AcuteCare Telemedicine Blog


Now is the Time

Like any other year, the beginning of 2013 brings a great deal of optimism about what surprising changes and exciting opportunities and a new year will bring, not just to healthcare, but to our everyday lives. We are living in an age of constant innovation and untamed enthusiasm for what is new. Every day, we read news about the pioneering of new solutions for age-old problems and find ourselves astonished by what we can accomplish with the collective knowledge of generations past and a zeal for moving towards the future.

Telemedicine is a prime example of an entire industry fueled by this fervor for innovation, and the resulting advances it has brought to the way we think about healthcare are nothing short of remarkable. Unfortunately, the level of investment in terms of initial costs and putting trust in new technologies has been enough of an obstacle to prevent many facilities to postpone the adoption of telemedicine.

Embracing telemedicine is about far more than flashy new technology and the promise of saving costs; it is about taking steps forward to make our world a better place. For example, the latest tragedy to make national news out of Newtown, CT served as a stark reminder that there are still great strides that need to be made in order to address the needs of individuals with psychiatric conditions. Fortunately, through telepsychiatry programs and the drastic improvements in patient monitoring capabilities afforded by telemedicine, it is easier than ever before to get help. Extending the attention and the care that is so desperately needed in cases such as these will undoubtedly help us prevent many such worst-case scenarios.

It is the hope of AcuteCare Telemedicine and other proponents of telehealth that the plethora of new equipment and methods available to providers will continue to propel healthcare towards an era in which every individual has unhindered access to the care they need. There has never been a more important time to push the many benefits of telemedicine into the spotlight, and take the first steps towards achieving this goal.



Investing in People

Telemedicine has garnered more attention as of late as a truly game-changing emerging field on the cutting edge of healthcare. Perceptions of the field have become increasingly favorable, but there is still a long road ahead to becoming part of the mainstream lexicon of medicine for patients and providers.

Presently, one of the most significant barriers to entry for new companies in telemedicine is the level of investment required on the part of potential client facilities. Revolutionary technology does not typically come cheap, and as healthcare spending continues to swell (albeit at a slower rate than previously), most facilities are working diligently to combat rising costs rather than add new programs to already bloated budgets.

The good news is that practical new technologies, regardless of how disruptive or expensive at the outset, have a habit of eventually finding their way into adoption. A common adage proclaims that every few years, the power of technology doubles and its price tag is halved. This implies that facilities which have temporarily chosen to forego the extensive advantages that telemedicine programs offer based upon steep startup costs will ultimately find the same solutions to be far more cost effective in the not-too-distant future. However, late adopters of telemedicine services do run the risk of losing their competitive edge. This is especially true in light of the rapid changes ahead in the healthcare landscape; the integration of telemedicine can make a hospital more independent of, or attractive to, consolidation by larger healthcare systems, depending on the goals of the client.

When considering teleneurology as a discipline in particular, hospitals must recognize that an investment in telemedicine is far more than an investment in the newest, best equipment; it is the foundation of a relationship with physicians who are among the most knowledgeable and experiences practitioners in their field. AcuteCare Telemedicine is truly technology- agnostic, meaning that regardless of the price tag of the machines that we leverage to connect with a facility’s patients or staff, a partnership with our physicians means that behind the machinery is the expertise needed to drastically improve the quality of care a patient can receive. We place value in finding quality tools to accomplish our mission, but our accessibility is by no means restricted by them.

Many healthcare leaders are still hesitant to make the investment in something new, but the time has come that the highest level of expert care be available to everyone, everywhere. It is our vision that hospital facilities will share in our agnosticism towards technology and invest in the people who will improve healthcare’s next generation.



ACT Discusses Teleneurology Outlook with Leading GA Stroke Professionals

Dr. Matthews Gwynn, Partner, AcuteCare Telemedicine (ACT) delivered a presentation discussing the future of teleneurology in the next decade during the quarterly meeting of the Georgia Stroke Professional Alliance (GSPA) on Wednesday, August 15th.

Dr. Gwynn’s presentation, visible online in its entirety here, was entitled “Beyond tPA: Teleneurology for This Decade.” Dr. Gwynn opened the presentation by discussing the prevalence of stroke, and covered a brief historical outline of the integration of telemedicine technologies in cutting edge neurological care. He then offered case studies demonstrating the value of teleneurology in creating a higher standard of stroke care in the future. Dr. Gwynn illustrated that teleneurology carries added benefits for not only improving care, but also serving to help healthcare providers meet changing standards and tightening budgets.

The audience was comprised of 60 of Georgia’s leading stroke professionals representing health care organizations across the state. The GSPA’s mission is to prevent stroke and optimize stroke care through professional networking and education. ACT is committed to promoting the availability and provision of specialized healthcare services in rural and underserved parts of Georgia through telemedicine technology.

“It is important to share and discuss with practitioners how the latest advancements in technology and technique can improve the prevention and treatment of stroke,” said Gwynn. “Presenting a positive outlook on the future of teleneurology to the GSPA was an outstanding opportunity to share our vision with other individuals who are leaders in our field. Hospitals, healthcare providers, and most important, Georgia citizens at risk for stroke benefit greatly from this exchange of knowledge.”

For more information about Dr. Gwynn and ACT, visit www.acutecaretelemed.com.

 



Looking Backwards to See Ahead – Part 5: Contracts & Technology

This is the final blog in a series chronicling the development of AcuteCare Telemedicine (ACT). Much of this reflection involves lessons learned at a past Annual Meeting of the American Telemedicine Association (ATA). What follows is an amalgam of facts, experience and opinions culled from that fantastic symposium and honed by hindsight. Today’s blog will focus on legal and technology issues.

As stated in Part 4 of this series, Running the Business, there are a myriad of issues confronting physician-entrepreneurs when establishing a telemedicine service. Physicians are trained to provide medical care, yet this is a technology business. Therefore, an overview of contracts and technology is paramount.

Contracts have to be written to fit the specific needs of each client. However, it is appropriate to have a boilerplate document that addresses both general contract features (e.g. non-malfeasance, non-compete, etc) as well as telemedicine specific features (e.g. the type of encounters covered, the times covered if not 24/7, etc). The contract should stipulate that the telemedicine provider will determine appropriate use of telepresence. If used for routine consults, a maximum number of encounters to be provided per time period can be stipulated in lieu of a sliding fee schedule. It is probably good practice to make it the obligation of the client hospital to maintain HIPAA compliance (e.g. not having the patient in an ED hallway) and assure patient identity prior to consultation (requiring the RN to show you the patient’s wristband ID [never thought of that, did you?]). The contract should also clearly state who is responsible for technical support (see technology below).

A few more legal issues bear mentioning. CMS may allow the originating site (i.e. telemedicine corporation) to do one time M.D. credentialing versus repeating at every client hospital. While CMS doesn’t apparently distinguish between corporations and health care centers, this credentialing allowance is likely in deference to university hospitals proving remote presence. It would ultimately be up to the client hospital to accept the remote provider’s credentialing process in lieu of their own.  Every business partner who has access to patient related data must have a HIPAA oriented contract. A written statement should be obtained from one’s malpractice provider documenting coverage for each state in which treating physicians are licensed.

There are ever expanding options for remote presence technology. Purchase or leasing of proprietary hardware by the client hospital has been the standard. This is attractive because the telemedicine provider makes more money and the hospital experiences lower upfront costs. In the long run, this is actually more expensive for the hospital, and obscures whether the service is providing medical care or simply technology. There are less expensive alternatives, including subscribiptions to web-based software for use with the clients preexisting resources (i.e. PC, webcam, ethernet, hospital IT department). However, choosing this technology will affect reliability; IT departments may not have dealt with the paradigm of providing 24 hour, secure, immediate, unfaltering access for physicians from remote sites.

The better alternative is the purchase of hardware and software from vendors dedicated to telemedicine technology and IT support. It has been demonstrated that client hospitals with a financial investment in the technology are more likely to use it. This leads to more encounters and a reinforcement of the value of the entire endeavor. The technology available varies from fairly fixed COWs (Computers On Wheels) to fully autonomous robots that can move independently between and within rooms, with one-time costs ranging from $25-60,000. Hospitals may then choose the technology based on budget, IT support, software and value added features (e.g. stethoscopes, government grant subsidies, etc). Hardware should undergo scheduled replacement (i.e. laptops every 3 years). Either a dedicated T1 line or reliable Wi-Fi are mandatory. Regardless of the technology employed, patient interaction should be standardized across sites by a telemedicine provider. This normalizes the decision process and improves remote partner (RN, MD) facilitation of exam at the bedside. A written protocol (e.g. NIHSS) is also useful. Finally, as technology continues to proliferate, the future holds great potential for interoperability of these systems with electronic health records, further revolutionizing patient care through telemedicine solutions.

Establishing a telemedicine service is a challenging yet extremely rewarding endeavor that will ultimately contribute to an overall higher standard of patient care. Armed with new insights culled from these experiences, AcuteCare Telemedicine is moving towards the future with consideration for the procedures and mechanics that are obligatory for success, yet not part of standard medical school curricula. 



Regional Solutions Are Best for a National Health Care Problem

Stroke affects every community in the United States. However, the risk varies by region (consider the “Stroke Belt” of the southeastern US), and the resources available for treatment have historically been unevenly distributed. Much of the disparity is cultural, but some is political. In the 18th and 19th centuries, where a river or mountain range limited travel, state boundaries were created. At the time, those natural boundaries impeded communication, but 21st century technology breaks those barriers with ease.  The federal government’s recent institution of 12 new telehealth regions takes into account the latest technological advances while maintaining regional autonomy. New broad-band internet availability in rural parts of the country now allows telehealth to provide high quality medical care in areas where geographical obstacles once prohibited.

Rapid stroke-specific care can be accomplished at any local hospital within a telehealth region. No longer does a zip code determine the quality of healthcare available to its residents. Fortunately, regionalism, an inherent aspect of human nature, is preserved, and for good reason when providing healthcare. Each region, unlike some individual hospitals, has all the specialty services needed, but still provides a manageable focus for organizing and monitoring quality of care. Compared to national approaches, regional telemedicine providers have knowledge of and experience with regional medical care and resources, making it easier to understand each region’s specific needs.

The Federal Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), created the Office for the Advancement of Telehealth (OAT) to promote the use of telehealth technologies for health care delivery, education, and health information services. Each region is managed by a regional Telehealth Resource Center (TRC). OAT provides a list of the current TRCs on their website as well as a map of their catchment areas.

The Georgia Partnership for Telehealth is a leader in the Southeastern Telehealth Resource Center, providing reliable and cost effective high speed internet service to medical sites in Georgia, Alabama and South Carolina, all of which are located in the aforementioned “Stroke Belt,” where incidence of stroke is highest. Linking a region’s medical resources to maximize patient care is a race against the clock (which in the case of stroke is a race towards saving brain), and telemedicine consultations now take just minutes. Simply put, an internet connection traveling the speed of light is a significantly more efficient means of linking these resources than an ambulance driving at full speed or a helicopter flying at 120 miles per hour. This is the power of 21st century technology.