AcuteCare Telemedicine Blog


Managing Diabetes Remotely With Telemedicine

Diabetes afflicts more than 22 million Americans, or 7% of the total population, and the number of people diagnosed every year is skyrocketing. At a cost of $245 billion in 2012, the disease’s toll on the economy has increased by more than 40% since 2007, according to a recent report from the American Diabetes Association.

Mississippi, which ranks second after West Virginia in the percentage of residents affected by the chronic disease, is taking steps to reduce devastating effects on the state economy and the overall health of Mississippians. Early this year, Gov. Phil Bryant, the University of Mississippi Medical Center and three private technology partners announced a plan to help low-income residents manage their diabetes remotely through the use of telemedicine. The goal is to help them keep the disease in check and avoid unnecessary hospitalizations while remaining as active and productive as possible. To make the project possible, Bryant signed a first-of-its-kind law requiring private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care.

The new reimbursement law will also pave the way for similar telemedicine projects for other chronic diseases, said Dr. Kristi Henderson, the University of Mississippi Medical Center’s chief of telemedicine, who is heading the project. Initially the project, called the Diabetes Telehealth Network, will enlist 200 people with diabetes in one of the state’s poorest regions, the Mississippi Delta, who will be given Internet-capable computer tablets loaded with software that will enable medical professionals at the University of Mississippi and a hospital in the region, North Sunflower Medical Center, to remotely monitor patients’ test results and symptoms. A third technology partner will provide technical support for the wireless telecommunications services needed to transmit the medical data.

The price tag for Mississippi’s telemedicine project is about $1.6 million. But to expand the program or recreate it somewhere else, Henderson said, would cost much less because the groundwork would be done. “We want to prove a model and replicate it.”

Nationwide, one in every five health care dollars is spent caring for people with diabetes, according to the American Diabetes Association. Mississippi’s telemedicine law, said Gary Capistrant, public policy director at the American Telemedicine Association, goes further than any other state to remove what the telehealth industry considers its biggest impediment, lack of insurance reimbursement.

Numerous states and medical groups already have expressed an interest in the project, Henderson said. “If we can do it in Mississippi, where chronic disease is at its worst, where poverty is at its worst, and where transportation and workforce issue are at their worst, we can make it work anywhere.”



Will Telemedicine Reduce the Wait at Hospital Emergency Rooms?

Waiting times at hospital emergency rooms has long been a problem.  Originally established to treat patients with injuries and illnesses in cases of extreme emergency treatment needs, todays hospital emergency facilities are packed with patients seeking treatment for every ailment from the common flu, minor cuts, sprains, strains, to severe injuries and illnesses.  As a result anyone who has ever had the misfortune to need to visit a hospital emergency room is well experienced in the art of waiting for treatment, in some cases, many long hours.

For years hospitals have attempted to stem the unrelenting flow of patients by diverting them to physician’s offices and off-site medical clinics and triage centers, still others post estimated waiting times on billboards and electronic signage located outside the hospital entrances.  The waiting goes on unabated.

To address this issue, a pilot study has been launched at UC San Diego Health System’s Emergency Department (ED) to use telemedicine as a way to help address crowding and decrease patient wait times.  The study is the first of its kind in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.  The study, called Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), brings telemedicine doctors to patients when the ED becomes busy.  An offsite doctor is paged, who then remotely links to a telemedicine station to see patients.  With the aide of an ED nurse, these patients are seen based on arrival time and level of medical need.

“This telemedicine study will determine if we can decrease wait times while reducing the number of patients who leave the ED without being seen by a physician,” said David Guss, MD, principal investigator and chair of the department of emergency medicine at UC San Diego School of Medicine.  “If the use of a telemedicine evaluation can be shown to be safe and effective, it may shift how care in the emergency department is delivered.”

“ED overcrowding increases patient risk and decreases patient satisfaction with emergency services,” said Vaishal Tolia, MD, MPH, FACEP, emergency medicine physician at UC San Diego Health System.  “Implementing telemedicine in the emergency department setting may improve the overall experience for both patients and medical staff.”



EMS Role is Critical to Stroke Treatment and Recovery

Each year, almost 800,000 Americans suffer a stroke, on average one American suffers a stroke every 40 seconds and one victim dies every 3 to 4 minutes making stroke the third leading cause of death in this country, after heart disease and cancer.

Innovations in the treatment of stroke have provided many new options for physicians and emergency room personnel over the past half-decade, but getting the stroke victim to the most effective treatment center still remains a critical element in a victims long term survival. EMS is a part of the success of any telemedicine program. Being able to quickly assess a patient to identify acute stroke symptoms is one thing – getting the patient to the closest most equipped hospital is another. Hospital associations and telestroke providers need to include EMS in the conversation as it will dramatically impact the lives in acute stroke events.  EMS teams must have a goal of getting potential stroke victims stabilized, evaluated, and to a primary stroke center in less than an hour.

To plan for an effective response, directors of EMS units should have a preplanned stroke protocol written for their teams, divide the EMS unit’s region into districts according to the nearest emergency department capable of treating acute strokes and maintain regular training sessions for EMS personnel.

The Utah Department of Health and The Bureau of Emergency Medical Services are leading the way in establishing effective procedures and communications to EMS personnel when it comes to transporting patients for the treatment of stroke. The Bureau has identified eight regional hospitals throughout the state as “Primary Stroke Centers”, hospitals that have undergone certification by the Joint Commission or DNV as specialized centers providing the highest level of comprehensive stoke care. This includes advanced time-critical emergency stroke care, including specialized radiology, neurology, and neurosurgery expertise, as well as complete inpatient treatment and outpatient rehabilitative programs for stroke patients.  In addition, 17 localized hospitals have been designated as “Stroke Receiving Facilities”, centers that have procedures, equipment, and protocols in place to provide time-critical emergency stroke care, in consultation with one of the Primary Stroke Centers.

For stroke victims, there is less than 4.5-hours after the onset of symptoms in which thrombolytic therapy offers an enhanced opportunity for a patient’s recovery.  Educating and training EMS and First Responders to identify, properly evaluate and transport victims to a Primary Stroke Center, or a Stroke Receiving Facility, is critical to the successful outcome of treatment for stroke victims.



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.



Check Your Head

In the wake of countless notable events including the deaths of several professional athletes in the past 5 years, new light has been shed on an epidemic which we are beginning to learn may be far more widespread than initially thought.

Researchers at Boston University recently published the largest study of chronic traumatic encephalopathy (CTE) to date. CTE, a progressive degenerative brain disease thought to stem from concussive trauma to the head, has been known to affect boxers since the 1920s, but only recently has gained notoriety as a serious concern for athletes of all ages across many sports. In these latest findings, 68 of 85 donated brains from deceased veterans and athletes with histories of head trauma showed visible evidence of the disease, including a staggering 34 of the 35 brains from former professional football players.

CTE

The greatest concerns sparked by our growing understanding of CTE’s causes and pathology are without a doubt related to the protection of younger children participating in sports and other activities where risk of injury to the brain is involved. The work of the BU researchers has led to drastically improved protective equipment and restructuring of rules and regulations to minimize the number and force of hits to the head, but it is nearly impossible to remove the potential for these injuries from sports at any level.

Thus, the best possible measures that can be taken are to prevent any repeat injury of the brain. Taking the lead, the NFL has instituted mandatory on-field concussion screening following hard hits. The NHL has also ordered that players with potential head injuries spend time in a ‘quiet room’ off the ice. Youth leagues are particularly concerned with preventing any participant who may have sustained an injury from getting back into the game and facing further danger.

Telemedicine offers the potential for significant further contribution to these efforts. With the help of technology, expert neurologists can always be on hand to examine potential head injuries, and monitor patients in the aftermath of an injury, aiding the recovery process. Thanks to telemedicine’s advances, logistics and associated costs are no longer obstacles to immediate and accurate concussion diagnosis and treatment.

The fight against CTE and other trauma-induced brain disease starts long before the first injury happens, but when it cannot be entirely prevented, telemedicine could play a role in ensuring fewer players incur more severe consequences later in life.



Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.



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.