AcuteCare Telemedicine Blog

Patients May Get A Dose Of Regulations When Reaching For Telehealth
July 24, 2014, 9:14 am
Filed under: Industry Standards, Telemedicine | Tags: , , ,

John Williams was feeling poorly after a long day of meetings with clients. He had traveled to Los Angeles for a series of presentations for a prospective client and was scheduled to meet with the decision-makers the following day. It was vital that he be at the top of his game, but he was feeling terrible and knew that he needed to see a doctor.

His customary sinus infection was keeping him from preparing for the important meetings.  Away from home, and after regular business hours, John decided to try a new service the hotel bellman had told him about. It would connect him with a doctor via a smartphone application. After downloading the app, John was connected with a board-certified doctor. Fifteen minutes after that, he had a prescription to address his troublesome symptoms and a list of things he could do to help fight-off future infections. He readily paid the $40 fee for the service and went on to complete his mission successfully the following day.

John’s story is becoming more common throughout the country as consumers look for more convenient appointments with healthcare providers. For a relatively reasonable fee, patients are connecting with a licensed physician via their tablet or computer when they are unable to see a doctor through more traditional methods.

The most common treatments available through telehealth include routine respiratory illness, fever, ear and urinary tract infections and skin or eye problems. In many states across the country consumers and physicians alike are enthusiastically embracing telemedicine when it comes to routine medical consultation and treatment for patients that don’t require intensive medical intervention. Online medical exams promise to be more convenient, lower-cost, and are generally offered for a fixed price. But perhaps more importantly, for many time-strapped patients, the usual long wait at a primary-care office or busy emergency room is avoided. The virtual experience is being offered in many states that have established telemedicine rules supportive of expanded virtual healthcare services.

Rules recently proposed by the Federation of State Medical Boards (FSMB) and several state legislatures are likely to hinder the expansion of virtual doctor-patient relationships, like John’s. While the FSMB guidelines simply require that the same standard of care for both in-person and telemedicine services be met for the formation of a valid patient-physician relationship, the proposed regulations in Tennessee will require that a patient-physician face-to-face meeting take place prior to the first virtual experience. Furthermore, additional in-person doctor-patient appointments are required at regular intervals in order to continue future telehealth encounters. While the need for such rules may be founded in legitimate concerns for patient safety, the practicality of such state-by-state restrictions is being debated.

In an era where state boundaries are being blurred by a push toward a more consistent and accessible national healthcare delivery model, consumers are eager to utilize their electronic devices, even for maintaining and monitoring their healthcare. It seems unlikely that restrictive rules, like those contemplated by Tennessee officials, will be able to stand the test of consumers looking for better access and more convenient and cost effective healthcare services offered through telecommunication technology, particularly when such unrestricted access may routinely be available in an adjacent state.

It may be too late for prudent and well-meaning state legislatures and bureaucracies to impose their rules on the new healthcare delivery model.  The more consumers recognize the choices and benefits virtual healthcare has to offer them, the more they are likely to exercise their influence over the regulatory process. Severely restricting or over-regulating virtual healthcare will be like putting the genie back in the bottle.


Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.

Dissolve the Debate. It’s Time to Solve the Individual State Licensing Issue

The past few decades has seen a once regional, state and national economic model evolve into one of global proportions. Industries once accustomed to conducting commerce at the state and perhaps national level now freely explore the world’s markets with ease, thanks to an explosion of telecommunication technology that permit even the most remote locations complete global across to products and services. At the turn of the 20th century, the rapid expansion to a national and interstate commerce model required significant change to a myriad state regulations in order to better accommodate the transition to a new national economic order. The changes of that era were not realized without some push-back from the well-established enterprises that sought to preserve their own economic and competitive positions.

Today, the practice of medicine, once the purview of localized practitioners and institutions, is evolving into a national and even international network of medical care givers and healthcare organizations. Telemedicine, the practice of medicine utilizing electronic communication, is revolutionizing the medical care delivery model throughout the nation and the world, crossing state lines and international borders to allow access to advanced medical care to patients once isolated by geography and social economic barriers. In an era of rising healthcare costs, physician shortages and increasing numbers of underserved patients, telemedicine looks to be a viable vehicle to lower cost, improve efficiency and expand access to once isolated populations. While many in the medical industry look to accelerate the trend toward telemedicine and telehealth, some formidable administrative obstacles to the rapid expansion of telemedicine continue to elude solution.

In the era when the practice of medicine almost always took place in face to face meetings and examinations with healthcare givers, the topic of individual state licensing of doctors rarely came to a discussion. But today, the application of restrictive state laws to telemedicine is creating a dampening effect on the practice of telemedicine and increasing the cost of its implementation.  Despite widespread agreement that something needs to change to overcome barriers to interstate practice of telemedicine, a clear consensus has failed to be realized. Some advocate a national licensure scheme and others support various forms of endorsement, mutual recognition and reciprocity. But despite all the debate, a workable and acceptable solution remains elusive. All the talk and seemingly endless study may be coming to an abrupt end.

The Federal Trade Commission (FTC) has announced that it is looking at taking a broader role in the interstate practice of telemedicine. Currently, individual states have jurisdiction over the licensing of physicians and medical caregivers. But if the FTC rules that interstate restrictions are anti-competitive, they have a right to intervene if out-of-state telemedicine professionals meet the same standards as those licensed within the state.

Regardless of their respective positions, most in the industry do not support a federal licensing system but, unless all participants in the debate quickly move beyond the talking and posturing stage, federal intervention may just preempt the process of arriving at alternative solution for all involved.

Telehealth: Impacting the Practice of Primary Care

Hundreds of employers of all sizes are contracting directly or through their insurers with telehealth providers to cut medical costs and give workers 24-hour access to doctors and nurse practitioners. Recently, Beth Ferrin’s 9-year-old son came home with a swollen throat and fever. It was after dinner, so she flipped open her laptop and dialed into LiveHealth Online, a service offered by her insurer, WellPoint, (WLP) that connects patients with doctors via video calls. After a quick diagnosis of strep infection, a prescription for an antibiotic was called in to a pharmacy near Ferrin’s home in Bellbrook, Ohio. Her other options would have been to see a doctor in the morning or risk a long wait at an urgent care facility. Beth’s willingness to seek treatment for her son via telecommunication technology counters some telemedicine critic’s prediction that patient insistence on face to face encounters with their physicians would be a significant barrier to remote medical care’s rapid expansion. Now it would appear that barrier was overstated and, in part, has been overcome. 

But some very legitimate concerns continue to exist among physicians about the safety and effectiveness of remote medical care. When asked about the throat infection treatment of Ferrin’s son, Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said: “The only way to diagnose strep is with a test. Best practices say you can’t just throw an antibiotic at somebody.” He says there’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication. But Telemedicine care works well for treating common conditions such as colds, flu, pink eye, and sprains, providers say. 

The widespread use of camera-equipped devices has made remote medical connections easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. The growth of Telemedicine has been spurred in part by the Affordable Care Act (ACA), which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently.

In response to concerns about the appropriateness of remote diagnosis and treatment, the American Telemedicine Association (ATA) is developing an accreditation program for telehealth providers and a bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telemedicine standards. Meanwhile, Telehealth companies are reporting double-digit revenue growth and attracting high-profile investors. MDLive CEO Randy Parker says. “Within the next few years, no consumer will even remember not being able to connect to their providers through telehealth.”

AcuteCare Telemedicine Leading Acute Care Telemedicine

The effort to provide high-quality healthcare solutions to every patient, regardless of geographic location, while reducing delivery costs is at the foundation of industry leaders efforts to revolutionize the traditional healthcare delivery model. Telemedicine is becoming the cornerstone of the solutions. Advances in telecommunication technologies is providing increased opportunities to decrease complications for patients in areas of high acuity like the critical care unit, as well as provide assistance in time-sensitive treatment decisions for emergencies such as stroke care.

InTouch Health® is the leader in acute care remote presence telemedicine. The company through its network of clinical care providers delivers innovative healthcare solutions that extend a doctor’s ability to manage patient care remotely, thereby removing critical time and distance barriers. The InTouch Telemedicine System allows physicians and other healthcare providers to conduct highly reliable, real-time, remote consultations.

AcuteCare Telemedicine (ACT), the largest practiced based provider of acute stroke and neurological care is now linked as a preferred provider with InTouch Health. Acute care telemedicine is an approach to urgent healthcare delivery in which specialists are focused on providing comprehensive, end-to-end remote presence clinical services, enabling a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision and care plan. With their remote expertise available at a moment’s notice, ACT is able to increase the likelihood that patients will obtain necessary stroke care within the critical “golden hour” following stroke recognition. The importance of using acute care telemedicine in the advancement of emergency healthcare is supported by the efforts of InTouch Health.

The ACT team of expert Neurologists is being recognized for setting new standards for excellence in Telestroke and urgent Teleneurology care. As clinical partners with hospital based and emergency physicians, they are positioned to successfully deliver remote, live and interactive Telestroke and other Teleneurology solutions that deliver the highest quality, affordable services and superior clinical outcomes for hospitals all around the world.

Technology is Advancing the Practice of Telepsychiatry

Telepsychiatry and other long-distance options for providing mental health care can help overcome problems related to location and distribution of specialty mental health services but should not be seen as a panacea for delivering care to rural areas in the United States, reported a research and policy brief from the Maine Rural Health Research Center. “Telemental health” (yet another new term) once depended on heavy-duty audio and video technology based in fixed studios to initiate care. Despite this coarse beginning, advances in computer technology and its near-universal adoption have resulted in improved delivery of Telepsychiatry and made it more cost effective and available to a wider audience, however, some non-technical hurdles remain to be cleared.

Until recently, “Telemental health” services were most commonly provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners, but now a pilot project begun at one critical-access hospital in collaboration with a psychiatrist and specialty mental health staff at a community mental health center has expanded to five additional hospitals. This system provides round-the-clock crisis evaluation and support at the hospital emergency departments and some say that “Telemental health” enabled them to provide services to rural persons that otherwise would not be available, but some nontechnical barriers such as poor Medicaid and commercial reimbursement rates, recruitment and retention difficulties, high numbers of patients without insurance, and high no-show rates serve as a drag on expansion of current programs.

The barriers experienced with “Telemental health” expansion is shared by other medical service disciplines seeking to enter or expand the utilization of telecommunication technologies that promise to revolutionize the delivery of medical care in the United States and across the world.  While progress is being made to overcome many of the most significant structural road blocks to expansion and adoption of these new technologies, much remains to be done to clear the path to a new medical care delivery model.

Maintaining a consistent push to encourage state and congressional representatives and health insurance industry leaders to move forward and embrace the revolution in healthcare must continue until each barrier is removed or neutralized.  The promise of delivering better, less expensive and more available medical care to millions of patients across the country depends on these continued efforts progressing and succeeding.

Is There a Doctor in the House?

For those who can still remember the day when your family physician came to the house in response to a telephone call requesting medical service, the current debate over the acceptance of telemedical services in place of face-to-face visits with a doctor will bring back memories of a similar debate exorcised over the abandonment of house calls with in-office visits. Back then the vocal decry from opponents to the change suggested that patients would reject the idea and inconvenience of traveling to the doctor’s office to receive medical care and that somehow the process would have a negative effect on the quality of health care.

Few predict that the face-to-face, hands on, talk to me now visits with a physician is likely to go the way of the personal home visits anytime soon.  However, organizations resistant to changes with the current medical services delivery model and are unwilling to consider utilizing telecommunication technology will not be able to meet the growing demands of the patients and communities they serve.

A recent study by Cisco reveals that 74 percent of consumers are open to virtual doctor visits.  The results of the Global Customer Experience Report focused on health care, demonstrated a shift in consumer attitudes toward personal data, telemedicine and electronic access to medical information. The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.

The results indicated that 80 percent of American’s were comfortable with submitting personal medical and diagnostic information to the cloud to help ensure that all relevant personal medical information is readily available to receive treatment.  Perhaps the most interesting result was that the findings challenged the assumption that face-to-face interaction is always the preferred health care experience by consumers. While consumers still depend heavily on in person medical treatments, given a choice between virtual access to care and human contact three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician interaction.

The benefits of face-to-face visits to quality of care are valid and current telemedical service visits will not likely replace all physician/patient personal interactions anytime soon, nor should they.  But recurring studies are beginning to reveal that patient’s reluctance and suspicions of telemedicine is no longer a valid excuse for delaying the broader expansion of telemedical services.

Perhaps we shouldn’t be all that surprised that patient objections to a reduction in face-to-face doctor office visits are fading.  Consulting with your family health care practitioner, via telecommunication technology, in the comfort and convenience of your own home has a familiar ring.  House calls revisited? What goes around comes around?