Telemedicine and Telehealth News

Telemedicine and Telehealth News

New Legislation Would Expand Medicare Reimbursement to Urban and Suburban Areas

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)

New Study Finds Telehealth Can Reduce Costs for Chronic Disease Care

Health plans can cut costs for businesses and employees by encouraging frequent phone or Web-video conversations between chronic-disease patients and doctors or nurses, University of Missouri research suggests. With chronic diseases generating 70 percent of U.S. health costs, they offer nearly $1.5 billion a year to be cut.

The telehealth interactions bring important symptoms to light earlier, "triggering early intervention from providers and reducing the need for patient hospitalization," said Bonnie Wakefield, a nursing school professor who studied patients who had been hospitalized with heart failure. Those with phone or video follow-ups "significantly delayed hospital readmission rates" compared to those without.

"People who suffer from chronic illnesses usually wait three to six months between office appointments," Wakefield said. Nurses who check in regularly with patients "provide a sense of security. Patients discuss concerns on a frequent basis, and nurses give advice and detect problems that the patient might not notice."

The result, she said, is fewer and shorter hospital stays, "lower health care costs" and patients who better "manage their diseases and ultimately feel better."

The report, "Home Telehealth for Heart Failure," will be published in the Journal of Telemedicine and e-Health.

(Source: Dayton Daily News, June 9, 2008)

Australian Research Finds Telemedicine Use in ER's Most Effective for Moderate Trauma

The use of telemedicine in emergency room's (ERs) is most effective for moderate trauma patients, according to a research paper published in the latest issue of the Medical Journal of Australia.

Professor Johanna Westbrook, from the Health Informatics Research and Evaluation Unit at the University of Sydney, and her co-authors evaluated whether the introduction of an emergency department telemedicine system changed patient management and outcome indicators. The study looked at the use of the Virtual Critical Care Unit (ViCCU), a telemedicine system that allows real-time, broadcast-quality, low-latency audiovisual communications between ER clinicians at different sites.

The study was conducted in the ERs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital - for one year before and 18 months after the introduction of the ViCCU.

In the study by Professor Westbrook and colleagues, the ViCCU appeared most effective for moderate trauma patients. For these patients, discharges increased significantly (45% to 63%), transfers decreased (48% to 25%), and treatment times increased. For critical care patients, admissions fell (54% to 30%), transfers increased (21% to 39%), and more procedures were performed.

For major trauma patients, treatment times and the proportion of admissions, discharges and transfers did not change significantly after introduction of the ViCCU.

Clinicians reported that the ViCCU allowed greater support to clinicians at the district hospital, while specialists at the large metropolitan hospital said their workloads had increased and that they felt a greater responsibility for patients at the district hospital, according to the authors.

The researchers are now calling for large-scale trials of telemedicine systems that include measurements of patient care and the impact on clinicians' work.

(Source: Medical News Today, June 16, 2008)

Healthcare Spending on Telecommunications Expected to Reach $55 Billion Over Five Years

The U.S. healthcare industry is expected to spend $55 billion on telecommunicationsover the next five years, according to a recently released study by Insight Research Corporation. The use of telecommunications by healthcare providers will grow at a compounded rate of 8.4 percent, from $7.5 billion this year to $11.3 billion in 2013. According to the report, "Telecom, IT, and Healthcare: Wireless, Wireline and Digital Healthcare, 2008-2013," an aging population and worker shortages are pushing healthcare providers to find alternative approaches to current business practices, including the use of telecommunications.

"Most of the high costs inherent in the current system are related to the proximity of the patient and provider, as well as to the archaic administrative systems used to manage records and exchange information," the study said. "Telecommunications can bridge these proximity gaps as well as provide a normalized set of baseline data that can remain secure and yet be shared among healthcare workers."

According to Insight Research President Robert Rosenberg, telecommunications and information technology providers have responded to the interest by providing more bandwidth, packet services and healthcare applications, such as video monitoring, electronic health records and telemedicine.

For telecommunications and IT providers, healthcare is an attractive market, Rosenberg said. The U.S. healthcare industry is a $2.3 trillion ecosystem of hospitals, physicians, pharmaceutical companies and insurance providers. Healthcare outpaces all other industries for growth rate and is projected to grow 6.9 percent per year to $4.1 trillion by 2016.

"This increased emphasis and spending on healthcare reflects the increased value that consumers perceive in medical treatment," Rosenberg said. "At the same time, providers and patients share the objective of improving healthcare quality and reducing costs. Information technology and telecommunications will play a critical role in addressing these objectives."

Rosenberg said many of the trends Insight Research has predicted in previous reports have come to pass.

(Source: Healthcare IT News, June 2, 2008)

State Telehealth News

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)