Telemedicine and Telehealth News 8/4/2008
Diagnosis of stroke patients has been dramatically improved through a program that connects patients to stroke experts through the Internet, according to UCSD Medical Center. The program, called Stroke Doc, was developed by the center and two local companies.
Stroke Doc improved diagnostic accuracy from 82 percent by telephone to greater than 98 percent, said Dr. Brett C. Meyer, co-director of the UCSD Medical Center Stroke Center. A study of Stroke Doc was halted when it was just over halfway through, because the results were so clear, Meyer said.
The collaboration brings together the fields of life science and wireless communications, two of the county's leading industries, to find ways to lower the cost of health care and improve quality. It gives scientific backing to the emerging field known as telemedicine, which hooks up doctors and patients at a distance through the Internet.
Carmel Valley-based BF-Technologies makes the program's audio/visual equipment, which the company says delivers an exceptionally stable video signal. The equipment costs about $24,000, the company says.
San Diego's Qualcomm Inc. developed the broadband wireless technology used to transmit information through a laptop when there's no wired connection. Now available to consumers, it was made first available to the Stroke Doc study.
This is the first time telemedicine has been scientifically demonstrated to improve patient care, as compared to a telephone consultation, said Meyer, co-director of the UCSD Medical Center Stroke Center.
"Telemedicine has been used for about 10 years, and there's been an assumption that it's been effective," Meyer said. "But it hasn't been tested."
The study was funded by the National Institutes of Health. It was published Aug. 2 in the online issue of the journal Lancet Neurology.
A standard broadband Internet connection and the BF-Technologies videocamera equipment is all that's needed on the patient's side, Meyer said. Alternatively, a wireless broadband connection through Verizon Wireless or Sprint can establish the connection through Qualcomm's wireless broadband technology.
"We've been stuck in traffic, and an ambulance has been stuck in traffic with us, but we've been able turn on a laptop and access one of the camera systems," in the ambulance, Meyer said.
Strokes kill more than 150,000 Americans annually, making it the third leading cause of death, according to the American Heart Association. Those who survive may suffer permanent brain damage. Prompt treatment reduces the risk of death or damage, not only improving patient health but saving money that would otherwise be spent on rehabilitation.
Most strokes are caused by blood clots in the brain. These can be broken up by a clot-busting drug called tPA, ending the stroke, Meyer said. But tPA is dangerous in some instances, Meyer said, and if wrongly given can cause brain hemorrhage or death. And relatively few doctors have the experience to make the correct call.
That's where Stroke Doc comes in, Meyer said. It gives a distant stroke expert the detailed information needed to decide whether tPA should be given.
Other partners in the study included Calit2, a research program of the UC system, and the Jacobs School of Engineering at UCSD.
(Source: North County Times, August 3, 2008)
Select Houston-area Wal-Marts will offer telemedicine clinics thanks to a partnership between Houston-based companies My Healthy Access and NuPhysicia. The companies will operate under the trade name "Walk-in Telemedicine Health Care."
The program is one of the service lines of NuPhysicia, which operates telemedicine methods developed by the University of Texas Medical Branch.
Glenn G. Hammack, NuPhysicia's president, said the program replaces the care typically provided by nurse practitioners at retail clinics.
"Our alliance takes that care a step further, bringing new levels of service, convenience and value to the retail health-care setting through interactive physician visits."
"In keeping with our mission to continually search for the best approaches to retail healthcare, we began evaluating proven telemedicine methods, and this led us to NuPhysicia," said My Healthy Access's president, Kathleen Delaney. "Our partnership with NuPhysicia will no doubt enhance services in our retail clinics to better serve our patients and offer us even greater potential for new business strategies in the future."
Under the agreement, physicians will use NuPhysicia's remote telemedicine through paramedics who will examine patients under the physician's direct supervision.
A two-way video communication is initiated during the patient visit, using split-screen technology. The patient can see and speak directly to the physician and see exactly what he/she is seeing on the screen. Electronic medical devices will allow the physician to visually examine the patient and even listen to his or her heart and lung sounds. The on-site paramedic acts as the physician's hands and carries out the treatment instructions.
"Simply put, the paramedic serves as the 'hands' of the physician, who uses medical devices such as an electronic stethoscope to listen to the heart, or other scopes that can see down the throat or in the ears - and the physician sees and hears everything live and in real time," said Hammack. "The physician performs the exam as if he or she was in the room with the patient."
"Our telemedicine methods have served hundreds of thousands of patients from Texas to as far away as the South Pole," continued Hammack." Similar live-video technology is now monitoring the most critically ill in ICUs across the nation," he added. "Now we can offer the residents of Houston access to convenient, high-quality health care."
(Healthcare IT News, July 21, 2008)
After more than four years in the mainstream in Florida and a few states, online doctor consultations are catching on, although not like many had hoped. Only a fraction of doctors offer the service, and a small number of their patients take advantage. However, proponents of e-consults said the number has jumped since Aetna, Cigna and other insurers began paying for them nationwide in January. They predict the practice will one day become a prime option for patients dealing with simple health issues.
"It's really convenient for the patients and great for the doctors, too," said Dr. Maureen Whelihan, a West Palm Beach obstetrician who has consulted online for 15 months.
Blue Cross Blue Shield of Florida began offering online physician contacts in 2004 as a way to improve patient satisfaction, ease office burdens on doctors and save a little money, said Lynn Monson, the insurer's director of health information technology.
A few thousand of the insurer's 28,000 doctors belong to the various online systems, and the number is growing. From all those Florida doctors, Blue Cross pays for a dozen e-consults per month on average, although many more may be using the system for free contacts, Monson said.
"I would love to see it take off like hotcakes, but it hasn't," Monson said. "It's something that's going to come of age."
Surveys show patients like the idea of contacting doctors by e-mail. But in California, only 4 percent of people reported doing so last year.
"The reality is that most patients unfortunately are not tuning in yet," said Dr. Nigel Spier, a Hollywood OB/GYN who answers patient e-mails daily and late at night. "Younger patients are catching on. But certainly the reflex is that if people have a question, they pick up the phone, they don't go to their computer."
To contact a doctor online, patients go to a password-protected Web site to find forms requesting lab results, prescription refills, appointments and office matters. Typically these are free and fielded by the office staff.
To initiate an e-consult about medical issues, patients answer a series of questions about their illness and medical history. The system often asks different questions depending on the patient's answers, as a doctor would. The doctor gets notified of the inquiry and posts an answer online for the patient to look up.
"When they fill out the form, all the questions I would have asked [in person] are already answered," Whelihan said. "I can actually make a pretty good diagnosis."
E-consults cost $25 to $40, payable by credit card. If insurance covers it, the patient may only face a small co-pay.
"Once [patients] use it once or twice and realize how nice it is, they use it more and more," said Reyes, who started e-consults in April.
Some doctors and medical organizations are skeptical of e-consults, saying an online exchange cannot replace a face-to-face visit and increases the risk of a doctor misdiagnosing a serious problem.
"There's so much potential for miscommunication when you can't see someone's face or detect the tone of their words, or watch their body language," said Dr. David Hutchinson, president of the Minnesota Academy of Family Physicians.
Proponents of cyber-medicine dismiss such fears, saying doctors can use their judgment to restrict e-consults to simple health issues.
Reyes' hand-held wireless unit jangled with an online question from a man whose ulcer resumed bleeding one night. He said he quickly called and ordered him to the emergency room.
RelayHealth, a leading online consultation system, says about one-third of its e-consults end with the doctor asking to see the patient in person.
Doctors who like the approach tend to be younger and tech-savvy. They find that dealing online with routine illnesses and matters is faster and more efficient than taking phone calls, and produces better records.
The online systems also ease foot traffic at a time when office visits have surged by 20 percent in five years, federal figures show.
The fact that big insurers have started covering e-consults bodes well for growth, supporters say. Cigna and Aetna tested e-consults since 2006 in Florida and other states before going national. Insurance officials said the service fits the trend of having patients take more responsibility for their health and costs.
The number of Cigna doctors using the system jumped by one-third this year, spokesman Joe Mondy said, but still has reached only 12,000 of 500,000. At Aetna, not 5 percent of 490,000 doctors are signed up, spokesman Walt Cherniak said. Doctors may hold off unless many patients show interest, while patients may not even know their doctor has access.
RelayHealth, a California e-consult firm, has signed up 17,000 doctors since 1999, said Ken Tarkoff, vice president and general manager. Thousands more use Medem Inc., Medfusion and others.
One in 10 of Spier's 5,000 patients have signed up for his service. One in five of Whelihan's 5,000 patients have; she fields one e-consult daily.
"A lot of physicians say, 'You're so out there.' We're really not," Reyes said. "This is 2008, folks. This is a natural evolution."
(Source: Florida Sun-Sentinel, July 21, 2008)
The Louisiana legislature recently passed a mental healthcare reform package which included two bills on telemedicine. The first, HB 653, will help all mental health professionals' complete actual exams to assess patient's needs. The law allows for the use of telemedicine through video and audio technology to enable psychiatrists in different locations to issue emergency certificates that may be needed to commit individuals in crisis.
The second bill concerning telemedicine is HB 193. The legislation ensures that physicians and other mental healthcare professionals who are providing telemedicine services on a voluntary basis for the Department of Health and Hospitals (DHHS) will now have medical malpractice liability coverage. The bill eliminates a major barrier in current law that would discourage physicians from volunteering to provide telemedicine services to patients throughout the state.
Senate bill 287, the "Louisiana Consumers Right to Know Act" requires DHHS to create a web site to be launched before April 30, 2009 so that healthcare consumers will have access to reliable information on costs and quality issues. DHHS will publish key performance data on healthcare providers and health plans to include complication rates for procedures, average costs for procedures, and the number of procedures a provider has performed. This information will enable consumers to compare providers across a range of performance categories.
The Act also calls on DHHS to form a Health Data Panel with healthcare stakeholders and technology experts from the state to advise the agency on best practices needed to collect provider data, adjust the data for accuracy, and to make the data on the web site clear and easy to understand.
The Governor's budget also supports the second year of the Louisiana Rural Health Information Exchange, a partnership between the Rural Hospital Coalition and LSU Health Sciences Center. The HIE uses telemedicine and electronic health records to connect rural hospitals with the resources at the LSU Health Sciences Center to host the network. This accounts for $13.5 million of the $18 million in funding.
(Source: Federal Telemedicine News, July 15, 2008)
As part of his infectious diseases practice, Dr. Javeed Siddiqui regularly sees California State Department of Corrections and Rehabilitation prisoners as patients. It's just that he's never in the same room with them. The UC Davis physician is a part of the increasing role that telemedicine has been playing in inmate care in the past two years.
Between 1997 and 2006, about 50,000 corrections agency inmates were seen by doctors via telemedicine. In the year ending June 2008, the patients numbered more than 16,000.
Doctors who treat inmates say telemedicine is a win-win because it's easier on them and the patient, more cost-efficient for the prison system and provides a patient base for medical institutions.
Transporting prisoners for outpatient visits costs taxpayers a lot of money and is logistically difficult, said Dr. Thomas Nesbitt, head of the UC Davis telemedicine program.
Community providers near prisons can be backlogged, but with telemedicine, "patients don't have to wait," said Annie Brennan, who schedules telemedicine appointments for the prison system.
"I've never come across a situation where I feel I need to see the patient in person," Siddiqui said of his telemedicine experience.
Ricky Reeder, a prisoner at Mule Creek State Prison in Ione, has had hepatitis B and C for at least 12 years. He's been a telemedicine patient for about one year.
"It's a lot easier than going to the yard to see the doctor," said Reeder, 54. He likes that he can get in and out of appointments quickly.
Reeder likes seeing the same doctor every time. His infectious diseases doctor also treats his other health needs, even prescribing him multi- vitamins, he said.
About 30 percent to 40 percent of UC Davis telemedicine consultations are with inmate patients, Nesbitt said.
"They needed specialty services," he said of the corrections agency. "We had specialty services. Our equipment talks to each other."
For UC Davis, prison telemedicine is a stable source of business that allows the medical center to have a program big enough to also serve smaller, rural hospitals, said Nesbitt.
Doctors in the prison system said patient feedback has been positive.
"I'm pleasantly surprised with their lack of concern about not seeing a live doc," said Dr. Dwight Winslow, prisons medical director. "Maybe they're getting attention they previously weren't given. Maybe they grew up with TVs and they accept it as the way business is done."
Winslow believes telemedicine is underutilized. All 33 state prisons have the technological capabilities, though some institutions don't use their equipment. He aims to use it in more prisons and to recruit more specialist partners.
Prison health care has changed dramatically, Winslow said, since it was put under federal receivership in 2001 after a federal judge found that the program violated the U.S. Constitution's prohibition against cruel and unusual punishment. The challenge is now figuring out how telemedicine fits into the delivery plan, he added.
According to Siddiqui, receiver J. Clark Kelso has demonstrated an increased commitment to telemedicine, having visited the UC Davis telemedicine offices several times.
"He looks at technology as real tools to solve (the prisons') problems. He's investing in these tools," Siddiqui said.
(Source: Sacramento Bee, August 3, 2008)
The telepsychiatry program at the University of New Mexico Health Sciences Center recently received a significant grant at a ceremony on July 29.
The $767,192 grant will be used to research and develop telehealth services across the state that allow providers to use real-time video links to treat behavioral health patients in remote, underserved areas.
The money was appropriated by ValueOptions New Mexico, a private entity that manages the state's public behavioral health expenditures.
(Source: New Mexico Business Weekly, July 28, 2008)
The Davis Family Foundation of Falmouth, Maine has awarded $25,000 to Maine's HomeHealth Visiting Nurses. The grant funds will bring new advancements in telehealth technology to patients at high risk for hospitalization.
HomeHealth Visiting Nurses' current telehealth project will install telehealth units in the homes of chronic disease patients who are at high risk for re-hospitalization following hospital discharge or recent disease exacerbation. This equipment allows for 24-hour monitoring of vital signs, patient education and medication compliance.
National studies show that telehealth services significantly reduce hospitalization and emergent care rates, improve medication management and enhance patient's health knowledge and self-care abilities. Using the new equipment, patients will learn to: search the electronic library for educational information about their illness; transmit data to nurses, such as vital signs and confirmation that they have taken their medication; reply to text questions from nurses; and transmit messages to tell nurses how they are feeling. Skilled nurses monitor patients remotely and contact them regularly via telephone to provide reassurance and coaching, clarify any changes in their condition (i.e. weight gain or shortness of breath), identify when medical intervention is necessary, and arrange for access to needed care. The equipment also includes patient education resources that will teach patients disease-specific self-management skills.
HomeHealth Visiting Nurses pioneered Home Telehealth in York County in 2002, bringing live, interactive video "visits" between clinicians and patients. The program was expanded in 2005 to Cumberland County.
(Source: Seacoast Online, July 24, 2008)
U.S. Department of Health and Human Services (HHS) Secretary Mike Leavitt recently visited southern Alaska to see how telehealth is being used to improve access in rural parts of the state.
To better understand the challenges of access to care, Leavitt visited Native villages and two regional tribal health consortiums.
Leavitt will met with tribal leaders to discuss the healthcare goals of the Alaska Native people and viewed demonstrations of how telemedicine and telehealth are employed to increase access and quality of care to Alaska Native communities. The use of telemedicine and telehealth is making an important impact on improving access to healthcare in rural Alaska.
"While Alaska faces unique access to care challenges, the healthcare delivery systems in place serve as model of effective telehealth and telemedicine for other rural communities," Leavitt said. "I look forward to continuing my work with local, state and tribal leaders to address barriers and increase access to care."
(Source: Healthcare IT News, July 24, 2008)
Connecticut Governor M. Jodi Rell recently announced the award of a $75,000 grant to VNA Health at Home in Watertown, CT, to help implement a telehealth monitoring program.
VNA Health at Home provides home health care services to patients of all ages in the Greater Waterbury area. The telehealth program will allow patients to check their vital signs daily with an at-home monitoring system and send the information via computer to their home health nurses.
"This grant will help improve the care and quality of life for so many people who rely on home health care," Gov. Rell said. "The dedicated nurses of the VNA will have another important tool to help them carry out their mission."
The grant is from the Connecticut Health and Educational Facility Authority (CHEFA), a quasi-public agency that helps Connecticut nonprofit organizations enhance their programs and continue their ongoing health and education services for citizens of this state.
(Source: Town Times News, July 17, 2008)
Rochester General Hospital in New York recently unveiled a new telehealth robot.
The technology allows physicians to connect remotely with patients without having to physically travel miles away. Conversely, patients may receive care or consultations with specialists not generally available in rural areas, in particular, without having to make a costly drive to, in this area's case, a Rochester hospital. While doctors say face-to-face interaction with patients is preferred, telehealth technology, such as using robots, may save time and gas money.
Urologist Dr. Ralph Madeb, medical director of the new Department of Telehealth at Rochester General, said the technology will also mean that patients may receive timelier treatment and avoid unnecessary transfers to Rochester hospitals from more rural facilities.
The program's first robot is up and running at Newark-Wayne Community Hospital, an RGH affiliate.
The goal, Madeb said, would be to eventually also have robots at other area hospitals, like Clifton Springs.
Using the new electronic communication, which includes both visual and audio components, physicians and surgeons based at Rochester General have already used the robot to provide more than 500 consultations and care to patients at Newark-Wayne. Specialists are available for consults in dermatology, bariatric surgery, cardiology, endocrinology, plastic and vascular surgery, urology and a number of other areas.
"It really extends the specialist's hands," Madeb said, and can be used anywhere there is Internet service. To communicate through the robot, doctors need only a laptop computer and joystick with which to remotely move the about four-foot-tall device.
Called Remote Presence Robotics, it is believed that the RGH-Newark telehealth network is the first of its kind in the northeast and one of only two in the nation.
"Patients and doctors are excited about it," said Diane Ewing of the RGH staff.
Using the new technology, Newark patients who have met with doctors via the robot talked with Madeb and others recently.
She could still meet one-on-one with a specialist, said one of the patients, who wasn't named, and not miss as much time off work or spend the money it would cost for gas to drive to Rochester.
"Not having to drive to Rochester is a positive," agreed another patient, who also wasn't named.
Plastic surgeon Dr. Ralph Pennino has been using the technology and predicts that it will become more common in the coming years.
"You can do an exam and pretty much everything you want through this (robot)," he said.
The video screen "head" of the robot has the ability to zoom in very closely to patients. It also has screen-in-screen technology, so that a doctor can see his patient and vice versa.
"The great thing is that a doctor can show up anywhere in the world," Madeb said.
There was some worry that doctor-patient interaction would be lost and patients wouldn't like the robot, he conceded, but that doesn't seem to be the case because it's not just a phone call.
The doctor and patient are still face-to-face and the doctor can see a problem area, if necessary. Both the robot and the video screen have the ability to rotate 360 degrees, and the robot can also move forward and back.
The robot also includes a telephone, if a more confidential consultation is needed, a printer, advanced head gear, and even a digital stethoscope. The unit can even upload X-rays, Madeb said.
The point is, he said, patients want to and should be able to be treated close to their homes ... and this robot facilitates just that.
(Source: Messenger Post, July 18, 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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