11/26/2009
The market for telemedicine devices and services will generate $3.6 billion in annual revenue within five years, a new study claims. The study by the Silver Spring, Md.-based research firm Pike & Fischer, says mobile-services companies, such as AT&T, Verizon, Sprint and Nextel, will take a sizeable chunk of the business. It predicts that smaller software and device manufacturers likely will be targets for acquisition.
The need to control health care costs, as well as advances in wireless broadband networks, smart phones and data compression technologies, will fuel telemedicine growth, the report states. Funding from the American Recovery and Reinvestment Act also will support a surge in broadband-enabled telemedicine services, such as remote patient monitoring and mobile access to electronic health records, it adds.
Wireless applications, devices and services will account for more than 70% of the telemedicine market within five years, according to the report.
(Source: Health Data Management, October 8th, 2009)11/26/2009
Northeast health insurer MVP Health Care will begin reimbursing its network of more than 22,000 physicians for Web-based consultations with patients covered through most of its benefit plans. The Schenectady, N.Y.-based payer covers more than 750,000 members in New York, Vermont and New Hampshire. The company is working with Mohawk Valley Medical Associates, an independent physician association in Schenectady, to identify 200 early adopter physicians in its service area. MPV Health Care also is seeking at least 50 additional early adopters in other markets.
The insurer will use the webVisit consultation software of the RelayHealth division of McKesson Corp., San Francisco. Further details, including the amount of reimbursement for online consultations, were not immediately disclosed.
(Source: Health Data Management, October 20, 2009)11/26/2009
USDA announced that 111 projects for $34.9 million in grants will to go to 35 states to increase to expand access to healthcare services in rural areas. The funding will be provided through USDA's Rural Development's Distance Learning and Telemedicine Program (DTL). The program's goal is to help expand telecommunications, educational resources, and computer networks throughout rural communities. The funds are part of USDA's annual budget.
Some of the specific funding examples include:
-
- Avera Health in Sioux Falls, South Dakota to receive $396.693 to provide video conferencing and telemedicine services to connect 16 rural hospitals and clinics to regional medical facilities in Sioux Falls, Yankton, and Aberdeen
- Georgia Partnership for Telehealth, Inc. to receive $436,218 to add 14 Tele-Trauma sites in the state
- Brazos Valley Community Action Agency in Texas to receive $233,831 to use telemedicine to help provide health and educational services in the surrounding counties
- Oklahoma State University for Health Sciences to receive $287,013 to establish video conferencing and other telemedicine equipment to use to consult with four rural clinics and to provide rural medical education
- St Anthony Hospital in Oklahoma to receive $493,638 to serve as a hub for six rural hospitals to provide for a video teleconferencing network, to introduce imaging and interactive consultations, and to provide medical education for emergency services
- Iowa's Clarke County Public Hospital to receive $356,243 to purchase video conferencing equipment and devices to connect the hospital to local sites
- Baptist Health in Arkansas to receive $295,357 to fund a critical care medical network to connect six rural medical centers and a major hospital site in Little Rock
In general, the DLT grants going to health organizations and hospitals throughout the country ranged from $62,000 to $500,000. The grants went to facilities in Alaska, Alabama, Arkansas, Arizona, Colorado, Georgia, Hawaii, Iowa, Idaho, Indiana, Kansas, Kentucky, Maine Michigan Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Virginia, Vermont Wisconsin, West Virginia, and Wyoming.
(Source: Federal Telemedicine News, November 22, 2009)10/5/2009
Thanks to factors including a looming physician shortage, the health care reform debate and the increasing willingness of insurance companies to pay for the practice, telehealth is on the verge of becoming routine.
"More and more companies are seeing the benefits of telehealth," said Greg Billings, senior director at the nonprofit Center for Telehealth and E-Health Law in Washington. "If that doctor looking at that skin rash didn't diagnose it as skin cancer until later, the cost of treatment of that skin cancer is going to be a heck of a lot more."
Universities, technology companies and hospital systems, including the University of Maryland, have been experimenting with telehealth since the 1990s. A major insurance provider - UnitedHealthcare of Minnesota - recently announced a national push to persuade its network of professionals, including thousands here in Maryland, to adopt telehealth for their patients.
Remote consultation and diagnosis are ways for medicine to become more efficient even as physicians and other health professionals are increasingly in short supply, policy experts say. For patients living away from advanced hospitals in urban areas, they add, it's potentially lifesaving.
Telehealth systems can screen patients for diabetes, eye disease, kidney problems, nerve damage, vascular disease and complicated pregnancies. The technology is available and relatively inexpensive. It's the regulatory hurdles that present the challenge, experts say.
Because of licensing restrictions, specialists might have trouble treating and prescribing medicine for patients they are examining electronically across state lines. Also, only a handful of states require insurers to cover telehealth care - and Maryland isn't one of them.
"These are the thorny issues," said Dr. Elizabeth A. Krupinski, an assistant director in the radiology department at the University of Arizona and a past president of the American Telemedicine Association. "The nursing profession has done a lot more in that area than physicians in terms of cross-state licensure. The problem is that every state has their own twist on the regulations."
But telehealth is nevertheless growing. Johns Hopkins Medicine International has used telehealth technology to link its specialists with physicians and patients by videoconferencing in other countries, such as the United Arab Emirates, Lebanon, Panama, Singapore, Chile and Turkey.
Alex Nason, the telehealth program director at Hopkins, said the institution is exploring the possibility of applying telehealth approaches within Maryland. The hospital already has a partnership with Howard County General Hospital in which a robot with a video camera can act as a Hopkins doctor's eyes and ears during a patient consultation.
"Telehealth is not about geography; I really think it's about access," said Nason. "Whether you're 500 miles away or 5 miles away, if you can't get there, you can't get there."
UnitedHealthcare this summer kicked off a national tour that emphasizes the latest telehealth technologies. An 18-wheeler parked at a Cherry Hill school contained videoconferencing and digital diagnostic tools. UHC officials said the company, whose network includes 4,900 hospitals and covers 223,000 Marylanders, is building the first national telehealth network to help physicians cater to underserved areas, rural and urban.
"It's a fundamental new way to provide that connection" to specialist care, said James Cronin, chief executive of the Minnesota-based company's Mid-Atlantic division. Such technology isn't intended to replace patients' connection to a primary care physician, he said. Instead, it's meant to hook them up quickly to specialized care that's sometimes difficult to find.
Telehealth equipment can be installed in physicians' offices, small clinics, hospitals, and even workplaces for from $10,000 to $100,000. Hardware could include an electronic records system, digital diagnostic equipment, video monitors and cameras.
With federal subsidies toward incorporating the latest electronic systems, physicians and hospitals have at least some incentive to upgrade their computer networks.
Last year the Maryland Hospital Association found that the state is 16 percent below the national average for the number of doctors available for clinical practice. The shortage was greatest in Southern and Western Maryland and on the Eastern Shore.
(Source: Baltimore Sun, September 14, 2009)9/11/2009
by Michael Edwards, Maine Telemedicine Service News, Sept. 11, 2009
Both Maine and New Hampshire in the Summer of 2009 passed and obtained Governor signatures for laws which require insurance companies to pay for services delivered by telemedicine. Along with Oregon earlier this year, this brings the total to 12 for states with similar statutes (joining California, Colorado, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Texas, and Oklahoma - see the
Telemedicine Information Exchange). In the case of Maine, the new law supplements Medicaid reimbursement for telemedicine services delivered by interactive video sessions, whereas in New Hampshire, Medicaid does not cover telemedicine except in selected pilot waiver programs.
For the benefit of other states who may ponder such a step, we cover here some details about the similarities and differences in the laws and discuss some of what we know about how these laws got through the state legislatures.
Process Leading to Maine Law
The Maine Legislature passed the bill LD 1073, "An Act to Provide for Insurance Coverage of Telemedicine Services" on May 12, and Governor Baldacci signed it into law on June 11th. The law, Chapter 169 MRSA 4316, contains the following provisions:
- Definition. For the purposes of this section, "telemedicine," as it pertains to the delivery of health care services, means the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. "Telemedicine" does not include the use of audio-only telephone, facsimile machine or e-mail.
- Coverage of telemedicine services. A carrier offering a health plan in this State may not deny coverage on the basis that the coverage is provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the covered person and a health care provider. Coverage for health care services provided through telemedicine must be determined in a manner consistent with coverage for health care services provided through in-person consultation. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telemedicine as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation.'
The Governor's office included this statement of support in a
press release after a signing ceremony:
"Telemedicine offers opportunities to increase the accessibility of health care, ensure that appropriate medical information is available, reduces medical errors and reduces health care costs," Governor Baldacci said. "This bill makes sense and I am pleased to sign it."
The sponsor of the bill was Rep. Anne Perry, a Family Nurse Practitioner in Washington County. Co-sponsors included Rep. Hannah Pingree, Linda Sanborn, Meredith Strang Burgess, and Sharon Anglin Treat. Surprisingly, the final bill passed in the House on May 7th with a 136 to zero roll-call support; the Senate passed the bill "in concurrence" on May 12th. During the committee review process, hearings, and sub-committee sessions, the bill received major support from the Maine Hospital Association and major hospital corporations with active telemedicine programs, including
Eastern Maine Healthcare and
Maine Health. Major health insurance providers opposed the bill. At the final hearing, a presentation by Tom Key, Director of
Maine Telemedicine Services and the Northeast Telehealth Resource Center, made three major points: 1) the law would promote the use of telemedicine, 2) substantial evidence supports the benefits of telemedicine on the efficiency and efficacy of health care delivery, and 3) the improvements in timeliness and rural access for services acts to enhance the quality of health care.
The strategic role played by Rep. Perry in devising and shepherding the bill through and the Governor's readiness to sign it into law was founded on extensive prior planning efforts. As a member of the Board for the Regional Medical Center at Lubec, Perry was well attuned over the years to the promise of telemedicine in Maine and advised by the health center's Maine Telemedicine Services and project staff of its Northeast Telehealth Resource Center. She was "kept in the loop" during the 2007 review proceedings of the Governor's Telehealth Workgroup, and she participated in the development of a plan for rural health that included strategies to advance telemedicine solutions.
Both planning efforts recognized reimbursement as a major barrier for widespread development of telehealth services in Maine. Whereas the Telehealth Workgroup proposed group efforts to produce more convincing documentation of telehealth benefits, the Rural Health Work Group called more directly for action to address reimbursement issues. Under the mandate of the 2006-2007 Maine State Health Plan, the Telehealth Workgroup involved many stakeholders to "to develop strategies to help Maine achieve an appropriately-developed, utilized and reimbursed telemedicine infrastructure that serves the best interest of patients". The effort was coordinated by Peter Kraut of the Governor's Office of Health Policy and Finance and Kim Crichton of the Maine Health Access Foundation. Also commissioned by the Governor under recommendation of the State Health Plan, the 14 member Rural Health Work Group, in teamwork with the Maine Office of Rural Health and Primary Care and Center and Maine Center for Disease Control and Prevention, had a broader mission to "to assess the capacity of Maine's rural health system to deliver essential health services necessary to promote and preserve the health of Maine's rural citizens.
The April 2008
"Report of Maine's 2006-2007 State Health Plan Telemedicine Workgroup"[pdf] found that three major Maine insurance providers (Cigna, Aetna, and Harvard Pilgrim) had policies not to pay for patient visits with providers using distance technology, while one (Anthem) did reimburse for some telehealth services. The insurance providers participating in the workgroup's meetings argued that there is neither sufficient demand from patients, providers, and employers, nor sufficient data on the quality and effectiveness of telemedicine services, for them to modify their reimbursement policies. Citing
reviews from Agency for Healthcare Research and Quality, the report agreed there was not sufficient data to make any conclusions about outcomes, leading to a recommendation in the
Maine 2008-2009 State Health Plan [pdf] that the State Office of Rural Health and Primary Care lead a discussion forum with a goal of "creating an evidence-base (which services telemedicine is used for; what the outcomes, costs and benefits are, etc.) to establish the business-case for telemedicine and share this information with insurers, providers, and employers." The Feb. 2008 report of the Rural Health Work Group,
"A Plan for Improving Rural Health in Maine" [pdf], commended the efforts of the Telehealth Workgroup, but recommended more explicitly that "commercial insurers should address reimbursement issues, especially adequate reimbursement for host site transmissions" and that both they and the State Medicaid program, MaineCare, "explore the use and reimbursement of store and forward services; and establish reimbursement for tele-home health services".
Process Leading to New Hampshire Law
The New Hampshire Legislature passed the bill, SB 138, on June 13th, and Governor Lynch signed it into law on July 16th. The
New Hampshire Telehealth Act, Chapter 259, specifies that:
- It is the intent of the general court to recognize the application of telemedicine for covered services provided within the scope of practice of a physician or other health care provider as a method of delivery of medical care by which an individual shall receive medical services from a health care provider without in-person contact with the provider.
- An insurer offering a health plan in this state may not deny coverage on the sole basis that the coverage is provided through telemedicine if the health care service would be covered if it were provided through in-person consultation between the covered person and a health care provider.
- Nothing in this section shall be construed to prohibit an insurer from providing coverage for only those services that are medically necessary and subject to the terms and conditions of the covered person's policy.
The legislative process accelerated when an earlier version of the bill was amended and passed by the Senate in March (with a 17-5 vote). It was championed by sponsor Senators Kathy Sgambati and Peter Burling, and sizable set of co-sponsors: Senators Debbie Reynolds, Matthew Houde and John Gallus and Representatives Liz Merry, Sharon Nordgren, James Aguiar, Thomas Donovan, Alida Millham, and Peter Batula. The New Hampshire Telehealth Program, a consortium led by Director Louis Kazal, M.D. and Co- Director David Price, helped write both the bill and the amendment. The New Hampshire Hospital Association and New Hampshire Medical Society both have noted on their Websites the support they provided for the bill during its review by the legislature (
NHHA,
NHMS), while major health insurance providers in the state opposed the bill, as did the New Hampshire House Republican Alliance (
NHRA) [pdf]. As reported in the
New Hampshire Business Review, supporters argued that passage would reduce health care costs and enhance rural patient access to specialty care services. Opponents expressed the view that passage would drive up health care premiums and foster unsupervised experimental medicine.
As a precursor to the development of the bill, the
New Hampshire Telehealth Program engaged many health care stakeholders in 2007-2008 during their strategic planning for a statewide telehealth network. Maine Telemedicine Services of the Regional Medical Center at Lubec was contracted to facilitate the discussions and help draft the report. The report and prior needs assessment work in 2006 explicitly highlighted the barrier that limited reimbursement plays in implementation of telemedicine services in the state, setting the stage for the legislative efforts.
The amendment to the bill made by the House in June involved revising the definition of telemedicine services to be subject to reimbursement. Dr. Kazal favored the original definition, which was meant to include clinical services delivered by e-mail data exchange (termed "store-and-forward", as common in teleradiology and teledermatology practice). In part influenced by the wording in the Maine bill and that used in Medicare provisions for telemedicine coverage, Kazal reports that some legislators favored a definition that sanctioned only interactive video sessions as reimbursable. The compromise definition finally adopted does leave open store-and-forward services:
"Telemedicine," as it pertains to the delivery of health care services, means the use of audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include the use of audio-only telephone or facsimile.
According to the NH Hospital Association, before the new law goes into effect (Oct. 14th), providers, carriers and the NH Insurance Department will meet to work on the carriers' guidance to providers.
Summary
The success of these two states in enacting laws to mandate private insurance reimbursement was founded on a prolonged period of planning. In both cases, hospitals and provider groups were supportive and insurance providers were not. Concern for the evidence base for telemedicine is often raised as an issue, but the prospects of enhanced access and cost savings from more timely care seemed to motivate passage of the bills with very few legislators voting against them. The resulting laws are similar, except that the New Hampshire version is more open to store-and-forward applications.
About the Author
Michael Edwards, PhD, is Director of Research and Evaluation at the Regional Medical Center at Lubec, Maine, where his work includes 12 years of service with its division Maine Telemedicine Services and recent OAT-funded project Northeast Telehealth Resource Center.
(Source: Author Submission, September 11, 2009)8/28/2009
The Health and Human Services Department recently indicated that it received no applications to operate the National Telehealth Resource Center. Because no one applied, HHS said it is extending funding for the existing operator of the National Telehealth Resource Center, the Center for Telehealth & E-Health Law (CTeL) until a new competition can be held in 2010, according to a Federal Register notice published Aug. 26. HHS is providing $225,000 in noncompetitive supplemental grants to the existing center for the year ending Aug. 31, 2010.
HHS' Health Resources and Services Administration (HRSA) is releasing the supplemental funding to the CTeL, which serves as the current National Telehealth Resource Center, so it can continue to provide technical assistance services to regional telehealth centers, the department said.
"HRSA received no applications for the National Telehealth Resource Center," the Federal Register notice states. "Since no organization applied to serve in the capacity as a NTRC, it is urgent that the Center for Telehealth & E-Health Law continue to provide its services until next year without disruption when HRSA can conduct a new competition for the provision of these services."
The Center for Telehealth and e-Health Law has been operating since 1995. It was selected as the National Telehealth Resource Center in 2006.
(Source: Federal Computer Week, August 27, 2009)
4/30/2009
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)
4/30/2009
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:
- Health Information Exchange of Montana ($13.6 million) - In an area with no connections to Internet2 or National Lambda Rail - nationwide dedicated Internet backbones - a new fiber network will connect health care providers in Montana to enable distance consultation, electronic record keeping and exchange, disaster readiness, clinical research, and distance education services.
- Palmetto State Providers Network ($7.9 million) - This project will connect health care providers to a fiber optic backbone to enhance simulation training, remote intensive care unit monitoring, and medical education programs across South Carolina.
- Iowa Health System ($7.8 million) - This project will use new network connections to link health care providers in Iowa to an existing statewide, dedicated, broadband healthcare network, Internet2, and National LambdaRail.
- Heartland Unified Broadband Network ($4.7 million) - This project is expanding and enhancing an existing network to increase the use and quality of teleradiology and increase distance education activities throughout Iowa, Minnesota, Nebraska, North Dakota, South Dakota, and Wyoming.
- Rural Wisconsin Health Cooperative ($1.6 million) - This project has augmented an existing shared electronic health records project that will provide health care providers in Wisconsin with access to redundant connectivity and data centers, as well as higher speeds that will range from 10 to 100 Mbps.
- Alaska Native Tribal Health Consortium ($10.4 million) - The consortium's network, which will serve primarily rural health care practitioners, will unify and increase the capacity of disparate healthcare networks throughout Alaska, allowing them to connect with urban health centers and access services in the lower 48 states.
(Source: FCC Press Release, April 17, 2009)
4/30/2009
Congressmen Mike Thompson, D-California recently introduced telemedicine legislation would provide $30 million in grants to help health facilities pay for telehealth equipment and expand telehealth support services. Currently about 80% of Americans do not have access to telemedicine because of restrictions that limit funding for these types of facilities to rural areas. The Medicare Telehealth Enhancement Act (House Resolution 2068) would expand Medicare reimbursement to urban and suburban areas and include more facilities, the press release states. It will also allow doctors to monitor patients remotely.
Co-authors include reps. Bart Stupak, D-Mich., Lee Terry, R-Neb., and Sam Johnson, R-Texas.
"As health care becomes more expensive, we need to use smart innovations such as telemedicine technology to help lower costs and expand access for all Americans," said Thompson in a release. "Allowing doctors to remotely monitor a patient who has congestive heart failure not only helps the patient stay healthy, it also reduces costly visits to the emergency room. The Obama Administration has indicated that telemedicine will be an important part of their health care reform agenda, and I look forward to working with them to expand access to this important technology."
Last July, Thompson and Stupak's provisions to expand the types of facilities authorized to provide telehealth care were passed into law as part of the Medicare Improvement for Patients and Providers Act. This bill will further expand the type of facilities that are eligible.
(Source: Eureka Times Standard, April 27, 2009)
3/26/2009
Health insurers would no longer be able to require that a doctor meet a patient face-to-face in order to be reimbursed under a bill passed recently by the New Hampshire Senate. Senate Bill 138, which defines telemedicine and requires its coverage, passed the Senate on a 17-5 roll call vote. The measure now goes to the House for approval.
Supporters maintain that the bill will both lower health-care costs and provide better care in rural areas.
"This is going on now," said Sen. Kathy Sgambati, D-Tilton. But she said that there is "confusion on how to bill" for such services that is preventing some providers from engaging in the practice.
"This is vastly going to reduce the costs of health care and help with early detection," said Sen. Debbie Reynolds, D-Plymouth. Telemedicine would help with early detection and "access to specialty care that would reduce the severity of diseases."
But opponents questioned whether the bill is yet another insurance mandate that would drive up premiums. Others worried that it would result in unsupervised experimental medicine, though proponents pointed to language that defines telemedicine as having to fit in the current scope of practice.
(Source: New Hampshire Business Review, March 19, 2009)
