8/4/2008
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)
8/4/2008
iHealth Beat, in a piece entitled
Does Telemedicine Have a Role in Technology-Enabled Health Care Reform, explores the use of telemedicine to reduce costs, improve access, and deliver quality care in reforming the U.S. healthcare system.
Richard Friedman, a professor of psychiatry at Weill Cornell Medical College, in a New York Times article entitled
Take Two Prozac and E-Mail Me in the Morning, describes his experiences using email to communicate with his patients.
7/15/2008
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)
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)
6/20/2008
The Department of Health Care Policy and Financing in
Colorado recently held a meeting to discuss how a new telemedicine project authorized and funded by Colorado Senate Bill 196 would work. The use of telemedicine included in the legislation is to be implemented in the home health program. Diana Huerta and Sean-Casey King are both leading the telemedicine project for the Department and at the meeting reported on the progress being made to meet the spirit of the legislation. According to Huerta and King, the next step after conducting discussions and listening to comments is for the Department to draft rules for the program.
According to King, the goals are to roll out the program quickly, enable providers to have freedom in determining telemedicine needs, ensure cost savings by closely monitoring claims data and the clinical process, and make certain that the program maintains quality of care. The project will not pay for technology equipment, but home care providers will be compensated on a flat-fee monthly basis to use technology in their own way in treating clients.
The program will be implemented in two phases. Phase 1 will be put into place to benefit clients in acute home health and at the beginning of the acute period, the provider would determine as to whether the client should receive telemedicine. During the acute period, the provider does not need to assess whether the need for telemedicine is at Level 1 of Level 2.
At the end of the acute phase, if the client is expected to go or return to long term home health, a telemedicine level determination must be made. So at this point, the agency will need to document whether they believe the client will benefit from the use of telemedicine in long term home health.
The agency will also determine if the client should receive Level 1 or Level 2 telemedicine, based on the amount of nursing interaction needed. The agency will need to document their reason in the client's medical record. Most importantly, clients in Phase 1 can only receive telemedicine during the long term home health period if they received care during an acute home health period.
Once the telemedicine level is determined, the provider may bill Medicaid once per calendar month and must assess the client's need and level for telemedicine at the beginning of each home health plan of care period.
The information, determination, and the patient's records will be reviewed by a third party vendor to learn how different providers are making these decisions. At this point, the department may develop a standard tool for all providers to use in determining telemedicine needs and levels. The third party vendor also will have the responsibility to ensure that claims are submitted appropriately and the third party vendor is to be chosen through the Request for Proposal process.
Phase 2 of the plan does not include telemedicine for clients who have not had an acute episode. However, if cost savings and need can be established, the Phase 2 roll-out may include the option for providing telemedicine to long term home health clients who have not had an acute episode.
In other legislative actions, the Governor of Colorado signed legislation in June on healthcare. One of the new pieces of legislation SB 135 will streamline healthcare and make it easier for doctors, nurses, and patients to get information from insurance companies. The legislation created a standardized health plan ID card for patients will use 21st century technology for the electronic exchange of information.
Colorado's Blue Ribbon Commission for Healthcare Reform was formed to study and to establish healthcare reform models in the state. A report released in 2008 by the Commission made a number of recommendations to increase the adoption of health information technology. The Commission's report recommends that a statewide health information network focusing on interoperability be established and supports creating an electronic health record to work across systems for every person in the state with protections for privacy. In addition, the Commission supports a statewide data system to provide specific care guidelines and performance measures.
To help support some of the Commission's suggestions for healthcare reform, SB 217 was introduced in March 2008 to develop the Centennial Care Choices program. The bill encourages the use of health information technology and telemedicine including health information exchanges, electronic health records, and e-prescribing. The bill would encourage establishing pay-for-performance programs and would provide consumers with educational materials on how to access internet-based healthcare tools.
(Source: Federal Telemedicine News, June 18, 2008)
Some 495 Chicago-area veterans are using "telemental health services" at six VA community-based outpatient clinics in
Illinois. Last year, 24,000 veterans sought telemental health care throughout the U.S. Projections for 2008 show that 36,000 to 40,000 people will seek such treatment by year's end.
"Many researchers have done studies on telemental health, and it stands up reliably to face-to-face service," said Adam Darkins, chief consultant for care coordination for the U.S. Department of Veterans Affairs.
"There is a slight remoteness about it, but it's all about relationships," Darkins said. "It's really working out."
Doctors say the technology has helped reach thousands of patients who might not have sought treatment otherwise.
Psychiatrist John Lim currently treats about 23 people a week using telemental health technology, primarily for evaluations and medication management.
Lim said doctors can order medication to be mailed out under the heading of "routine," "as soon as possible" or "overnight," depending on a patient's needs. If a veteran needs medicine immediately, another doctor at the center can provide a written prescription to be filled at a local pharmacy.
Lim gives high marks to the quality of the consultations, though he said they cannot always supply all of the information needed to make an assessment.
"You see [the patients] and you hear them, but you miss a little bit of facial expression," Lim said. "You can't see their hands and arm movements well. You can't smell alcohol on their breath."
Still, he said, "In terms of treatment, I get 95 percent of what I need."
He said that if something is missing, he can call in a nurse and ask questions or get impressions.
Lim said some mental health screenings are exceedingly difficult using telemental health technology. Testing for Alzheimer's disease or dementia, for example, can require patients to draw or write on paper, which can be tough for the therapist to see.
"That's hard to do when you are not in the same room," he said. "They'd have to hold something up to the camera—it's doable, but that's the hardest thing."
He said only one out of every 100 patients say they feel uncomfortable talking to a computer screen. Another 5 percent will remark unprovoked that they enjoy the technology.
"The actual talking and discussion is equal and straightforward," he said. "Rarely do I get someone who doesn't like it."
Bruce Roberts, chief of mental health at Hines, said the hospital plans to expand the telemental health program by adding another computer to each of its current sites—except for Joliet, which already has two.
He said the cost of one video terminal with a service contract is about $5,000. This does not include infrastructure costs.
Roberts said the VA does not have any immediate plans to allow veterans to access their doctors from their home computers, but he acknowledged that possibility for the future.
He said, too, that Hines is taking many other steps toward meeting patients' needs.
In 2005, Hines had 100 mental health staff members, including psychiatrists, psychologists, social workers, addiction therapists, rehabilitation specialists and other support staff. Today, it has about 195 people working in this capacity.
Roberts expects the department to grow significantly in the coming few years. He has asked for—and believes he will get—up to 114 additional staff members by 2010.
Roberts said the need for mental health services has increased not only because of returning veterans but also because of older veterans who have mental health episodes triggered by constant reminders of war on television and in the newspapers.
Roberts said he doesn't want soldiers to become lifelong patients. He said he wants to help them recover, which means getting them the fastest, best treatment possible.
(Source: Chicago Tribune, June 9, 2008)
California's San Joaquin County California drastic shortage of physician specialists could improve rapidly with the announcement that San Joaquin General Hospital has been selected as one of six initial telemedicine programs using video technology to link out-of-area doctors with local patients.
The half-dozen sites spread throughout the San Joaquin Valley are at the forefront of what is expected to become a larger project using telemedicine technologies to connect physicians with patients in some of the region's most rural and underserved communities.
San Joaquin County has one of the worst ratios of doctors to patients in the state at just one licensed physician for every 686 residents. The statewide average is one physician for every 379 residents.
"In terms of need, there is clearly a need here for more doctors and more hospital beds," San Joaquin County's Health Care Services Director Ken Cohen said earlier this year.
Using high-resolution video equipment provided by the Valley Telehealth Partnership based at the University of California, Merced, sites will be able to access specialists for real-time video consultations with patients. Medical specialties at first will include dermatology, psychiatry, pediatric specialties, endocrinology and gastroenterology, with more to come.
Installation of equipment and training is expected to take place this summer at all six sites. In addition to San Joaquin General in French Camp, the initial telehealth partners include Castle Family Health Centers in Atwater, Mercy Hospital Family Care Clinic in Merced, National Health Services in Oildale, Sierra Kings District Hospital in Reedley and United Health Center in Kerman.
UC Merced received nearly $1 million in 2007 - $500,000 from AT&T, $200,000 from the California Emerging Technology Fund and $250,000 from the California Partnership for the San Joaquin Valley - to establish the Valley Telehealth Partnership.
"This project will improve access to specialty care in the near term and provides a foundation for the UC Merced School of Medicine in the long term by extending opportunities for medical education throughout the Valley," said Maria Pallavicini, UC Merced's dean of natural sciences, who oversees the partnership and leads planning for the three-year-old university's proposed medical school.
More than 170 health care facilities and clinics from Stockton to Bakersfield and the Sierra foothills were surveyed and considered as initial sites for the telehealth program, but the partnership's funding allowed only the six sites along with a hub at UC Merced.
Jennifer Smith, UC Merced's telemedicine project manager, said one of the benefits will be the ability to bring together patients, their primary-care physicians and specialists.
"What's so rare is that you get that team together. It's so exciting," Smith said.
Pallavicini noted that the same equipment used for telemedicine can be used for learning purposes to educate physicians and patients alike.
(Source: Stockton Record, June 6, 2008)
A new telehealth venture by Avera Health could help ease a looming physician shortage in
South Dakota. A pilot project at Avera will put telehealth services in rural hospital emergency rooms. The eEmergency project will link rural hospitals in the Avera network to the system's four hub hospitals in Sioux Falls, Aberdeen, Mitchell and Yankton.
"We really need to support the rural communities," said Deanna Larson, Avera's vice president of quality initiatives. "We need to support the local physicians and keep them out there."
The project works like this: When patients are taken to emergency rooms in rural hospitals, doctors and nurses there must determine how serious the patient's condition is to know whether to transfer them on to a larger hospital.
Health care professionals already talk with doctors by telephone in larger cities when traumas happen. Now they'll use a two-way camera system to talk to a doctor.
"In small communities like this, when we get major emergencies, it doesn't happen very often, so it isn't as much as routine as in trauma centers," said Dr. Tom Dean, an independent family medicine doctor in Wessington Springs, one of the eEmergency sites. "Having their input at a time when we're getting patients stabilized is helpful."
The cameras used for telemedicine are advanced enough that doctors can listen to heart sounds and look into patients' ears.
"You can move the camera and focus even on a label on a medication bottle," Larson said.
In small communities, doctors aren't at the hospital 24 hours a day. When a patient comes to the emergency room at 3 a.m., often other staff such as nurses and physician assistants are there. A nurse can use the eEmergency system to call a doctor to help evaluate patients before a local physician arrives, Larson said.
"It gives them the same kind of access they would have in a larger hospital," she said. "And reducing that gap in time we expect would help save lives and would make a difference for patients."
South Dakota is facing a physician shortage as baby boomers age, and 18 counties don't have doctors living there. Having the support of doctors through telemedicine can act as a big recruitment bonus for doctors in rural areas, said Dr. David Kapaska, Avera McKennan's senior vice president and chief medical officer.
"This allows us to spread ourselves to all of our people and all of our facilities in a way that we leverage the finest minds to assist everyone," Kapaska said.
The project also might cut down on the number of air ambulance transports from rural areas to larger cities.
A 2006 study by researchers at the State University of New York in Buffalo looked at emergency telehealth consultations between a state prison and a hospital emergency room. The study found that 38 percent of patients who normally would have been taken to the emergency room avoided a trip because they were evaluated instead through telemedicine.
The eEmergency program is partially funded with federal grants to help with the cost of equipment.
(Source: Sioux Falls Argus Leader, May 31, 2008)
The Fordham Clinic in Webster Country,
Missouri, will soon be offering telehealth services in through the Telehealth Initiative, a service offered in conjunction with the University of Missouri-Columbia.
"In many cases, we are ahead of schedule, as we have many services in place already," said Robert Marsh, executive director of the Fordland Clinic. The first telehealth services to be offered at the Fordland Clinic will be dermatology and psychiatry.
Patients who need to see a specialist where there is a long waiting time in other cities, can be seen through the telehealth network within a week or two by university physicians. In most cases, this will save the patient a drive to Springfield, Columbia, Kansas City or St. Louis.
The Fordland Clinic views its Telehealth site as a community resource. "This is not just for our staff and patients, but any Webster County medical provider can schedule their patients with the university (or other sites) and we just provide the access. Any Webster County medical provider can come and obtain continuing education. Any agency from the Webster County Health Unit to the Emergency Management office to the Webster County Sheriff's (Department) can use this community resource on a space available basis," said Marsh.
Eventually, Fordland Clinic hopes to offer all of the direct patient care services available via the telehealth network. Additional services will be added over time, and university radiologists will be able to provide rapid official reading of X-rays. This will come about as soon as grant funds are located that will pay for the needed equipment.
Eventually, plans for the telehealth network through Fordland Clinic to offer adolescent medicine (such as eating disorders), autism clinics, burn clinics, child health, children and special needs (department of health, psychology), endocrinology, genetics follow-up care, hip and knee, internal medicine, medical ethics consultations, Missouri occupational injury clinic, neurology, orthopedics, physical consultations with geriatric specialist, radiology, rheumatology, spine and surgical follow-ups.
These services will provide clinical services to patients without them having to travel to the doctor's offices, monitoring a patient's vital signs from a remote health care facility and even transmitting patient information from a rural clinic to a radiologist in an urban hospital.
(Source: South County Mail, June 11, 2008)
The
Arizona Telemedicine Program at Yuma Regional Medical Center (YRMC) got a positive review last month from Dr. Ronald Weinstein, director of the program at the University of Arizona Health Sciences Center.
"Telemedicine is the practice of medicine at a distance using video imaging and telecommunications technologies," wrote Weinstein in an e-mail. "The Arizona Telemedicine Program is a large statewide program. It provides the telecommunications infrastructure for telemedicine, telemedicine training and many telemedicine services over its network."
The telemedicine program came to YRMC as part of the Arizona Department of Health Services Children's Rehabilitation Services program. YRMC'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 YRMC last month to get an update on current telemedicine activities at YRMC 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," wrote Weinstein.
Mike Sisson, applications administrator at YRMC, 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 Plasma Panasonic flat screen television," he wrote in an e-mail.
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 is 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 YRMC. "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."
Dr. Weinstein said that he would like to see YRMC be an example to other hospitals who would like to implement the program. "This program is fabulous," said Weinstein. "The people of Yuma are extremely fortunate to have this here."
(Source: Yuma Sun, June 15, 2008)
On the first floor of Barton Memorial Hospital in South Tahoe,
California, Dr. Clint Purvance sits in front of a computer holding a joystick.
Upstairs in Room 210, a patient named Kathleen, who was admitted to the intensive-care unit the night before, waits to see if she is stable enough to be moved into regular patient care. As she lies in bed, Kathleen suddenly notices a faint humming and turns to observe an unlikely visitor entering her room.
Wearing a "Dr. Robot" name tag, the visitor, an InTouch Health RP-7 robot, wheels into the room with Purvance's face on the monitor.
From his office, Purvance speaks into a microphone attached to a headset: "How do you feel?" he asks through the robot.
Kathleen replies that she feels better. Purvance takes a closer look by zooming in on the image of her on his computer screen.
"Are you feeling short of breath?" Purvance asks.
An attendant places a stethoscope on Kathleen so Purvance can hear her breathing through the headphones he's wearing. Under other circumstances, Purvance could have walked upstairs to see Kathleen, but on Wednesday, he was performing a demonstration of the robot for hospital staff and visitors.
Barton is considering the robot as an option for its telehealth initiative, said Monica Sciuto, Barton HealthCare System director of public relations and marketing. "Dr. Robot" roamed Barton's halls Tuesday and demonstrated its abilities Wednesday.
During the demonstrations, attendees took turns test-driving the robot. At one point, the computer "doctor" rolled over to the hospital's coffee stand to order a cappuccino.
Barton began its telehealth initiative last August so patients could access more specialists without leaving South Lake Tahoe, Sciuto said. Specialized services are most needed in neurology, hepatology, nephrology and pulmonology, plus a cardiologist who is available around the clock.
Since Barton is in a rural area, the population doesn't exist to sustain the specialists, Sciuto said. The robot is a possible solution to that.
Michael Foster, an InTouch Health field organization trainer, said the company also produces software used with the robot for specific medical conditions, such as strokes.
When administering treatment to stroke victims, time is valuable. The robot allows specialists in remote locations to assist in diagnosis and treatment of stroke patients in a timely manner. InTouch Health was founded in 2002 and has distributed more than 175 RP-7 systems to 80 hospitals around the world.
Sciuto said patients respond well to physicians on the robot monitors because they are able to see and connect with them, Foster said. Sciuto said it is the hospital's goal to have a telehealth system in place by the end of the year.
(Source: Tahoe Daily Tribune, June 20, 2008)
6/20/2008
Congressmen Mike Thompson (D-CA) and Kenny Hulshof (R-MO) introduced legislation that would increase the number of health facilities that offer telehealth services to Medicare recipients.
Telehealth, the delivery of health services via telecommunications, is a proven method for doctors and patients to effectively communicate from separate locations. This technology is an important resource for transmitting medical advice, information and imaging, but Medicare reimbursement for telehealth services is currently limited to rural areas and specific types of health facilities.
The Thompson-Hulshof legislation would expand Medicare reimbursement to urban and suburban areas and include more facilities, like skilled nursing facilities and home health services. It will also allow doctors to monitor patients remotely.
"People in rural Congressional Districts like ours often have to travel long distances to see a specialty physician," said Thompson. "We know that telehealth technologies are an effective way to bring high-quality, affordable healthcare to Americans, no matter where they live. This legislation will make sure Medicare recipients can access telemedicine technology in more cities and towns and in more health facilities. As healthcare becomes more expensive, telehealth technology is a great way to help people get the care they need."
"Telehealth has the potential to make the best treatments and medical professionals available to any American," said Hulshof. "This legislation has broad support from the medical community, as we all share the same goal: to take full advantage of medical and technological advances to save lives and keep people healthy. Telehealth also has great potential to save billions of taxpayer dollars, so this bill is truly a win-win."
The legislation also provides $30 million in grant funding to help health facilities pay for the telehealth equipment and to expand telehealth support services.
Telehealth has shown it provides better management of chronic diseases, reduces emergency room admissions and lowers healthcare costs. Telehealth services can also play an important role in addressing the epidemic of physician shortages in rural America by bringing physician specialty services to remote communities. In addition, faster diagnoses enabled by telehealth allow patients to get care more quickly.
(Source: Redwood Times, June 11, 2008)
5/24/2008
Pennsylvania State Rep. Mark Cohen, D-Phila., has introduced legislation that would require the state's medical assistance program to reimburse telemedicine services to medical assistance patients at Medicaid rates.
Telemedicine allows patients to visit with physicians live over the Internet and makes it possible for physicians to capture and send video, still images or other data to specialists for diagnosis or follow-up treatment, rather than physically sending the patient to the specialist through referral.
Cohen said telemedicine is becoming more widely used to meet the needs of underserved populations, including people living in rural and remote areas, low-income and uninsured residents, and those enrolled in Medicaid. Other states offer Medicaid reimbursements for telemedicine services, but Pennsylvania does not.
"These services cost less than office visits and are generally used when office visits are deemed unnecessary," Cohen said. "Telemedicine lowers health-care costs, is more convenient to patients by saving travel time and gas money, and allows providers to handle more patients.
"The savings in ambulance costs for transporting medical assistance patients to providers alone are predicted to amount to tens of millions of dollars annually. But, unfortunately, because providers are not reimbursed for telemedicine services to medical assistance patients, many do not offer them."
Cohen's bill (H.B. 2545) was introduced this week and is expected to be referred to the House Health and Human Services Committee for review.
(Source: Rep. Mark Cohen Press Release, May 15, 2008)
Four regional
Arkansas hospitals have joined a new round-the-clock telemedicine program that links their doctors with University of Arkansas for Medical Sciences (UAMS) neonatologists anytime a newborn requires special medical attention. A neonatologist specializes in the care of newborns up to two months old.
The neonatal telemedicine program links UAMS neonatologists on staff at UAMS and Arkansas Children's Hospital (ACH) with the Medical Center of South Arkansas in El Dorado, St. Edwards Mercy Medical Center in Fort Smith, Washington Regional Medical Center in Fayetteville and Willow Creek Women's Hospital in Johnson.
This latest telemedicine program serves Arkansas women and their babies who live in outlying areas. The program will assist local physicians with low-birth-weight newborns and those with other medical emergencies.
UAMS expects to add another eight hospitals to the program by the end of the calendar year, said UAMS' Whit Hall, M.D., a neonatologist who is leading the regionalization effort.
"UAMS has provided high-risk obstetrics consults, but this is the first time we've been able to go into the nurseries of Arkansas' regional hospitals to consult with their neonatologists or pediatricians," said Curtis Lowery, M.D., chairman of the Department of Obstetrics and Gynecology in the UAMS College of Medicine, and co-director of UAMS' Center for Distance Health.
ACH's Angel One helicopter will be used to transport mothers and their sick newborns to the most suitable hospital in the program. The patients' medical needs and available bed space among the participating hospitals will determine the most suitable placement for each newborn.
Low birth weight is a leading cause of infant death and disability and an economic burden for private and public health insurance programs. Hospitals with specialized perinatal care can improve birth outcomes and even reduce medical costs, Hall said.
The program for newborns builds on UAMS' innovative, nationally recognized ANGELS program for high-risk pregnancy cases, said Lowery, M.D. Lowery created the program that makes UAMS' board-certified maternal-fetal specialists available to hospitals statewide using telemedicine technology. ANGELS stands for Antenatal and Neonatal Guidelines, Education and Learning System.
"ANGELS has improved the transportation and referrals of these high-risk mothers and we hope that providing in-nursery telemedicine support will further decrease the mortality rates of low-birth-weight infants," Lowery said.
The program for newborns is funded by UAMS' Center for Translational Neuroscience (CTN) and its Community Based Research and Education (COBRE) Core Facility. Funding for this program originated at the NIH's National Center for Research Resources.
"The CTN is pleased to provide funds to implement this neonatal telemedicine program, which is one of several programs the CTN has funded that help improve medical treatment for infants," said Edgar Garcia-Rill, Ph.D., director of the CTN and professor of neurobiology and developmental sciences.
(Source: UAMS Press Release, May 14, 2008)
Plans are under way to more than double the size of VA clinic in Rochester,
Minnesota,to handle soaring patient numbers. "The present facility is just sort of bursting at the seams," said Dr. Michael Koopmeiners, medical director of the VA's Community Based Outpatient Clinics. The new Rochester clinic is slated to have three rooms outfitted with a flat panel screen and video camera. This will allow for telemedicine, where patients can talk with a specialist at the Minneapolis VA Medical Center without having to make the trip, Koopmeiners said.
"I think it's a great idea if they increase the amount of services they are able to provide," said Dodge County Veteran Service Officer Todd Nelson. "It will benefit now only the patients, but it will save the VA money in the long run so they are not sending them up to the cities all the time."
(Source: Rochester Post Bulletin, May 23, 2008)
5/24/2008
The
Canadian province of Saskatchewan's move to regulate telehealth could steer out-of-province doctors away from the practice, a national advocacy group says. The Canadian Society of Telehealth wrote to Health Minister Don McMorris earlier this month asking him not to approve a proposed bylaw that would require doctors to get a special license and pay a fee to treat and diagnose Saskatchewan patients by phone, videoconference, Internet and other technological means.
"The bylaw proposal put forward by (the) Saskatchewan College of Physicians and Surgeons will significantly reduce the willingness of non-Saskatchewan-based physicians to provide telehealth services to Saskatchewan residents," society president Laurie Poole wrote to McMorris. "By imposing this fee, the college is effectively transferring significant costs and inconvenience back to the patient."
But college associate registrar Bryan Salte said the group has it wrong. Current Saskatchewan law makes it illegal for doctors to see patients without being licensed in the province, and that is preventing some doctors from offering the service at all.
In fact, some doctors have even said they will stop offering telemedicine in Saskatchewan until they can do it legally, Salte said.
"I don't see how a bylaw deters people any more than this current hurdle does," Salte said.
Last month, the college's council passed a bylaw to create a new class of license for doctors who want to see Saskatchewan patients via telemedicine. Those treating 12 or fewer patients in a year would pay nothing; seeing between 13 and 52 patients would cost $250. Getting the license would require less paperwork than a full medical license. Anyone seeing 52 patients or more each year would need to shell out $1,430 for a regular Saskatchewan license.
Trevor Cradduck, vice-president of the Canadian Society of Telehealth's board, worries creating these bureaucratic hoops means doctors won't make the effort to jump through them.
"Even if it's for free, they're unlikely to send all of the paperwork to the College of Physicians in Saskatchewan," Cradduck said. "It's so much easier to say, 'Come and see my in my office.' "
When patients have to travel for such consultations, it's a burden on their finances and their time, Cradduck said. Gas, airfare, hotels and food aren't covered medical expenses, and a caregiver may need to take time off work -- all for what might amount to a 10-minute appointment with a specialist.
Cradduck said Quebec and B.C. have dodged the problem by defining telehealth as the practice of medicine where the doctor is located (and already has a license). The society would like to see a national system of permits that would allow doctors to do telemedicine across Canada without applying individually to each province and territory.
Salte said the new bylaw -- once it has the minister's approval -- is supposed to encourage doctors to do telemedicine in Saskatchewan, not push them away.
Salte said a national system of permits wouldn't be allowed under the Canadian constitution, which gives provinces the power to license doctors. Even then, physicians would still need to fill out paperwork to get a permit.
Furthermore, not charging doctors for telemedicine permits would mean the cost of keeping tabs on them would be offloaded onto doctors who live in Saskatchewan and pay to be licensed, Salte said. That would be unfair, since some out-of-province doctors want to do telemedicine to make money.
If anyone is to practice telemedicine legally, the government will either have to approve the college's proposed bylaw, he said, or amend the Medical Profession Act, potentially creating new problems about regulating offshore doctors.
McMorris said the ministry is currently mulling the issue over. He hasn't yet been briefed or made a decision about the college's proposed bylaw.
"It's always a balancing act," he said. "We want to ensure that the safety of the public is paramount. We also realize the benefits of telehealth."
(Source: The Saskatoon StarPhoenix, May 16, 2008)
The three three national eHealth and telemedicine associations of
Germany,
Austria and
Switzerland have recently joined forces and enforced their cooperation by a formal agreement.
Across Europe and worldwide, telemedicine and telehealth services respond to today's health and social demands, i.e. treatment of chronic patients, support for the quality of life of elderly people living at home and the empowerment of citizens/patients to make healthcare choices. With the evolving European-wide availability of eHealth infrastructures, new opportunities for highly interconnected telemedicine services emerge. Given the ubiquity of networks and the mobility of patients in Europe it is impossible to deploy sustainable telemedicine services without international, European and worldwide dimensions.
To accomplish this joint vision, the three National eHealth and Telemedicine Associations of Germany (DGG), Austria (ASSTeH) and Switzerland (SATMeH) have recently joined forces and enforced their cooperation by a formal agreement. The agreement was signed at the "1st D-A-CH Cooperation Meeting" held in Mannheim, Germany, in the premises of Vitaphone, one of the pioneers in the provision of telemedicine services supported by a highly professional Telemedicine Service Centre. The cooperation agreement foresees close, cross-border collaboration for various subjects of eHealth and telemedicine supported by regular consultations and joint meetings of the associations. Foreseen results are joint publications, conferences and exhibitions at medical and eHealth fairs. Even more important will be the development of agreed guidelines for various aspects of telemedicine, educational curricula and providing harmonised advice to model and pilot projects.
As G�nter Steyer, President of the DGG states "The significance of telemedicine in practice is vastly increasing throughout Europe. Following the introduction of health telematics infrastructures like e.g. the German eHealth card, clinical teleservices become increasingly important. Also the European Commission has prioritised telemedicine in its 2008 action planning. Especially for chronic diseases and patients at risk, telemedicine is an essential module to cope with the challenges of the European Healthcare systems, particularly those induced by the demographic changes. The cooperation of the European Associations for eHealth and telemedicine is hence of utmost importance to pave the way for a coherent European eHealth infrastructure, which has to be build on international standardisation while still recognising National developments and regulations."
(Source: eHealth News, May 11, 2008)
Monrovia has opened a new telemedicine center in the city of Ulaanbaatar in the Scientific Center for Mother and Infant. The center will allow Mongolians who must travel great distances to see a doctor to, instead, receive medical assistance via the telephone.
The system will cover all residents of eight provinces including Khovd, Khovsgol, Dornod, Ovorkhangai, Darkhan-Uul, Orkhon, Selenger, and Dornogobi.
Since the telemedicine program was launched in Mongolia in September 2007, some 700,000 Mongolians have taken advantage of the service.
(Source: Mongolia Web News, May 20, 2008)
On the surface, it seems quite ordinary - a medium-sized, silver box not much different than your average suitcase, but the equipment inside has changed the way patients recover from heart surgery. With the equipment, nurses at Saint John Hospital in New Brunswick,
Canada, are able to measure the vital signs, electrocardiogram, blood pressure and oxygen saturation of patients recovering from surgery in their home, and determine if they are recovering properly or need additional assistance.
Now in its 10th year, the telehealth's program coordinator Krisan Palmer was honored as "industry person of the year" at the knowledge industry award ceremony earlier this month. "It's nice to know we're finally being recognized by the IT sector, that telehealth is a viable industry," she says.
The telehealth center is a small operation, run by a staff of 10, including Palmer and a secretary, out of a small space on the first floor of the Saint John Regional Hospital.
The applications, says Palmer, are endless, and help serve patients from all over New Brunswick and beyond. But it's the post-cardiac surgery care program that began in 1998 that really sets Saint John's telehealth program apart.
The program has served 4,000 patients in and around New Brunswick, and this year Palmer expects to assist more than 700 through the program.
"It's the fact that psychologically these patients are going home but they don't feel like they're going home alone. They know they're talking to a nurse every day," said Marc Pelletier, head heart surgeon at the Saint John hospital.
Pelletier was born in Edmundston, but after studying at top schools across North America, he returned to New Brunswick last summer to take the top job, after James Parrott, who helped found the telehealth centre, retired.
"I was in California, at Stanford, the mecca as it relates to information technology - the school where the Google guys went, all that stuff - but something like this wasn't even on the radar," he says.
"I come here, kind of a have-not-province, but it's got a very good cardiac centre and one of the reasons it's good is things like (telehealth)."
When Palmer first made the switch from working as a nurse in intensive care to the telehealth department, she was hardly a technological wizard.
It took her an hour to figure out how to turn on her laptop when she first took it home, she says. But since then, she's become a pioneer in her field, won several awards, and called "one of the country's foremost experts on long distance applications for healthcare" by Time magazine.
Health care providers from around the globe - Nunavut, Virginia, Norway, Sweden, Cameroon, China - have since come knocking for help to set up similar programs.
Palmer says the technology is not just for people that live far from the regional hospital; it has also proven cost-effective for local patients.
"People say it's not for people in Saint John or Quispamsis," she says.
"But if you look at the example of a congestive heart failure patient with a low income who lives uptown, it's a cab here and a cab back. That's twenty dollars out of their pocket that they may not have."
Though the technology is not new, there still isn't a standard, marketed piece of equipment designed to serve patients recovering from heart surgery in their home.
Palmer and the telehealth team worked technology companies and health organizations in 1998 to develop their own machine that combined a video phone, with equipment to measure vitals, and other important information. All of it fits in the fire proof silver case patients or their caregiver can put back on a bus to Saint John when they're done.
Palmer says they are in the process of creating a more advanced version of the equipment.
The new units will allow people to hook the machine up to the internet (or phone jack), and will be adaptable to serve patients with other problems, such as congestive heart failure, diabetes, high-risk pregnancies.
"Once they finish the development of it they will take that to market and I'm sure that it'll be old news because everybody will be doing it."
(Source: New Brunswick Business Journal, May 19, 2008)
5/9/2008
Telehealth is one of the uncertain issues before the
Missouri state legislature this month. Telehealth is part of a major healthcare bill, the Missouri Health Transformation Act, approved by the Senate and facing a cloudy future in the House. Part of the bill is a version of Governor Blunt's "Insure Missouri" program for lower-income Missourians---an issue some house leaders have written off for the session.
Senator Tom Dempsey of St. Peters wants the state health department to establish guidelines for use of telehealth and for the doctors who will use it. Dempsey says the system is especially useful in rural areas where specialists might be a long distance from the patient.
Some insurance companies don't cover diagnosis or treatment through telehealth. Dempsey's bill says they will--but not unless the House does something with it. Right now the bill has not been given a committee hearing in the House and the session ends in mid May.
(Source: MissouriNet, May 4, 2008)
Front-line care providers in rural
Alaska have a new way to help meet their patients' mental health needs. Alaska Psychiatric Institute and Alaska Federal Health Care Access Network now offer a free monthly behavioral health videoconference to Alaska Native Tribal Health Consortium providers.
"Mid-level primary health-care providers are the first contact for people who need behavioral health treatment," said institute CEO Ron Adler of the Alaska Department of Health and Social Services.
"These videoconference lectures and consultations let providers around the state ask behavioral health specialists about medication and treatment options."
Alaskans' need for mental health services, especially in remote communities, is clear.
The suicide rate for rural Alaska children is nine times the national average. The Alaska Native adult death rate from suicide is four times greater than the national average; from alcohol, seven times greater.
"This collaboration brings a substantial benefit to our clinical partners, who are confronted with a range of pressing mental health needs," said Kathleen Graves, director of behavioral health for Alaska Native Tribal Health Consortium.
The consortium is the managing partner of the Alaska Federal Health Care Access Network.
The continuing education sessions, which began in late February, are available to all 34 health organizations in ANTHC. The sessions also provide professional development opportunities, building providers' confidence and proficiency with videoconferencing equipment.
As providers build their technical skills, they are more likely to be creative and apply videoconferencing to a wider range of health-care applications, from nutritional consultations to pre-surgery instructions.
The new sessions are part of a broad range of telehealth services offered by API's Telebehavioral Outpatient Mental Health Clinic. API psychiatrists and other licensed mental health professionals, psychologists and social workers routinely use videoconferencing to treat clients around the state as part of the state's Telebehavioral Healthcare Services Initiative.
Alaska Psychiatric Institute's Alaska Recovery Center provides therapeutic services that help individuals achieve a personal level of satisfaction and success in their recovery. API works in partnership with individuals, their families and community network, and providers.
The Alaska Federal Health Care Access Network began in 1998 as an Alaska Federal Health Care Partnership project to improve health care to federal beneficiaries in Alaska using telemedicine technology. The network has expanded to more than 300 sites in Alaska and elsewhere in the United States, as well as several international locations, including Panama, Greenland and Saudi Arabia.
The system includes a Web-based client interface as well as videoconferencing solutions and support.
(Source: The Artic Sounder, April 25, 2008)
Three women dressed in colorful saris talk with doctors in Little Rock,
Arkansas, from a video screen at the front of a conference room at the University of Arkansas for Medical Sciences. The women are doctors at the CARE Institute of Medical Sciences, a hospital more than 8,700 miles away in Hyderabad, India.
Each Thursday, videoconferencing technology allows them to participate in sessions on treating high-risk pregnancies hosted by Dr. Curtis Lowery, UAMS director of obstetrics. "We can have an exchange of ideas," said Dr. V. Shanthi, an obstetrician at the private Hyderabad hospital.
St. Vincent Health System uses telemedicine technology to monitor home health patients, and Baptist Health uses it as an "extra set of eyes" to watch intensive-care patients 24 hours a day, seven days a week.
Telemedicine has tremendous potential to cut rising health care costs and improve access to medical care, health-care officials said. But there are obstacles to extending services, such as medical licensing requirements and the United States system of paying for medical services.
There will always be a need for people to visit doctors' offices in person, said Devon Herrick, health economist and senior fellow with the National Center for Policy Analysis, a Dallas-based nonprofit research group.
"Face-to-face meetings are the optimal way to have a physician visit," he said. "The physician can respond to how you look, talk and act, and they can ask follow-up questions. Telemedicine will never replace the face-to-face physician visit."
But telemedicine could be used in a large number of cases in which face-to-face contact isn't necessary, such as prescription renewals and lab tests.
Overall, the health-care industry has been slow to utilize communications technology used in other industries for decades, Herrick said. Lawyers, accountants and other professionals talk to clients via telephone and e-mail, but many doctors are just beginning the practice.
"Telemedicine is increasingly becoming an acceptable way to interact with physicians," Herrick said.
One problem is that insurance companies traditionally have no system to pay a physician for a phone or e-mail consultation, although some companies are starting to provide some reimbursement for such services, Herrick said.
Health-insurance companies are increasing telemedicine services. Kaiser Permanente, for example, has a secure Web site where patients can post questions and get direct doctor responses. Medical liability insurers are also beginning to offer coverage for telemedicine.
Medical licensing is another major barrier to expanding telemedicine services, Herrick said. Physicians have to be licensed in each state where they wish to practice. That makes it difficult for doctors wanting to provide services across state lines.
The Arkansas State Medical Board provides medical licenses for out-of-state doctors but doesn't track the number of doctors providing telemedicine services in Arkansas.
ANGELS, or Antenatal and Neonatal Guidelines, Education and Learning System, at UAMS has linked doctors at Arkansas hospitals and clinics since 2003 with the goal of reducing premature births.
The system expanded to the Hyderabad hospital about two months ago, said Lowery, the system's director. Officials hope to expand the overseas exchange to other countries, such as Russia, Australia, South Korea and China.
"I think there is a huge possibility for a great virtual-medical university," Lowery said.
UAMS made the Hyderabad link during a February 2007 visit with former Indian President A.P.J. Abdul Kalam, said Dr. Hari Eswaran, UAMS associate professor of international medicine.
Prasad Sistla, chief of telemedicine at the CARE Institute in Hyderabad, said the hospital has had videoconferencing technology since October 2001, and is part of a telemedicine network of 12 hospitals in India and South Asia. UAMS is the hospital's first contact overseas, Sistla said.
Doctors in Arkansas use ANGELS to communicate between hospitals. Dr. John Mesko is an obstetrician-gynecologist at Mena Regional Health System, a 65-bed community hospital. He said he uses the system to consult with specialists in Little Rock on high-risk pregnancy patients, including sending ultrasound images.
In many cases, it prevents the patients from having to drive to Little Rock to see the specialist directly, Mesko said. The educational opportunities allow him to keep up with the latest techniques.
"I'm hearing the newest, latest stuff every week," Mesko said. "As a little hospital in a rural town to be doing things the same way as they're doing in Little Rock is pretty awesome."
Lowery said UAMS is expanding telemedicine services to other specialties. ANGELS holds a weekly teleconference for Arkansas pediatricians, in which doctors from two Hyderabad hospitals also participate. Future offerings will include broadcasting of grand rounds for residents practicing statewide and conferences on subjects such as cervical cancer.
Within the next six months, UAMS will start a statewide telestroke program by which doctors treating patients with symptoms of stroke in rural emergency rooms can consult with neurologists elsewhere in Arkansas.
Of course, there are costs involved. Lowery said line charges for the network can be $500 to $800 per month. The federal government currently pays for the lines in Arkansas, but smaller hospitals might not be able to afford the technology without the help.
"By doing this we are able to meet needs that are just not possible through traditional medicine," Lowery said. "As we show the benefits of working together, people will do more and more."
At Baptist Health Medical Center-Little Rock, registered nurses sit at six stations in the electronic intensive care unit, or eICU, monitoring patients in Baptist Health's intensive-care units in Arkadelphia, Heber Springs, North Little Rock and Little Rock.
The nurses complement those treating patients in the hospitals. From their stations, they can check patients' vital signs and medical records. They can see and talk directly with patients, family members, nurses and doctors in the hospital rooms. Cameras mounted in the rooms allow them to zoom in to check small details, such as the dilation of a patient's pupils.
"We're here as an extra set of eyes," said eICU director Vicki Norman. "Our goal is to look for all the tiny little details to make sure that nothing's being missed."
There are more than 35 eICUs at hospitals nationwide, with technology provided by Baltimore-based VISICU, Inc. Since Baptist started its eICU three years ago, it has expanded monitoring from 53 beds to 142 beds.
The eICU is staffed 24 hours a day, seven days a week by registered nurses with an average of 19 years of experience. Physicians, including critical-care internists, cardiologists and a thoracic surgeon, are there from 7 a.m. to 7 p.m. on weekdays and 24 hours a day on weekends.
"That way there is never a missed beat," Norman said. "It has really transformed the way we do critical care. Geography is not a barrier."
At St. Vincent Health System, homebound patients in the 11 counties served by the system's Visiting Nurse Association of Arkansas use computerized devices to check their vital signs, said Denise Looker, the association's home health administrator. The information is sent through a secure Internet connection for review by nurses, allowing them to monitor chronically ill patients from afar.
"It allows us to monitor the patient every day without having to be in the home every day," Looker said.
They check things like weight, blood pressure and heart rate. Some patients have machines that prompt them to take their medicine and answer routine questions, such as how well they slept or whether they have any swelling.
Looker said the technology has helped St. Vincent reduce hospital visits for chronically ill patients. Nationally, about 37 percent of former heart attack patients end up returning to the hospital. At St. Vincent, 4.5 percent of heart attack patients were rehospitalized last year.
Herrick said telemedicine will become more prominent as insurance companies, medical boards and other regulatory agencies make it easier to practice.
"I think it will be like a snowball effect," Herrick said.
Lowery of UAMS said the health-care system will have to adjust.
"Right now health care is one size fits all, and that's a problem," he said. "[Telemedicine] allows you to match needs with resources.
"In three to 10 years, I think this will be the way medicine is practiced. It will be an integral part of what we do."
(Source: Arkansas Democrat-Gazette, April 28, 2008)
Six
Maryland hospitals facing a shortage of emergency room doctors plan to use physicians in
Delaware to electronically monitor intensive care patients, officials announced yesterday.
Under the program known as Maryland eCare, a critical care doctor, or intensivist, based at a command center in Wilmington will oversee overnight care for as many as 150 patients and provide guidance to on-site nurses. Officials said the collaboration with the hospitals, the first of its kind in the nation, is needed, especially in exurban and rural areas. Three of the six hospitals are in Southern Maryland.
The program, funded with a $3 million grant, "allows us to provide the same high level of care at 2 in the morning as we provide at 2 in the afternoon," said Maryland eCare Director Marc T. Zubrow, director of critical care medicine at Wilmington's Christiana Care Health System, where the critical care doctors will be based. "It's about crisis prevention rather than crisis response."
A video camera and computer terminal positioned in a patient's room will send vital signs, test results and information about patient responsiveness to Wilmington, where a doctor and several nurses will view the data and photographs on high-resolution computer monitors.
If command center staff members see the patient's health deteriorating, they can communicate with nurses to provide medicine or additional tests.
Officials said the electronic program will drastically reduce response time during overnight hours in intensive care units, which generally rely on on-call doctors between 7 p.m. and 7 a.m. Instead of paging a staff physician and losing time waiting for a return call, the nurse can talk to an intensivist almost immediately, Zubrow said.
"It makes patient care safer and reduces the risk of errors," said Christine M. Stefanides, president of Civista Medical Center in La Plata, one of the hospitals involved in the project. "It makes nurses, other doctors and patients feel more secure that they're well cared for."
The technology, known as eICU, was developed by Baltimore-based Visicu, a medical technology company, and is used in about 200 hospitals throughout the country. Sentara Healthcare in Roanoke was the first hospital to use the system, and Inova Fairfax Hospital was another early adopter.
The Maryland eCare program will serve 71 patient beds in six hospitals by 2010, officials said, with at least four other hospitals considering participating. The Washington area hospitals are Civista, Calvert Memorial Hospital in Prince Frederick and St. Mary's Hospital in Leonardtown. Other participants include Peninsula Regional Medical Center and Atlantic General Hospital on the Eastern Shore and Washington County Health System in Western Maryland.
Hospital officials said the collaboration was formed in response to drastic shortages of critical care doctors. There are currently 6,000 intensivists in Maryland, Zubrow said, compared with a projected need of 35,000 in the next 12 years.
"Telemedicine, of which this is a part, is a critical component of our health-delivery system in the face of physician shortages," said House Majority Leader Steny H. Hoyer (D-Md.), whose Southern Maryland jurisdiction includes three of the hospitals in the project and who spoke at a launch event in the District yesterday.
James Xinis, president of Calvert Memorial Hospital, said Maryland eCare would not supplant the need for on-site doctors and nurses but would aid them in decision making and allow them time off at night. The command center in Wilmington will operate between 7 p.m. and 7 a.m. weekdays and around the clock on weekends and holidays.
"This raises the level of care available locally," Xinis said. "Other hospitals who have used similar programs show a decrease in mortality rates by as much as 25 percent."
The program's first three years will be funded by a grant from Maryland CareFirst, an insurance provider that is part of the Blue Cross and Blue Shield network. Once individual hospitals launch the program, they will be responsible for $37,700 per intensive care bed each year.
(Source: Washington Post, April 29, 2008)
4/16/2008
The Centers for Medicare & Medicaid Services (CMS) has published a new regulation establishing Part D e-prescribing standards for four types of information. The new rule will go into effect on April 1, 2009. According to HHS Secretary Mike Leavitt, establishing standards for e-prescribing under Medicare's prescription drug program will help pave the way for the widespread adoption of e-prescribing throughout the medical community.
This regulation applies to:
- Formulary and benefits: This standard will enable doctors and other prescribers to find out information on what drugs are covered by a Medicare eligible individual's prescription drug benefit plan
- Medication history: This standard will enable doctors, other providers, as well as dispensers to communicate about prescribed medications a beneficiary has taken or is taking including those prescribed by other providers
- Fill status notification: This standard will enable doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient's prescription has been picked up, not picked up, or has been partially filled
- Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the NPI to identify individual healthcare providers in Part D e-prescribing transactions.
For more information, please visit
www.cms.hhs.gov/EPrescribing.
(Source: Federal Telemedicine Update, April 7, 2008)
