Telemedicine and Telehealth News

Telemedicine and Telehealth News

New York Study Finds Pediatric Telemedicine to be Cost Effective Alternative to ER Visits

Telemedicine is a cost-effective way to replace more than a quarter of all visits to the pediatric emergency department, according to a community-wide study conducted in New York.

Ailments, such as ear infections or sore throats, that virtually always prove manageable by telemedicine made up almost 28 percent of all pediatric ER visits in Rochester, N.Y., during one year, according to investigators from the University of Rochester Medical Center. Their findings were presented recently at the 2008 Pediatric Academic Societies annual meeting, in Honolulu.

"We learned that more than one in four local patients are using the pediatric emergency department for non-emergencies," lead investigator Dr. Kenneth McConnochie, a professor of pediatrics at the University of Rochester's Golisano Children's Hospital at Strong, said in a prepared statement. "This mismatch of needs and resources is inefficient, costly and impersonal for everyone involved."

McConnochie and his colleagues, who direct a Rochester-based telemedicine program that provides interactive, Internet-based pediatric health-care service to the area, analyzed data for all pediatric visits to the largest emergency department in the city. Based on their experience, they determined at least 12,000 visits were ones they routinely treat with success via telemedicine.

The other visits were either problems that sometimes are treatable through telemedicine, such as asthma attacks; or ones beyond the scope of the technology, such as a serious wound or injury.

"This would've not only freed up emergency resources to people who needed them more, it would have afforded smaller co-pays for parents and more timely, personalized care," McConnochie said.

In related research presented at the meeting, McConnochie suggested that telemedicine could also help insurers and the community by providing better quality care at a lower price -- saving insurers more than $14 per child per year in that local community.

The conclusion was reached by studying two groups of children that were almost identical, but one had access to their doctor's office, the emergency department and telemedicine technology for care, while the second had only the first two options. "We found that the first group of families, which had access to telemedicine for their children, did in fact access care for illness overall nearly 23 percent more often than the second group," McConnochie said.

But since children with telemedicine access had 24 percent fewer ER visits, which cost about seven times the cost of a doctor office or telemedicine visit, the telemedicine group ultimately still cost insurers less per child over a year.

(Source: Healthday News, May 9, 2008)

International Telemedicine Nonprofit Organization to Treat 30,000 Child

The Medical Missions for Children charity (MMC) recently announced that will treat its 30,000th child via telehealth in June. The organization has created what it calls the Global Telemedicine & Teaching Network to enable U.S.-based doctors to consult with foreign pediatric physicians through a distance-medicine network called the Telemedicine Outreach Program so they can help diagnose and treat children worldwide. Technology also has allowed MMC to expand its services to include educational content for health care providers and patients in multiple countries.

"MMC fulfills a host of health- related needs throughout the world," says Alberto Salamanca, the Mexico-based president of MMC's Latin America region. "Technology has proven to be the most important tool to carry the mission and vision of MMC."

Medical Missions for Children is a nonprofit organization that uses technology to disseminate medical care and knowledge from the U.S. to medically underserved locales around the world. Its annual budget is US$15 million, 90% of which goes to technology costs. Project champions include MMC co-founders Frank and Peg Brady, and President and COO John Riehl.

The organization has 18 full-time workers, with 10 in technology-related positions. MMC has saved thousands of children's lives while also spreading medical knowledge around the world, thereby allowing local doctors to use their new skills to more effectively treat other patients. It allows participating hospitals in developing countries to contact medical specialists from U.S. hospitals to help diagnose and treat severely ill children. The consultation is done through teleconferencing, obviating the time and expense of travel.

Frank Brady says there's a dire need for such services. One out of every three children who comes to MMC has been misdiagnosed, and 85% of the properly diagnosed patients need their treatments adjusted.

MMC's first case linked doctors at St. Joseph's Children's Hospital in Paterson, N.J., where MMC is based, to physicians in Panama treating an 8-year-old boy with a cranial deformity.

Brady used about $100,000 from his retirement savings to buy Polycom Inc. teleconferencing equipment, which included integrated diagnostic equipment in addition to a monitor, a camera and speakers, for the Hospital del Ni�o in Panama City. He also bought a Polycom setup for doctors at St. Joseph's.

"We showed it could work, and we started putting it in hospitals around the world," Brady says.

The MMC network now connects volunteer doctors from 27 Tier 1 U.S. hospitals with pediatric health care facilities in 108 countries. In addition, MMC now operates a global satellite and IPTV network called the Medical Broadcasting Channel, as well as the Global Video Library of Medicine and the Giggles Children's Theater, which brings entertainment to pediatric patients in the U.S.

"It's a great humanitarian use of telemedicine," says Craig Stephens, an associate professor of biology at Santa Clara University in California and chairman of the judging panel for the health category of The Tech Museum Awards program, which is administered by The Tech Museum of Innovation in San Jose. MMC was a 2006 Tech Museum Awards laureate.

As it grows, MMC's IT needs remain very similar to what they were in its early days, says John Riehl, MMC's president and chief operating officer.

However, compared with earlier tools, today's teleconferencing equipment supports much richer interactions among doctors and offers more-advanced diagnostic capabilities. For example, cameras can provide magnified views of the skin, and scopes can look into patients' eyes and noses.

MMC has also started employing high-definition videoconferencing equipment, which can be used to view digital images, Riehl says. This gives doctors real-time access to MRIs, CT scans and X-rays, without loss of image quality.

"They can look at the same image at both locations with quality that allows them to draw diagnostic conclusions," Riehl says.

Improvements in equipment haven't addressed all of MMC's challenges, however. Brady says there are times when MMC must send its own staffers to foreign hospitals to set up equipment because of a lack of on-site expertise. The World Bank, which provides equipment for hospitals around the world, also helps install MMC's equipment. Polycom has also provided support to hospitals, Brady says.

Cost and access to bandwidth can also be challenges.

For example, in late 2005, MMC started working with Armenia's National Institute of Child and Adolescent Health. When MMC was negotiating for high-speed Internet service with Armenia's sole service provider, the ISP initially asked for $7,500 a month before agreeing to $500.

Despite the cost, the return is significant. Dr. Konstantin Ter-Voskanyan, a pediatric cardiologist and president of the Armenian Association of Pediatric Professionals, says MMC collaborated with local doctors on seven cases in 2007, and the collaboration saved several lives by allowing doctors to make the proper diagnosis and set up the right treatment.

Frank Brady started his tech-driven Medical Missions for Children organization with an old-fashioned tool: person-to-person networking.

"When I want to meet with a chairman, I just keep on talking to people until I get the right introduction," Brady says. "Even our trustees aren't trustees because they give us a lot of money -- it's because I value their Rolodex. I'm able to get to a whole lot of people that way."

Indeed, Brady's ability to build his organization relied as much on personal contacts as it did on IT connections. For example, a friend introduced him to Alberto Salamanca, who at the time was head of the Bolivian mission to the United Nations. Salamanca introduced Brady to Ambassador Mary Morgan-Moss, deputy permanent representative of the Republic of Panama to the U.N.

Brady says both people were instrumental in introducing him to contacts in Latin America.

"You get a lot more things done if you start from the top and work your way down," Brady says, noting that he uses ambassadors to the U.N. to gain access to -- and persuade -- the first ladies of various countries to be champions of MMC's work.

And even in the cases where the patients died, "the consultation had a positive impact," Ter-Voskanyan says, because the exchange of information helped the Armenian doctors learn how to deal with similar cases in the future.

At the request of the Armenian medical community, MMC also implemented an online environment for continuing education, and it now records and publishes lectures through a portal it hosts and makes those available to Armenia's pediatric health care professionals.

Riehl says that the system's underlying technology is from Accordent Technologies Inc., which donated about half of the tools needed.

"We have always first identified the technology providers that offered the goods and services that best met our needs and then attempted to build a philanthropic partnership with them," Riehl explains.

In addition to using Accordent equipment for its education portal, MMC uses products from Intelsat Ltd. for its satellite broadcast technology and tools from LHS Productions Inc. for its video library and broadcast scheduling setup.

MMC also has had a partnership with Polycom since 2001, when the Pleasanton, Calif.-based vendor named MMC a winner in a contest for innovative use of its videoconferencing equipment. Since then, Polycom has donated money and equipment to MMC.

Says Polycom Chairman and CEO Robert Hagerty, "It's the ultimate example of telemedicine at its finest."

(Source: Computer World, April 28, 2008)

New Research Finds Home Telehealth Significantly Delays Hospital Readmission Rates

A researcher with the University of Missouri discovered that patients who received a telehealth intervention from care providers experienced significantly delayed hospital readmission rates when compared to patients who received only traditional care.

"Telehealth interventions have the potential to allow for earlier detection of key clinical symptoms, triggering early intervention from providers and reducing the need for patient hospitalization," said Bonnie Wakefield, professor in the MU Sinclair School of Nursing, in a statement. "Reducing the length and frequency of hospital stays can lower healthcare costs for patients and hospitals, which helps patients manage their diseases and ultimately feel better."

To better understand the relationship between the use of technology and patient-provider interactions, Wakefield evaluated the effectiveness of a telehealth home-based intervention in patients with heart failure.

These patients were randomly selected to receive follow-up by telephone or videophone after hospitalization for heart failure. Wakefield noted that previous research on traditional clinic visits found that quality patient-provider relationships can improve patient satisfaction, adherence to treatment, clinical outcomes and understanding of information.

"Telehealth does not necessarily change the care providers give. Rather, it changes the communication channel between clinicians and patients to minimize geographic barriers and enhance delivery of service," Wakefield said. "According to patients, it is not important how the interaction happens, but just that it happens. People who suffer from chronic illnesses usually wait three to six months between office appointments with their care providers."

"With video and telephone technology, nurses have the ability to interact regularly with patients and provide a sense of security. Patients discuss concerns on a frequent basis, and nurses give advice and detect problems that the patient might not notice," added Wakefield.

Wakefield highlighted that it is critical to accurately match technologies to patient needs. Further evaluation is needed to determine which patients may benefit most from specific telehealth applications and which technologies are most cost effective.

"Although older patients may not be accustomed to using technology, it doesn't mean they aren't willing to learn," Wakefield said. "Older patients feel they are contributing to society and education by testing innovative technology. They appreciate when health care professionals take time to invest in their well-being".

The study, "Home Telehealth for Heart Failure," is set to be published in the Journal of Telemedicine and e-Health.

Wakefield's study sheds light on key areas of opportunity where technology can be used to improve a patient's recovery and shorten downtime after hospitalization. Such findings will not only lead to new explorations within the health community, it will also contribute to new applications that will be available in the industry to address these specific issues. Such advancements will be a positive addition for the healthcare industry, and new revenue opportunities for vendors.

(Source: TMCnet, May 8, 2008)

Hospitals Using Telehealth to Provide Efficient ICU Care

The use of electronic ICU systems (eICU) are moving forward and more and more military and civilian hospitals are finding that being able to electronically monitor intensive care patients can provide more efficient care. For example, the Tripler Army Medical Center located in Hawaii is the first military medical center to use telemedicine technology for long distance ICU care.

The system's high resolution cameras feed data into a bank of computers using real-time transmissions. Critical Care specialists are then able to examine, diagnose, and monitor intensive care unit patients in conjunction with local doctors at U.S. military installations in Guam and Korea.

The critical patients at both the Naval Hospital in Guam and the Army Hospital Yongsan in Korea can be stabilized under the direction of intensivists at Tripler. Dr. Benjamin Berg , an intensivist at the University of Hawaii's Telehealth Research Institute said, "patients can be treated and many times the need for air evacuation can be eliminated or delayed at a cost of more than $100,000. If they need to be, stabilized patients can be brought to Tripler on a regularly scheduled medical flight mission when they are in better condition to fly.

The fiber optic internet-based technology was used during a boiler room explosion on the Guam-based submarine tender USS Frank Cable in December 2006. The ability of surgical and critical care specialists to remotely examine and triage the sailors helped the initial stabilization and evacuation of the severely burned sailors from the hospital in Guam to Brooke Army Medical Center in San Antonio, Texas.

The program provides that physicians in the intensive care unit have immediate access to critical care specialists, such as cardiologists and pulmonologists available 24/7. The consulting doctors at Tripler are able to quickly view a patient's chart, labs, and other data as well as directly see the patient using a video camera. In the future, the telemedicine technology may be used for patients aboard ships at sea, or in forward deployed locations such as field hospitals.

In the civilian sector, rural Maryland hospitals facing emergency room physician shortages now have doctors in Delaware electronically monitoring their ICU patients. The Christiana Care Health System in Delaware has been using the eICU program for emergency care since 2005 and was the first health system in the country to adapt the program to monitor critically ill patients in their emergency departments and post anesthesia care units.

The Christiana eCare services are now expanding to hospitals in rural communities in Maryland using the program known as "Maryland eCare". The six rural Maryland hospitals collectively admit more than 66,000 patients per year.

Marc T. Zubrow, MD, Director, Critical Care Medicine at Christian Care serves as the medical director overseeing the "Maryland eCare" project along with a team of critical care nurses and physicians, said "using this technology in rural Maryland will mean that patients and families will have better care close to home."

The system enables patients to be remotely monitored through video and audio technology combined with intelligent monitoring plus alarm systems. The eICUs remote center closely monitors patients for any physical change, and then immediately alerts local caregivers and recommends corrective action.

The system was developed at VISICU located in Baltimore by two former Johns Hopkins critical care physicians. More than 200 hospitals across the country are now using the system.

(Source: Federal Telemedicine News, April 30, 2008)

Study Finds that Remote Monitoring Can Improve Outcomes of Heart Failure Patients

Remote monitoring can improve the condition of mobile heart failure patients and may reduce hospital readmissions, according to a pilot study that included 150 patients admitted to Massachusetts General Hospital in Boston.

The patients, average age 70, were randomly selected to receive usual care for heart failure (68 patients) or remote monitoring (42 patients). Forty of the patients declined to participate. The study was conducted by the Center for Connected Health, a division of Partners HealthCare.

The patients in the remote monitoring group received telemonitoring equipment to track vital signs such as heart rate, pulse and blood pressure. They weighed themselves daily and answered a set of questions about symptoms every day. The information was transmitted via the telemonitoring device to a nurse, who would call weekly or more often if a patient's vital signs were outside normal parameters.

After three months, patients in the remote monitoring group had lower average hospital readmission rates (31 percent) compared to patients in usual care (38 percent) and those who refused to participate (45 percent). The patients in the remote monitoring group also had fewer heart failure-related readmissions and emergency room visits than patients in the other two groups.

"The goal of our Connected Cardiac Care program for this group of patients is to reduce hospital readmissions, provide timely intervention and help them understand their condition using home telemonitoring," lead author Dr. Ambar Kulshreshtha, a research fellow at Harvard Medical School and Massachusetts General Hospital, said in a prepared statement.

"Participating physicians are pleased with the program and consider it a success," said Kulshreshtha, who added that the initial data suggests that "Connected Cardiac Care is a win-win for our patients and health-care providers," and has the potential to have "a dramatic impact on improving the lives of heart failure patients and reducing hospital admissions."

The findings were presented at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Baltimore.

The researchers plan to expand the Connected Cardiac Care program to target 350 mobile heart failure patients by this summer.

An estimated 5.3 million Americans have heart failure, and hospital discharges for the condition increased from 400,000 in 1979 to 1.08 million in 2005, an increase of 171 percent, according to background information in a news release about the study.

(Source: Washington Post, May 1, 2008)

State Telehealth News

Telehealth is one of the uncertain issues before the Missouri state legislature this month. Telehealth is part of a major healthcare bill, the Missouri Health Transformation Act, approved by the Senate and facing a cloudy future in the House. Part of the bill is a version of Governor Blunt's "Insure Missouri" program for lower-income Missourians---an issue some house leaders have written off for the session.

Senator Tom Dempsey of St. Peters wants the state health department to establish guidelines for use of telehealth and for the doctors who will use it. Dempsey says the system is especially useful in rural areas where specialists might be a long distance from the patient.

Some insurance companies don't cover diagnosis or treatment through telehealth. Dempsey's bill says they will--but not unless the House does something with it. Right now the bill has not been given a committee hearing in the House and the session ends in mid May.

(Source: MissouriNet, May 4, 2008)



Front-line care providers in rural Alaska have a new way to help meet their patients' mental health needs. Alaska Psychiatric Institute and Alaska Federal Health Care Access Network now offer a free monthly behavioral health videoconference to Alaska Native Tribal Health Consortium providers.

"Mid-level primary health-care providers are the first contact for people who need behavioral health treatment," said institute CEO Ron Adler of the Alaska Department of Health and Social Services.

"These videoconference lectures and consultations let providers around the state ask behavioral health specialists about medication and treatment options."

Alaskans' need for mental health services, especially in remote communities, is clear. The suicide rate for rural Alaska children is nine times the national average. The Alaska Native adult death rate from suicide is four times greater than the national average; from alcohol, seven times greater.

"This collaboration brings a substantial benefit to our clinical partners, who are confronted with a range of pressing mental health needs," said Kathleen Graves, director of behavioral health for Alaska Native Tribal Health Consortium.

The consortium is the managing partner of the Alaska Federal Health Care Access Network.

The continuing education sessions, which began in late February, are available to all 34 health organizations in ANTHC. The sessions also provide professional development opportunities, building providers' confidence and proficiency with videoconferencing equipment.

As providers build their technical skills, they are more likely to be creative and apply videoconferencing to a wider range of health-care applications, from nutritional consultations to pre-surgery instructions.

The new sessions are part of a broad range of telehealth services offered by API's Telebehavioral Outpatient Mental Health Clinic. API psychiatrists and other licensed mental health professionals, psychologists and social workers routinely use videoconferencing to treat clients around the state as part of the state's Telebehavioral Healthcare Services Initiative.

Alaska Psychiatric Institute's Alaska Recovery Center provides therapeutic services that help individuals achieve a personal level of satisfaction and success in their recovery. API works in partnership with individuals, their families and community network, and providers.

The Alaska Federal Health Care Access Network began in 1998 as an Alaska Federal Health Care Partnership project to improve health care to federal beneficiaries in Alaska using telemedicine technology. The network has expanded to more than 300 sites in Alaska and elsewhere in the United States, as well as several international locations, including Panama, Greenland and Saudi Arabia.

The system includes a Web-based client interface as well as videoconferencing solutions and support.

(Source: The Artic Sounder, April 25, 2008)



Three women dressed in colorful saris talk with doctors in Little Rock, Arkansas, from a video screen at the front of a conference room at the University of Arkansas for Medical Sciences. The women are doctors at the CARE Institute of Medical Sciences, a hospital more than 8,700 miles away in Hyderabad, India.

Each Thursday, videoconferencing technology allows them to participate in sessions on treating high-risk pregnancies hosted by Dr. Curtis Lowery, UAMS director of obstetrics. "We can have an exchange of ideas," said Dr. V. Shanthi, an obstetrician at the private Hyderabad hospital.

St. Vincent Health System uses telemedicine technology to monitor home health patients, and Baptist Health uses it as an "extra set of eyes" to watch intensive-care patients 24 hours a day, seven days a week.

Telemedicine has tremendous potential to cut rising health care costs and improve access to medical care, health-care officials said. But there are obstacles to extending services, such as medical licensing requirements and the United States system of paying for medical services.

There will always be a need for people to visit doctors' offices in person, said Devon Herrick, health economist and senior fellow with the National Center for Policy Analysis, a Dallas-based nonprofit research group.

"Face-to-face meetings are the optimal way to have a physician visit," he said. "The physician can respond to how you look, talk and act, and they can ask follow-up questions. Telemedicine will never replace the face-to-face physician visit."

But telemedicine could be used in a large number of cases in which face-to-face contact isn't necessary, such as prescription renewals and lab tests.

Overall, the health-care industry has been slow to utilize communications technology used in other industries for decades, Herrick said. Lawyers, accountants and other professionals talk to clients via telephone and e-mail, but many doctors are just beginning the practice.

"Telemedicine is increasingly becoming an acceptable way to interact with physicians," Herrick said.

One problem is that insurance companies traditionally have no system to pay a physician for a phone or e-mail consultation, although some companies are starting to provide some reimbursement for such services, Herrick said.

Health-insurance companies are increasing telemedicine services. Kaiser Permanente, for example, has a secure Web site where patients can post questions and get direct doctor responses. Medical liability insurers are also beginning to offer coverage for telemedicine.

Medical licensing is another major barrier to expanding telemedicine services, Herrick said. Physicians have to be licensed in each state where they wish to practice. That makes it difficult for doctors wanting to provide services across state lines.

The Arkansas State Medical Board provides medical licenses for out-of-state doctors but doesn't track the number of doctors providing telemedicine services in Arkansas.

ANGELS, or Antenatal and Neonatal Guidelines, Education and Learning System, at UAMS has linked doctors at Arkansas hospitals and clinics since 2003 with the goal of reducing premature births.

The system expanded to the Hyderabad hospital about two months ago, said Lowery, the system's director. Officials hope to expand the overseas exchange to other countries, such as Russia, Australia, South Korea and China.

"I think there is a huge possibility for a great virtual-medical university," Lowery said.

UAMS made the Hyderabad link during a February 2007 visit with former Indian President A.P.J. Abdul Kalam, said Dr. Hari Eswaran, UAMS associate professor of international medicine.

Prasad Sistla, chief of telemedicine at the CARE Institute in Hyderabad, said the hospital has had videoconferencing technology since October 2001, and is part of a telemedicine network of 12 hospitals in India and South Asia. UAMS is the hospital's first contact overseas, Sistla said.

Doctors in Arkansas use ANGELS to communicate between hospitals. Dr. John Mesko is an obstetrician-gynecologist at Mena Regional Health System, a 65-bed community hospital. He said he uses the system to consult with specialists in Little Rock on high-risk pregnancy patients, including sending ultrasound images.

In many cases, it prevents the patients from having to drive to Little Rock to see the specialist directly, Mesko said. The educational opportunities allow him to keep up with the latest techniques.

"I'm hearing the newest, latest stuff every week," Mesko said. "As a little hospital in a rural town to be doing things the same way as they're doing in Little Rock is pretty awesome."

Lowery said UAMS is expanding telemedicine services to other specialties. ANGELS holds a weekly teleconference for Arkansas pediatricians, in which doctors from two Hyderabad hospitals also participate. Future offerings will include broadcasting of grand rounds for residents practicing statewide and conferences on subjects such as cervical cancer.

Within the next six months, UAMS will start a statewide telestroke program by which doctors treating patients with symptoms of stroke in rural emergency rooms can consult with neurologists elsewhere in Arkansas.

Of course, there are costs involved. Lowery said line charges for the network can be $500 to $800 per month. The federal government currently pays for the lines in Arkansas, but smaller hospitals might not be able to afford the technology without the help.

"By doing this we are able to meet needs that are just not possible through traditional medicine," Lowery said. "As we show the benefits of working together, people will do more and more."

At Baptist Health Medical Center-Little Rock, registered nurses sit at six stations in the electronic intensive care unit, or eICU, monitoring patients in Baptist Health's intensive-care units in Arkadelphia, Heber Springs, North Little Rock and Little Rock.

The nurses complement those treating patients in the hospitals. From their stations, they can check patients' vital signs and medical records. They can see and talk directly with patients, family members, nurses and doctors in the hospital rooms. Cameras mounted in the rooms allow them to zoom in to check small details, such as the dilation of a patient's pupils.

"We're here as an extra set of eyes," said eICU director Vicki Norman. "Our goal is to look for all the tiny little details to make sure that nothing's being missed."

There are more than 35 eICUs at hospitals nationwide, with technology provided by Baltimore-based VISICU, Inc. Since Baptist started its eICU three years ago, it has expanded monitoring from 53 beds to 142 beds.

The eICU is staffed 24 hours a day, seven days a week by registered nurses with an average of 19 years of experience. Physicians, including critical-care internists, cardiologists and a thoracic surgeon, are there from 7 a.m. to 7 p.m. on weekdays and 24 hours a day on weekends.

"That way there is never a missed beat," Norman said. "It has really transformed the way we do critical care. Geography is not a barrier."

At St. Vincent Health System, homebound patients in the 11 counties served by the system's Visiting Nurse Association of Arkansas use computerized devices to check their vital signs, said Denise Looker, the association's home health administrator. The information is sent through a secure Internet connection for review by nurses, allowing them to monitor chronically ill patients from afar.

"It allows us to monitor the patient every day without having to be in the home every day," Looker said.

They check things like weight, blood pressure and heart rate. Some patients have machines that prompt them to take their medicine and answer routine questions, such as how well they slept or whether they have any swelling.

Looker said the technology has helped St. Vincent reduce hospital visits for chronically ill patients. Nationally, about 37 percent of former heart attack patients end up returning to the hospital. At St. Vincent, 4.5 percent of heart attack patients were rehospitalized last year.

Herrick said telemedicine will become more prominent as insurance companies, medical boards and other regulatory agencies make it easier to practice.

"I think it will be like a snowball effect," Herrick said.

Lowery of UAMS said the health-care system will have to adjust.

"Right now health care is one size fits all, and that's a problem," he said. "[Telemedicine] allows you to match needs with resources.

"In three to 10 years, I think this will be the way medicine is practiced. It will be an integral part of what we do."

(Source: Arkansas Democrat-Gazette, April 28, 2008)



Six Maryland hospitals facing a shortage of emergency room doctors plan to use physicians in Delaware to electronically monitor intensive care patients, officials announced yesterday.

Under the program known as Maryland eCare, a critical care doctor, or intensivist, based at a command center in Wilmington will oversee overnight care for as many as 150 patients and provide guidance to on-site nurses. Officials said the collaboration with the hospitals, the first of its kind in the nation, is needed, especially in exurban and rural areas. Three of the six hospitals are in Southern Maryland.

The program, funded with a $3 million grant, "allows us to provide the same high level of care at 2 in the morning as we provide at 2 in the afternoon," said Maryland eCare Director Marc T. Zubrow, director of critical care medicine at Wilmington's Christiana Care Health System, where the critical care doctors will be based. "It's about crisis prevention rather than crisis response."

A video camera and computer terminal positioned in a patient's room will send vital signs, test results and information about patient responsiveness to Wilmington, where a doctor and several nurses will view the data and photographs on high-resolution computer monitors.

If command center staff members see the patient's health deteriorating, they can communicate with nurses to provide medicine or additional tests.

Officials said the electronic program will drastically reduce response time during overnight hours in intensive care units, which generally rely on on-call doctors between 7 p.m. and 7 a.m. Instead of paging a staff physician and losing time waiting for a return call, the nurse can talk to an intensivist almost immediately, Zubrow said.

"It makes patient care safer and reduces the risk of errors," said Christine M. Stefanides, president of Civista Medical Center in La Plata, one of the hospitals involved in the project. "It makes nurses, other doctors and patients feel more secure that they're well cared for."

The technology, known as eICU, was developed by Baltimore-based Visicu, a medical technology company, and is used in about 200 hospitals throughout the country. Sentara Healthcare in Roanoke was the first hospital to use the system, and Inova Fairfax Hospital was another early adopter.

The Maryland eCare program will serve 71 patient beds in six hospitals by 2010, officials said, with at least four other hospitals considering participating. The Washington area hospitals are Civista, Calvert Memorial Hospital in Prince Frederick and St. Mary's Hospital in Leonardtown. Other participants include Peninsula Regional Medical Center and Atlantic General Hospital on the Eastern Shore and Washington County Health System in Western Maryland.

Hospital officials said the collaboration was formed in response to drastic shortages of critical care doctors. There are currently 6,000 intensivists in Maryland, Zubrow said, compared with a projected need of 35,000 in the next 12 years.

"Telemedicine, of which this is a part, is a critical component of our health-delivery system in the face of physician shortages," said House Majority Leader Steny H. Hoyer (D-Md.), whose Southern Maryland jurisdiction includes three of the hospitals in the project and who spoke at a launch event in the District yesterday.

James Xinis, president of Calvert Memorial Hospital, said Maryland eCare would not supplant the need for on-site doctors and nurses but would aid them in decision making and allow them time off at night. The command center in Wilmington will operate between 7 p.m. and 7 a.m. weekdays and around the clock on weekends and holidays.

"This raises the level of care available locally," Xinis said. "Other hospitals who have used similar programs show a decrease in mortality rates by as much as 25 percent."

The program's first three years will be funded by a grant from Maryland CareFirst, an insurance provider that is part of the Blue Cross and Blue Shield network. Once individual hospitals launch the program, they will be responsible for $37,700 per intensive care bed each year.

(Source: Washington Post, April 29, 2008)

Telemedicine Technology and Vendor News

After launching a communications revolution, cell phones are talking up a potentially life-saving new role in telemedicine. Researchers in the United States and Brazil recently described development of a simple, inexpensive telemedicine system that uses ordinary cell phone cameras to collect medical data from patients and transmit the data to experts located offsite for analysis and diagnosis.

The system is ideal for developing countries or remote areas lacking advanced medical equipment and trained medical specialists, the researchers say. The system can also transmit urgent medical data from battlefields, disaster zones, and other dangerous locations, they say. The study is scheduled for publication in the May 15 issue of the American Chemical Society's Analytical Chemistry, a semi-monthly journal.

The key to a successful medical treatment is a quick, accurate diagnosis of disease. But some areas, particularly in developing countries, lack access to advanced medical equipment and trained medical personnel that are required for a speedy diagnosis. A better, more practical system for conducting medical analysis in these remote areas is needed.

Enter cell phones: The popular, inexpensive devices are owned by almost 3 billion users worldwide, or roughly half the world's population. Millions of new cell phone users are added each year in countries such as Africa, India, China, and South America. When equipped with cameras, the ubiquitous devices can conceivably be used in remote areas as the eyes and ears of doctors without the need for an on-site visit.

"The cellular communications industry is, and will continue to become, a global resource that can be leveraged for detecting disease," says study leader George M. Whitesides, Ph.D., a professor of chemistry at Harvard University in Cambridge, Mass. Two recent studies by other researchers showed that cell phones can be used to acquire and transmit images of wounds and rashes to off-site locations for diagnosis, he notes.

In the new study, Whitesides collaborated with researchers in Brazil to design a prototype system that combines cell phone cameras with easy-to-use, paper-based diagnostic tests that undergo color changes when exposed to certain disease markers. The researchers demonstrated the feasibility of the system by using paper test-strips to collect and characterize artificial urine samples, as urine can be easily obtained from patients and contains a wide range of disease markers.

Using a simple cell phone camera, the scientists took pictures of the color-changing test-strips and transmitted them remotely to an off-site expert. The trained expert accurately measured glucose and protein levels -- used as hallmarks to diagnose various kidney diseases -- from the test-strip image. Similar tests can be conducted on other body fluids, including teardrops and saliva, the researchers say.

Besides diagnosing diseases in humans, the system can also be used to detect disease in plants and livestock and for testing the quality of water and food, the researchers say. The development of cheaper, mass-produced diagnostic tests will make the system more widely accessible in the future, notes Whitesides, who is known for his pioneering research toward making medical diagnostic tests more widely available for the developing world. He is also the recipient of the 2007 Priestley medal, ACS' highest honor.

(Source: Science Daily, May 6, 2008)



Executives at AMD Telemedicine, a provider of telemedicine hardware and software solutions with over 5,000 installations in more than 72 countries, recently announced that a discussion on the value of telemedicine during a disaster with noted emergency medicine physician, Richard Aghababian, MD, is available on the AMD web site.

Dr. Aghababian, a fellow of the American College of Emergency Physicians (FACEP), an Associate Dean for Continuing Medical Education at the University of Massachusetts Medical School (UMMC), past Chairman of the Department of Emergency Medicine at the University of Massachusetts Medical School and past president of the American College of Emergency Physicians (ACEP) explains that telemedicine can play a vital role in the triage process, which is often a critical tool at disaster scenes.

"Unlike day to day (emergent) operations in which a whole team works together to save one life, in disaster medicine, there can be many more victims than one's immediate resources can handle. So that takes a different mindset. One has to switch from everything for one to best outcomes for the group," said Dr. Aghababian. "(One has to determine) how to best allocate resources to do the greatest good for the greatest number. (In this process) triage is an important facet -- the ability to determine who, with immediate treatment will live, and who might not, and who can wait for treatment for a while. Telemedicine can be of great help here to identify and understand patterns of injury, as well as to access information and experience on treatment."

Noting that preparedness is the key to successful response, Dr. Aghababian also discusses how telemedicine training can be vital prior to a disaster and what that training would entail.

"Dr. Aghababian's considered opinion is another vote of support for the value of telemedicine," said Steven Normandin, president of AMD Telemedicine. " A true aid in the triage process, telemedicine can not only provide a critical, visual link between a disaster site and experienced medical personnel at a distant facility, but it can also be a conduit of vital patient data to enable life-saving treatment to begin right in the field."

To view Dr. Aghababian's comments on the role of telemedicine in disasters, visit the AMD Telemedicine web site at http://www.amdtelemedicine.com/DrA.html.

(Source: AMD Telemedicine Press Release, April 23, 2008)



Phone-based telehealth nursing is in demand, and all you need to do the job is a telephone and a computer - not to mention a great deal of clinical experience and expertise. Telehealth nurses are RNs who operate 24/7 telephone lines set up to provide triage information and support. They work within all types of healthcare settings and telephone call centers. Some telehealth nurses work from home.

"Telehealth nursing is a subspecialty within ambulatory care nursing with its own body of knowledge and expertise. [They] assist callers to make informed decisions about health problems they may be experiencing," said Charlene Williams, MBA, BSN, RNC, BC, president, American Academy of Ambulatory Care Nursing (AAACN), and a telehealth nurse employed by WakeMed Health and Hospitals in North Carolina.

Like Williams, many telehealth nurses have 10-20 years or more of clinical experience with superior assessment skills often gained while working in hospital emergency or acute care departments, pediatric services, dialysis centers, home health and other nursing specialties.

"Telehealth nurses have a broad-based experience in caring for both adults and children," Williams pointed out. They must be patient with callers, speak clearly and have good active listening skills, she added. Independent thinkers, they are multi-taskers able to type, talk and listen at the same time.

Telehealth nursing is a fast-growing triage service, as well, said Lynda Trafton, RN, vice president of clinical services at CareNet, a call center based in San Antonio in business since 1998.

CareNet RNs refer to guidelines based on 400 symptoms organized and indexed by Relay Health Corporation. They respond to questions ranging from inquires about health information to someone having chest pain and everything in between.

"Our RN operators must have high levels of assessment skill, because 90 percent of our calls are symptom related," said Trafton, who has more than 22 years of nursing experience, about half spent in pediatric and adult EDs.

Although there is no mandate for telehealth nurses to be specialty certified, AAACN recommends nurses take its Ambulatory Care Nurse Certification Examination. "Certification gives telehealth nurses and the nursing profession more credibility," Williams said. "This examination includes information about telehealth nursing."

Telehealth nurses follow practice standards from AAACN and professional guidelines set up by their employers. And, "as long as they follow organizational guidelines just as they would in other fields of nursing" Williams said, they will continue to "have among lowest rates of legal actions brought against them."

Most telehealth call centers are accredited by URAC, a Washington, DC-based healthcare accreditation and certification organization. URAC Health Call Center standards apply to organizations providing triage and health information services to the public when conducted by telephone, via the Web or other electronic means.

According to URAC, its standards assure RNs, physicians "or other licensed individuals perform clinical aspects of triage and other health information services with timely, confidential and medically-appropriate care and treatment advice."

General telehealth services are not open to the public, but rather members of healthcare and community organizations that purchase these services through major health insurers, HMO's and Medicare to assist patients and employees.

Medical centers, EDs, physician office groups, university health centers, pharmaceutical companies and home health and hospice agencies are some of the organizations that use telehealth services.

In addition to providing members with 24/7 triage services, telehealth nurses teach members about disease management processes, explain healthcare navigation systems and discuss drug interactions and drug regime complications. Some nurses instruct members about the proper use of healthcare products and services. Others monitor health conditions for seniors who live alone at home.

For instance, nurses at Intellicare, a telehealth call center located at Portland, ME, for instance, give patients with diabetes educational support about durable medical equipment like meters and test strips. "They also explain drug interactions and complications that may happen due to drug regimes," said Lisa Monteleone, RN, BSN, vice president, clinical operations.

A healthcare contact center company, IntelliCare serves providers (physician groups and hospitals), payors (health plans, self-insured employers, and other groups), and clinical service providers (such as disease management companies).

IntelliCare's URAC-accredited contact centers serve more than 250 clients and more than 850 healthcare facilities across the country. According to the company, it has more than 300 employees, including more than 200 RNs who communicate directly with patients to provide healthcare decision support, triage, and other assistance.

(Source: Advance for Nurses, April 27, 2008)



Trauma surgeon Dr. Scott Dulchavsky isn't looking to take away from the adrenaline-infused thrill of climbing Mount Everest. He simply wants to ensure that those who make the trek to the world's highest peak do so in good health. That was his charge last Monday when from his laptop back in the United States, Dulchavsky guided a group of Canadian alpinists through a physical check-up via a satellite link. The climbers, who at the time were nearly two-thirds their way to the summit, used a portable ultrasound machine -- about the same size of a laptop -- to scan parts of their body and send the images to Dulchavsky.

"You get great images with zero training," Dulchavsky said as he demonstrated the machine using his own arms in his office at Henry Ford Hospital. As he did so, grainy white images of his wrist bones flashed on the screen. "We're pushing the boundaries on what we can do with ultrasound."

Chairman of the surgery department at Henry Ford, Dulchavsky is no stranger to extreme challenges. For the past 15 years, he's helped pioneer new paths in telemedicine, a fast-growing sector of the medical field that allows doctors to confer with patients in far-flung locations using secure broadband connections.

His patient roster includes everyone from Olympic athletes to astronauts manning the International Space Station. He's also performed ultrasound scans on players of Detroit sports teams, including the Tigers and Red Wings.

"Now, if Apolo Ohno goes off the short track, I can pull it up on my computer at Starbucks and say 'uh oh'," Dulchavsky said of the Olympic speed skater.

A Detroit native, Dulchavsky got his start investigating the use of ultrasound images in orbit when he linked up with the National Aeronautics and Space Administration in the early 1990s. There, he devised a system that allowed astronauts to conduct their own scans using the ultrasound wand and sending those images back to earth for doctors to view.

Back then, he said, carting an MRI machine or CT scanner to outer space was no easy feat, so NASA turned to light-weight ultrasound machines, which render images by bouncing sound waves off internal body parts.

For the astronauts, the discovery was a boon. "It turned out to be the most interesting and useful (experiment) that we'd performed," said Leroy Chiao, a NASA astronaut who'd worked with Dulchavsky from the International Space Station. "As we go farther into space, establish a base on the moon and go out to Mars, this remote diagnostic technique is going to be very useful."

Telemedicine, the merging of medicine and telecommunications, is often used by emergency rooms and radiology departments to send images to a specialist off-site and by home health agencies and private doctor's offices that may not have frequent face-to-face access to their patients.

Much of Dulchavsky's research takes place in NASA's anti-gravity aircraft, often referred to as the "vomit comet" for its stomach-turning free falls. At the heart of his research is a 10-pound portable ultrasound machine which he gives to subjects, and via a video link, guides them on how to roll the wand over various parts of the body to examine broken bones and collapsed lungs. The anti-gravity aircraft allows him to probe how the ultrasound machine performs in weightless environs.

In the long run, Dulchavsky envisions his research as having more down-to-earth applications. He is currently conducting research in rural Madagascar where a team of researchers plans to install ultrasound units and train personnel on how to use them to improve prenatal care for pregnant women. In August, he plans to attend the Olympic Summer Games in China to continue investigations on using ultrasound to monitor the health of competing athletes.

And then, there's Mount Everest, where he's testing how the machine performs in high altitudes.

On Monday, he linked with his subjects through his laptop. Using video, Dulchavsky showed the climbers how to move the ultrasound wand over the right and left side of the chests. His task was to check for a pulmonary condition that often surfaces in low-pressure environs.

Asked whether providing medical care to climbers on Mount Everest might blunt the thrill of the life-risking climb, Dulchavsky, who is an avid snowboarder and pilot, simply shook his head. "If you had an elevator there," he said. "That may take some of the fun out of it."

(Source: Detroit News, April 19, 2008)



According to the American Medical Association up to 70% of doctor office visits are merely informational and unnecessary and could be avoided with a phone or e-mail consultation. Consult A Doctor, a provider of consumer-driven telemedicine services may transform the inefficiencies of the healthcare marketplace and reduce costs by as much as 25%. Consult A Doctor members have unlimited access to consult with physicians by phone or secure e-mail from anywhere, day or night. Members can even be prescribed medication if appropriate for common illnesses and have it called into their local pharmacy or sent directly via overnight delivery. "Accessible by anyone, from anywhere ... 24 hours a day, 7 days a week, 365 days a year, the benefits in a time of need are truly priceless, but we are able to offer them for pennies a day." Says Wolf Shlagman, Consult A Doctor founder and CEO.

The National Center for Policy Analysis and The Center for Health Transformation have both recently released reports that detail the problems in the current healthcare system and profile how innovative companies are using the Internet, improvements in computer software and the advent of high-speed telecommunications networks in innovative ways to make medical care more accessible and convenient to patients, to raise quality and to reduce costs. Both studies independently conclude that companies offering such services will enjoy rapid adoption of their services and growth in the coming months.

The American Journal of Health Promotion recently found a 26% reduction in healthcare costs and 28% reduction in sick leave absenteeism in companies with telemedicine and preventative health programs. Consult A Doctor's telehealth solutions reduce unnecessary visits to the doctor or emergency room, allowing members alternatives to visiting their primary care physician purely for information, refills and other basic reasons. This correlates to less time off work for minor health issues, increased productivity and reduced overall healthcare claims and costs by up to 25%.

The National Center for Policy Analysis released the Convenient Care and Telemedicine Report, by Devon M. Herrick in November of 2007 which stated "the use of information technology for diagnosis, treatment and monitoring of patients' conditions -- brings a new dimension to 21st century healthcare. Entrepreneurs are using the Internet, improvements in computer software and the advent of high-speed telecommunications networks in innovative ways to make medical care more accessible and convenient to patients, to raise quality and to reduce costs."

(Source: Consult a Doctor Press Release, May 1, 2008)

International Telehealth News

The College of Physicians and Surgeons of Saskatchewan, Canada has decided doctors who counsel or diagnose Saskatchewan patients through video, telephone or the Internet are technically practicing medicine in the province -- and should be licensed the province. The college's council passed a bylaw spelling out new rules governing the practice of telemedicine in Saskatchewan, college lawyer and associate registrar Bryan Salte said.

Health Minister Don McMorris has 90 days to consider the bylaw, Salte said. The rules will take effect as soon as the minister gives his OK.

Last fall, Salte told the college council he knew of at least two cases where patients had to travel out-of-province -- one to Calgary and the other to Toronto -- to see doctors, when the same consultation could have happened by videoconference.

"It usually saves the patients a great deal of challenge, or inconvenience, if they can simply go to a telemedicine centre in Saskatoon when the physician's in Edmonton," Salte said. "It avoids them having to do all that travel."

Also, several out-of-province doctors have contacted the college, saying they'd be willing to see Saskatchewan patients remotely, but Salte was unable to say whether they'd be breaking the law.

Doctors' insurance coverage could also be a problem. If a (hypothetical) B.C. physician jumps in to provide an emergency consultation to a Saskatchewan patient "out of the goodness of his or her heart," a physician could face serious consequences for practising somewhere insurance doesn't cover them, Salte said.

If adopted, Canadian doctors can apply through a simplified licensing procedure, in which they prove they have the credentials to be licensed in Saskatchewan. If they plan on seeing fewer than 13 patients a year via teleconference, the license would be free. Those seeing between 13 and 52 patients will need to pay a $250 licensing fee and doctors who will see more than 52 patients will need to shell out the $1,430 for a regular Saskatchewan license.

Telemedicine has the potential to become increasingly important in the field of radiology, Salte said. The province's hospitals are in the process of digitizing imaging tests like CT scans, MRIs and X-rays, so once captured, the images could be viewed by health professionals across the province -- or beyond, if necessary.

"With the digitalization of those images, it means you can interpret those images easily in your office, or in Vancouver, or in Toronto," Salte said.

Salte said he also knows of an epilepsy clinic in Edmonton that has been seeing some pediatric Saskatchewan patients. Some similar consultations could be done via videoconference.

Saskatchewan is one of the last provinces in Canada to move to regulate telemedicine, despite a national recommendation a decade ago saying the provinces should adopt consistent rules governing the practice.

(Source: The Saskatoon Star Phoenix, April 28, 2008)



Northern Ireland's Department of Health and Social Services is getting set to issue a grant for the supply of telehealth services to cover 5,000 people by 2011. The initiative will see Northern Ireland invest £46m in telemedicine services to better support chronic disease management. Some 40 telehealth suppliers hoping to participate are today in Belfast for an information exchange day and expo, demonstrating their products and services.

Once implemented, the province will become one of Europe's leading providers of telehealth services to its population.

"The aim is to do this at scale and find new ways of working," said Dr Andrew McCormick, permanent secretary of Northern Ireland's Department of Health and Social Services and Public Safety, speaking at the e-health 2008 conference in Portoroz, Slovenia.

Dr McCormick added: "This is an example of what can be done with new technology and an opportunity to respond to the challenges of ageing populations we will all face." He explained that the province faces particular demographic pressures as it moves from away having a relatively young population.

He said Northern Ireland had the advantage of one integrated health and social care agency with responsibility for the planning, delivery, finance and regulation of health and social care. "There are opportunities that arise from that."

Dr McCormick explained that Northern Ireland had developed "a public health-led strategy based on ICT-enabled early intervention."

An early tangible result of this strategy was the January opening of the European centre for Connected Health in Belfast.

Dr McCormick added Northern Ireland benefited from being a good size to carry forward e-health projects of this kind. "We're small enough to work quickly but large enough to be meaningful."

The permanent secretary added: "Northern Ireland has the potential to be a pilot at the European level and show how ideas can be applied."

(E-Health Insider, May 8, 2008)



Hospitals in Dubai in the United Arab Emirates (UAE) have implemented telemedicine systems that ensure patients stay in constant touch with their health providers in case of emergencies. "They need not panic and rush to hospital fearing the worst," explained Dr Azan Binbrek, consultant cardiologist and head of Cardiology Department in Rashid Hospital.

Patient data is recorded and transmitted via landline/mobile telephone through the event recorder, a simple device which also acts and an ECG machine. The collected data is then processed and immediately relayed vie email/fax to the healthcare professional.

"Telemedical monitoring offers many advantages and new opportunities for patient management in the field of cardiology (as well as for those suffering from other chronic illnesses, including diabetes and blood pressure," he pointed out.

He said that many people, including youngsters, faced palpitations from time to time. "These may be benign in nature, but as care providers, we have to distinguish between them correctly. By the time a patient rushes to the hospital, the vital recordings needed may not be available. In this case, the event recorder plays an important role by sending the required data to a physician on time," explained Dr Binbrek.

Dr Fauz Gataby, Marketing Associate, Vitaphone ME, providers of similar German technology explains that telemedicine is already being used worldwide to monitor chronic illnesses. "A cardiac patient cannot make it to a hospital before two hours minimum. The time lapse causes gaps in proper ECG recordings," he said.

Using the gadget is easy. "Place it on your chest, and press a button. The ECG will be done automatically. This data has to be transferred to a mobile or regular phone through the infrared which will convert it to a PDF file and send it to a pre-allocated number (to a healthcare provider)," says Dr Gataby.

(Source: Khaleej Times, May 3, 2008)

Telemedicine In The News

iHealth Beat, in an article entitled Virtual Visits Moving Into Medical Mainstream examines the current status of online medical consults. In the United States, two large insurers recently announced plans to reimburse physicians for online consultations with patients.Aetna expanded a three-state pilot project to the rest of the U.S. after determining that paying physicians to consult with patients online in California, Florida and Washington state was a success. And Cigna, one of the biggest investor-owned health benefits organizations in the United States, announced plans to pay for online visits beginning in January 2009. In Canada, the Canadian Medical Association launched a national Web site this month that will let patients and doctors exchange information online and will sometimes serve as a substitute for office visits.

The PBS Nightly Business Report recently featured a brief segment on telemedicine. After interviewing a few telemedicine experts, it concludes: "When it comes to routine care, many private insurers still insist on in-person consults. But experts see that changing as the nation seeks lower cost alternatives for delivering quality healthcare."

Joshua Rowe, the chairman for telemedicine company Broomwell Healthwatch, dicusses home telehealth in anarticle entitled Home is Where the Best Heart Care Is. He makes the case of how a cardiac telemedicine service can improve patient care while cutting the cost of congestive heart failure in the U.K

ATSP & TIE News

Implementation of Home Telemonitoring for Chronic Disease: New Article on the TIE

A new article on a case study for implementing a home telehealth program has recently been published on the TIE's article section. The article summarizes a study to query the sequence of medical professionals, hospital liaisons, quality controls, and home health nurses about the implementation of telemonitoring. It looks at what barriers stood in the way of a telemonitor protocol from becoming the standard of practice, and what changes where deemed necessary to implement this technology. Support the TIE

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