Telemedicine and Telehealth News 7/15/2008
On July 9th, the Senate passed the comprehensive Medicare legislation. This legislation with a number of important issues of importance to the Medicare community will also expand the list of telehealth originating sites to include hospital-based renal dialysis centers, skilled nursing facilities, and community mental health centers. The vote was the second attempt at passing this legislation after a vote for cloture failed in June.
The legislation has been vetoed by President Bush. However, both the House and the Senate passed the measure with sufficient margins to override a veto and it is likely that it will be overridden.
In other legislation, the Senate and House spending bills will boost telehealth funding. Both the Senate and House appropriations committees released FY 2009 spending bills that will increase funding for the Office for the Advancement of Telehealth (OAT)to $7,100,000 from a FY 2008 level of $6,700,000, while the Senate bill would increase OAT funding to a full $8,000,000.
The "Promoting Health Information Technology Act of 2008" (HR 6179) introduced on June 4th by Representatives Dave Camp from Michigan and Sam Johnson from Texas seeks to utilize public private partnerships and tax incentives to help the adoption of HIT.
A practice of five physicians could easily spend upwards of $200,000 to implement an electronic health record. To speed adoption, the PHIT Act would allow physicians who purchase HIT to deduct a larger portion of this business expense more quickly. The Act would also eliminate the arbitrary 2013 sunset HHS has placed on hospitals providing physicians with software for electronic health records.
The legislation would strengthen telehealth in several ways. Section 303 in the legislation would help to provide telehealth services across state lines, calls for a study on expanding home health and related telehealth services, examine how to pay for home health telehealth services, and look at ways to expand the list of sites to include county or public mental health clinics.
The legislation requests a study done by the Office for the Advancement of Telehealth to report on the use of store and forward technology for telehealth. This study needs to include an assessment of the feasibility and the costs for expanding the use of these technologies.
(Source: Federal Telemedicine News, July 13, 2008)
Physicians would be allowed to bill for follow-up inpatient consultations delivered electronically under a proposed rule from the Centers for Medicare and Medicaid (CMS) that sets Medicare payments for 2009. The CMS is proposing to add new codes specific to the telehealth delivery of follow-up inpatient consultations. The codes are intended for use by providers who are consulted by a patient's attending physician regarding care but are not available for a face-to-face encounter.
The proposed rule could spur other health insurers to do the same. As defined, these inpatient telehealth consultations would include monitoring a patient's progress, recommending care-management changes or advising on a new plan of care in response to changes in the patient's status. Telehealth visits or e-visits would be done in real time, using an interactive communications system, except in Alaska and Hawaii, where store and forward technology is being used in federal telemedicine demonstration projects, the CMS said.
Payment for these follow-up visits would include all consultation-related actions done before, during and after communicating with the patient remotely, such as reviewing patient data and talking with other health providers on the care team and family members as well as completing medical records, according to the CMS.
The three new billing codes would each reflect the complexity of the telehealth consult. The first would be a straightforward visit, taking about 15 minutes, the second would include medical decision making that is somewhat complex and taking about 25 minutes, while the third code would reflect a patient visit of about 35 minutes that includes a more thorough conversation and decision making, the CMS said.
The American Medical Association has called for e-visit reimbursements that accurately reflect the scope and complexity of the work involved. Without reviewing all the details yet, the AMA would be, in concept, "all for it," a spokeswoman said.
While e-visits are still new, some health plans have already started reimbursing providers for them, said Jonah Frohlich, senior program officer at the California HealthCare Foundation, a not-for-profit research group in Oakland. Five health plans in California pay $40 per telehealth visit, and some national health plans are piloting the concept, he said.
"The biggest benefit is that using telehealth visits for routine question and answer can help deal with physician backlog and be convenient for the patient," Frohlich said, adding that health plans tend to adopt billing practices led by the CMS.
(Source: Modern Healthcare, July 2, 2008)
A new survey from Frost & Sullivan finds that the European telemedicine market generated revenues of $118 million in 2007 and could reach $236 million by 2014. Frost officials say that although the telemedicine industry has reached great heights in Europe, certain technological advances have inadvertently led to new hurdles. Problems such as lack of physician acceptance of novel telemedicine technologies and the pressing need for standards have begun to haunt the industry, according to the firm's report. An effective telemedicine technology will help in increasing the number of patients that physicians treat remotely lowering the costs and travel times associated with treatment, the report says.
Although the technology in industry is becoming increasingly sophisticated and powerful, prices for computers, software and transmission equipment are falling, Frost says. To widen the deployment of telemedicine, many market participants are lowering the cost of technologies.
Also, health organizations are increasingly using telehealth technology to monitor patients remotely, according to the report. However, the lack of payer reimbursement is a major barrier to broader adoption. But questionable returns on investment, the technology is perceived to be extremely expensive, the report says.
Frost says that if the government wishes to keep pace with future demands for healthcare and reduce escalating healthcare costs, they will be compelled to adopt certain eHealth strategies accompanied by concrete actions. The number of Web sites/portals dedicated to patients with specific diseases will expand as well as the number of households connected to the Internet grows, according to the firm's report. This trend will also increase online communication between doctors and patients, Frost officials say.
"While it is apparent that the telemedicine industry is in the midst of great change, it is not clear how the industry will look in the years to come," said Frost & Sullivan Research Analyst Janani Narasimhan. "Technological developments have the potential to not only alleviate the current growing pains but also provide some solutions for the major challenges facing the business of telemedicine delivery."
(Source: TCMnet.com, July 10, 2008)
Writers working in telemedicine and knowledge management as researchers and practitioners are invited to submit book chapters to be published by IGI Global, www.igi-pub.com.
The Handbook of Research on Knowledge Management in Telemedicine: Advanced Ethics, Policy and Regulatory Applications will cover a wide range of topics from early adopters of Telemedicine to the latest innovation and futuristic tele-robotic technologies.
In the fields of knowledge management in telemedicine and associated fields of datamining and biomedical ontology, there exists a need for an edited collection of articles in this area. The book aims to provide relevant theoretical frameworks and latest empirical research findings in the area.
More information, including submission submission procedures and contact information can be found here.
(Source: IGI Global Press Release, July 5, 2008)
A new online report by the California HealthCare Foundation examines the evolution of telemedicine in California and identifies the technological, financial, regulatory, and user-related hurdles that may be stifling further progress. It finds that while some patients have benefited from early innovators who transformed inventive technology projects into statewide telemedicine programs and e-health networks, the impediments to broader adoption remain daunting.
Although the authors acknowledge the persistence of such barriers, they also suggest that given the explosive growth in Internet use, the expansion of remote communication models, and the relentless pressure to cut the cost of care delivery, the time may finally be ripe for telemedicine. The report concludes by exploring questions about the key factors that could affect the proliferation of telemedicine technology in California.
The complete report and a related eight-minute video demonstrates how clinics in rural and urban locations are using telemedicine is available here.
(Source: California HealthCare Foundation, July 10, 2008).
Nevada officials responding to a critical lack of mental health resources are hoping technology, newly licensed counselors, partnerships with higher education and community education about suicide will reduce deaths and improve the quality of life for rural Nevadans.
Nevada is addressing the lack of rural mental health services with an Internet-based program, which connects patients to a psychiatrist through a Web camera. Last year, legislators enacted a law to license new mental health counselors and partnered with state colleges and universities to create academic programs specific to rural mental health.
Nevadans in the 15 rural counties, excluding Washoe and Clark, commit suicide at a rate more than double the national rate. In 2004, the most recent year for which data are available, 27 out of 100,000 people in the state's rural counties killed themselves. The rate for the state and Washoe County was 19 per 100,000. The national rate was 11 per 100,000.
Officials say a precise reason for the high rate is unknown, but lack of mental health professionals, distance between communities and the stigma of seeking treatment all contribute to the problem.
Alaska, the national leader in suicides, is mostly rural communities. Many parts of Alaska are accessible only by boat or aircraft. Ron Adler, CEO and executive director of the Alaska Psychiatric Institute, said the state also has a shortage of professionals, especially to treat children. The cold and heavy snow prevent professionals from traveling to rural areas in Alaska.
Adler said the state has used telemedicine for about 20 years. In the last five years, video conferencing was added for assessments and patient sessions with psychiatrists at eight rural clinic hubs throughout the state.
Telemedicine also is used to train physicians in Alaska. Since April, free monthly video conference trainings have been offered to physicians regarding medications and treatment for mental illness.
"Technology makes a world of difference in providing care in a timely and affective way," Adler said. "We all know that when people ask for help, they are inviting you in. That's the time to give them services. That's what video conferencing does."
(Source: Reno Gazette-Journal, July 14, 2008)
The California Telehealth Network, a state program providing expanded broadband and telecommunications access to rural clinics, is soliciting applications form clinics interesting in participating.
Some 400 clinics have already expressed interest in the $30 million federally backed program, which is co-managed by the University of California Office of the President and the UC-Davis Health System.
The program, part of a larger Federal Communications Commission initiative, will create a statewide telecommunications infrastructure so that people in rural areas might use technology to access medical services that do not exist in their communities.
Clinics that join the program will have get a free broadband connection and the ability to tap into specialty and emergency care services around the state.
California Telehealth Network hopes to connect 100 clinics in the first year of its three-year effort.
To apply clinics must complete an online readiness survey and submit a brief Letter of Agency, expressing interest in participating. The deadline for submitting the letter is July 30.
Information and instructions are available at www.caltelehealth.org, or call (916) 734-3008.
(Source: East Bay Business Times, June 24, 2008)
For Yuma Regional Medical Center patients who can't afford to visit specialists outside Yuma, Arizona, the medical center's partnership with the Arizona Telemedicine Program connects patients to specialists through technology.
The Arizona Telemedicine Program at the medical center got a positive review last month from Dr. Ronald Weinstein, director of the program at the University of Arizona Health Sciences Center.
The statewide program came to Yuma Regional as part of the Arizona Department of Health Services Children's Rehabilitation Services program.
The center's Neonatal Intensive Care Unit is linked to the University Medical Center in Tucson, for emergency consultations on infants with serious, often life-threatening conditions. It also provides services for disabled children in the Yuma area.
Weinstein came to visit Yuma Regional in May to get an update on current telemedicine activities and to assess the utilization of its services.
"Babies' lives have been saved in the YRMC Neonatal Intensive Care Unit. Dozens of children with severe disabilities are being seen by a pediatric orthopedic surgeon in Phoenix over the network," Weinstein said.
Mike Sisson, applications administrator at Yuma Regional, works with telemedicine for children's health services.
The equipment he works with is a Tandberg Edge 95 MXP PrecisionHD camera that is connected to a 50-inch Panasonic flat-screen plasma television.
Sisson said that he works mostly with children who are in wheelchairs and whose families cannot afford to drive outside of Yuma to see a doctor.
Sisson helps the doctors in Phoenix or Tucson to see how a child moves and looks through the plasma screen. There are also therapists in the room with Sisson, who become the doctors' hands by bending, moving and feeling a child's extremities.
Sisson said that the patients love this new program.
"Sometimes it is the only way (for them) to see the doctor."
Gregory Warda specializes in neonatology and works in the intensive-care unit with newborn babies at Yuma Regional.
"This is a great solution," he said. Through the screens "we can see doctors and nurses ... It's just like they were right here ... and I can ask the doctor questions instead of writing a letter."
(Source: Arizona Republic, July 13, 2008)
The use of telemedicine in Ohio is expanding. Nationwide Children Hopsital in Columbus plans to establish a connection with a hospital in Zanesville later this year and is shooting for links with four other hospitals serving rural areas next year. The hardware costs hospitals about $7,600.
Dr. Rachel Brown, a physician at Nationwide Children's, said the high-definition connection enables doctors to see a newborn's color and breathing, determine whether the child might be in shock and evaluate blood pressure.
Children's Hospital Medical Center of Akron is using telemedicine to connect special-needs children at two schools in rural areas of Ashland and Wayne counties to their family doctors if the children get sick at school. The system features video conferencing, electronic stethoscopes and the capability to transmit photos of symptoms. The hospital plans to expand to two more schools.
Nationwide, the use of telemedicine is also growing. Doctors at the Richmond VA Medical Center are consulted via video hookup about cardiology patients at the Beckley (W.Va.) VA Medical Center, which is 200 miles away; the TeleCare Network in Bismarck, N.D., uses video conferencing to deliver mental-health treatment from psychiatrists to patients in nursing homes and group homes in North Dakota, South Dakota and Montana; Richard Schein, a graduate student at the University of Pittsburgh, uses video conferencing to outfit patients in rural areas with wheelchairs.
Dr. John Fortney, pediatrician and senior medical director at Adena, said he first viewed the technology as an expensive toy but has since been won over.
"This is the wave of the future," Fortney said.
Pediatricians at Adena have used the connection between 50 and 100 times, mostly to consult with the specialists in Columbus about a patient. Transporting patients to Columbus has declined by about half.
"I can present them with special problems I'm having and be able to direct them visually to the area I'm concerned about," Fortney said.
The doctors use the Ohio Supercomputer Center's high-speed optical network, which has more than 1,850 miles of fiber with the large bandwidth necessary to transmit high-definition images in real time.
(Source: Chillicothe Gazette, June 30, 2008)
"These organizations deliver vital services to their communities – meeting real medical needs and making real impacts," Governor Doyle said. "I am pleased that we are able to award these grants that advance and improve health care in our state. The USF program continues to provide extraordinary value and assistance to all of the state's telecommunications customers."
The Telemedicine Program is part of the Universal Service Fund, which awards grants annually to non-profit medical clinics and public health agencies. The grants help clinics purchase telecommunications equipment to promote advanced medical services and enhance access to medical care in underserved areas.
The telecommunications technology the grants help fund improves communication between patients and healthcare staff and communication between medical experts throughout the state. The Telemedicine Grant Program has awarded more than $3.1 million to Wisconsin non-profit healthcare providers since the program began in 2006.
The complete list of non-profit organizations that received grants can be viewed here.
(Source: Wisconsin Office of the Governor Press Release, June 24, 2008)
Women who live in rural areas and have high risk pregnancies often have to travel to a larger city to see a specialized doctor. However, in Arkansas, patients can go to any Arkansas hospital and talk to her doctor live. The telemedicine program links to all 84 hospitals in the state through a secure, isolated network that only hospitals can tap into.
"This technology allows the patient to have access to the same kind of physicians you have in the large cities, but over interactive video," said Dr. Curtis Lowery of the University of Arkansas for Medical Sciences in Little Rock.
In the patient's room is a genetic counselor and the ultrasonographer to help Dr. Lowery see the images.
"There's not a program like this in America that is extensive as this," says Lowery.
If he needs to hear the heart beat there is an electronic thesascope that a nurse can put on a person's heart. To have Dr. Lowery at other hospitals' fingertips is crucial. He's one of only four maternal- fetal medicine specialists in the state.
"In the event we see something unfamiliar or abnormal then we are able to get him immediately," says ultrasonographer Bill Hickey.
It saves time, travel, extra doctor visits and potentially the life of an unborn child.
The telemedicine program started five years ago. Doctors are also use the technology for education conferences and are looking into connecting with hospitals in India, Russia and Australia.
Doctors are also using the technology for women who have abnormal pap smears and need a colposcopy, which checks the cervix.
(Source: TodaysTHV, June 26, 2008)
The new report "Home Health Care during an Influenza Pandemic: Issues and Resources" highlights the critical need for home healthcare technologies in providing care during a pandemic influenza event. The report funded by the HHS Assistant Secretary for Preparedness and Response and CDC, and developed by AHRQ, describes the resources and the technology needed by home healthcare providers and community planners to prepare for such an event.
The report stresses the need for telehealth technologies to deliver patient care and to do advanced planning and coordination at the local level. Using technologies would allow remote monitoring of patients and the ability to prompt patients on taking medications.
The equipment needed includes:
"Tiny Tom", an innovative new telemedicine service which will help with the care of sick babies in North Queensland, Australia was recently in Townsville.
Tiny Tom is the latest development of the telepediatric service, a major research project run by The University of Queensland's Centre for Online Health (COH), a research center based in the Royal Children's Hospital in Brisbane.
COH Deputy Director, Dr Anthony Smith said the new service linked clinicians at Mackay Base Hospital, by video, with the neonatal intensive care unit (NICU) at The Townsville Hospital.
"Tiny Tom is a mobile and wireless telemedicine system that facilitates weekly virtual ward rounds between Townsville and Mackay hospitals," Dr Smith said.
"During the ward rounds at the NICU, Tiny Tom is wheeled up to an infant's beside to enable a direct video-conference consultation between the specialists in Townville and the care team in Mackay so that they can discuss the progress of the patient.
"Tiny Tom also enables parents and family members, who are unable to travel to Townsville, to see their baby and talk to NICU specialists and nursing staff," Dr Smith said.
The Executive Dean of UQ's Faculty of Health Sciences, Professor Peter Brooks, said that the Centre for Online Health was doing valuable work.
"The Centre provides pediatric consultations at a distance which has really demonstrated how these new technologies can link patients in rural and remote areas to specialists and other tertiary services that would, by their very nature, only exist in major centers.
Director of Pediatrics at Mackay Base Hospital, Dr Michael Williams praised the new service.
"This service has given us the opportunity for ongoing involvement with our babies at The Townsville Hospital thus allowing us to build up a greater awareness and understanding of the clinical issues that our babies have been experiencing and hence we have a much greater clinical understanding when they return," he said.
The research will investigate the potential economic and clinical benefits of using telemedicine in neonatal intensive care.
UQ Centre for Online Health researcher, Mr. Nigel Armfield said that in addition to the potential benefits of improved continuity of care, it was hoped that Tiny Tom was a way of involving family members more fully in the ongoing care of their baby and the subsequent planning for the return home.
(Source: University of Queensland Press Release, June 27, 2008)
Greater use of cutting-edge healthcare technologies in England moved a step closer with the establishment of a new network to help expand use of telehealth and telecare in helping patients with long-term conditions.
The new network is known as the Whole Systems Demonstrator Action Network and will be run by The Kings Fund and the Care Services Improvement Partnership, backed by Department of Health funding. It will ensure that information from pilot schemes in Kent, Cornwall and Newham, who are making use of the latest assisted technology, is shared among experts to help spread best practice.
The Department of Health has already announced 31 million Pounds ($62 million USD) for three pilots in Kent, Cornwall and Newham, tasked with trialing telecare and telehealth techniques in the management of conditions such as diabetes and chronic lung disease.
The new network creates an action research program involving 10-12 partner groups, made up of people from PCTs, local authorities and third sector organizations to share information from the pilots. These specially invited partners are leaders in the use of high-quality assistive technologies and their experiences will provide important insights.
The Network is accompanied by a public, free-to-access website providing access to published materials on the evidence base in the development of telecare, telehealth and community-based telemedicine. Anyone can register with WSDAN to receive e-mail alerts to news, events and publications and its developing library resource.
(Source: Medical News Today, July 11, 2008)
Regional medical centers are making extensive use of the Ontario Telemedicine Network (OTN) in Canada, both in communicating with and offering clinical examinations and diagnoses of patients in the region, and as a resource for specialists for, and from, other hospitals across the province.
"Because of northeastern Ontario's geographic vastness we have become good at embracing innovation that helps close those distances," said Sudbury Regional Hospital telemedicine co-ordinator Nancy Wilson RN.
"The OTN allows us to provide care to patients in their own communities, with the obvious benefits of patient comfort and system efficiency."
OTN was formed when three telemedicine networks were integrated in April 2006 and officially launched later that year. OTN has 255 members, 484 sites locations, and 945 systems, making it the largest telemedicine network in the world. Since 2003/2004 OTN has seen a 600 per cent increase in the use of its clinical, education and administrative events.
Northern Ontario represents the largest percentage use of OTN in the province. The HRSRH accounts for 11 per cent of the activity, making it the busiest site in the network.
The Regional Cancer Program (RCP) clinical service is the largest single user of the system, with every oncologist at the RCP using telemedicine to communicate with patients across the region. The Memorial site has the largest number of specialists, cardiothoracic and vascular, providing care from one system across the network.
Through state of the art technology, physicians can listen to a patient's heartbeat, conduct an ear examination, or investigate a skin lesion, among other things. The network also holds great advantages for clinical education, allowing busy clinicians to participate educational activities without the need for travel.
(Source: NorthernLife.ca, June 26, 2008)
The first regularly scheduled inter-provincial telehealth sessions in Canada are taking place in an Alberta hamlet every Monday. McKay, a community of 600, started the sessions as a pilot project but recently decided to continue its contract with Dr. John O'Connor for another year. O'Connor was the physician in McKay, some 500 kilometers north of Edmonton, from 1993 until August 2007, when he moved to Nova Scotia to establish a new practice.
"Dr. O'Connor is basically able to do anything as if he were here," said Jeff Winsor, a communications specialist with the Fort McKay First Nation.
"The only thing missing is him physically being here. But we luckily have Theresa (Maffenbeier) and Maureen (Boyes) here, and their hands basically have the same touch as John's. They know what he is looking for."
"It probably wouldn't operate as well as it does if you didn't have such a good working relationship between the nurses and John. They are so used to each other that they have a feel for what the other is thinking," said Winsor.
Maffenbeier has worked with O'Connor for the last 14 years, and is the public health nurse for the area. Boyes has been working with the clinic for the last two years but also worked in the community prior to that. Both women are registered nurses, while Boyes has a nursing degree.
The clinic in the community 60 kilometers north of Fort McMurray sees between 15 and 20 patients each week for the telehealth sessions, but staff there also deal with any patients through the week.
The large television has a camera mounted underneath that nurses use to zoom in on patients. The images are sent to O'Connor in real time, and it is almost like they are in the room together.
During a mock-up situation the nurses demonstrated how they would interact with a patient during an appointment using telehealth, and feed O'Connor the information.
O'Connor makes up the paperwork for the tests that must be done, along with prescriptions for patients he deals with.
The idea for the telehealth sessions came from a dissertation being written by Sharon Mah, a PhD student with the University of Calgary.
"Everyone was enthusiastic and co-operative. We had discussions with the First Nations and Inuit Health branch which is a part of Health Canada, and we were also talking to Yarmouth (Nova Scotia) regional health co-ordinators. So our initial assessment for the telehealth was about 15 pages about how it should work and what the outcome would be. We also had to look at whether patients would use the service or not," said Mah.
O'Connor currently practises in the small town of Barrington Passage, N.S., but is still committed to Fort McMurray and the surrounding areas.
"I like McKay, and I love the people there," said O'Connor.
"They had expressed a wish if we could stay in touch . . . so we felt it out, and we thought everything was happening for a reason. The telehealth room in Yarmouth was available on Mondays, which is the day that I use to go to Fort McKay when I lived in Fort McMurray. And the equipment was available in McKay. And the municipality here and the chief of staff at the hospital were all on board."
In addition to his weekly telehealth sessions, O'Connor travels back to Fort McMurray every six or seven weeks to work at the Northern Lights Regional Health Centre for five or six days. He also spends three clinic days in Fort McKay.
Every other week he is on call for the nurses at the nursing station in Fort Chipewyan, 220 kilometers north of Fort McMurray, and they can call him with any problems or questions.
"We had a case a couple of months ago, where a woman came to 'see' me at the clinic who was having odd symptoms. On closer questioning I suspected she was having angina. We called for the ambulance from Syncrude to come to McKay, and then the ambulance transferred her to the hospital. And indeed she ended up in (intensive care). That was a few months ago," said O'Connor.
Everything about the telehealth sessions has been documented from the time that the program was first set up. All of this information will be presented to the Canadian Society of Telehealth in October in Ottawa. O'Connor said the only downside of the sessions can be the technology. He is looking forward to upgrading to a hand-held camera, which will enable the nurses to more easily zoom in on symptoms like rashes for O'Connor to observe. It will also allow them to take still photos and fax them to specialists.
O'Connor also said that at times, especially with abdomen problems and hernias, he wishes he could put his own hands on the patient, but also knows that the nurses know what they are looking for and can describe what they are feeling.
"For the other doctors that might be thinking about telehealth I would say just to try it. You will realize how easy it is. I have the fullest confidence that this approach could easily be tried in any locale," said O'Connor.
(Source: Times and Transcript, June 24, 2008)
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About the authors: Josie Henderson is the Director of the Telemedicine Research Center. Will Engle is the Executive Director of the Association of Telehealth Service Providers.
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