5/7/2009
Christian Hageseth , the former Colorado physician who prescribed an antidepressant over the Internet to a Stanford student who later committed suicide was recently sentenced to nine months in county jail. He faced up to a year in jail after pleading no contest in February to a single felony count of practicing medicine without a license.
His case is one of the first criminal prosecutions of a practitioner for using telehealth without having a license in the patient's state. More information about the Hageseth case can be found
here and
here.
San Mateo County Superior Court Judge James Ellis said he would allow Hageseth to serve his sentence in Colorado as he recovers from heart surgery and ordered him to pay $4,200 to the California medical board, which investigated the case. Chief Deputy District Attorney Steve Wagstaffe said prosecutors would insist Hageseth stay behind bars for the entire sentence and not be allowed to serve the time in a work program or some other kind of release.
Hageseth's lawyer, Carleton Briggs, who had tried to get an appellate court to dismiss the charge, said Friday that the case would hurt the practice of medicine.
"Telemedicine is now dead," he said. "No doctor in his or her right mind would now pursue telemedicine unless licensed in all 50 states," which would be prohibitively expensive.
But Deputy District Attorney Jennifer Ow said the prosecution was targeted at an illegal practitioner who "was not licensed in any state to do what he did."
(Sources: San Francisco Chronicle, April 17th, 2009; San Jose Mercury News, ‎April 18, 2009‎)4/30/2009
Doctors already involved in
Australia's embryonic telemedicine sector, which allows patients to consult specialists hundreds or thousands of kilometers away, say the Government's plans to build a $43 billion national fiber-optic network is a good first step to encourage further roll-out of such hi-tech services. But they say the full potential of telemedicine will only be realized when governments make it easier. Currently, only face-to-face consultations qualify for Medicare rebates, a disincentive for GPs and other private doctors to get involved.
Mark Coulthard, a pediatric intensive care specialist at Brisbane's Royal Children's Hospital, often participates in long-distance consultations using equipment that allows two-way communication with a studio set up in regional towns.
Instead of traveling to the state capital for a specialist consultation, patients travel to the studio in their town, where the specialist can see and hear them, and see their scans and other information.
Coulthard says once complete, the planned national fiber-optic network would allow doctors to devise "creative ways of delivering health services, and also directly into the home". "It will give us a mechanism to make headway in areas that are normally difficult to reach," he says.
But educating staff in how to use the new systems would also be vital. While telemedicine consultations between Brisbane and Mackay were a regular event, similar equipment in nearby Rockhampton was underused because staff there were undertrained and uncomfortable with using it.
Anthony Smith, deputy director of the Centre for Online Health at the University of Queensland, says the proposed new infrastructure is "an important piece of the puzzle, but not the most important piece". "It's really important that to have telemedicine accepted as a mainstream service, that it's funded appropriately," he says.
Marianne Vonau, executive director of critical care at the Royal Brisbane and Women's Hospital, and the first Australian-trained female neurosurgeon, recently conducted a telemedicine clinic in Brisbane in which she reviewed the progress of a four-year-old child in Mackay.
The child, Grace Druery, had had a shunt implanted in her head to drain fluid that had built up in her skull due to a congenital condition. Without the telemedicine facility, Grace and her mother Leanne would have had to fly the 800km from Mackay to Brisbane.
(Source: The Australian, April 10, 2009)
The first ever telemedicine center in
Cameroon recently became operational. Known as Genesis Telecare, it was inaugurated in the city of Yaounde by the Secretary General in the Ministry of Public Health, Professor Fru Angwafor III. The project is the fruit of a public-private sector partnership between the Genesis Futuristic Technologies and the Ministry of Public Health. Some 200 sites are expected to be connected to the network in the next two years.
Through the telemedicine center, patients in remote or rural areas can electronically get health care services including consultation and treatment without having to travel long distances.
With the aid of video conferences technology, patients can be consulted from the district hospital by a specialist doctor in Yaounde. The medical equipments used for the operation are computerized, making medical diagnosis to be exchanged instantaneously.
With the introduction of telemedicine, health care services are expected to be less expensive, faster and easily reachable.
Jacques Bonjawo, Director General of Genesis Futuristic Technologies said during the pilot phase of the project, hospitals in Yaounde and Douala will be connected to rural hospitals nationwide.
The Abong Mbang District Hospital, in the South region is the first rural hospital to be connected to the network and was used at the inauguration to consult a patient.
(Source: Africa News, April 23, 2009)
To address the shortage of medical specialists in the country with a population of 700,000,
Bhutan's Ministry of Health has launched two telemedicine projects, where an expert from India can diagnose and advise on a case of a critically ill Bhutanese patient�all via the internet and through videoconferencing.
Bhutan's Prime Minister Lyonchhoen Jigmi Y Thinley and the Indian ambassador to Bhutan, Sudhir Vyas, inaugurated the projects�SAARC (South Asian Association for Regional Cooperation) Telemedicine Network and Bhutan Rural Telemedicine�during the ministry's annual conference in Thimphu, Bhutan's capital.
The real-time video conferencing will require an internet bandwidth of 384 kbps, while the rural telemedicine will use the existing infrastructure of dial-up internet connectivity.
With this telemedicine innovation, the Health Ministry hopes to improve the accessibility and quality of healthcare by harnessing ICT. Apart from getting advices from India, this remote doctoring will also enable Bhutanese specialists to attend to patients in other parts of the country.
"Through telemedicine, doctors and specialists will be able to keep in touch with their peers and keep up with medical advancement in technologies," said Gaki Tshering, Head of the ICT Unit at the Ministry of Health.
(Source: FutureGov Magazine, April 23, 2009)
4/30/2009
Congressmen Mike Thompson, D-California recently introduced telemedicine legislation would provide $30 million in grants to help health facilities pay for telehealth equipment and expand telehealth support services. Currently about 80% of Americans do not have access to telemedicine because of restrictions that limit funding for these types of facilities to rural areas. The Medicare Telehealth Enhancement Act (House Resolution 2068) would expand Medicare reimbursement to urban and suburban areas and include more facilities, the press release states. It will also allow doctors to monitor patients remotely.
Co-authors include reps. Bart Stupak, D-Mich., Lee Terry, R-Neb., and Sam Johnson, R-Texas.
"As health care becomes more expensive, we need to use smart innovations such as telemedicine technology to help lower costs and expand access for all Americans," said Thompson in a release. "Allowing doctors to remotely monitor a patient who has congestive heart failure not only helps the patient stay healthy, it also reduces costly visits to the emergency room. The Obama Administration has indicated that telemedicine will be an important part of their health care reform agenda, and I look forward to working with them to expand access to this important technology."
Last July, Thompson and Stupak's provisions to expand the types of facilities authorized to provide telehealth care were passed into law as part of the Medicare Improvement for Patients and Providers Act. This bill will further expand the type of facilities that are eligible.
(Source: Eureka Times Standard, April 27, 2009)
3/26/2009
Health insurers would no longer be able to require that a doctor meet a patient face-to-face in order to be reimbursed under a bill passed recently by the New Hampshire Senate. Senate Bill 138, which defines telemedicine and requires its coverage, passed the Senate on a 17-5 roll call vote. The measure now goes to the House for approval.
Supporters maintain that the bill will both lower health-care costs and provide better care in rural areas.
"This is going on now," said Sen. Kathy Sgambati, D-Tilton. But she said that there is "confusion on how to bill" for such services that is preventing some providers from engaging in the practice.
"This is vastly going to reduce the costs of health care and help with early detection," said Sen. Debbie Reynolds, D-Plymouth. Telemedicine would help with early detection and "access to specialty care that would reduce the severity of diseases."
But opponents questioned whether the bill is yet another insurance mandate that would drive up premiums. Others worried that it would result in unsupervised experimental medicine, though proponents pointed to language that defines telemedicine as having to fit in the current scope of practice.
(Source: New Hampshire Business Review, March 19, 2009)3/26/2009
Telehealth is expanding in Wyoming and across the country. This month, the state passed a law giving the Wyoming Department of Health's rural health office the authority to work with other states and organizations to lay the groundwork for more telehealth exchange.
Telehealth is particularly valuable in Wyoming. The state's rural nature and sparse population make it more difficult to attract health professionals, and it reduces demand for highly specialized doctors. Many in the state's medical community see telehealth as a way to bring advanced care to the Wyoming's most remote settlements.
What excites many health experts is the prospect of a nationwide telehealth network that would allow a Wyoming patient to be treated by the country's finest hospitals without buying a plane ticket.
The federal stimulus package's strong support for health technology carries with it the expectation that states will work together to create a nationwide telehealth network, said Dr. James Bush of the Wyoming Department of Health. Bush is helping design a comprehensive telehealth network in the state.
Bush said medical licensing laws could be a roadblock to a national network. New rules enacted by the Wyoming Board of Medicine make it easier for out-of-state doctors to obtain licenses to practice telemedicine. Bush hopes medical officials in all states will agree to recognize each other's licenses, at least to some degree, to allow more unfettered exchange of medical expertise and treatment.
"We could have more access to super specialists all around the country who would otherwise need to get licenses in 50 different states," Bush said.
Kevin Bohnenblust, executive secretary of the Wyoming Board of Medicine, said the state licensing process shouldn't stand in the way of telehealth, but the board's first goal is to protect Wyoming citizens.
"We don't want that state line to be sort of a boundary," Bohnenblust said. "We want to be able to regulate (telehealth) without standing in the way of it."
Rex Gantenbein, director of the Center for Rural Health Research and Education at the University of Wyoming, said the technology for telehealth has been around since the 1990s, but a funding increase in the past few years has pushed the practice into Wyoming's medical mainstream.
"Since then there's been an increasing amount of interest in it to the point now where most of the hospitals in the state have some telehealth capacity," Gantenbein said.
In 2007, a $500,000 telehealth program linked 24 of Wyoming's 26 acute care hospitals to facilitate video conferencing. Currently, the majority of telehealth in the state provides educational courses and connects medical professionals. Hospitals use the system for meetings and to conveniently provide training for their employees.
For instance, the Cheyenne Regional Medical Center offered an eight-week nurse education course broadcast from the University of Washington -- something that would have been impossible without the hospitals' telehealth capacities.
Doctors say the next step for Wyoming is to treat patients remotely on a large scale, both within the state and across state lines. Telehealth can save hours of driving for patients living in rural areas for whom a specialist is hundreds of miles away.
"Things that we've seen the biggest need for in the state is the ability to provide specialty care," Gantenbein said. "Everything from dermatology, cardiology and stroke care."
In other states, telemedicine is being used to treat mentally ill patients, monitor the elderly in nursing homes and even evaluate incarcerated prisoners.
Dennis Ellis, executive director of the Wyoming Medical Society, said the networks cut costs and negate the need for what he calls "windshield" time. Ellis said Wyoming is well-suited for a comprehensive telehealth network.
"It's easier to get all of Wyoming all on the same page than to get Denver on the same page," Ellis said.
(Source: Casper Star Tribune, March 16, 2009)
2/27/2009
The former Colorado doctor who illegally prescribed generic Prozac online to a Stanford University student who subsequently killed himself pleaded no contest yesterday to felony practicing medicine in California without a license. The deal settles Christian Hageseth's case - a complicated one that stretched over three years, including seven motions to dismiss, an appellate court ruling on jurisdiction and a consistent stance by the defense that county prosecutors could not try him for practicing in the state because he never stepped foot in California.
Although the decision does not bring back John McKay, the university freshman who obtained the drugs from an online pharmacy, prosecutor Jenny Ow said his family is happy with the resolution. The felony conviction also puts doctors on notice of consequence for their actions via the Internet, Ow said.
"It lets doctors know that if you're going to prescribe online you better have a California license," Ow said. "You're telling people online you are qualified to do what you're doing and people rely on you."
In return for his plea, Hageseth was promised no state prison and up to one year in jail. He will be sentenced April 17.
Hageseth, 68, changed his plea yesterday at a pretrial conference, much to Ow's surprise. Just last week, Hageseth's defense was pushing to resolve discovery issues and scheduled another hearing March 5 to argue the case should be dismissed due to lack of jurisdiction.
Defense attorney Carl Briggs said he was prepared to go forward but his client's illness was too serious to keep going. The last trial delay to Hageseth's case was due to recent cardiac surgery chalked up to the stress of the case.
Briggs anticipates Hageseth's health will play a role in his ultimate sentence but regardless hopes he will receive only time already served.
Hageseth's case has drawn wide attention from those who believe it breaks new ground in Internet law and commerce that travels over state lines via cyberspace.
Like Ow, Briggs believes his client's case will make doctors and others working online act with caution because of the ramifications.
"This is a situation that curtails if not eliminates telemedicine," Briggs said, adding those in rural areas may get less access to medical care if they cannot turn to the Internet or phone for an out-of-state medical center for advice.
In June 2005, McKay was a freshman at Stanford University who purchased 90 capsules of generic Prozac by credit card at the online pharmacy site USAnewRX.com. The request was signed off on by Hageseth in Colorado and shipped from the Mississippi-based Gruich Pharmacy Shoppe. McKay submitted a medical questionnaire before Hageseth's prescription in which he claimed to have received the drug before. At the time of McKay's online purchase, Hageseth was not allowed to fill prescriptions because he had a restricted medical license for an unrelated relationship with a patient he later married. He had since been reinstated but was again suspended.
McKay committed suicide that August and prosecutors charged Hageseth the following May.
The defense long held Hageseth cannot be tried for practicing medicine in California if he personally was in another state but prosecutor Ow countered he was here in essence via the Internet.
A state Appeals Court ultimately ruled that Hageseth could be prosecuted in this state and local prosecutors expected him to voluntarily surrender. Instead, in October 2007, Sidney, Neb. police stopped him for allegedly speeding and learned of an outstanding $500,000 arrest warrant issued by San Mateo County.
His bail was consistently reduced until finally he was released on his own recognizance.
The defense hoped to be bolstered by the dismissal of a federal lawsuit by McKay's parents after experts testified the drug did not cause McKay's suicide.
In May 2008, Hageseth was ordered to stand trial and has moved his trial date several times leading up to yesterday's plea deal.
(Source: San Mateo Daily Journal, February 27, 2009)
1/28/2009
As telemedicine continues to increase in popularity, it is critical for physicians to understand potential risks when communicating with patients by e-mail or phone. The Doctors Company, a national insurer of physician and surgeon medical liability with 44,000 members, has developed guidelines to help physicians successfully navigate telemedicine liability risks.
"Adopting telemedicine best practices is vital to enhancing quality of care while simultaneously decreasing liability exposures," said David B. Troxel, MD, the Medical Director of The Doctors Company. Troxel urges physicians to become educated about the risks of telemedicine and employ safeguards against litigation.
Outlined below are some guidelines physicians should follow when treating patients by phone or e-mail:
Telephone Best Practices:
-Inform patients in writing about when it is appropriate to seek telephone advice. Provide examples of the types of complaints, such as minor headaches, cuts, and bruises, that may be adequately dealt with over the phone. Also, give examples of problems that are likely to require an office or emergency room visit.
-Only physicians or qualified staff such as RNs, NPs, and PAs should provide telephone advice. Written protocols need to be prepared for office staff and should include what questions to ask, recommended responses for minor problems, and which calls to refer immediately to a doctor or schedule for an office appointment.
-Give callers ample time to explain their problems. Avoid leading questions. For example, instead of asking, "Do you have any chest pain?" ask, "Exactly where do you feel pain?"
-Ask the caller to repeat the instructions back to you.
-Be careful about prescribing by phone, especially for new complaints. If your diagnosis is wrong, the medicine could be ineffective or even harmful.
-Document calls for advice in the medical chart, using the caller's own words whenever possible. If one of your staff members handles and documents calls, review the notes to make sure the adviser followed guidelines and dispensed appropriate advice.
E-mail Best Practices
-Be careful what you write. Never put in an e-mail what you would not say in person.
-E-mails should be focused and concise. Always check your spelling and grammar and never use all caps.
-Incorporate your contact information in every message sent by using the automatic signature function in your e-mail software.
-Never use abbreviations. When communicating with patients, abbreviations can lead to dangerous misunderstandings.
-Include a disclaimer. Communicate your ground rules for e-mail exchanges up front. A standard disclaimer might read as follows: "Electronic mail is not secure, may not be read every day, and should not be used for urgent or sensitive issues."
-Maintain patient confidentiality. Conduct online communications with patients over a secure network that contains encryption technology. Standard e-mail services don't meet HIPAA requirements.
-Obtain informed consent. Be sure your patient signs an informed-consent form before initiating online communications. The consent form should list the appropriate use and limitation of online communications.
-Limit online communications to existing patients. Online communications of any kind are best suited for patients previously seen and evaluated in an office setting. Initiating a physician-patient relationship online may increase liability exposure.
-Pick up the phone. If you cross e-mails with another party two or three times, or if there is an emotionally charged issue involved in what you want to communicate, stop e-mailing and place a phone call instead.
The Doctors Company is a member of the eRisk Working Group for Healthcare and helped to develop guidelines for health care providers on the use of online communications. For more information on the guidelines, physicians should visit
www.medem.com/node/1058
(Source: The Doctors Company Press Release, January 21, 2009).
1/28/2009
Bloch Consulting Group, publishers of the Federal Telemedicine News Update, has released a 2009 edition of their
Federal Agencies: Activities in Telehealth, Telemedicine, and Health Technologies report. With a new administration in Washington, the government is poised to make major changes in how it funds major research, operations, and grants in the telemedicine, telehealth and informatics sectors
Learn all about these activities at 24 major cabinet-level departments and independent agencies. The 200-page Federal Agencies report, a valuable resource for: anyone who needs to keep tabs on Federal activities in the telehealth field -- and zero in on the activities being funded -- should be reading this report right now. It will save you many hours of research time.
More information about the report can be found on the
Federal Telemedicine News website.
(Source: Federal Telemedicine News, January 2009
AT&T is developing a software tool and networking platform that will use wireless devices to record a patient's health measurements at home and send the data to the doctor. AT&T's system runs on both Wi-Fi -- enabling videoconferencing -- and a second wireless technology named ZigBee, which receives data from medical sensors. ZigBee consumes considerably less power than Wi-Fi, so monitoring devices, including thermometers, pill dispensers, blood-pressure monitors, and pulse oximeters, can use small batteries to transmit data over long periods of time.
Home-based monitoring services like AT&T's -- which is approaching the trial stage -- could transform how doctors interact with their patients. "The health-care industry is under a lot of stress," says Bob Miller, executive director of AT&T's communications-technology research department, "so there's a drive to explore ways of delivering better care at lower cost." And greater convenience for both doctor and patient: If a physician notices, for instance, that a blood-pressure medication isn't working, or if the patient isn't taking the drugs regularly, she'll be able to arrange a videoconference with the patient to discuss solutions.
AT&T isn't alone in exploring telemedicine technology, and the good news is that firms in this growing niche are banding together. AT&T is a member of the Continua Health Alliance -- the group also includes Bayer, Cisco, GE, IBM, and Novartis -- which is working to make medical-monitoring devices interoperable.
(Source: Fast Company, January 15, 2009
Health Hero Network recently said that the first large-scale, multi-year rollouts and evaluations of its Health Buddy System have shown success in helping improve the care of high-cost Medicare beneficiaries and veterans while reducing costs and hospitalizations.
The Centers for Medicare and Medicaid Services announced this month that it is extending and expanding Health Hero Network's Health Buddy Project, designed to show how doctors, nurses, and patients using telehealth technology can improve care and reduce hospitalizations associated with chronic conditions such as heart and lung disease and diabetes. The three-year project, which began in 2006 at medical groups in Wenatchee, Washington, and Bend, Oregon, has been extended to January 31, 2012. The project, being conducted in partnership with the American Medical Group Association, will also potentially be allowed to expand to one additional site in the second year of the extended program.
The announcement comes on the heels of the U.S. Department of Veterans Affairs' publication of four years of data showing a reduction of 19 percent in hospitalizations and 25 percent in bed days of care among a population of 17,025 veterans enrolled in the VA's Care Coordination and Home Telehealth (CCHT) Program. Health Hero Network has been the leading provider of telehealth technology to the CCHT program.
The company's Health Buddy System, the telehealth platform deployed extensively by the VA and used in the CMS Health Buddy Project, helps individuals with chronic conditions stay healthier while empowering their caregivers with knowledge to keep complications from worsening to the point where those individuals need to be hospitalized. Since late 2007, Health Hero Network has been a wholly owned subsidiary of Robert Bosch North America.
The Health Buddy System supports individuals with chronic conditions in self-care, while keeping them in daily contact with their caregivers. Individuals who use the system get support in self-care behaviors -- including medication compliance, diet, and exercise -- tailored to their unique conditions. Their caregivers get an actionable stream of knowledge to make targeted interventions at the first sign of symptoms or gaps in behavioral or knowledge that -- left unremediated -- could lead to a painful and expensive hospitalization.
The Health Buddy Project is being conducted under Medicare's Care Management for High-Cost Beneficiaries Demonstration. The project brings Health Hero Network together with the American Medical Group Association, as well as Wenatchee Valley Medical Center in Wenatchee, Washington, and Bend Memorial Clinic in Bend, Oregon. The program's design involves supporting physicians, nurses, and Medicare beneficiaries with the Health Buddy System in a relationship that keeps those beneficiaries healthier and out of the hospital through self-care and early detection of complications.
"The programs in the demonstration have had a positive impact on selected high-cost Medicare beneficiaries and have met and/or exceeded the savings target required in the demonstration agreement," the Centers for Medicare and Medicaid Services said in a news release announcing the extension of the Health Buddy Project, as well as two other Care Management for High-Cost Beneficiaries programs. "By extending the demonstration for another 3 years and frequently evaluating their financial status, each of the programs would have the opportunity to continue to impact their populations, maximize savings, and assist CMS in determining the replicability of the programs."
In a groundbreaking study published December 31 in The Journal of Telemedicine and e-Health, VA clinicians revealed the outcomes of the first multi-year evaluation at scale of the agency's Care Coordination Home Telehealth Program. Researchers reported that telehealth initiatives successfully reduced hospitalizations by up to 20 percent and improved the overall health conditions of patients who used the systems.
VA researchers praised telehealth systems for being able to provide daily contact with a patient base dispersed over wide geographies and for the behavioral improvements seen in patients who were presented with daily assessments through telehealth devices. The study also cited the program's modest cost of $1,600 per enrolled patient per year. The VA plans to rapidly expand the deployment of its telehealth program, forecasting more than 50,000 patients will be monitored on telehealth systems by 2011.
"The policy effects that result from the implementation of CCHT are profound," VA researchers said in the findings of their recent paper. "If 50% of patients requiring (non-institutional care) can ultimately be managed in a way that means they get improved access to care at lower cost and higher quality, then this represents an important advance. It means that a low cost and flexible solution will be available to deal with the large numbers of patients with chronic care conditions that health care systems know they need to serve."
Renowned for ease of use, the Health Buddy System empowers patients and the people who care for them by improving patient self-care and behavior while enabling care providers to access timely information and intervene before conditions become acute. The system's features start with the Health Buddy appliance and other licensee devices that allow patients to communicate with healthcare professionals by answering a small number of daily questions related to their medical condition and activities. The system offers analytics that then stratify and present this data -- through a secure Web-based interface called the Health Buddy Desktop -- to empower healthcare professionals to quickly identify problems and take corrective action.
The Health Buddy System features health management programs delivering personalized daily monitoring and patient education in order to promote positive behavior change and provide timely, relevant, and actionable information to care providers; many Health Hero Network programs are certified by the National Committee for Quality Assurance (NCQA). Health Hero Network customers are using programs, delivered on the Health Buddy System, that cover a wide range of conditions including heart failure, cardiovascular disease, diabetes, asthma, COPD, and mental health.
(Source: Health Hero Press Release, January 23, 2009)
Therapy Source, has developed a service, TheraWeb, which allows face to face therapy sessions to be replaced with Web, audio and video conferencing sessions. The service offers patients and doctors a secure place to have therapy sessions free from viruses or access by uninvited parties -thanks to robust encryption and unique identity authentication.
The TheraWeb offering is used specifically for speech and language therapy. And, according to the company's latest news release, the services has helped youngsters in particular, to have access to specialists they require simply by using the computer and an Internet connection. Not only are computers a very well known and popular tool among the younger generation, but screenings, assessments and other therapies can be conducted at more flexible times and even when weather issues arise.
In one scenario, the solution is making it possible for a 12 year-old student to easily sign into the Web-based therapy service and take part in an interactive speech and language session with his therapist, Lisa Brady, who is physically located hundreds of miles away.
"TheraWeb eliminates the hurdles normally associated with therapy sessions, such as scheduling, travel time, location, expense, and the ability to locate a qualified therapist who is near the patient," Brady said.
"In addition, the computerized approach can raise patient interest in the therapy, particularly in children, who are very computer savvy. This technology is completely natural for them."
Therapy Source offers qualified speech, occupational, physical, psychological and related therapy services to educational and healthcare organizations in Pennsylvania, New Jersey, Delaware and Ohio.
(Source: TMCnet Healthcare, January 27, 2008)
Research and Markets, an international market research and data firm, recently announced the publication of a "Telemedicine and E-Health Law" report.
When do Medicare and Medicaid requirements (including reimbursement and fraud and abuse provisions) apply to e-health transactions? What liabilities are associated with telemedicine? The use of the Internet and high-tech communications in health care has led to new approaches to medical treatment-and to challenging legal questions.
Telemedicine and E-Health Law includes topics from the licensing requirements for physicians who provide medical services electronically across state lines to the HIPAA privacy issues raised by the sharing of electronic health records across computer networks.
This book includes also includes chapters on tax, antitrust, intellectual property, and other aspects of e-health-all packed with expert advice that will help you steer clear of difficulties. The report is updated as needed, generally two times each year. More information can be found on
their website.
(Source: Research and Markets Press Release, January 16, 2009)
12/14/2008
Medicare will now pay for nursing home patients to be treated by telemedicine, reducing the number of expensive trips to the hospital. The new federal rule allows nursing homes to charge a $20 facility fee for each patient using telemedicine. But they would need to spend several thousand dollars for cameras, monitors and secure broadband internet connections.
Traveling to see the doctor can be even more difficult for frail, elderly nursing home patients. That's why in Wadena, MN, some patients don't leave the nursing home when they have an appointment at Tri-County Hospital.
Hospital Telemedicine Manager Robin Klemek says they decided to monitor nursing home patients who have bedsores or other wounds by camera even though Medicare didn't fully reimburse for the care. She said that allows nursing home staff to talk directly to hospital staff, saves hospital staff the time spent traveling to the nursing home, and reduces the stress on, elderly patients who might otherwise need to be brought to the hospital for an exam.
"A lot of them were having to be brought in by stretcher and then they have to wait in the clinic for their appointment," explained Klemek. "It was just not a good situation, not a good way to provide patient care."
Not having to take a nursing home patient out into bitterly cold weather is an obvious benefit. But transporting those patients is also a big expense.
A study in Maine found an average savings of $580 for each nursing home patient seen with a telemedicine appointment.
There's not enough data to quantify how much money could be saved in Minnesota, according to University of Minnesota Professor Stuart Speedie, but he's looked at case studies where transportation added more than $1,000 to a patients doctor visit.
So it seems like an obvious place to save some health care dollars. But there's a catch.
Speedie points out that most nursing homes in Minnesota don't have the technology for telemedicine, and he doubts they will rush to buy that equipment.
"It will be a difficult decision for nursing homes to make to install this technology. Obviously nursing homes are not flush with cash to spend on such activities right now. They operate on a pretty thin margin as it is," said Speedie.
Practitioners say telemedicine equipment that cost $55,000 a decade ago can now be purchased for about $5,000.
Telemedicine savings would quickly pay for the cost of equipment, according to Stuart Speedie. But, most of those savings would go to Medicare or private insurers, not nursing homes.
Stuart Speedie said potentially, state government stands to see the most savings. "I think given the current economic situation and looking for every possible method of saving money and knowing how the costs of healthcare are increasing dramatically, I think states are going to have to move in the direction of much greater encouragement if not requiring more care be provided by telemedicine," said Speedie.
Its unclear how many nursing homes might consider becoming a telemedicine site. The Minnesota Long Term Care Association which represents the states nursing homes, declined to discuss the new Medicare rules. "I think it will be significant, but it's all about endless possibilities," said Minnesota Telehealth Network Project Director Cindy Uselman. "I think it's about what makes sense and I think more people are going to join in on it. It's time for more people to get on board and I think the conditions are right."
Tri-County Hospital Telemedicine Manager Robin Klemek won't speculate on how the Medicare rule change might expand telemedicine. But based on her experience in Wadena, she knows the potential.
"We know the patients are going to benefit. We know the doctors are going to benefit because they won't have to leave their clinic to go out for the morning. I think it's going to help their productivity because they won't have that windshield time," said Klemek.
The new Medicare reimbursement rule takes effect in January. The change also expands telemedicine coverage to community mental health centers and renal dialysis facilities.
(Source: Minnesota Public Radio, December 14, 2008)
12/14/2008
New guidance to improve access to telemedicine for EU citizens and healthcare professionals across
Europe was recently published. The European Commission telemedicine communication aims to increase and broaden telemedicine services, including diagnosis, treatment and monitoring at a distance across Europe.
The communication, which has been adopted by the Commission after two years of consultation, sets out ten proposed actions to promote telemedicine, including harmonization of standards and the removal of regulatory and legal barriers. Despite the potential benefits that telemedicine can provide, its use is still limited in most parts of the EU. The communication can be downloaded from
here.
"Telemedicine can radically improve chronically ill patients' quality of life and give people access to top medical expertise. It is our duty to make sure patients and health professionals can benefit from it" said Viviane Reding, European Union Commissioner for Information Society and Media.
EU Health Commissioner, Androulla Vassilou, commented: "Telemedicine tools can indeed deliver improvements both in quality of care and patient safety as well as increase access to healthcare. This means both better services for citizens, and more innovative and efficient health services".
The communication also aims to promote the development of Europe's telemedicine industry, already a multi-billion sector globally. It says the European telemedicine industry, especially SMEs, can tap the financial and clinical benefits from this expanding market, provided that barriers to development such as market fragmentation are addressed.
Better legal clarity within European countries on telemedicine and between them, are recommended as essential steps to speeding and spreading its adoption. Similarly enabling steps are called for on ensuring a European Union-wide broadband infrastructure and on interoperability of telemedicine devices.
Key actions are also proposed on communication to increase the confidence and acceptance of telemedicine services among users. Particular emphasis is given to encouraging provision and dissemination of scientific evidence of its effectiveness and cost effectiveness.
The communication defines the necessary steps to be taken by Member States, the European Commission and stakeholders including healthcare providers and the industry.
The telemedicine communication is based on an extensive consultation phase during 2007 and 2008 which involved Member States, health professionals, patients associations and industry representatives. It received strong support from all parties.
(Source: e-Health Europe, November 11, 2008)
The Dublin Mid-Leinster Stroke Network in
Ireland has secured 250,000 Euro, about $316,000 USD, of funding to finance a cutting edge telemedicine project to help stroke patients.
The funding will be used to purchase at least three remote presence solution (RP7) robots, which allow doctors to inspect and diagnose patients remotely via a laptop. It will also go towards buying 10 to 12 laptops, which will allow consultants to access the robot and diagnose patients.
The robots, one of which was demonstrated in Tallaght Hospital, Dublin, over the summer, are planned to be put in Tallaght, Naas, and Mullingar hospitals, Director of Stroke Services in Tallaght Hospital, Dr. Ronan Collins, told IMN.
Dr. Collins said that he was hopeful that additional robots can be acquired for Tullamore and Portlaoise hospitals, which are also part of the stroke network. "It marks a great step forward. This telemedicine technology is not only significant for stroke, but will allow physicians to make accurate diagnosis in a range of other specialties. The great thing about the particular system we are setting up is the flexibility it allows in diagnosing patients," he commented.
Dr. Collins said the robots will be particularly effective in delivering thrombolysis care. The roll out of the pilot project, which will last from between six to seven months, will begin in early 2009. Meanwhile, the HSE has gone out to tender for a framework agreement for the provision of non-invasive cardiology equipment worth in the region of 3 million Euros.
Ambulatory devices, electrocardiogram machines, and stress testing equipment are planned to be delivered under the framework agreement.
(Source: Irish Medical News, December 5, 2008)
The long-term prognosis for stroke patients is better at community hospitals equipped with monitoring technology, trained multidisciplinary teams, and teleconsultation capability, German researchers recently found. Hospitals that implemented such stroke unit treatment in the Bavaria region of
Germany significantly reduced combined death, institutional care, and disability among stroke patients by 35% at 12 months and by 18% at 30 months compared with other community hospitals, said Heinrich J. Audebert, M.D., of Charite Hospital.
"The set-up of stroke wards in community hospitals with appropriate facilities and education supported by telemedicine-linked academic stroke centers offers a new way to provide specialized stroke care in smaller hospitals," the researchers concluded.
Their Telemedical Project for Integrative Stroke Care (TEMPiS) compared five hospitals that implemented the stroke intervention with another five general community hospitals in the same in region but without specialized stroke services or telemedical networking.
The intervention included establishing stroke wards with multidisciplinary stroke teams trained through continuing medical education and monitoring facilities, developing standardized treatment protocols at the centers, and providing a 24-hour teleconsultation service through two academic stroke centers.
The researchers had previously shown three-month survival and dependency advantages at hospitals that made these changes and joined the telemedicine network.
To see what the long-term effects were, the researchers studied outcomes for the 3,060 consecutive patients with ischemic or hemorrhagic stroke admitted from July 2003 through March 2005 after the stroke care system was set up. After about two and a half years of patient follow-up, cumulative survival rates were 68.0% in the intervention group compared with 65.5% in the control group.
The intervention appeared to have its greatest effect early after stroke. The two hospital groups had the largest absolute difference in this outcome at three months (10.4% versus 9.3% at 12 months and 5.2% at 30 months). The impact of the intervention may have been offset by an increasing impact of other factors such as age and other diseases with time, Dr. Audebert and colleagues said.
They cautioned that the effect of the changes implemented at the community hospitals could not be attributed to telemedicine consultation alone because only 36% of admitted stroke patients at these hospitals had a teleconsult.
They pointed out that "in contrast to randomized, controlled trials that balance all observed and unobserved confounders between treatment and control groups, we cannot rule out that some unobserved differences in patient characteristics between the intervention group and the control group contributed to our results."
As an example, they noted that the intervention might have changed the characteristics of patients admitted to these hospitals because stroke patients in some areas were preferentially sent to intervention hospitals expecting better care.
(Source: MedPage Today, November 20, 2008)
Dr. Bitange Ndemo, the Permanent Secretary in the Ministry of Information of
Kenya, is not a medical doctor but has recently been advocating a new initiative to interlink hospitals across the country will bring to an end cases of misdiagnosis. The plan involves connecting all hospitals in Kenya with the Internet, partly to help doctors make informed diagnoses and even consult their colleagues via secured Internet traffic before they administer any drugs.
It appears the world of telemedicine is making a desperately needed entry into the Kenyan healthcare system. Misdiagnosis by doctors remains a serious problem in Kenya, with some local pathologists saying that almost 50 per cent of hospital deaths result from it.
With the new initiative, doctors manning rural dispensaries will be able to order medical supplies directly from the Kenya Medical Supplies Agency (Kemsa) at the touch of a button.
This will be a major break from the current situation where dispensary administrators usually order drugs and equipment through district hospitals, with obvious delays in delivery because of bureaucracy involved.
Dr. Ndemo says the Government is spending money to provide free broadband (internet traffic) to hospitals and universities across the country. The spending marks the advent of telemedicine in Kenya, the concept of providing medical services using various IT tools.
The hospitals are expected to use internal funds to buy a computer for Internet access. Globally, telemedicine is seen an answer to lack of medical services to remote areas in Africa, at a time when health related objectives are at the core of the millennium development goals, which aim to eradicate extreme poverty by 2015.
Telemedicine is not entirely new in Kenya, considering there was a rollout in Wajir, Mandera and Ijara districts in 2005, but this was done using high frequency (HF) radio similar to those used by police officers rather than computers. The impact has been positive, according to an impact study conducted in 2006.
It was found that the timeliness of month reporting by the district hospitals improved by 100 per cent in Mandera and Wajir hospitals when doctors and nurses started using interlinked HF radios.
The number of referral cases made by the hospitals in those districts improved tremendously. Cases referred by sub-district hospitals improved by 122 per cent while health centres rose by 94 per cent.
Linking of the hospitals is already being done via the fibre optic cable being rolled out across the country. However, this will only be useful when Kenya is connected to under sea fibre optic cable later next year. In the meantime, hospitals will access Internet broadband via the satellite.
The hospitals will also be equipped with a new system known as TelePresence, similar to the video-conferencing. This facility has been developed by Cisco Systems and will enable doctors and nurses at all levels of government to make consultations on the medical issues.
It will also facilitate the access of medical data via the Internet, access medical records and order drugs.
The roll out of telemedicine will go hand in hand with the implementation of Health Management Information System (HMIS), which is meant to interlink all government health facilities.
The government is working with the Aga Khan University Hospital to develop the system. The system will make it easy for the government to capture community healthcare data from the grassroots level.
This data will help in knowing what drugs to send to which places, hence improve the management of medicines. It will also enable healthcare workers to understand what measures to take in preventing certain diseases in specific areas.
An early warning system for diseases can also be developed by the use of community health care data to predict possible outbreaks or epidemics. He said the system will make it easier to connect the telemedicine program to a reformed National Health Insurance Fund (NHIF).
The Health Management Information System will also make it possible to generate Internet content on Kenya's medical issues, which is presently at dismal levels.
The telemedicine plan also involves what is known as e-learning, a concept where medical professionals are trained via the internet. Aga Khan University Hospital for instance has been using e-learning to train its personnel across East Africa.
An Israeli company known as E-Doctor World has also set up base in Kenya to train doctors and nurses through e-learning and provide technology that will make it easier to run telemedicine programs.
Another initiative seeks to replace the paper based system used by health centers in Nairobi for ordering and supplying anti-retroviral drugs. It is known as Wireless Reach Initiative spearheaded by a telecommunications company called Qualcomm.
It has provided an ordering system, software, laptops and Internet connection to 22 clinics across the city.
(Source: Business Daily Africa, November 18, 2008)
Children suffering from chronic ear diseases in remote indigenous communities in
Australia will be treated by Brisbane specialists in a telemedicine first.
The telemedicine initiative was recently trialed in Queensland's remote Cherbourg region, 300 kilometres north-west of Brisbane, will provide via an e-health mobile medical van specialist care to almost 1000 Aboriginal and Torres Strait Islander children who would otherwise be unable to visit a doctor.
E-Health project director Dr Anthony Smith said 85 per cent of indigenous children in the state were suffering from glue ear - painful perforations of the ear drum and subsequent hearing loss.
Glue ear, medically known as otitis media, is an inflammation of the middle ear which causes a build-up of fluid behind the ear drum.
Cherbourg Community Health Service's Cecil Brown heralded an epidemic in ear disease should indigenous children continue to be deprived of adequate health care.
"All our young kids are walking around with puss coming out of their ears and they're passing it on to their brothers and sisters and cousins," Mr Brown said.
"And those with perforations of their ear drum have just learnt to live with the excruciating pain."
He said the illness was crippling the community's youth, with the consequent hearing difficulties impairing a child's ability to learn.
He said many children with hearing difficulties were labelled as having behavioural problems.
"And all of our kids don't progress to senior school," he said.
Dr Smith said a higher rate of middle ear infections in the indigenous community compared to the wider community was caused by a number of factors including poor hygiene and a resistance to standard antibiotics.
A further outbreak was "inevasible", Dr Smith said, without rigorous screening.
A custom-designed vehicle, emblazoned with Aboriginal artwork, has therefore been converted into a mobile medical clinic and equipped with the tools necessary to screen children for ear diseases annually.
Health screening information collected by specially trained indigenous health workers will be stored in a secure online database, from which specialists at Brisbane's Royal Children's Hospital will be able to review cases, diagnose and recommend treatment.
"We hope to screen more than 90 per cent of children aged three to 15, and up to 1000 children annually, and contribute to improved health outcomes in the community," Dr Smith said.
"(This) will help ensure the early detection and monitoring of children at higher risk of developing the chronic disease.
"It will also ensure that treatment and follow-up services are delivered in the most efficient manner."
The three-year project will initially focus on detecting health conditions which impact on children's hearing and vision, as well as monitoring general health and well-being, Dr Smith said.
"However, there is potential to expand the screening service to include other specialties such as dentistry and dermatology," he said.
(Source: Brisbane Times, December 9, 2008)
