Telemedicine and Telehealth News 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)
by Dr. Raymond J. Petras, B.E., M.A., Ph.D.
Introduction
Telemedicine is the practice of health care delivery, diagnosis, consultation, treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation (ARS 36-3601).
Although telemedicine has been around since the 1960's (Bashshur and Lovett, 1977), it hasn't become an integral part of day-to-day sports medicine. High equipment costs, liability, and data security (media) concerns have lead to its slow introduction and limited use (Obstfelder et al., 2007).
What are some possible applications of telemedicine with athletes and sport participants? One application might be a consultation with a distant specialist to obtain the correct the diagnosis. Another might be the observation of the player's rehabilitation routine. A distant consult could help reduce his pain, improve his performance or act as a follow-up session whether he is on the sideline, in a medical facility, training room, or in a hotel room.
Athletes and sports medicine professionals would most likely utilize telemedicine methods of data transfer, diagnosis, and distant interactions with specialists that are available to the general public. However, for financial reasons or reasons that might put an athletic career in jeopardy, athletes have a greater need to return to play as quickly as possible.
At some point, it is possible that the elite athlete might obtain preferential treatment when utilizing telemedicine. But for now, professional and elite sport teams and individual athletes hesitate to utilize the new technology. This is because the athletes are accustomed to being face-to-face with medical professionals and have the financial means to do so (Grana, personal communication, August 26, 2008).
With high financial stakes, one would think that there would be a great deal of demand for telemedicine in university, elite, Olympic and professional (high-level) sports. This does not appear to be the case. Literature on its applications in sports is minimal. This is partly due to the inherent secrecy within professional and elite sports, and, in part, due to telemedicine not being mainstream.
Pain and Injury Telephone Triage
The following case shows that high-tech, costly telemedicine methods are not necessary to achieve meaningful, lasting results. This article will report on the conditions leading up to the use of the POTS (plain old telephone) connection to return a university football All-American tight end back to the field of play safely, quickly and at a high-level of performance.
Coach Vic Wallace, Head Football Coach, Lambuth University, Jackson, TN, relayed a story about his All-American tight end. When he was head football coach at the University of St. Thomas, St. Paul, MN, just before moving to Lambuth, he hired a "mental trainer", similar to a sports psychologist, to work with the team to enhance performance and injury management. He noted that his players after working with his mental trainer were performing very well. One day he said, "I made off-handed comment to my mental trainer. 'Wow!' I said, "This 'mental' stuff is working really well for performance, can you do anything for injuries?"
It was prior to the eighth game of the 1994 football season and Lambuth University was two wins away from a conference title and the national playoffs.
"We had an All-American tight end who was on crutches and unable to put weight on his ankle. He had been X-rayed by an orthopedic doctor who said he wouldn't be able to play," Wallace said. "On Thursday, I called my mental trainer and asked him if he ever worked with someone over the phone. He said he worked with an ice hockey player before, but it helps to see facial expressions.
"I put my player in my office and the mental trainer worked with him for 40 minutes over the phone. My player came out of the room carrying his crutches and his pain was gone. Coach Wallace was careful to point out that his mental trainer always worked in conjunction with the team's physicians and trainers, on the sidelines and in the training room. And he stated, "They had the final say as to whether the athlete was healthy enough to play and they give him the okay. We went on to win the conference and we made it into the national playoffs (Bassetti, 2001, n.p.; Petras, in press)."
Potential Problems for Using Telemedicine in Sports
Using telemedicine for pain and injury management could pose several problems. One, without meeting or seeing the athlete in-person, the athlete's condition or responses could be misinterpreted. Two, the exchange between the athlete and the specialist might be too impersonal and negatively affect the athlete. Three, the athlete may not confide with the specialist like he would in-person. And four, if the specialist were to misinterpret some key issue, the athlete might be reinjured or become more severely injured. That would put the specialist at risk for a malpractice lawsuit. Although face-to-face is ideal, it is not always possible.
The above projected problems and concerns with working over the phone are valid. However, with the correct protocols, checks and balances, problems can be minimal to nonexistent.
Recommendations
In introducing telemedicine, one should utilize what is available. It is not necessary to have expensive or high-tech equipment. There are many advantages to using a telephone: 1. It is convenient: the athlete can be anywhere there is a phone. 2. It is less expensive than video conferencing and 3. Available 24/7. Coverage is possible except in the most very remote locations and no other special equipment is necessary.
Conclusion
We must not lose sight of low tech and simple, thoughtful telemedicine interventions. With the telephone, a good physician or skillful consultant can work wonders with little expense, as reported. As these successful cases build the public's awareness, and demand for access to these applications will increase.
Telemedicine's potential is well summed up by Dr. Devi Shetty:
"In terms of disease management, there is [a] 99% possibility that the person who is unwell does not require [an] operation. If you don't operate you don't need to touch the patient. And if you don't need to touch the patient, you don't need to be there. You can be anywhere, since the decision on healthcare management is based on history and interpretation of images and chemistry…so technically speaking, 99% of health-care problems can be managed by the doctors staying at a remote place—linked by telemedicine." (Bagchi, 2006)References
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)
Unable to send stroke specialists to every emergency room, a growing number of medical centers that specialize in stroke are bringing their expertise to patients through telemedicine.
"People who have strokes in isolated areas are pretty much dead in the water. You need to give them a lifeline to stroke centers," said Dr. L. Nelson Hopkins III, chief of neurosurgery at Kaleida Health and chairman of neurosurgery at the University at Buffalo.
Based at Millard Fillmore Hospital, Hopkins leads the most advanced stroke telemedicine system in New York State, with connections to 10 smaller hospitals in the region.
Telemedicine isn't new, but applying it to stroke is.
Early evidence from Buffalo and elsewhere suggests that telemedicine links improve the chances that patients will survive a stroke and avoid paralysis and other major problems.
Carney believes that the telemedicine link played a part in her getting treated quickly enough to avoid devastating brain damage.
"I was eventually able to walk out of the hospital and am still able to speak," said Carney, whose left arm remains paralyzed.
New York started a telemedicine initiative in 2006 to address the lack of neurologists and neurosurgeons in rural areas. The program is modeled after a system at the Medical College of Georgia that uses a technology called REACH, or Remote Evaluation of Acute Ischemic Stroke, to establish connections between hospitals and evaluate patients' risks.
"The technology gives smaller hospitals access to neurologists, and can be used for other services like psychiatry and trauma," said Dr. John Morley, medical director in the state's office of health systems management.
Millard Fillmore, a state-designated stroke center, acts like a hub to 10 spoke hospitals, including Niagara Falls Memorial, Brooks Memorial in Dunkirk, Olean General, Medina Memorial and Wyoming County Memorial.
Other REACH systems in New York operate in Syracuse, Rochester and Cooperstown. In addition, the Catholic Health System last year established a telemedicine link between its stroke center hospitals and Mount St. Mary's Hospital in Lewiston.
"Telemedicine allows us to provide a higher level of care wherever the patients show up," said Holly C. Bowser, vice president of neurosciences at the Catholic Health System.
In many instances, patients who might have suffered a stroke first show up in smaller hospitals and then often get transferred to stroke centers too late to be treated with tPA, a clot-busting drug that stops the progression of a stroke. The drug must be given within three hours after symptoms start.
The faster a patient receives treatment the less chance that brain cells will die.
Carney, an assistant women's basketball coach at Geneseo State College at the time of her stroke last year, arrived at Olean General's emergency room in time to get tPA. But the drug, which does not work in every patient, didn't solve her problem.
Based on the telemedicine evaluation, she was quickly transferred to Millard Fillmore, which specializes in procedures to reopen blocked blood vessels. Doctors there inserted a tiny tubelike device called a stent in her brain to restore blood flow through a damaged artery.
"I'm a poster child for telemedicine," said Carney, who hopes to return to coaching if she regains movement in her arm with therapy. "There are so few stroke specialists in [Cattaraugus County]. It's really important to be able to get rapid access to that level of care."
Telemedicine for stroke remains a work in progress. It costs hospitals here about $25,000 for a three-year contract with Millard Fillmore. That may seem like a relatively minor amount, but it is a challenge for smaller facilities that may question whether telemedicine is that much more valuable than having emergency room doctors consult with stroke specialists by phone.
There are no standard national guidelines yet for stroke telemedicine. There is little research on its effectiveness, although studies indicate that the technology is worth pursuing.
In addition, private health insurance companies have yet to create separate reimbursements for telemedicine that can cover the cost of equipment and technical support.
"We believe telemedicine is cost-effective for stroke, but we also need to do the research to show it. We see many more patients getting tPA, and that's more cost-effective than caring for people who've suffered a stroke," said Dr. Bart M. Demaerschalk, a Phoenix neurologist who reviewed the state of the field in a recent issue of Mayo Clinic Proceedings.
Hopkins said that one of the biggest benefits of the program is that it is increasing awareness among patients and emergency room personnel about stroke and its treatments.
But he also argues for a reevaluation of the state's stroke center designation, which New York has given to 114 hospitals, saying the current practice of taking suspected stroke patients to the nearest stroke center doesn't always make sense. Instead, he advocates a higher designation for hospitals that can provide newer, interventions round-the-clock to restore blood flow in the brain.
With growing awareness of stroke, Hopkins said, there are more patients who are candidates for the interventions, and those patients should be transferred to hospitals that can provide the latest therapies in a timely manner.
(Source: Buffalo News, April 21, 2009)
The Federal Communications Commission (FCC) recently announced the approval of $35.6 million in funding under its Rural Health Care Pilot Program (RHCPP) for the build-out of five broadband telehealth networks that will link hospitals regionally in Iowa, Minnesota, Montana, Nebraska, North Dakota, South Carolina, South Dakota, Wisconsin, and Wyoming. In addition, $10.4 million in funding has been approved for the design of a telehealth project in Alaska. Collectively, these projects are eligible to receive $46 million in reimbursement for the engineering and construction of their regional telehealth networks.
The FCC established the $417 million RHCPP to increase patient access to care via telemedicine and support the transfer of electronic medical records, which will improve the quality of care for patients. Nationwide, 67 projects are eligible to receive RHCPP funding for telehealth networks serving 6,000 health care facilities in 42 states and three U.S. territories, using broadband technology to bring state-of the-art medical practices to isolated rural communities. At this time, 29 of these projects have developed or posted requests for proposals to select vendors to build out their broadband networks, while the remaining projects are preparing their requests for proposals as part of the competitive bidding process.
"I am pleased with the progress that these rural health care initiatives are making to develop telemedicine programs, build highways for electronic medical records and, overall, increase patient access to health care in the regions they serve," Acting Chairman Michael J. Copps said. "There is great potential to improve health care for those communities that currently have limited access to primary, specialty and preventive care; as well as to enhance public safety by connecting health care providers, public health officials and first responders to these networks so that they can share crucial data during emergencies."
The following is an update on specific RHCPP projects:
The Ohio Telehealth Video Resource Center (TVRC), a not-for-profit center recently launched a web site to make the center's video conferencing services available to physicians and healthcare education professionals worldwide. TVRC serves as an international resource center and video hub of telehealth activities for statewide, national, and international activities. The TVRC site provides video conference hardware and software requirements that has scheduling tools, telehealth news, instructions, and an e-health forum.
"TVRC supports the use of high quality video for health education and training, research, and associated clinical activities," explains Charles R. Doarn, the Center's Executive Director. "Healthcare providers with little technical experience can easily access TVRC resources to communicate via high-quality video conferencing with other health providers."
TVRC clients have the opportunity to share "grand rounds" where doctors can meet to discuss multiple patients, see demonstrations on new and emerging clinical practices, hold multi-center interactions, and conduct clinical trials and other research projects. The Center also provides a technology forum for the continued development of telehealth processes and standards.
Several years ago, Ohio invested in telehealth by advancing a statewide fiber optic network and then piloted telehealth projects at the Ohio Academic Resources Network (OARnet), the technology infrastructure arm of the University System of Ohio. OARnet established TVRC an international resource partnering with the World Bank, Internet2, and the Ohio supercomputer Center.
Early telehealth projects included a series of video conferences with U.S. trauma specialists sharing insights with healthcare professionals in Latin America, Africa, and South Asia. Another pilot project involved U.S. surgeons demonstrating orthopedic knee surgery for colleagues in China.
TVRC is empowering change and the video resources are benefiting a wide range of applications in both clinical environments and the classroom. For example, the Nationwide Children's Hospital's eNICU in Columbus Ohio uses high definition video permitting neonatal experts to examine infants at rural and remote locations.
Another innovative project, the International Virtual e-Hospital Foundation (IVeH) is a non-profit organization supported by the Department of State and based in Anchorage Alaska. IVeH was created to help rebuild the medical system in Kosova and other developing countries by implementing telemedicine, telehealth, and virtual educational programs.
Another group the Medical Missions for Children dedicated to serving the medical needs of catastrophically ill children in underserved international areas is using the Global Telemedicine and Teaching Network to help children in need. The GTTN also broadcasts continuing education programs and supports telemedicine consults among a global network of medical specialists.
(Source: Federal Telehealth News, April 29, 2009)
The Office of Superintendent of Public Instruction (OSPI) in Washington State is providing a bidding opportunity on a Request for Proposal (RFP) for a "Special Education and Related Services Teletherapy Pilot Project".
OSPI is initiating this RFP to solicit proposals from firms, school districts, institutes of higher education, medical facilities, and other agencies interested in participating on a project to develop, implement, and evaluate a teletherapy pilot program to provide designated special education and/or related services to students with disabilities ages three (3) through twenty-one (21) from rural, suburban, and urban locations within Washington State. The objective is to provide speech language, occupational, and physical therapy services via point-to-point teletherapy technologies in pilot public school districts that, due to unfilled personnel vacancies and/or personnel shortages, do not currently have the required special education-related service providers to implement services identified on special education students' individual education plans.
For more information, please read the complete RFP file available here.
(Source: OSPI Press Release, April 24, 2009)
An Oregon state bill that would expand opportunities for Oregonians and their doctors to take advantage of telemedicine passed recently passed the state senate. Senate Bill 24 requires health insurers to cover telemedical health service if that service otherwise is covered by the plan.
Access to health care services, especially specialists, is a major challenge for rural Oregonians in particular. Allowing patients to seek consultation through telemedicine will save time and money, backers say.
The bill now goes to the House for consideration.
(Source: Salem Statesman Journal, April 8, 2009)
Blue Cross and Blue Shield of Minnesota plans to offer its 10,000 employees and dependents the chance to use a "virtual clinic," an Internet site that can connect them with a doctor for a live 10-minute consultation for a flat fee.
When the system goes live this fall, doctors throughout Minnesota will be able to use a videocam or instant messaging to diagnose and treat anything from headaches to urinary infections in patients they've never met in person.
The virtual clinic is just a pilot project at this point. Blue Cross officials say they want to work out the bugs before rolling it out to the public.
Blue Cross officials are betting that this kind of technology will play a pivotal role in transforming health care -- making it far more convenient than ever, and saving money in the process. In fact, many Twin Cities clinics are trying to reinvent the doctor visit, using the Internet and other technologies to deliver care in new ways.
Today, patients must go to the doctor's office because that's how doctors get paid, said Patrick Geraghty, president and CEO of Blue Cross and Blue Shield of Minnesota.
"We want to change that model," he said. He argues that many doctor-patient encounters could be handled virtually, saving expensive trips to the clinic or emergency room.
"We think there's a productivity impact as well," he added. "If you can have an online transaction, you may not have to spend that half a day where you have to go over and wait at a physician's office. That may be an online transaction that happens in minutes.
Dr. Roy Schoenberg, who created the virtual-clinic software, said he tried to inject new meaning into the phrase "the doctor will see you now."
If a woman needs an obstetrician-gynecologist, he said, the virtual clinic "will get [her] within seconds in front of a live credentialed ob-gyn."
For Minnesota patients, the clinic will only use doctors licensed within state, said Schoenberg, president of a Boston-based software company, American Well. "These are the same ob-gyns that are on the provider network of the health plan," he said. "These aren't just any doctor Joe Schmo."
The software is designed to match patients and doctors automatically. A screen pops up, asking patients if they'd like to talk with the first available generalist, pediatrician or other specialist. If they're not sure, a series of questions pops up on the screen to help narrow the search.
Then a "matching providers" list appears, with photos and short bios on selected doctors, complete with data on their training, location and what languages they speak.
If they're available immediately, a green button says "connect now." If they're busy, there's an amber button to "enter waiting room."
With a webcam, the patient and doctor can watch each other as they talk, or exchange instant messages. In one corner, a digital timer keeps track: "Time Remaining, 3:50."
Schoenberg says that, statistically speaking, 10 minutes are usually enough. "That's typically longer than what you have when you're sitting in a physician's office," he said. The doctor also will have access to the patient's electronic medical record, drawn in part from Blue Cross claims data. And every new encounter becomes part of the permanent record.
So far, only one state, Hawaii, is using the system.
Hawaii Medical Service Association, the Blue Cross affiliate, introduced its virtual clinic in January; so far, more than 140 doctors have signed on, and more than 1,000 patients have registered to use it, said spokeswoman Laura Lott. The doctors receive $25 for each 10-minute session (more if it's after 10 p.m.); patients pay a $10 copay (for Blue-Cross members) or $45 (for nonmembers.) So far, Lott said, there have been "hundreds of conversations," many of them about colds, flus, rashes, muscle aches and strains.
In Minnesota, Blue Cross officials haven't worked out all the details, but they plan to go one step further. They're setting up special kiosks in Blue Cross office buildings in Eagan and Virginia, Minn., to encourage employees to use the virtual clinic during work hours. The kiosks may be equipped with electronic monitors, for example, to take their blood pressure or other simple tests.
"There's a lot of exciting new technologies coming on the market that will allow for monitoring of patients from a distance," said Geraghty.
(Source: Minneapolis Star Tribune, April 13, 2009)
Construction for the North Country Telemedicine Project in New York is slated to begin in May. The project will allow nearly 30 north country health care facilities to exchange information on site with each other and facilities in Onondaga and Oneida counties.
The Development Authority of the North Country was chosen from among proposals submitted, and is awaiting a contract with the Fort Drum Regional Health Planning Organization, which is heading up the telemedicine effort.
David M. Wolf, DANC's general manager for its open access telecom network, said after permitting and material ordering takes place, fiber-optic cable will be hung on poles and equipment will be installed at customer locations.
The project will be made possible through DANC's 700-mile fiber-optic cable network, which was designed to help businesses be more competitive, attract business and offer enhancements for educational, governmental and health institutions.
"The project overlays very well with our network," he said. "Most of these sites are close to where we already were. In terms of fiber, we have to have an extra 15 miles of additional build-out."
In 2007, the health planning organization was awarded $1.98 million from the Federal Communications Commission to create an electronic network connecting the hospitals in Jefferson, Lewis and St. Lawrence counties. Two dozen community clinics, county public health offices and regional hospitals in Syracuse and Utica also will be a part of the telemedicine project.
The health planning organization provided a cash match of $190,000 to the FCC money, while the project's participants provided the two-year service delivery cash match of $160,000, for a total match of $350,000.
Denise K. Young, the health planning organization's executive director, said the telemedicine project has made good progress with the construction announcement.
"After a lot of planning, ground work and effort with our partners, we're finally prepared, moving forward and moving toward getting fiber," she said.
Many of the hospitals have some connectivity now, but the telemedicine project will expand their ability to deliver telemedicine and to complete the move to electronic record-keeping, she said.
The fiber-optic lines will allow the facilities to share data in the fields of radiology, cardiology, dermatology and behavioral health. Physicians will be able to have video conferences with specialists or review a digital image in the office.
"Some of our hospitals will come online before others," Mrs. Young said. "They really need the fiber, and are ready for it to happen."
(Source: Watertown Daily News, April 9, 2009)
Hoping to combat rising medical costs, Illinois prison officials have quietly begun investigating a new way to treat inmates.
A review of state documents shows that Illinois Department of Corrections Director Roger Walker met late last year with a top doctor from the Texas prison system. The subject of their Dec. 11 meeting at corrections headquarters in Springfield was telemedicine, in which inmates receive medical advice from a doctor linked to the prison via video conferencing equipment.
The concept, already in use in Texas, California and elsewhere, is drawing a cautious response from the state's largest public employee union, which represents correctional officers, nurses and other workers within the sprawling state prison system.
"We don't know what they might be looking at. At face value we don't believe telemedicine in a prison setting is a good idea," said Anders Lindall, spokesman for the American Federation of State, County and Municipal Employees union.
Prison officials say the idea could result in some savings to taxpayers.
"That is another avenue we are looking at to combat the rising medical expenses," said corrections spokesman Derek Schnapp.
The projected savings could come by avoiding the expense of transporting an injured or ill inmate to an outside medical facility.
At their meeting, Walker met with Dr. Owen Murray of the University of Texas Medical Board, which oversees prison medical services in the Lone Star State. Schnapp said the two discussed ways of saving money through video consultations.
Murray, an Illinois native, oversees the medical, mental health and dental services for more than 120,000 offenders within the Texas Department of Criminal Justice. Illinois' prison system contains about 45,500 inmates.
It isn't clear how much Texas saves by using telemedicine. Murray could not be reached for comment.
A survey by the U.S. Department of Justice found Illinois spent about $73 million on medical costs in 2001. That translates into about $1,605 per inmate each year.
Eight years later, Illinois officials report that the cost of health care at state prisons has risen more than 60 percent to $118 million overall, or about $2,593 per inmate.
Schnapp said there is no time-table for implementing telemedicine.
Rather, he said, "It's an exploratory type thing. Maybe it would help us on cutting down costs."
(Source: Illinois Quad City Times, April 23, 2009)
A new telemedicine robot was recently unveiled at Mercy Folsom Hospital in California. The robot, a diagnostic tool, can be operated by a neurospecialist in another city to examine a stroke patient in Folsom. The robot was purchased using a $500,000 donation made by the Elliott Family Foundation.
Mercy Hospital in Folsom is the first in the Sacramento region the use the new telemedicine technology, according to Dr. Asim Mahmood.
"When a stroke happens, time is critical and patients need treatment as quickly as possible," said Mahmood, Mercy's regional medical director of neurovascular medicine and neurology. "The telemedicine program allows Mercy stroke specialists to evaluate a patient in a matter of minutes and that access to care could be life-saving."
(Source: Folsom Telegraph, April 24, 2009)
Mountaineer Doctor Television provides telehealth and education services throughout West Virginia and Maryland. Currently, there are 42 member sites in West Virginia and one in Maryland.
Dr. Maggie Jaynes, a pediatric neurologist and WVU School of Medicine professor, has been conducting telemedicine consultations for a little more than 10 years through a location in Lewisburg. She began telemedicine consultations in Martinsburg last year.
"The numbers of telemedicine clinics are increasing," she says. "I probably see 20 kids a month this way."
She says the program makes a lot of sense. Having the specialist seeing the patient via video allows the patient to keep that personal relationship with their primary care physician; that physician and the specialist can coordinate a lot via electronic medical records, the telemedicine consultation or other means.
"As a group, we can develop a plan for the patient," says Dr. Jaynes. "We can pass information easily, and the primary care physician can give me good feedback because he or she is seeing the patient on a regular basis and knows what is going on in the patient's life that may be affecting that patient."
"Every state has one if not more telemedicine networks," says Chris Budig, director of development for Mountaineer Doctor Television, WVU Health Sciences Center. "It's becoming more prevalent - Kansas, Texas, Kentucky, Pennsylvania, Ohio, California and Wyoming have massive networks. West Virginia is not as giant as some, but for the most part, the West Virginia medical community has been very active since beginning to get telemedicine in the state."
He says telemedicine is not a new concept.
In the 1950s in Nebraska, the psychiatric profession used micro TV technology.
In the 1970s in Boston at Logan Airport, Budig says they used telemedicine in disaster planning and implementation programs.
In the 1980s, companies were working on compressed video for NASA and the U.S. military. Video conferencing was perfect for use on the battlefield. The technology became available to the public in the late 1980s. Fortune 500 companies started using the technology for video conferencing.
The first groups to use it for medicine were WVU, University of Kansas and University of Georgia, in the early 1990s.
An Appalachian Regional Commission grant in 1992 kick-started MDTV. Later, grant funding from the Federal Office of Rural Health Policy expanded the program.
Overseen by WVU School of Medicine, MDTV has more than 40 sites throughout the state, and Budig says 19 more are being added. Those sites in this area include Harpers Ferry Family Medicine, City Hospital, Veterans Affairs Medical Center and Michael Medical in Moorefield. In Maryland, a nearby site is Garrett County Memorial in Oakland.
Telemedicine clinics are currently available in pediatric neurology, psychiatry, rheumatology, nephrology, endocrinology and dermatology. Budig says the need ebbs and flows, so clinics are adjusted accordingly.
Patients must get a referral from their primary care doctor for telemedicine clinics, and Budig says some insurances may not cover the cost as it may not be considered a necessity. Some insurances accepted are mountain State Blue Cross Blue Shield, Medicaid, Medicare and PEIA. Patients may need to find out in advance if they are covered for telemedicine clinics.
Budig points out also that because the time is blocked out as a video conference clinic, the patient is seen closer to the exact appointment time than some in-office visits may be in typical doctor's office.
"This is a patient service, not a doctor service," he says. "It's easier for a family practitioner to send someone to another city than setting up a schedule of telemedicine appointments. But it's a wonderful service to families because it does not disrupt their lives so much; so, we are asking primary care doctors to go the extra mile. A doctor who does not have the equipment can refer a patient to a facility that has the equipment."
(Source: Martinsburg Journal, April 12, 2009)
In a new study funded by NIH, educators overwhelmingly embrace Behavior Imaging technology as a telemedicine tool for more effectively treating children with autism. Dr. Uwe Reischel, M.D., Ph.D, of Boise State University coordinated a study that examined not only the efficacy of "B.I. Capture" (a behavior imaging tool that captures and stores behavioral events via remote control video) in treating students with autism, but also looked at how easy it is for teachers and behavior specialists to use the technology.
"We are finding that autism educators are receptive to using telemedicine and specifically B.I. than we had originally expected," noted Reischl. "This is especially so for participants who not only want to use it for behavior analysis, but who also see it as a useful tool for assessing student skills, giving or receiving consultation, and for training students and staff."
Behavior Imaging was initially developed by the Georgia Institute of Technology and is now marketed by Caring Technologies/TalkAutism in Boise, ID. The system is able to capture on video, a child's behavioral episodes in educational, clinical, and home environments. Behavioral data is captured on video and then the video is used to characterize recognized aspects of behavior to assist in the diagnosis, treatment, and research of autism. The video can be viewed, annotated, and stored online, so that behavioral experts can guide students progress from anywhere in the world.
An earlier phase of the study demonstrated that the technology enabled a 43% reduction in errors when collecting data for the Functional Behavior Assessment program. Now in addition to more effective clinical diagnoses and treatment, behavior imaging can help qualified practitioners save time and money by not always observing autistic behavior in people in person.
"B.I Care" is another platform now used by professionals to diagnose, evaluate, treat, train, and provide remote consultation for autism, TBI, PTSD, and other conditions. The new system B.I. Care will be unveiled and exhibited at the ATA Annual Meeting in Las Vegas and complements B.I Capture.
For more information go to www.bicapture.
(Source: Federal Telemedicine News, April 22, 2009)
Wireless Cardiac telehealth systems are not only advancing care, they're turning into marketing tools that companies can use to sell surgeons on their pacemakers and other implanted cardiac devices (ICDs). The pitch? Home-monitored patients should have fewer health problems, but only those with compatible implants can sign up for each provider's service.
Medtronic dominates the cardiac telehealth market with its CareLink patient network. Launched in 2002, it boasts 350,000 patients in 20 countries, with 12,000 more enrolling each month. But the company's lead may narrow. St. Jude Medical is now rolling out the latest update of its competing Merlin.net network. The new product should help St. Jude grab 5 to 7.5 percentage points of the global $6.5 billion ICD market over the next five years, projects UBS Securities (UBS) analyst Bruce Nudell.
Marketed as an all-in-one package, St. Jude's Merlin line includes several implanted devices that connect to Merlin.net, an Internet-based repository from which authorized doctors have access to patient information. The third version was approved by the U.S. Food & Drug Administration on Mar. 22.
The new software can combine hundreds of measurements taken from medical devices with other information stored in electronic health record databases such as Microsoft's Health Vault and Google Health to predict changes in a patient's health. St. Jude, based in St. Paul, Minn., says the system also has better doctor alerts and comes in more languages. The network is a free service to those with enabled devices.
St. Jude began selling the network across Western Europe in late April. Though Medtronic's CareLink is already on the market in Europe, St. Jude beat Boston Scientific (BSX). So far, the $4.36 billion company has signed on more than 40,000 patients and 1,200 clinics, with patient enrollment growing 17% month over month and clinic enrollment growing 19%. "St. Jude is continuing to advance toward the cutting edge of technology and should gain the most share in 2009," says Christopher Warren, an analyst at Caris & Co. in New York.
Medtronic, though, doesn't seem too worried about St. Jude's advance. The Minneapolis company had $13.52 billion in 2008 revenue and commands about 45% of the global ICD market, with the other 55% split almost evenly between St. Jude and Boston Scientific. Having Europe well covered, Medtronic plans to introduce CareLink to another 10 countries this year. (It's also free for patients with a Medtronic device.)
Medtronic says its head start and scale give CareLink an edge. Users have provided 4 trillion pieces of health data, enabling Medtronic to write better algorithms to keep watch on patient care. "There's always been someone coming after us, but we have been the leader and will continue to be," says Pat Mackin, Medtronic's senior vice-president of cardiac rhythm disease management.
(Source: Business Week, April 27, 2009
Tunstall Healthcare recently announced the launch of its RTX3371 telehealth monitor - an interactive telehealth device with in-built GSM/GPRS mobile phone technology that collects vital signs wirelessly from a range of external devices such as weight scales and blood pressure cuffs.
In addition, the RTX3371 telehealth monitor's spoken voice functionality allows it to collect subjective patient information from patient questionnaires, and to automatically transmit the data to a clinical backend software application based on an open architecture interface.
According to Anthony Taroni, Director of Sales at Tunstall: "The availability of GSM/GPRS cellular coverage in the USA and the rapid increase in the number of people replacing regular phone lines with wireless and mobile phones has set new standards for home hubs and the way they provide connectivity in order to ensure effective telehealth delivery. This wireless device offers service users the freedom to place the device anywhere in the home independent of phone plugs, increasing user satisfaction and acceptance."
SourceL Tunstall Press Release April 30, 2009
NuPhysicia recently launched their Medicine At Work service, which brings retained physician services to the workplace, using video telemedicine to connect board certified doctors and patients.
Medicine At Work delivers innovative medical instruments, telecommunications equipment, and, through its retained physicians, professional healthcare services directly to employees at their place of work. Using two-way video, the doctor providing services to Medicine At Work conducts examinations in real-time with the assistance of a specially trained on-site paramedic.
Melody Reid, NuPhysicia's Executive Director for Employee Health Services, said, " Industry research shows that on-site care enables employers to control healthcare costs, while giving employees convenient access to medical attention from physicians at work during business hours. Employees visit Medicine At Work clinics at the worksite for doctor visits, prescriptions when needed, one-on-one wellness coaching, and other healthcare needs, without the time away from work and expense normally associated with seeing a doctor."
Dr. Michael Davis, Senior Vice President of NuPhysicia, stated, "Through the physicians associated with this program, Medicine At Work(TM) offers a full-time medical presence in the workplace, blending high technology telemedicine and high touch. The doctors use innovative tools and equipment and secure electronic medical records (EMRs), and develop an old-fashioned doctor-patient relationship with the focus on improving employee health."
A Medicine At Work clinic is cost-effective and space-efficient to outfit, needing only a minimum of 12 X 12 feet of space, an electrical outlet, Internet connection and a door for privacy at the employer site. Medicine At Work provides all furnishings, equipment, clinic staff and medical care services for a fixed monthly cost per employee.
(Source: NuPhysicia Press Release, April 16, 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)
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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)
Veterans with chronic conditions can manage their health and avoid hospitalization by using home telehealth technology provided by the Department of Veterans Affairs (VA) in their homes, according to a recent study. The study found a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations for patients using home telehealth. The data also show that for some patients the cost of telehealth services in their homes averaged $1,600 a year - much lower than in-home clinician care costs.
"The study showed that home telehealth makes health care more effective because it improves patients'' access to care and is easy to use," said Secretary of Veterans Affairs Dr. James B. Peake. "A real plus is that this approach to care can be sustained because it's so cost-effective and more veteran-centric. Patients in rural areas are increasingly finding that telehealth improves their access to health care and promotes their ongoing relationship with our health care system."
The authors of the study in the current issue of the journal Telemedicine and e-Health are VA national telehealth staff members. The study looked at health outcomes from 17,025 VA home telehealth patients.
VA''s home telehealth program cares for 35,000 patients and is the largest of its kind in the world. Clinicians and managers in health care systems, as well as information technology professionals, have been awaiting the results of the telehealth study, said Dr. Adam Darkins, chief consultant in VA's care coordination program, who led the study.
"The results are not really about the technology, but about how using it helps coordinate the full scope of care our patients need," said Darkins. "It permits us to give the right care in the right place at the right time."
The VA's Under Secretary for Health, Dr. Michael J. Kussman, said the key to the program's success is VA's computerized patient record system. "Data obtained from the home such as blood pressure and blood glucose, along with other patient information in the electronic system, allows our health care teams to anticipate and prevent avoidable problems," he said.
VA health care officials emphasize that home telehealth does not necessarily replace nursing home care or traditional care but can help veterans understand and manage chronic conditions such as diabetes, hypertension and chronic heart failure. Patients'' partnership with the medical team can delay the need for institutional care and maintain independence for an extended time.
(Source: VA Press Release, March 25, 2009)
HRSA's Office of Health Information Technology (OHIT) recently posted information on the Telehealth Resource Center Grant Program (HRSA-09-195). The grant program administered by the Office for the Advancement of Telehealth within OHIT supports the development of Telehealth Resource Centers as an independent source of technical assistance to help healthcare organizations, networks, and providers implement cost effective telehealth programs. This is mainly to help serve rural and medically underserved areas and populations.
The program will provide funding for fiscal years 2009-2011. Approximately $1,800,000 is expected to be available annually to fund six grantees. The grant application is due April 22, 2009. Matching funds and cost sharing are not required for these grants. The maximum award for an individual Regional Center will be $325,000 for FY 2009 with the maximum award of $175,000 for the National TRC for 2009.
Eligible applicants can include public and private non-profit organizations and institutions, including state and local governments. The regional centers can be collaborative organizations composed of more than one entity, but only one entity can be the official applicant for the funding�all others can be members of the consortium or network. For profit entities may be part of a consortium but cannot be the grantee.
For more information, go to www.grants.gov or contact Monica M. Cowan, Public Health Analyst, Office for the Advancement of Telehealth at 301-443-0076.
(Source: Federal Telemedicine News Update, March 15, 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)
Remote patient monitoring technology enables healthcare providers to treat patients before their conditions becomes more acute, according to a new study from the Spyglass Consulting Group. According to the study, remote monitoring not only saves unnecessary trips to the emergency department but prevents re-admissions to the hospital. An estimated 97 percent of healthcare organizations rely on remote patient monitoring to improve clinical outcomes for critically ill patients, the study says.
Trends in Remote Patient Monitoring 2009 is a follow-up to the Spyglass Consulting Group's 2006 report on the same topic. Spyglass is based in Menlo Park, Calif.
"Early adopters of remote patient monitoring solutions are capitated managed care organizations having fiscal responsibility for their patients across the continuum of care," said Gregg Malkary, managing director of Spyglass. "These organizations include health maintenance organizations, integrated delivery systems, home health agencies, hospices, disease management companies and government agencies like the Department of Veterans Affairs."
Among the key findings are:
Forty-eight percent of healthcare organizations interviewed have funded home telehealth initiatives themselves. A strong return on investment exists for healthcare delivery networks serving as provider and payer, including such organizations as Kaiser Permanente and the Veterans Administration.
Convergence with consumer electronics products enables patients to use devices with which they are already comfortable, including smart phones, personal computers and cable boxes. Prices for remote patient monitoring devices and associated peripherals need to drop from several thousand dollars to less than $500 per unit before healthcare organizations will make further investments to support their patients with other chronic diseases.
Healthcare payers are resistant to providing reimbursement for remote patient monitoring despite evidence of their efficacy by the Veterans Administration, which has deployed more than 35,000 units. Healthcare payer reimbursement is focused on a healthcare delivery model ill-equipped to address the needs of an aging Baby Boomer population with chronic illness. Payers reward healthcare providers for the quantity of the procedures performed rather than the quality of care delivered.
(Source: Health IT News, March 24, 2009
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About the authors: Josie Henderson is the Director of the Telemedicine Research Center. Will Engle is the Executive Director of the Association of Telehealth Service Providers.
