurologists focused on stroke or acute stroke care.  “With the shortage of neurologists and increased demand for stroke care, especially in rural or underserved communities, ACT works with healthcare organizations to establish teleneurology programs that increase access to critical neurological care,” comments Dr. James Kiely, Partner, ACT. “We remain agile with each client so as to integrate with an existing teleneurology program or assist in establishing a new program, whether a rural hospital or a large healthcare system.”

“We are pleased with the growth of our business and even more excited about the number of hospitals and patients we positively impact,” comments Gwynn.



The Challenge of Connecting Telemedicine to Electronic Health Records

Much of the debate about telemedicine and the effect it is imposing on the established healthcare delivery model 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. Organizations are already integrating electronic health records (EHRs) systems but telemedicine adds another layer of integration.

To successfully access patient data, telehealth providers will need to achieve interoperability between various information technology systems and software applications and must be able to communicate, exchange data, and use the information that has been exchanged seamlessly across all types of digital communication devises. Tom Bizzaro, vice president of health policy for First Databank says, “We have to universally acknowledge the value of interoperability within healthcare IT systems. Indeed, sharing data across systems can help to improve care quality and efficiency in the country’s health system and lead to success of value-based reimbursement models. However, all players – providers, payers, patients and vendors alike – need to truly embrace the value EHR interoperability, putting it above any proprietary concerns.”

In speaking about the future of the connected healthcare system, Steve Cashman, CEO of HealthSpot, said “The future of the connected healthcare system lies in solutions that deliver care to patients where it’s most convenient for them through unique partnerships that extend the care of traditional health systems and local medical communities through different forms of mobile health and telemedicine. By embracing new technologies, we can treat a greater number of people with more efficient and relevant means of care. With the addition of cloud-based electronic health records and coordination of care between traditional and connected healthcare models, we can build an even better experience for patients and providers. Building connected healthcare systems will also allow us to engage with patients on a deeper level, incentivizing them to seek care and empowering them to participate in preventative measures.”

Congressional House leaders recently unveiled a draft of the 21st Century Cures Act, which aims to “accelerate the discovery, development, and delivery cycle to get promising new treatments and cures to patients more quickly.” The original draft did not include language pertaining to telemedicine, but a new draft includes language about the interoperability of electronic health records and requires electronic health records to be interoperable by Jan. 1, 2018. The College of Healthcare Information Management Executives (CHIME) President and CEO Russell Branzell and Board Chair Charles Christian want better patient identification to be included in the new legislation in order to better secure access to patient information. The duo called it the “the most significant challenge” to safe health information exchange. A subsequent statement by CHIME to FierceHealthIT read, “Increasing access to patient data alone will not translate into better patient care. We would encourage the committee to emphasize both the need to increase access and exchange health information, along with the value of being able to use the data to improve care.” The American Telemedicine Association (ATA) CEO Jonathan Linkous, expressed his hope that Congress will adopt “at least a few measures” to expand access to telemedicine.

The shift to EHRs in large healthcare organizations and in clinical practice certainly proved challenging.  As telemedicine becomes a standard of care, EHR integration becomes a key component to long-term success.

As AcuteCare expands into various healthcare organizations, Dr. James M. Kiely, Partner, AcuteCare Telemedicine (ACT) comments on the complexity of integration with EHR systems. “Currently, we are able to enter patient data via a secure but separate, web-based portal or by using some very good software that allows data integration. Both solutions require manual staff intervention which can often be slow and cumbersome; the antithesis of what telemedicine is supposed to represent. As with EHR integration, it might take considerable time and effort to create a platform that simplifies the integration.”



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.



Patching the Current System Will Not Advance the Great Promise of Telehealth

The deliberate march towards meeting the Federation of State Medical Boards’ (FSMB) goal of streamlining medical licensing of physicians continues. The FSMB promises that a new compact of seven states will trigger changes that will ultimately help reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education and credentials. Last month Idaho and Utah were the latest states electing to join Montana and West Virginia as this compact attempts to speed up the process of licensing doctors across state boundaries. While some question why only seven states are required for implementation of this compact, just three more states are now needed to initiate the process that promises to remove a formidable barrier to telemedicine growth nationwide.

Despite being one of the most promising technologies to improve patient care and lower the rising costs of healthcare, telehealth is surviving in a regulatory environment that was established during an era devoid of modern telecommunication devices and technology. State physician licensing is currently controlled by 50 state medical licensing boards, each with their own requirements, policies and credentialing criteria. The current licensing process is a substantial impediment to the advancement of telehealth across state lines, sparking an intense debate over the need for a traditionally unpopular nationalized licensing system.

In an attempt to ward off yet another federal intrusion into states affairs, last year the FSMB proposed a voluntary national compact on joint licensing for the states. The goal is to secure the cooperation of enough states to quiet any calls to replace state-based physician licensing with a national program. The reason for the compact is that the FSMB previously approved a telemedicine policy that defines the location of the practice of medicine as the state where the patient is located, not the physician. The model legislation calls for at least seven states to participate in the compact in order to form a governing commission made up of representatives from the participating states.

From the outset industry leaders and telemedicine supporters saw the effort as a weak attempt to stem the growing tide to replace an outdated and inefficient system. The FSMB compact does little to address the cost associated with acquiring a license in each state and in fact increases the costs by adding fees associated with handling and processing the information.

Washington Board of Osteopathic Medicine and Surgery Executive Director Blake Maresh says, “For some, the interstate compact offers a tested Constitutional precept that could creatively forestall federal intervention that might otherwise supplant the longstanding authority of state medical boards, for others the possibility of other state boards licensing physicians who practice in their states, coupled with the establishment of new governmental organizations, leaves them uneasy at best.”

It is certain that the authors of state and federal constitutions could not have envisioned the advance of modern technology and the impact of those advances on preserving and improving the lives of their constituents. Delivering the benefits of increased access to the latest and best medical care, improved patient outcomes and lower costs must trump preserving outdated constitutional precepts. We must intensify our focus on implementing new processes designed to advance the great promises of telemedicine.



Do We Risk Getting Lost, Getting There from Here?

For the healthcare industry, this is the year for consumers to leverage new communication technology and the benefits it promised to lower cost and increased access to quality medical care.  Greg Donahue of Benefitspro said, “Telemedicine is becoming a hugely popular health care product, and a great way to connect doctors and medical facilities with patients. Although many people are still not familiar with its application or availability, the medical community is acutely aware of the cost savings and efficacy of providing direct access between the healer and the sick.” And in a recent Harris survey, more than half of American healthcare consumers indicated that they want to use telemedicine to connect with a physician is an indication that providers are in sync with their patients on the subject of telehealth and its impact on developing a new healthcare delivery model.

With a dozen or so state legislature’s and medical boards currently eying legislation and regulations that could, if adopted, remove the barriers to unfettered progress in the expansion of telemedicine nationwide, the discussion now centers, not on the factual merits of telemedicine, but rather on the question; how do we get there, all together, from here? As one watches the process that a few states have been going through in recent weeks, even the most cynical and experienced observers have to be amazed at the variety of results all the individual States efforts have produced. One thing is truly obvious; determining how we all get to the same destination is taking us all over the map.

While one universal theme consistently centers on the premise that practicing telemedicine shall use the same standard of care as if the healthcare services were provided in person, commonality ends there. Some states require face to face encounters between doctor and patient to exist prior to a virtual treatment, some require a previously established doctor patient relationship via in-person or through telecommunication, some require face to face relationships with exceptions for emergency or specialized care and others ban out-right telemedical care without a previous face to face doctor patient relationship. In a few instances, state law makers have gone as far as determining and mandating the specific illnesses that can or cannot be treated via virtual care.

Addressing the rising high cost of healthcare, universal accessibility and the looming threat of a doctor shortage should be a goal shared by all entities with the responsibility to impact and initiate effective solutions to our healthcare crisis. Technology can and will play a significant role in meeting those shared objectives, but only if all stakeholders gravitate towards setting policy that permits some individuality and flexibility but promotes continuity across all existing boundaries such that it does not interfere with the efficient application of that technology.

The journey to removing the barriers to progress is not concluded and the elongated process may, in the end, produce a better set of solutions for all. Collective intentions focused on the creation of a new and better healthcare delivery model for providers and their patients will help is all get there, together, from wherever we are.