AcuteCare Telemedicine Blog


Removing Well Entrenched Impediments to Advancing Telemedicine Benefits

A recently published study in Telemedicine and e-Health found that despite numerous benefits to expanding telemedicine that there are three major barriers that remain to fully implementing the benefits of telehealth. Health care professionals agree that Telemedicine has and will continue to change care delivery and patient outcomes by expanding patient access, reducing service gaps, improving service quality, providing additional clinical support, delivering enhanced patient satisfaction and improved adherence to care standards.

Advances in powerful technology is transforming care facilitation, making real-time audiovisual communication more feasible and permitting physicians the ability to remotely consult with a patient via a robot and LCD screen.  Remote specialists and physicians can treat patients and save lives with the use of a broadband card, an internet connection from a cell phone tower and a laptop. This illustrates the amazing potential of telemedicine but the study found that serious human barriers to nationwide telemedicine still remain.

The study surveyed emergency and critical care remote presence telemedicine users from 53 healthcare institutions across North America and Ireland. One hundred-and-six surveys were completed. Sixty-eight percent of respondents were physicians, 17 percent nurses and nurse practitioners and 8 percent were administrators. The results indicated that three major human barriers for telemedicine in the areas of regulation and finance need eradication to fully implement the benefits of telemedicine.

     – Licensing for Physicians. A major benefit of telemedicine is the ability to consult remotely with physicians and patients across state boundaries, but today the current approach to medical licensing requires health providers to obtain multiple state licenses and adhere to diverse and sometimes conflicting state medical practice rules. The medical licensing process is not only complicated but also lengthy and expensive and it represents a major barrier to the expansion of telemedicine.

     – Credentialing. Credentialing can become very complicated especially for hospitals with hub and spoke models because physicians from each hospital have to have the credentials at every hospital.  The time it takes it to acquire all necessary documents and finish an application is time that could be used training medical staff to use telemedicine and bring the benefits of telemedicine to deserving patients. The current method for credentialing should be streamlined to facilitate easier credentialing at multiple facilities leading the way to wider telemedicine implementation and increased accessibility.

     – Reimbursement. A huge financial issue for telemedicine is the lack of reimbursement and capital expenditure for services. Similar to licensing issues, reimbursement models are different across the states with each having its own regulation for private payers with little or no consistency for telemedicine reimbursement.

Removing these impediments to the expansion of telemedicine remains a daunting task. Change never comes easy, particularly when it requires the cooperation of various bureaucratic agencies, multiple governing bodies and a wealth of well entrenched administrative procedures and regulations that were designed and implemented in a time when advanced communication technologies were little more than fantasy and science fiction. A continued focus on removing these barriers must intensify in order to bring the many proven benefits of telemedicine to patients throughout the country and the world.



Advancing the Benefits of Telehealth and Telemedicine

Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. “You know what HD television looks like. You can actually see the pimples on the actors’ faces,” she says. “I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure.” A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.  The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.

The rural health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.

For many states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. Telehealth is the use of technology to deliver health care, health information or health education at a distance. Real time telehealth communications allows the patient and physician to connect and interact through video conferencing, telephone or video health monitoring device.  Store and forward telehealth refers to the transmission of data, images, sound and video from one care giver to another.

Forty-two states currently provide some form of Medicaid reimbursement for telehealth services and 17 states require private insurance companies to cover telehealth services. While individual states appear to be well out in front of the federal government on supporting telehealth innovation, the federal government is finally moving to catch-up with the recent introduction of “The Telehealth Enhancement Act of 2013 (H.R. 3306).”  The bill promises to strengthen Medicare and enhance Medicaid through expanded telemedicine coverage and calls for the adoption of payment innovations to include telehealth and to make other incremental improvements to existing telehealth coverage. Another Congressional bill, “TELE-MED Act of 2013” (H.R. 3077) would permit certain Medicare providers in a state to provide telemedicine services to Medicare beneficiaries in a different state.

The convergence of medical advances, health information technology, and a nationwide broadband network are transforming the delivery of health care by bringing the health care provider and patient together in a virtual world, especially those in disadvantaged areas. Telemedicine has the potential to improve health care access and quality to patients in urban and rural America alike, but a variety of barriers, such as reimbursement and licensing issues, continue to stand in the way of more aggressive, widespread adoption.

The recent progress by state and federal governing bodies to recognize the significant advantages of increased telehealth services for all Americans with the introduction of new and meaningful legislation to address and remove established barriers to expansion, is encouraging to those in the health care community whose fundamental goal is to provide the best quality medical care to their patients no matter where they live.



Mobile Healthcare and Monitoring on the Brink of Revolution

Wireless in-home health monitoring is expected to increase six-fold in the next four years. A recent study by InMedica indicates that 308,000 patients were remotely monitored by their healthcare provider for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension, and mental health conditions worldwide in 2012. While congestive heart failure accounts for the majority of remote monitoring, it is expected that diabetes will supplant COPD with the second largest share of telehealth patients by 2017.  It is predicted that more than 1.8 million people worldwide will utilize mobile monitoring in the next four years.

Telemedicine is seen as a significant tool among healthcare providers for reducing hospital readmission rates, track patients chronic disease progression or provide advanced specialized medical treatment to patients in remote areas.  Four main factors are driving the demand for increased use of telemedicine and telehealth; Federal Readmission penalties introduced by the U.S. Center for Medicare and Medicaid Services (CMS);  healthcare providers desires to increase ties to patients and improve quality of care; insurance providers who are looking to increase their competitiveness and reduce in-patient pay-outs by working directly with telehealth suppliers to monitor their patient base; and an anticipation for future increased demand for telehealth services by patients.

Of the billions of dollars spent on health care each year, 75% to 80% of it goes for patients with chronic illnesses such as diabetes, heart disease, asthma and Alzheimer’s disease.  With rising costs and the anticipated shortage of physicians and healthcare providers over the next decade, utilizing the telemedicine technologies is becoming increasingly important to the routine delivery of medical services and monitoring of chronic diseases.

Even telepsychiatry, the use of secure Web-based video conferencing technology, and ambulatory patients, those who have been diagnosed with a disease at an ambulatory care facility but have not been hospitalized are expected to experience significant increased utilization of telemedicine among healthcare professionals in the next four years.  A plethora of emerging mobile technology, such as wearable wireless monitors to smartphone attachments will offer consumers the ability to track everything from core vital signs to impending heart attacks by discovering problems with heart tissue are on the horizon, offering a revolution in digital medical technology.

Speaking to those resisting the new mobile technology, Dr. Eric Topol, a professor of genomics at the Scripps Research Institute, recently encouraged the medical community to end paternal medicine, where only the physician has access to healthcare information, and to embark on a new beginning where patients own their data.  Dr. Topol compared the new mobile technology to the Gutenberg press and the way it revolutionized the way information was shared throughout the world.

We are embarking into a new era where patients have the mobile tools to better enable them to participate in their own medical diagnoses and treatment.



Evolution / Revolution

After more than two decades in experimental and somewhat limited practice, telemedicine is poised to experience a revolution in use and acceptance by medical care providers and patients alike. The journey since its practical inception has been fraught with challenges, both in the tangible technical arena as well as the human/emotional one, and the pace to this point has been more accurately described as evolution as opposed to revolution.

Significant barriers remain to be removed from the telemedicine pathway to full acceptance as an innovative healthcare delivery model, but many of the once formidable obstacles are rapidly falling by the wayside. Paula Guy, CEO of the Georgia Partnership for Telehealth, says “It’s not about the technology anymore, it’s about applying it… In the next few years, it will no longer be known as telehealth. It’s just going to be the way we do healthcare.” Still, the intangibles are lagging behind in the acceptance curve, the most predominant being the persistent concern for the effects of technology on redefining the doctor-patient relationship.

From the patient standpoint, the level of acceptance is gaining at a quicker pace than that of the doctors and their service provider associates. Greater access to specialized medicine, convenience factors, and the concern for rising healthcare costs have eased the reluctance of patients, who are now accepting lessened one-on-one contact with their care providers, although nobody is predicting this personal interaction will go away for good.

Physician’s reluctance is based in part on a good deal of research that indicates a clinician’s physical presence in the room, along with simple companionate personal consultation, has therapeutic value. There’s also a worry that without face-to-face access to the patient, the physician will miss something important or that over-enthusiasm for telemedicine services will deprive patients of the essential hands-on component of care.

To many, the advantages of telemedicine in terms of bolstering the quality and availability of enhanced medical care must be weighed against the potential harm that could result from patients not having in-person contact with their physicians. The real solution to overcoming this challenge is to discover an optimal intersection of technology and personal, hands on care. It remains just ahead in the evolutionary path of telemedicine, where it can enable a true revolution instead.



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.



Information in an Instant

There are countless factors that prevent patients from getting to see their doctors. Sometimes the simple fear of ‘getting sick’ and missing time at work or important commitments to our friends and family can stop us. Other times, distance, obligation, or extreme weather conditions can inhibit our ability to get to the hospital, even in cases of emergency. Whether the problem is voluntarily or logistically difficult, doctors and patients have long looked for solutions to these challenges to create a better standard of care.

Thankfully, the 21st century has afforded society some incredible opportunities to mitigate the barriers that stand between people and adequate healthcare services. Many disciplines of medicine are now mobile, capable of patient and doctor interaction regardless of the distance separating them. We have medical devices and software that can perform tasks such as automatically reading and uploading vital statistics for patient monitoring directly into an electronic health record. It has already been widely shown that reducing unnecessary hospital visits results in cost savings for the provider and the patient alike. Now, technologies such as those used in this type of monitoring is also enabling doctors to take better care of patients, helping them maintain an open line of communication, without being too invasive.

Between new monitoring techniques and the proliferation of location-based services, doctors can now effectively keep 24/7 tabs on at-risk patients, and might even be capable of sending the appropriate emergency response to victims of heart attack or stroke. It is mind-boggling to think that through powerful new devices and lightning-fast internet infrastructure, a doctor could actually know a stroke is progressing before the patient does.

With the prominent role we as a society assign to technology, it seems only fitting that it is now working to help save our lives. Physicians 50 years ago could hardly have envisioned these futuristic capabilities; it is an extremely exciting time to be practicing medicine on the cutting edge of technology.



An Instant Second Opinion

When citizens of a past age first envisioned practical telemedicine in 1924, the images and words on display at Worlds’ Fairs and in magazines likely seemed outlandish – a very optimistic and very distant look into the future. Few could have imagined that technology would make such great strides as to allow the development of a widely implemented network of functioning telemedicine programs less than a century later. Other futurists over the years have dreamed big, pushing forward medical innovation by imagining things like cure-all superdrugs and efficient and clean and precise surgery without a scalpel that are, believe it or not, now becoming reality as well.

As thought-provoking as these examples are, few of these big ideas are in actuality as practical or realistic as the avenues that have been opened for physician collaboration by advances in technology. Collaboration may be a lower impact medical advance than, say, leaps in prosthetics technology, but today, hospital leaders and physicians work considerably more interdependently to improve clinical outcomes and simultaneously combat healthcare logistical challenges and expenses. Increased capacity for collaboration is a major improvement enabled by powerful new telecommunication technologies that allow live consultation between physicians, regardless of distance, and unites the many individuals involved in any one patient’s care.

Telemedicine programs have helped hospital administrators create a better practice environment that results in improved recruiting and retention and fosters a virtuous cycle of better patient care and financial outcomes. One of the greatest advances simply by facilitating two-way conversation for professionals who are used to talking at each other instead of with each other. Collaboration is, in reality, the most tangible of telemedicine’s many benefits.