5/9/2008
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)
5/9/2008
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)
5/9/2008
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)
5/9/2008
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
The ATSP wishes to thank
A&D Medical, sponsors of the TIE's
Home Telehealth section for its continued support. A&D Medical offers innovative products that combine cutting-edge technology and convenience.
The TIE is maintained by the
Association of Telehealth Service Providers, relying on
sponsorships and
memberships in order to maintain operations.
Get Published on the TIE
The Telemedicine Information Exchange welcomes submissions of original articles on topics appropriate for this website. Possible subjects might include commentary on telemedicine/telehealth issues or policy, reports of current research projects, or new applications of telemedicine/telehealth.
4/16/2008
Philips Electronics recently released the final results of a survey conducted by Fazzi Associates of nearly 1,000 home care agencies in the United States. Results of the Philips National Study on the Future of Technology and Telehealth in Home Care show that nearly one third of large agencies are currently using a telehealth system and that industry use of telehealth is expected to double over the next two years, principally as a means of managing patients with chronic disease. In addition, over 88 percent of agencies report that telehealth services led to an increase in quality outcomes, as evidenced by a reduction in unplanned hospitalizations and ER visits, and over 71 percent report an improvement in patient satisfaction.
Co-sponsored by Philips, the National Association for Home Care & Hospice (NAHC), and Fazzi Associates, this first-of-its-kind study gathered insights about the use of home care technology from nearly 1,000 agencies across the U.S. The study represented all major segments of home care: large and small, rural and urban, free-standing and hospital-based, and for profit and not-for-profit.
"What makes this study so important is that it is the first representative sample study on technology and telehealth in home care that has ever been undertaken," said Val Halamandaris, president and CEO of NAHC. "We now have a much clearer sense of how specific segments of home care are responding to and using these technologies. One finding that is particularly significant is that the utilization of telehealth by home care agencies also correlates directly with providing the highest quality of care."
"Philips Home Healthcare Solutions was pleased to sponsor a study of this magnitude that could provide insights to advance the home care industry, as well as share these findings at no cost to the field," said Mike Lemnitzer, senior director, Philips Telehealth Solutions. "We believe that home health agencies will be a critical part of the solution to the U.S. healthcare crisis and ensure a continuum of care from the hospital to the home."
According to Dr. Robert Fazzi, project co-director, the Philips study was designed to address questions that are most on the minds of agency leaders about the role of four major home care technologies: human resources and billing systems, point of care systems, electronic medical records, and telehealth systems. Given the importance of telehealth to the future of home care and hospice agencies, much of the study focused on the various types of telehealth systems being used, the components of these systems, what agency leaders liked and disliked about their systems and most importantly, what leaders felt were the most significant impact of these systems on various aspects of quality and financial outcomes. Among the findings were:
- 17.1 percent of agencies use some type of telehealth system. A much higher percentage of large agencies (32.0%) report that they provide telehealth services.
- 88.6 percent report that telehealth led to an increase in quality outcomes:
- 76.6 percent report a reduction in unplanned hospitalizations
- 77.2 percent report a reduction in emergency room visits
- 71.3 percent report that telehealth services improved patient satisfaction. No agency reported that it reduced patient satisfaction.
- 83.9 percent state that less than one in ten patients refused a home telehealth system.
- 79.2 percent of patients or family members were reluctant to have the telemonitoring system removed.
- 42.8 percent report that telehealth led to a reduction in cost. A similar number reported it as cost-neutral.
- 63.5 percent report that telehealth had no impact on clinical caseloads. As more agencies use telehealth and move up the learning curve, clinical productivity measures may increase
- 49.7 percent report telehealth decreased on-site visits
- 45.2 percent report telehealth increased the number of referrals
- 56.9 percent report that their nurses were very receptive to having a telehealth service after one year as compared to 36.3 percent at the beginning of the program.
- 89.1 percent stated that given everything they know today, they would still have started their telehealth program.
To request a copy of the full report, please visit
www.philips.com/HomeCareStudy.
(Source: Philips Press Release, April 4, 2008)
4/16/2008
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 home telehealth technology.
Support the TIE
The ATSP wishes to thank
A&D Medical, sponsors of the TIE's
Home Telehealth section for its continued support. A&D Medical offers innovative products that combine cutting-edge technology and convenience.
The TIE is maintained by the
Association of Telehealth Service Providers, relying on
sponsorships and
memberships in order to maintain operations.
Get Published on the TIE
The Telemedicine Information Exchange welcomes submissions of original articles on topics appropriate for this website. Possible subjects might include commentary on telemedicine/telehealth issues or policy, reports of current research projects, or new applications of telemedicine/telehealth.
4/16/2008
The Charité University Hospital, part of Berlin University in Berlin,
Germany, has opened a center for cardiovascular telemedicine that will carry out research and provide services to patients. It is the first academic telemedicine center in Germany to support a full 24/7 call-center service.
Until now German telemedicine projects have mainly used the commercial call-centers of telemedicine providers, such as PHTS or Vitaphone. The new center will carry out clinical research on telemedicine for cardiovascular patients, and act as a telemedicine call-center for patients on home monitoring programs.
Located within one of the hospital's main buildings, the center initially has 15 employees, including five medical doctors.
"Charité is planning to become a leading academic player in the field of telemedicine", said the managing director of the university hospital, Detlev Ganten. e said that the hospital was already engaged in international telemedicine consultations, for example as the academic centre of excellence for the telepathology network of the International Union Against Cancer, and as a telemedicine partner of Shanghai University Hospital. To open its own call centre was the next logical step, said Ganten.
The first big project at the new centre began a few weeks ago with the 'Partnership for the Heart' project, a clinical study on telemonitoring for patients with chronic heart failure. "We managed to recruit 600 patients in three months", said Friedrich Köhler, a cardiologist and the medical director of the center.
The 'Partnership for the Heart' project aims to show a reduction in mortality rates and hospital admissions for heart failure patients, due to the assistance of telemedicine.
"Unlike other telemedicine studies in heart failure, this one is designed according to the criteria for an FDA approval. If successful, telemedicine in heart failure patients will finally be reimbursed on a regular basis within the German public insurance system", said Köhler. This would be a major breakthrough, since it would mean that every doctor with heart failure patients could issue a "prescription for telemedicine".
Long-term funding for the Charité telemedicine centers yet to be secured. Currently the center has 6m Euro, supplied by the ministry of economy and the three industrial backers of the 'Partnership for the Heart' project: ICW, Robert Bosch, and Aipermon. The money will last until 2009, when the 'Partnership for the Heart' project ends.
"Afterwards the centre will raise money from different sources", deputy-group leader Stephanie Lücke told E-Health Europe.
As the center will function as a call-centert can generate income from health insurance companies. On top of this, further clinical and technical research projects are in the pipeline, which would attract funding from industry, politics or other donors. Finally, Charité Hospital itself is paying the doctors and providing the location.
"One of the next projects will be a clinical study for telemonitoring in pregnant women with pre-eclampsia", said Köhler. These women need blood pressure and CTG monitoring. Using telemonitoring, most of this could be done at home with a neonatologist checking the data online.
Another field of interest is congenital heart disease. Effected children often need close monitoring in order to identify the best opportunity for a cardiac operation. Telemonitoring in diabetics, and in patients with arterial hypertension, is also on the agenda for the future.
(Source: eHealth Europe, April 9, 2008)
Doctors and nursing staff from several municipalities in
Greece - plus four specialists from the Athens Medical Centre - have been trained in the use of telemetric systems as part of an extension of the country's telemedicine program.
The municipalities are members of the Inter Municipality Health & Welfare Network OTA across Greece. The training course, organized and supported by Vodafone Greece, was conducted by instructors from Vidavo, following a pilot program in 2006.
As part of their training the medical teams were also given equipment used to record life signs and a PDA device. The equipment given to the doctors allows them to examine patients with chronic diseases.
For example they can now take a cardiograph or check respiratory function if asthma is suspected at any of the regional medical offices participating in the program and transfer those examinations to the Athens Medical Centre to a cardiology or pneumonology expert, who will examine them and send his opinion back in the same way.
Consequently, regional medical offices will now be able to offer specific specialist services in addition to primary health care. The Greek telemedicine system is based on mobile telecommunications technology and offers multiple benefits to all participants.
Patients can practice preventive medicine, while at the same time geographical limitations are abolished and the sense of security felt by patients is strengthened thanks to direct access to specialist doctors.
Doctors in the regions can better manage their patients since they can provide specialist health care services in remote areas where there is no direct access to a central hospital, while at the same time they also have the opportunity to communicate and work with the specialists from the Athens Medical Centre.
(Source: Vodafone Greece Press Release, March 28, 2008)
Dr Winston Davidson believes that if the Jamaican government can develop an effective system of health care at the community level, then this could significantly cut costs for
Jamaica. In addition, he says, over time, the administration will have to consider the use of technology and automated systems in the public health sector to further reduce costs.
Ruddy Spencer, the health minister, says s there will be further discussions with Cabinet in another two weeks to develop plans for the advancement of telemedicine technologies in the island.
Telemedicine allows for doctors to manage and monitor their patients from a geographical distance using audio, video or computer technology. It also enables doctors to collaborate on patient care, participate in diagnostic procedures and keep abreast of current practices.
"It basically involves a combination of information technology with the management of health information to allow for patient access at any time and any place," Dr Davidson, who heads the Telemedicine Research and Development Unit at the University of the West Indies, Mona, explained.
Dr Davidson says for primary health care to be effective, it must be based on several components which include maintaining a healthy lifestyle, protection against the risk of certain diseases such as malaria and early detection.
He also says the private sector will have to play a role in the development of the public health sector.
"You are going to give access to every individual to primary health-care facilities without cost and that is basic. But when you move now to a higher qualitative level at the hospital, you have to put in place the resources to not only maintain that quality, but to improve it and be part of a system of global delivery."
(Source: Jamaica Gleaner, March 31, 2008)
A one-year telemedicine pilot project launched in July 2007 connects hospitals in
Ethiopia with
India's leading cardiac institute in Hyderabad in an effort to boost health care in rural Ethiopian communities.
The $2.3 million project is part of a larger $135.6 million pan-African electronic network, a joint initiative between the African Union and India to improve Internet connections and communications.
The project uses fiber-optic technology to connect physicians at Black Lion Hospital in Addis Ababa, Ethiopia, with physicians at Care Group of Hospitals in Hyderabad, India. So far, Ethiopian physicians have used the system more than 50 times to consult with Indian doctors, according to Asfaw Atnafu, an Ethiopian physician.
The project also has linked Black Lion with Nekempte Hospital, which is 185 miles west of Addis Ababa. Care Group is in talks to expand the project into Nigeria and Libya.
Indian officials estimate that 100 African patients have benefited from the pan-African network, which is linked to 12 specialist hospitals in India. India plans to continue providing funding and training for five more years before handing over the project to African countries.
(Source: iHealth Beat, April 3, 2008)
Northern Ireland is racing ahead of the rest of the UK in the development of telehealth, said GPC Northern Ireland. But GPs fear it is increasing workload and is not evidence based.
Dr George O'Neil, of Eastern LMC, said $92 million USD was being spent monitoring long-term conditions. Northern Ireland's Department of Health, Social Services and Public Health (DHSSPS) has just established the European Centre for Connected Health (ECCH) to link telehealth systems across Europe.
It will roll out systems to monitor 5,000 patients at home in Northern Ireland in its first year. GPs at the Northern Ireland LMCs' conference said the process of reading print-outs from the night before was time-consuming and unresourced.
Others worried that eventually the worried that the well would be monitored at home too. GPC Northern Ireland chairman Dr Brian Dunn said that technology to monitor chronic illness at home was here whether GPs liked it or not.
'Either GPs get involved and develop it, or the trusts will,' he said.
(Source: Healthcare Republic, April 8, 2008)State Telehealth News4/16/2008
Doctors at the University of Texas Medical Branch, in Galveston,
Texas, have used telemedicine for years to treat patients far away in the Texas prison system, corporate clients, rural Texans, and even researchers in Antarctica — all without leaving their hometown. Dr. Michael Davis and the other doctors who manage and use the medical branch's Electronic Health Network envision wider applications for the technology that had roots in the 1960s but, until the last decade, was still largely relegated to the realm of science fiction.
Obstacles remain. Patients tend to like to have their doctors close by, and insurance companies are still skeptical about potential cost savings. But as telemedicine technology gets smaller, cheaper and more refined, the government and insurers are paying close attention.
The potential of the technology ranges from chronic disease management — easy, in-home monitoring of patients to prevent expensive trips to the emergency room — to robotic surgeries controlled by physicians half a world away.
"The future of telehealth depends less on technology than it does politics: telecommunications laws, privacy laws, insurance reimbursement, licensure," said Will Engle, director of the
Association of Telehealth Service Providers, an international group based in Portland, Ore.
The telemedicine program at the medical branch is among the largest and most highly regarded of more than 250 programs identified by the association in a 2005 survey, Engle said.
When an inmate in any Texas prison unit needs medical services beyond what an on-site primary care physician can provide, a medical branch specialist is just a teleconference away.
Multiple videoconferencing screens allow both the patient and doctor to see themselves and each other. The patient can zoom in on the doctor's face, where expressions can speak volumes. And the doctor can see how his own face appears to the patient, a plus when delivering bad news, for example.
Self-adjusting cameras provide far better definition than the Web cam you'll find at an electronics store, and they allow doctors to see the entire room, or a section of skin as large as a deck of cards.
A laryngoscope, used for viewing areas not fit to mention in print, transmits a large, crisp image of the word "trust" inscribed on a dime inside a doctor's pocket.
In the 1990s, when the medical branch accepted the challenge of providing care for the entire prison system, one of the biggest problems was handling the reams and reams of medical records. Faxing unwieldy charts and patient histories was slow and prone to errors.
Now the records system is entirely electronic, down to the voice recognition system that takes dictation for doctors. It can handle those nonsense prescription medicine brand names and phrases like "prosthetic aortic valve replacement" without missing a beat.
With its 30 to 40 telemedicine studios, the medical branch was on pace to conduct 70,000 patient visits in 2007. During each visit, a registered nurse, emergency medical technician or other licensed medical professional was by the patient's side to help the doctor assess the patient.
"A lot of people think that it is not a personal form of medicine, that it's like a Coke machine that you walk up to and stick a credit card into it and a doctor appears on the screen," said Dr. Glenn Hammack, executive director of the Electronic Health Network at the medical branch. "That's really not anything we've been involved in nor do we advocate."
One of the earliest exercises in telemedicine came in 1967 at an airport, of all places.
Hammack said there were concerns that Logan Airport, at the edge of Boston Harbor, would be too isolated from medical care in a disaster. A black-and-white closed-circuit television network connected nurses and patients at an airport medical station to physicians at Massachusetts General Hospital.
When the medical branch started to provide care in Texas prisons, the initial goal was to reduce van rides. Telemedicine stations were installed in 10 percent of prisons. The installation was bigger than a home refrigerator and cost more than $250,000.
Today, all prison units have a telemedicine cart, and the medical branch's reach now extends around the globe. A "suitcase system" contains all the elements of the carts used in the prisons. It runs for hours on batteries, transmits information over standard wireless networks, and it fits in an overhead bin on an airplane. Mobile systems have been deployed to infectious disease research centers in countries around the world.
Many private insurers won't reimburse for telemedicine visits. But some states, including Texas, have passed laws requiring reimbursement just as if the consultations were face-to-face.
"I think insurance companies are just sort of conservative when it comes to looking at new policies," Engle said. "They've been waiting for the evidence to mount up that there are cost savings."
Health care providers and the telecommunications industry are aggressively seeking to provide such evidence.
A 2001 report to Congress by the U.S. Department of Health and Human Services said that, while a few small studies demonstrated cost savings from telemedicine, the benefits haven't been systematically evaluated on a large scale.
A 2007 study, funded partly by AT&T and released in November by Boston-based Partners Healthcare System, found that nationwide use of telemedicine systems in emergency rooms, prisons, nursing homes and doctors' offices could save $4.28 billion annually.
The study was also funded by the AT&T Center for Telehealth Research and Policy at the medical branch and by grants from the Dallas-based O'Donnell Foundation and the Galveston-based Kempner Fund.
Besides convincing insurance companies, telemedicine advocates will have to ease fears about malpractice liability and licensure problems.
In many cases, doctors can't legally treat patients across state lines using telemedicine.
In California, state investigators charged a Colorado doctor with a felony after he prescribed antidepressants over the Internet to a teenager in California. The teenager later killed himself.
In 2007, an appeals court ruled the state was within its rights to prosecute an out-of-state doctor for practicing in California without a license, even without setting foot in California.
On the other hand, patient satisfaction and worries about extending the technology to rural areas are proving to be less of a problem than some thought.
Surveys routinely show patients are satisfied with the quality of telemedicine visits versus face-to-face encounters, especially when they would have had to travel far to reach a doctor.
And the federal government is dishing out more money to extend high-bandwidth telecommunications to rural areas specifically for telemedicine. In 2007, the Federal Communications Commission announced a three-year, $417 million program to help rural health care groups build high-speed networks. The program includes roughly 6,000 hospitals, research centers and clinics in hard-to-reach places.
All of which may mean that the waiting room will one day be brought to your living room.
"You'll have access over the Internet," said Dr. Oscar Boultinghouse, chief medical officer of the network at the medical branch. "You'll have a set-top box, and we'll be channel 500 on your cable."
(Source: The Galveston County Daily News)
Wisconsin's health providers have been busy in the field of telemedicine, particularly when it comes to developing patient communication. Some of the chief customers of GE Healthcare, one of the largest medical technology firms in the world, include Providence Health & Services' care manager program for monitoring the warning signs of disease; and Park Nicollet Health Services' efforts to monitor patients with congestive heart failure.
Brandon Savage, chief medical officer for GE Healthcare IT, said that the home telehealth monitoring has decreased Park Nicollet's admissions by 45 per month. "That's people who, instead of being in the hospital, are at home with their families because they were able to reach out and just make minor changes early, rather than late, in the disease process," he observed.
Savage said that research and development of home telehealth continues thanks to newer technology, particularly crossovers from other industries. Sensors that keep track of prisoner activity can be modified for patients with dementia, noting changes in their behavior and informing doctors if the symptoms get worse. These sensors could be effective in individual homes, or could be expanded to cover nursing homes.
The Marshfield Clinic, which has built a reputation for providing care in areas without full medical services, also has been active in providing patients with telemedicine options that stress preventive care. The clinic has developed scales where patients are weighed daily and the weight is recorded into electronic medical records, sending notices if parameters are passed - parameters such as patient weight increasing more than three pounds in three days. From there, clinicians can decide if the change is important enough to alert a patient or schedule a future appointment.
Marshfield Clinic also is focused on setting up remote sites in areas without specialists, providing aid that is closer to home than hospitals. About 45 of these sites are set up for 100 providers, lending expertise in cardiology and pulmonary medicine. To deal with the lack of pharmacists in rural areas, they have developed remote pharmacies where local doctors are connected to pharmacists via video conferencing in an effort to rule out medication errors.
"The technology is really the second piece," said Nina Antoniotti, director of telehealth for Marshfield Clinic. "What we're talking about is preserving healthcare relations and the technology is used for that."
Other clinics are developing devices to improve patient care. Beyond their monitoring system, which Maro said averages 120 patients a day, Aurora has created the MD-2 personal medication system. A coffeemaker-sized device programmed to dispense medication on a schedule of six times every 24 hours, it is linked to the computer system of healthcare providers. It immediately sends a signal if the medication is not taken and can be set up to contact three other providers if there is no response.
Frank Byrne, president of St. Mary's Hospital in Madison, called home-based health monitoring "a short connecting flight from what we offer now," including emergency calls and alerts. He said physiologic monitoring (for things that do not cause illness) is a future option that could be implemented through Home Health United, a home health agency that St. Mary's co-owns with other hospitals.
(Source: Wisconsin Technology Network News, April 2, 2008)
Agafangel Lekanof is a resident of St. George,
Alaska who lives with a health condition called chronic obstructive pulmonary disease or COPD, a lung disease that makes it hard for him to breathe. His home is within minutes of the St. George Traditional Clinic, but for Lekanof it might as well be miles.
"If I was to walk it would take me an hour, the way my health is," said Lekanoff, who says his condition results from a lifetime of smoking cigarettes. "I get sick from going out in the cold, and I have to ride a four-wheeler or ask a brother to take me."
Until recently, Lekanoff's limited mobility – and his dislike for clinics and hospitals – made it difficult for health practitioners to monitor his precarious health. But that changed in September of this year, when Lekanoff became a pilot patient for the Eastern Aleutian Tribes' home telehealth monitoring system.
Launched in partnership with the Alaska Federal Health Care Partnership, telehealth is a health management strategy that gives patients with chronic conditions such as diabetes, obesity, high blood pressure and COPD the ability to monitor their own health without going to a clinic.
The key is a piece of equipment called the "Turtle 400," or turtle for short.
The turtle is a small touch-screen computer connected to equipment that measures vital signs such as blood pressure, blood oxygen and weight – the same health indicators that nurses test for at a clinic. The turtle also has a small chip that allows it to transmit information over the phone line.
Every day, telehealth users run test their vitals and enter the information into the turtle. Once finished, the user sends the information through the phone line to a server, where it is uploaded to a secure website that only a specific health care practitioner can access.
If the health practitioner notices anything out of the ordinary, he or she can follow up with phone call or an appointment.
The process takes Lekanoff about three minutes, yet last February it may have saved his life.
Chris Diaz, community health aide in St. George, logs on the telehealth Website each day to check Lekanoff's vitals. One day, he noticed that Lekanoff's weight had increased abruptly.
Diaz knew that a weight fluctuation could mean that Lekanoff was packing extra fluid around his heart or lungs and called up Lekanoff for a visit. Upon examination, Diaz's suspicions were confirmed – Lekanoff had pneumonia.
Because it had been caught early, Diaz was able to treat Lekanoff in St. George. Had the pneumonia been left to develop, Lekanoff may have needed a medical evacuation to a hospital in Anchorage. For people who have difficulty breathing, like Lekanoff, pneumonia can lead to death if untreated.
Mary Rydesky, chief information officer and director of technology and training for Eastern Aleutian Tribes, said Lekanoff's experience shows how telehealth can help rural residents and their health care practitioners throughout the state.
"If we can get to the health problem before it's critical, we have saved so much in medical costs, in the lives patients and the patients' health," Rydesky said. "Knowing (the vitals) can help keep patients out of hospitals ... . It can decrease medevacs, emergency room visits and help keep elders at home in their own village."
Mark Anaruk, project manager for telehealth monitoring at the Alaska Federal Health Care Partnership, said that home telehealth has been used successfully in caring for Alaska veterans since 2002.
"It was kind of a no-brainer to do it in rural Alaska, where we often fly instead of drive," Anaruk said. "The patient saves money by not having to travel as much, the health agency saves money by keeping the patient home and overall the patient's health is improved."
The turtles are currently being used by about 30 Alaska Native patients in Kotzebue, Fairbanks, Anchorage, Fairbanks and the Aleutian Islands areas. By July this year, he expects patients to come online in the Bethel, Copper River, China and Kodiak areas.
Telehealth home monitoring is currently offered at no cost to Alaska Natives or veterans with chronic diseases and to members of the armed forces. Each turtle costs about $2,000, but with each medevac costing about $20,000 to $30,000, "if we're able to prevent just one medevac that could pay for 10 or 15 of these set-ups," Anaruk said.
Back in St. George, Diaz said that the benefit of home telehealth monitoring goes beyond preventing crisis.
"It's an empowering tool," Diaz said. "A lot of times a patient will be in denial of his own health, but this makes the patient responsible for their own health care as well.
"It helps us communicate better and makes the patient appreciate his condition a little more," he said. "It's still a struggle but there is definitely an improvement in attitude and appreciation for his health."
"We could probably use a half dozen or so in the next year," Diaz said.
Home telehealth monitoring is currently being offered to Alaska Native patients, veterans or member of the armed forces. Patients interesting in participating in the program should contact their local health care provider.
(Cordova Times, April 11, 2008)
Sonora Regional Medical Center, in Sonora,
California, has introduced a series of state of the art telemedicine devices that will allow Community Home Care patients to be monitored while in the comfort of their own homes.
Under the program patients who may be at risk of being rehospitalized will be equipped with the Viterion 100 TeleHealth Monitor to track any significant changes in their vital signs including blood pressure, blood oxygen, temperature, weight and blood sugar. If vital signs change a Home Care staff member is immediately notified.
The national average for rehospitalization is between 18-20 percent. The Sonora Regional Medical Center figure for Community Home Care patients stands at 13 percent.
(Source: MML News, April 10, 2008)
4/16/2008
The nation's ability to rein in future healthcare costs, which hospital executives fear could reach unsustainable levels within a decade, may depend in part on emerging technologies that are taking patient engagement to a higher level, especially in the home. Home health monitoring and telemedicine for post-discharge care are nothing new, particularly with cardiovascular care, but it is taking on added dimension as new technology permits.
William Petasnick, CEO of Froedtert Hospital, Milwaukee, said the next generation of home health monitoring, also called home telehealth, will take consumers beyond routine pacemaker monitoring and into total remote monitoring. The business value of this new direction goes beyond the desire to reduce hospitalization, and therefore cost, and extends to better resource utilization in an era of nursing and other workforce shortages, the need to better manage chronic diseases, and the desire for better patient service and outcomes.
The hospitals of today, Petasnick noted, are trying to become more highly intensive in terms of their care environments. "With less-acute patients, the more we can keep them out of an institutional setting, that's better for care and it's a more effective use of resources," he said.
Home telehealth, according to Jonathan Edwards, research vice president for Gartner and a lead analyst on telemedicine, is a concept that uses these technological developments to assist patients who suffer from chronic or long-term medical conditions that historically require frequent visits to the hospital. Monitoring for cardiac patients is popular with several types of portable devices, but the technology is also used for cancer or diabetes patients whose vital signs suddenly can fluctuate.video conferencing.
"For patients with expensive conditions, it makes sense to have these devices rather than being admitted into the hospital," Edwards said.
Joan Maro, vice president of home care and hospice and chief nurse executive at Aurora Health Care in Wisconsin, said the technology Aurora uses for patient monitoring collects chemical levels and vital signs, with specialization to meet the requirements of many conditions. Monitors can read heart rate, blood pressure, weight, oxygen saturation, and temperature, sending signals to the Aurora offices for review and (if necessary) response by a trained nurse.
Daily monitoring, Maro said, allows clinical professionals to both keep an eye on patients in the event of emergency and also plan ahead for any new developments in their condition. Depending on the issues surrounding patient privacy, it may one day be possible for a patient's family to access their information over a distance.
"It would be a wonderful offering for the families caring for loved ones from a distance," Maro said. "They would be able to see that their blood pressure was in line or that they had taken their medications - even monitor them via camera."
One barrier to the use of telemedicine, Edwards said, is not the devices themselves but transmittal of data from those devices, and the lack of an infrastructure to monitor and detect the data. Without an appropriate recording system, the information collected cannot be compared to normal health criteria and therefore is of limited use to doctors and other providers.
Developing these records systems can be a problem, since telemedicine is held back by the oldest issue in the medical field: money. Maro said that at this time reimbursement for in-home monitoring is limited, chiefly due to a lack of documentation to prove that home health monitoring is cost-effective and leads to improved outcomes.
Funds are limited for telemedicine, Edwards said, because insurance and payer companies have been slow to lend support for the technology. These limitations mean that, in many circumstances, patients have to cover their own costs, leading to circumstances where third-party vendors have to bypass primary care and therefore are not integrated with the physicians' medical records.
"The group is paid by activity, so they don't have any incentive to keep the patient at home," Edwards said of healthcare's profit mentality.
Telemedicine's success, Edwards added, will depend on the success of pilot projects and grant funding, which help develop interest and documentation in the field. One of the more encouraging investments has been made by the U.S. Veterans Health Administration, which has thousands of patients suffering from conditions such as diabetes and cardiac failure. The field also is driven by organizations such as the Continua Health Alliance, which unite device developers committed to improving technology for home health devices.
Device development will also play a role, as the three areas of telemedicine identified by Edwards - messaging systems to prompt and alert patients, devices to record vital signs, and tools for video conferencing - continue the trend of merging into one device. Unified devices like these would allow healthcare providers to consolidate operations, a move that also could lead to wider adoption by insurance companies.
Of course, the most important factor for home health monitoring will be for developers to remember who they are designing the technology for. "For anybody, the issue is creating a healthcare environment and creating it where services are needed," said Nina Antoniotti, director of telehealth for Marshfield Clinic. "It's what's efficient for providers and giving [patients] a good experience."
Telemedicine is expected to expand with the specter of "Baby Boomers" approaching retirement, a trend that will dramatically increase the elderly population. "The elderly patients are more likely to have chronic conditions, which are typically more expensive to manage," Edwards said. "Therefore, an elderly population will need more home health monitoring."
Not everyone believes the aging population will be the primary driver of future healthcare costs. Donna Friedsam, associate director for health policy with the University of Wisconsin-Madison Population Health Institute, cited recent U.S. Congressional Budget Office and Office of Management and Budget analyses that suggest the aging population is not the only culprit.
In challenging the conventional wisdom, the Congressional Budget Office has issued a series of reports on the growth in healthcare costs. In one analysis, it notes that the aging of the population is frequently cited as the major factor contributing to the large projected increase in federal spending on Medicare and Medicaid, but asserts that aging accounts for only a modest fraction of projected growth.
According to the CBO, the main factor is the extent to which the increase in healthcare spending exceeds the growth of the economy. The CBO also indicates that gains from higher spending are not clear, but there is substantial evidence that more expensive care does not always mean higher-quality care. "Consequently, embedded in the country's fiscal challenge are opportunities to reduce costs without impairing health outcomes overall," the CBO stated.
The Office of Management and Budget goes a step further, saying the long-term fiscal challenge is "almost entirely unrelated" to demographics and Social Security, but it is mostly confined to inefficiencies in the private and public healthcare system - inefficiencies that concepts like home telehealth would address.
(Source: Wisconsin Technology Network News, April 2, 2008)
3/22/2008
FasPsych, a provider of provides professional telemedicine services, recently launched one of the first open telepsychiatry networks designed to serve clients regardless of where they are located or with which agency they are affiliated.
Many existing telepsychiatry networks were developed as internal solutions for one local or regional entity. FasPsych is different in that their system, rather than being built to singular access to care issues, was designed to serve multiple states and even other countries.
FasPsych's model allows any individual practitioner, group practice, hospital, company or agency, from a rural mental health clinic to a busy urban clinic, to obtain psychiatric services via video teleconferencing technology. After only being in business for 3 months, FasPsych is successfully delivering services to several rural Arizona mental health clinics. FasPsych will soon also be delivering services to:
- Rural Emergency Rooms
- Nursing Homes
- Jails and Prisons
- Military and their families
- Private patients in their homes
- Mental Health Clinics
- Native American Tribes
FasPsych has hired a group of highly talented doctors, nurse practitioners and a psychologist to ensure services can be delivered in areas where they were previously unable to access care. Services can also be provided in Spanish.
(Souce: FasPsych Press Releas, March 20, 2008)
AMD Telemedicine, a telemedicine equipment provider, recently announced that it had identified telemedicine eductional initiatives -- in the form of courses, clinical programs, and affiliated hospital networks -- affiliated with 23 U.S. colleges, universities and schools of medicine.
"Telemedicine initiatives that connect hospitals and learning institutions -- both those we've spotlighted and others that we were not able to identify as yet -- help to educate not only physicians, nurses and nurse practitioners, but also patients," said Steven Normandin, president of AMD. "Our online inquiries have netted some excellent examples of real telehealth/telemedicine educational programs in action. We hope to expand this list regularly to include more educational telemedicine projects going on in the U.S. and around the world."
Through this informal, online research project, AMD learned that within U.S. colleges and universities found on the Web, 14.6% offer telemedicine/telehealth courses; and 7% of those same U.S. colleges and universities include telemedicine/telehealth clinics, centers, programs, institutes, etc.
The 23 schools that make up that 14.6% include:
- East Carolina University, Brody School of Medicine
- Howard University, College of Medicine
- Loma Linda University
- Medical College of Georgia
- Mount Aloysius College
- Mount Sinai, School of Medicine
- Oklahoma State University
- Southern Illinois University, School of Medicine
- Texas Tech University, Center for Telemedicine
- The University of Hawaii, Telehealth Research Institute
- The University of Vermont
- UCDavis School of Medicine
- University of Arizona, Arizona Telemedicine Program
- University of Colorado at Denver
- University of Florida
- University of Kansas, Center for Telemedicine and Telehealth
- University of Miami, Miller School of Medicine
- University of Missouri, Columbia School of Medicine
- University of Rochester, School of Medicine and Dentistry
- University of Tennessee, Health Science Center
- University of Texas Medical Branch, School of Nursing
- University of Utah, Health Sciences Center
- University of Virginia, Office of Telemedicine
Each school offers a different set of telemedicine/telehealth programs.
(Source: AMD Telemedicine Press Release, March 19, 2008)
Since the first, relatively rudimentary incarnations of
electronic intensive care units (eICUs) were installed in U.S. hospitals just seven years ago, the technology and acceptance level have grown. As there is with most fundamental shifts in the way things are done, there was resistance to remote monitoring technology when it first became available around the turn of the century. Providers, patients and patients' family members were wary. But now, more than 200 hospitals in 28 states now use eICU technology.
Rising costs and a shortage of intensivists (critical care specialists) and critical care nurses have made it difficult for hospitals to staff ICUs adequately. Electronically monitoring patients from a central location allows one intensivist to care for many more patients than he or she would be able to in a traditional ICU setting. Doctors and nurses watch video displays and a set of monitors for medications, blood pressure, heart rate, oxygen levels and respiratory rate.
Although the technology has found its way into only a small percentage of U.S. hospitals (some estimate 12%-15%), those that have and use it are already looking around the next corner.
One company --
Visicu, based in Baltimore -- dominates the market for designing and installing eICUs in this country. It's now poised to deliver its patented technologies and processes to the rest of the world. Founded by two Johns Hopkins intensivists in 1998, Visicu was acquired this year by Royal Philips Electronics of the Netherlands in a deal reportedly worth more than $430 million.
The company's success is attributed to legal, as well as medical, acumen. When Visicu's founders Michael Breslow and Brian Rosenfeld, who managed adult critical care at Johns Hopkins Hospital for more than 25 years, began devising software and electronic systems to monitor patients, they took great care with the wording of patents.
"Visicu did a really good job in developing a very broad, robust method patent for their technology," Groves said.
Other companies have challenged different aspects of Visicu's patents, but so far the company is virtually alone in the marketplace. Visicu's dominance leads some industry insiders to worry that competitive pricing and new applications for the technology may be slower to develop. But hospitals where Visicu systems are in place are generally satisfied.
"They've been a very good steward of the technology," Groves said. "They solicit input and they listen and react very well.
"Obviously, Phillips is pretty bullish on them down the road," Groves added, "and I wouldn't be surprised to see the company start looking at other parts of the world."
(Source: iHealth Beat, March 12, 2008)
Healthanywhere, a Division of IgeaCare Systems, recently announced they have partnered with Canada's largest independently owned home care service provider, We Care Health Services (WCHS), to deliver a telehealth system that provides a comprehensive menu of services for those with chronic diseases and their caregivers.
WCHS will employ a combination of easy-to-use technology and traditional home care to monitor health and promote independence in one's home and integrates health promotion, symptom management and disease prevention to help clients stay on the targets set with their doctors. Patients with chronic diseases such as COPD, Coronary Artery Disease, post-coronary/stroke, arthritis, cancer, mental health/behavior disorders, diabetes and kidney or liver disorders will benefit from this program.
Healthanywhere is not meant to replace nursing visits, but it can significantly reduce the number of visits required, while the monitoring function has been shown to decrease the number of ER visits and hospital admittances for people using the system. As clients and their families learn more about their disease, their ability to identify problems earlier and to react in a proactive way promotes their independence and improves their quality of life. As clients enjoy daily monitoring of their condition, their peace of mind is increased, they do not feel they are "home alone" in a medical system that is overwhelmed with the demands placed on it.
(Source: IgeaCare Systems Press Release, March 7, 2008)
A new report by Global Industry Analysts, Inc predicts that the global market for
PACS and
teleradiology systems will reach US$4.4 billion by 2010. Factors such as increasing adoption of PACS across imaging centers and small hospitals, advancing communication and enterprise technologies, and ability of PACS systems to be integrated with other imaging modalities are expected to bolster the demand scenario.
Picture Archiving and Communication System or PACS is a technology centered upon leveraging computers and data communication technologies to collect, store, process, retrieve and disperse medical imaging data to hospitals and affiliated clinics geographically spread across the world. The technology is currently metamorphosing into a broad commercial application.
Despite all advantages and benefits offered by PACS and teleradiology, the transition to a digital information environment is fraught with various challenges and issues such as high cost of purchasing, installing and implementing a PACS system and uncertainty over security of patient data. Teleradiology represents one of the most advanced and widely reported application areas of telemedicine. Telemedicine is progressively gaining momentum as the medical society seeks to leverage telecommunications as a medium to enhance administration and performance of medicine.
According to the report, the United States, Europe, and Japan dominate the global PACS and teleradiology systems market, capturing more than 88% share of sales in 2006, as stated by Global Industry Analysts, Inc. PACS Systems represent the leading segment, accounting for about 64% share of the worldwide sales in 2007. In terms of PACS acceptance in diagnostic imaging, United States leads the world market.
The report, entitled "PACS and Teleradiology Systems: A Global Strategic Business Report" published by Global Industry Analysts, Inc., covers major market dynamics, trends, issues, and competition pertaining to the market. Analytical estimates and projections on market size have been presented in terms of dollar sales over the years 2000 through 2010, while long-term projections are provided over the time period 2011-2015.
(Source: Global Industry Analysts Press Release, March 15, 2008)
