AcuteCare Telemedicine Blog


Do State Medical Boards Need To Be More Forward-looking When Developing Telemedicine Rules?

Telemedicine has been around for several decades but 2015 is predicted as the year delivering healthcare through telemedicine reaches the tipping point. Patients are becoming more aware of the benefits of telehealth for routine medical services. Dr. James Kiely, Partner, AcuteCare Telemedicine LLC says, “State medical boards are struggling with finding a balance between patients’ demands for new models of care and patient safety as 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.”

The U.S. Congress and individual state legislatures are moving quickly to address payment, safety and quality of service concerns that accompany the new delivery model, which promises to increase access to medical specialist and lower the cost of routine visits to emergency rooms and physicians. The individual state medical boards, the governing bodies of healthcare delivery regulations and practice standards, are a bit more deliberate and inconsistent in setting forth new rules and regulations relative to the practice of telemedicine.

While one universal theme consistently centers on the premise that practicing telemedicine must use the same standard of care as healthcare services provided in person, collective commonality ends there. Although the majority of board efforts include guidelines, exceptions and standards of performance that address the important safety and quality concerns while permitting the practice of telehealth, some individual state board responses differ considerably.

The recent vote to accept proposed rule changes by the Texas Medical Board (TMB) might not be aligned with the majority of state medical boards. The new policy, which does not apply to mental health services, includes language that says physicians cannot prescribe a medication without first establishing a “defined physician-patient relationship.” That includes establishing a diagnosis through an examination performed during a face-to-face encounter.  This may be an effort to limit inappropriate dispensing of medications (e.g. broad spectrum antibiotics and narcotics), but appears to be sufficiently restrictive enough to effectively block the practice of most telehealth within the state.

In response to a legal challenge brought by telemedicine company Teladoc, federal Judge Robert Pitman, for U.S. District Court in Austin, Texas, issued a temporary restraining order and preliminary injunction to keep the TMB rules from going into effect. Teledoc, which operates in 48 states and performed nearly 300,000 virtual patient visits in 2014, challenged the legality of the TMB’s new rules. The American Telemedicine Association (ATA) expressed concern that “any policies addressing telemedicine not be overly prescriptive and inadvertently thwart the benefits of new technologies for improving care, expanding access and reducing costs.”

Given the more cooperative reactions of other state legislatures and medical boards, in regulating virtual healthcare across the country, the strict reaction of the TMB has proponents of telehealth questioning the reasoning behind the Boards restrictive posture. What is it about the delivery model that the Texas Board knows and fears that the rest of the medical community is missing? It is not that telemedicine is untested. In more than a decade of practice it has survived the scrutiny of industry experts and numerous regulatory bodies and has demonstrated its value to improving access and lowering costs while encouraging patients to take a more active personal role in their own medical care. Telemedicine is not a different kind of care, but rather a different method of delivering care.

The actions of the TMB certainly impact the implementation of telehealth programs nationwide, however they do not follow the actions of most state medical boards across the country. Nathaniel Lacktman, a partner at the law firm of Foley & Lardner and the leader of the firm’s telemedicine practice believes that the case could have implications for a number of other state boards as they develop rules surrounding telemedicine. Lacktman stated, “The court’s ruling may be a signal to state medical boards to be forward-looking and open-minded when developing rules, particularly when it comes to regulating new and innovative ways of providing healthcare to patients.”

Telemedicine is becoming a standard of care for specialty practices including neurology, cardiology, and psychiatry, among others. The hope is that each individual state medical board creates legislation supporting a healthcare solution that is designed to balance improved patient outcomes and increased access to quality care.



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.



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.



The Georgia Partnership for Telehealth Spring Conference

The Georgia Partnership for TeleHealth (GPT) was founded on the advances in the continually evolving telecommunications technologies. Since its formation in 2008, GPT has grown to become one of the most robust, comprehensive telehealth networks in the nation. The hallmark of GPT is the Georgia Telemedicine Program, an Open Access Network, which is a web of statewide access points based on strategicGPT Image partnerships with successful existing Telemedicine programs, and the creation of new Telemedicine locations, to maximize opportunities for timely specialty services. When fully realized, the Program will enable all rural Georgians to access specialty care within 30 miles of their homes. GPT’s services and support can provide state of the art telehealth solutions for all Georgians.

On March 25, 2015 GPT will be sponsoring their 6th Annual Spring Conference in Savannah, GA. The conference is a great opportunity for healthcare professionals from all medical disciplines and specialties to learn how the most up-to-date telecommunications technologies are impacting the delivery of stroke care and other healthcare services. Attendees will experience telemedicine in an applied framework, build network relationships and gain exposure to the latest in telehealth hardware and software technology. The conference will include a Grant Writing Workshop and will feature presentations from foremost experts in teleneurology.

Dr. Keith A. Sanders will be presenting a talk at the conference entitled “Outcome Analysis Demonstrates the Value of Telestroke”. Dr. Sanders is Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta and former Chairman of the Ethics Resource Committee and a partner in Atlanta Neurology, P.C. and AcuteCare Telemedicine (ACT). “As medical practitioners, we are expected to apply the latest techniques and technologies to the treatment of our patients. However, it is incumbent upon us to analyze the outcomes to gauge whether there are meaningful benefits and share that knowledge with the greater medical community. Indeed, state-of-the-art telemedicine technology is advancing stroke care and saving lives,” says Dr. Sanders. “I’m looking forward to sharing my experiences improving outcomes and expanding access to quality, advanced stroke care with my fellow Conference attendees.”

The GPT Spring Conference will begin on March 25, 2015 and run through March 27, at the Hyatt Regency-Savannah at 2 West Bay Street, Savannah GA 31401. Online registration is now open. An array of exhibitor opportunities is now available. Additional information is available by contacting Samantha Haas at samantha.wainright@gatelehealth.org.



AcuteCare Telemedicine Selected as Gator 100 Honoree

When the University Of Florida (UF) sought to recognize and celebrate the achievements of university alumni, they reached out to their Warrington College of Business Administration (WCBA) and the Center for Entrepreneurship & Innovation (CEI). The collaboration produced the Gator 100, an annual programGator100_HonoreeBadge_CMYK designed to recognize and rank the fastest growing, Gator alumni-owned or led businesses from around the world each year. Candidates are nominated from all graduates of the University of Florida. “CEI is excited to honor top Gator alumni entrepreneurs from schools and colleges across the UF campus,” said Nola Miyasaki, Director of Gator StartUps. “The Gator100 exemplifies one of CEI’s core values of contributing to a vibrant culture of entrepreneurship across our campus and the Gator Nation.”

To qualify for inclusion in the Gator 100, candidate companies must be in operation for five years or more and have verifiable revenues in excess of $100,000. A University of Florida alumnus or group of alumni must have owned 50% or more of the company; must have served as the Company’s CEO, President or Managing Partner. In addition, the alumnus must have founded the company and been active as a member of the most senior management team. “The Gator100 is an important initiative that recognizes entrepreneurial excellence,” explains Dr. Michael Morris, the Academic Director of the entrepreneurship program at UF. “It is open to any and all companies founded or run by Gator alumni, and recognizes those who are achieving growth, innovating, and making a difference in their communities.”

At the Gator 100’s inaugural event this month, Dr. James M. Kiely, a graduate of University of Florida’s College of Liberal Arts & Sciences (CLAS), accepted University recognition for his partnership in AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for stroke and AcuteCare Gator 100 Trophyemergency neurological care. Founded in 2009, ACT allows hospitals to access highly-respected expert Neurologists and Telemedicine technologies twenty four hours a day through the application of the latest telecommunication technology. ACT ranked as the 16th fastest growing Gator-led business.

Dr. Kiely is a partner in Atlanta Neurology, P.C. and Medical Director of the Neurophysiology Departments at Northside Hospital and St. Joseph’s Hospital of Atlanta. He is a member of the Epilepsy Foundation of Georgia and a past Chair of their Professional Advisory Board. After graduating with Honors from the University of Florida, he received a M.D. from Emory University and earned a Ph.D. from the Emory Department of Pharmacology for a thesis on nervous system control of blood pressure. He completed a Neurology residency at the University of Virginia, with fellowship training in Epilepsy and Intensive Monitoring. During this tenure, he was the recipient of national awards for epilepsy research. Dr. Kiely is Board-certified in Neurology with added qualifications in Clinical Neurophysiology. He was recently named one of America’s Top Doctors by US News and World Report.

Congratulations to AcuteCare Telemedicine on being selected to the 2015 Gator 100!



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.



Sharing Experience and Knowledge on Cerebrovascular Diseases

It is even a busier time than usual for medical professionals who are focused and dedicated to fighting cardiovascular diseases and stroke. The American Heart Association (AHA) will be sponsoring The International Stroke Conference, “Connecting the World to Stroke Science,” on February 11-15 at the Music City Center in Downtown Nashville. It is the world’s largest meeting of medical professionals dedicated to the science and treatment of cerebrovascular disease and will attract more than 4,000 cerebrovascular experts from around the world including neurological specialist from AcuteCare Telemedicine (ACT). The leading practice-based provider of telemedicine services for hospitals seeking around-the-clock stroke and other urgent neurological care will be an exhibitor at this premier AHA event.

On March 25, 2015 the Georgia Partnership for Telehealth will be conducting their 6th Annual Spring Conference in Savannah, GA. The conference is a great opportunity for Primary Care Providers, specialty physicians, advanced practice nurse practitioners, Physician Assistants, Registered Nurses and medical facilities administrators to learn how the most up-to-date telecommunications technologies are impacting the delivery of stroke care and other healthcare services. Attendees will experience telemedicine in an applied framework, build network relationships and gain exposure to the latest in telehealth hardware and software technology. The conference will include a Grant Writing Workshop and will feature presentations from foremost experts in teleneurology.

Dr. Keith A. Sanders will be presenting a talk at the conference entitled “Outcome Analysis Demonstrates the Value of Telestroke”. Dr. Sanders is Director and Founder of the Stroke Center of St. Joseph’s Hospital of Atlanta and former Chairman of the Ethics Resource Committee and a partner in Atlanta Neurology, P.C. and AcuteCare Telemedicine (ACA). “As medical practitioners, it is incumbent upon us to not only apply the latest techniques and technologies to the treatment of our patients but to share our experiences and knowledge with the greater medical care community on how state-of-the-art telestroke technology is advancing cardiovascular care and saving lives,” says Dr. Sanders. “It is a privilege to have the opportunity to share my experiences on improving and expanding access to quality, advanced cardiovascular care to patients no matter where they live.”

The GPT Spring Conference will begin on March 25, 2015 and run through March 27, at the Hyatt Regency-Savannah at 2 West Bay Street, Savannah GA 31401. Online registration is now open. An array of exhibitor opportunities is now available. Additional information is available by contacting Samantha Haas at samantha.wainright@gatelehealth.org.