On December 11th, IVCi and Polycom hosted a webinar covering Collaborative Healthcare and its connection to Accountable Care Organizations & EHR Implementations. The session was co-presented by Dr. Deborah Jeffries, Polycom’s Director of US Healthcare and Cheryl Henshaw, Polycom’s Director of Grant Assistance. The session provided some insightful content on applying visual collaboration to patient care as as well as some of the grants available to help fund these initiatives.

SLIDES PRESENTED:

WEBINAR RECORDING:

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Congress
In the wake of the Government shutdown, Congress continues to debate several different legislative proposals and provisions. One aspect involves the repeal of the medical device tax which charges a 2.3% tax on all medical devices; including some telemedicine components. The provision to repeal this tax is on the table; however, Capistrant says while this is possible it is not probable.

Bill HR 3077 was introduced by Congressmen Devin Nunez and Frank Pallone to allow providers with one state license to provide care via telemedicine to Medicare beneficiaries wherever. A similar bill, HR 2001, by Charles Rangel would provide the same for VA beneficiaries. These bills will essentially make one license enough for healthcare providers working with federal agencies or federal programs. This will help expand access to telehealth services which can provide numerous cost benefits to both patients and providers.

Greg Harper’s bill, mentioned in the last webcast, to improve Medicare coverage for telehealth has not been introduced because of the shutdown. However, because this is the beginning of a two year congressional session, even if this bill does not get passed this fiscal year there is still next year.

FDA
The FDA has released final guidance on mobile medical applications in an attempt provide clear direction to device makers and application developers as to what constitutes as a medical device and needs to go through the FDA approval process. Their regulatory focus will be on medical apps that present a greater risk to patients if they do not work as intended. Additionally, the FDA will develop a web-based platform for developers to seek advice about devices and situations. This will provide better guidance and make it clear as to when the FDA needs to be engaged and what the provisions will be.

States
Fiscal year 2013 was a very busy year for state telehealth legislation and this year will be more of the same. Much of the legislation that was not enacted last year will be reintroduced in 2014. At the top are the 10 states that had proposals for parity with private insurance companies that were not enacted. These states include Connecticut, Florida, Illinois, Massachusetts, Ohio, New York, South Carolina, Tennessee, Washington, and Pennsylvania.

In other news, it was reported that an Oklahoma doctor was disciplined for using Skype to treat patients. However, the use of Skype was inconsequential to what physician Thomas Trow was doing wrong. The main disciplinary issues were Trow’s over prescription of narcotics and failure to maintain medical records. In fact, Trow had previously received disciplinary action from the Oklahoma Medical Board (OMB) for over prescribing, narcotics violations, and record violations. The OMB filed action September 12 and 16 and put out proposals that, according to Capistrant, may be over-reaching and affect telemedicine. The ATA is working with the OMB to ensure these new provisions do not negatively affect telehealth services.

Guidelines
ATA is currently working on a series of guidelines and telehealth best practices for remote ICU, burns and wounds, and primary and urgent care. They are currently awaiting review and approval from the Board and should be available in the next few months.

The next This Month in Telemedicine webcast is scheduled for October 29, 2:00-3:00PM EST.

The thought of implementing a new Electronic Medical Records (EMR) system is enough to make anyone in a healthcare organization wake up in a cold sweat. Switching from paper charts to an entirely new way of providing patient care is a daunting task for most physicians as it requires a brand new set of processes and procedures.

However, the benefits of EMR can no longer be ignored. Not only does storing medical records digitally help prevent filing errors, patient records can be backed up in multiple locations significantly reducing the threat of losing patient health information in an emergency. Plus, the data is accessible almost anywhere allowing physicians to view medical history and treat a patient regardless of where they are.

As a result, five leading health systems have created the Care Connectivity Consortium to pioneer the use of electronic medical records. Together, Intermountain Healthcare (based in Utah), Geisinger Health System (Pennsylvania), Group Health Cooperative (Washington), Kaiser Permanente (California), and Mayo Clinic (Minnesota) are working to develop a secure way of sharing patient information regardless of the vendor used to originally create the record.

The five healthcare systems involved have an enormous geographic reach and access to large volumes of patients. They must work together to develop, test and implement processes and procedures to quickly access and share patient information across multiple different EMR systems. Additionally, the Consortium must address how to obtain a patient’s advance consent and then store it properly to ensure it is readily accessible in the event of an emergency visit, states Todd Allen in a blog article.

Visual collaboration technologies can help connect geographically dispersed members of the Care Connectivity Consortium and enhance the collaboration experience. Audio visual integrated rooms designed to support complex data allow participants to share multiple forms of content from multiple sources. Therefore, members participating in collaboration sessions can view different EMR interfaces side by side along with other data to help advance the EMR process.

These collaboration rooms can also be used within different areas in the health systems. For example, operations staff can meet to discuss best practices around EMR and other hospital operations. Roundtable sessions can also be conducted by connecting medical specialists and allowing them to discuss recent findings, best practices and treatment options.

Once the Care Connectivity Consortium has created an effective process, the organization can utilize collaboration solutions to train physicians, administrators and other staff members through recorded Video on Demand sessions. Embedded video clients can then allow anyone with questions to connect via video to an EMR specialist and receive clarification. Furthermore, embedding video solutions in the EMR system itself would allow doctors or nurses to connect with a patient’s primary physician.

As a mother of three very accident prone children, I have been to the Emergency Room in Intermountain Healthcare’s network. There is a small peace of mind in knowing that when we arrive, my child’s entire medical history will be available with just a click of a mouse. I applaud the Care Connectivity Consortium for their effort in advancing Electronic Medical Records and hope that one day mothers across the country are able to experience these same benefits.

April’s This Month in Telemedicine by the American Telemedicine Association, hosted as always by Jonathan Linkous, Chief Executive Officer, and Gary Capistrant, Senior Director of Public Policy discussed state and federal updates, collaborations, and quality assurance.

State Licensure Remains a Hot Topic
Gary Capistrant went over the basic situation of licensure, including a proposal that would let Medicare recipients to (virtually) cross state lines for care but would impose a requirement that the patient and doctor have a previous relationship, i.e. an initial consultation in person has to occur. While some states do allow that a legitimate patient-doctor relationship can be established via video, this proposal does not recognize that and could be a “step backward” for telemedicine, plus require states to enforce a prior relationship where they hadn’t done so before.

“In terms of our principles on licensure, we want to be regulated the same as in-person services, not held to a higher standard or a lower standard,” said Capistrant. The ATA has set up a petition. Also, some states are deciding that telemedicine needs regulating but are doing so by treating it as a separate health service, even though telemedicine was already active under the current medical regulations.

State Activity
Three states have enacted full parity with private insurance: Mississippi, plus Medicaid and state employee benefits; Montana, including parity with private; and New Mexico. Connecticut and Missouri passed parity bills in Senate, which are now moving to their respective Houses. New York recently introduced a parity bill, and Ohio will soon follow suit.

ATA is finalizing state best practices guidelines for home telemedicine and remote monitoring, and in the works: school-based care, telemental health, and more.

Federal Action
A workgroup was recently announced, a joint effort between the FDA, FCC, and Office of National Coordinator. A report is due in January 2014 examining the overlap of some issues that are overseen by the various agencies, including consumer health devices, electronic health records, and clinical decision support.

“It’s a little bit of a mess right now in terms of the regulation and one of the reasons they have this is group is because there’s a little bit of uncertainty amongst the different agencies over who’s taking the lead on what,” explains Linkous.

Quality Assurance
A big area of activity for ATA is quality assurance, which, although it’s flown under the radar somewhat, is getting plenty of attention now. ATA’s next board meeting will see the approval of the organization’s practice guidelines for online video-based telemental health. “A very important role for ATA is to weigh in and try to get some meaning and some semblance of order to what’s happening,” says Linkous.

ATA’s board has also approved the move towards ATA becoming an accrediting body with the end goal of becoming a reliable information source for consumers. They’re also involved with some trade associations to improve consumer awareness. Linkous: “It’s important that consumers know that if you’re not getting access to telemedicine, you could and you should and you need to ask your doctor about it.”

Next year, look for a cohesive effort by patient and consumer groups to expand telemedicine, including physician communications, consultations, lab results, etc., which should all be accessible online by patients.

The Q&A: A Selection of Questions Asked & Answered

Q: Define telemedicine, telemedicine, etc.

A: I think we should come up with a contest to see who can come up with the most names that relate to telmedicine. E-consults, e-health, telemedicine, telecare, e-care, telepractice, remote care. About 6 or 7 years ago we had a board meeting in Chicago and we talked about changing the name of the ATA. We talked about what we should change it to…we spent about 3 hours of the board meeting [discussing this] so at the end, we just threw our hands up in the air and left it as it is.

We define telemedicine very broadly as providing healthcare to patients or consumers using telecommunications.

Q: How can companies assist ATA in the process of getting legislation passed?

A: ATA has a Circle Membership and Industry Council and we have corporate members representing anything from large, multi-national, multi-billion dollar companies to a small ma and pa [businesses], but all of them have a stake in this. And if there’s a large corporation that has a Washington office with a staff of people who are full-time policy people, yes, please let them get in touch with us. We’d love to talk with them about what they do. Or if you’re an organization that has a consultant online who does work in Washington, or if you’re a small company in another state and you have an area representative…it’s important that you get very active…There’s always things to do at the state level.

Annual Meeting
ATA’s annual meeting will be held next week in Austin, Texas, from May 5 to 7. For a free exhibit hall pass, click here to register and enter  the code VIPcomp13.

Telemedicine continues to be one of the most exciting advancements in the delivery of healthcare today. The benefits are significant and legislation throughout the United States is being passed to provide parity between a telemedicine visit and a live, in-person doctor visit. At a high level, telemedicine is about extending the reach of healthcare and providing care to those who may not have access to specialists and other needed experts.

Within telemedicine there are a number of very specific applications that are finding their place in hospitals throughout the country and the world. Telestroke is the application of telemedicine technology for the diagnosis and treatment of stroke victims.

According to the Centers for Disease Control and Prevention more than 795,000 people in the United States have strokes and 130,000 of those stroke victims lose their lives. One of the greatest allies to a stroke victim is time. The sooner a patient is able to be seen and diagnosed by a doctor, the higher likelihood of a positive outcome. Many of the treatment options available today are highly effective but require a rapid diagnosis.

Of the many treatments out there, two are particularly time sensitive. Thrombolytic drugs dissolve the clots that block the flow of blood to the brain. These drugs need to be given as quickly as possible. Another option is tPA which is an enzyme that can help dissolve blot clots as well. It is found naturally in the body and if given within three hours of stroke symptom onset, it has a high success rate ofpreventing the stroke from occurring. This, however, is highly dependent upon the recognition of early stroke signs and symptoms.

The application of telemedicine to stroke, or telestroke, is usually deployed in a hub and spoke model. Hospitals with stroke/neurology services serve as the hub and allow connections from outlying or rural hospitals, known as spokes. Many of these rural hospitals simply do not have access to neurology and stroke specialists so these hubs can assist with timely diagnosis and treatment.

The technology of telemedicine allows neurologists to remotely examine patients when they are admitted to an emergency room or the hospitals. These doctors can review CT scans and other diagnostic tests quickly and make real-time decisions on initial treatment.

Beyond the obvious benefits to the patient, there are several other key advantages to telestroke including:

  • Reduced Costs: For hospitals who have established a comprehensive stroke care center, the investment is significant. This prevents smaller hospitals from implementing these critical programs. With a telestroke program in place, patient care is not sacrificed when budgets are not available.
  • Fewer Transfers: When facilities are lacking the specialists needed to care for strokes, it can become necessary to transfer those patients to larger, more distant facilities who offer a stroke center. The cost of these transfers is incredibly high, both for the patient and the medical facility. With remote specialists on hand, patients can stay in one facility, get the care they need, reduce the risk of their condition worsening, and ultimately save the system money.
  • Training: When local doctors get exposed to stroke specialists they are able to get real-world training on key stroke indicators and how to rapidly respond to them. This type of training can make the difference between a full recovery and a life of stroke complications.

The application of video conferencing and telemedicine technology to healthcare is truly exciting. As facilities continue to bring this technology on board, patients will be the ultimate beneficiaries. The highest level of healthcare diagnosis and treatment should not be reserved for those who live in proximity to major medical centers. Telemedicine technology has the potential to reduce or eliminate both geographic and financial barriers that can prevent access to high quality healthcare for everyone.