Another Review of the Value of the TeleICU

Abstract from Telemedicine and eHealth Journal online March:


Telemedicine has been utilized in various healthcare

areas to achieve better patient outcomes, lower costs of providing

services, and increase patient access to care. Tele-intensive care unit

(ICU) technology has been introduced as a way to provide effective

ICU services to patients with reduced access, as well as to decrease

costs and improve patient care.

Materials and Methods:

tmj.2014.20.issue-1.coverThis was a literature search and

review of case studies. The search was limited to sources published in

the last 10 years (2003–2013) in the English language. In total, 55

references were used for this research exploration inquiry.


Tele-ICU was found to be an effective way to use technology to decrease

costs of providing intensive care, while improving patient

outcomes such as mortality and length of stay. Several case studies

supported the use of telemedicine in ICUs to provide intensive care to

patients who lived in rural areas and lacked access to traditional

ICUs. Furthermore, it was noted that, although the initial costs for

tele-ICU startup were significant, as much as $100,000 per bed, the

benefits of the utilization of this technology can offset those costs by

reducing costs by 24% via decreased length of stay for patients.


The findings of this study have suggested that the

implementation of tele-ICU may have been more beneficial than

costly, and it may have provided healthcare organizations the opportunity

to increase quality of care and decrease mortality, while it

might have decreased costs of delivering ICU services in both rural

and urban areas


Posted by: C3O Telemedicine News

Posted on: March 14th, 2014

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A Multicenter ICU Telemedicine Study – More from UMass

imgresJust released in the March issue of Chest, the UMass Memorial Critical Care Operations Group released it latest study of almost 119,000 patients representing 56 ICU’s in 32 hospitals.

The results:

  • Mortality in the ICU was significantly better than the controls.
  • Adjusted Hospital LOS was less.
  • Individual reasons for reduced mortality included:
  1. Intensivist involvement within one hour of admission
  2. Timely use of performance data
  3. Adherence to best practices
  4. Quicker alert response times


Posted by: C3O Telemedicine News

Posted on: March 11th, 2014

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Telemedicine and State Medical Licensure Issues: Why We Need To Have Resolution

Christine Vestal, Pew/Stateline Staff Writer9:44 a.m. EST March 7, 2014

U.S. Rep. Peter Welch watches a demonstration of a telemedicine conference call between doctors from Central Vermont Medical Center and 40 miles away at Fletcher Allen Health Center on Nov. 6, 2013 in Berlin, Vt.(Photo: Toby Talbot, AP)

Demand for doctors — whether in person or via a computer screen — is expected to surge as millions more Americans become insured under the Affordable Care Act. About 10 million people already rely on telemedicine, often from doctors who live in another state.

As a result, more physicians are applying for medical licenses in multiple states — a costly and time-consuming proposition for some. Without a license to practice medicine in the patient’s state of residence, both doctors and patients may be at legal risk.

Many states are embracing telemedicine by encouraging it in their Medicaid programs and requiring private insurers to pay for it. But they have made little progress in removing medical licensing barriers that proponents of the technology say have kept doctors and hospitals from expanding even more.

Telemedicine was once the purview of small town doctors who needed to consult with specialists available only in larger urban areas. Today, telemedicine technology is even being used to conduct surgeries using robotics, typically only in emergency situations such as during war.

Most telemedicine consists of video teleconferencing between a doctor and a patient. Doctors also routinely use telemedicine technology to transmit and discuss diagnostic images and to remotely monitor patients with chronic diseases so they don’t have to leave their homes or nursing facilities.

For some consumers, it is the primary way they receive medical care. Using Skype on a computer or FaceTime on an iPhone, patients discuss their symptoms and show their doctors any visible evidence of their conditions, such as a swollen eye or skin rash. Patients most often conduct these consultations from home or their workplace. In some cases, patients go to a medical facility and use high-end, secure equipment to teleconference with a doctor in another location.

Much of the growth in telemedicine is expected to be in remote monitoring of patients with heart and lung diseases and diabetes, who have recently been discharged from a hospital. The aim is to detect health problems early enough to prevent them from being sent back to the hospital.

States have argued that easing licensing requirements could jeopardize patient safety. If doctors practice in a state without obtaining a license there, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. Also, these doctors would not benefit from any legal protections the state may have against malpractice lawsuits.

Proponents of telemedicine argue that since doctors take standardized national exams and most requirements are set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. They say state medical boards are simply trying to shield doctors from out-of-state competition and preserve state revenues from licensing fees.


The cost to doctors of obtaining multiple licenses is estimated at $300 million a year, according to Gary Capistrant, public policy director at the American Telemedicine Association. That does not include the fees doctors pay for their primary licenses in their home states. For hospitals and medical practices that operate in multiple states, the burden of licensing limits the number of doctors who are willing to participate, he said.

State medical licensing fees vary from a low of $150 in Michigan to a high of $1,290 in Rhode Island. Most range from $200 to $600, with lower renewal fees. Of the roughly 850,000 practicing physicians in the U.S., 17 percent have at least two state licenses and 6 percent have three or more, according to a 2010 survey.

Now, under pressure from major telecommunications and health care firms that want to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. Patients would have greater protection than exists now, because states that join the compact would share data on any ongoing investigations of licensed doctors.

The proposal, to be considered at the annual meeting of the Federation of State Medical Boards in April, would expedite the licensing process for doctors who want to practice across state borders. Similar interstate compacts have been used for other types of licensing, including driver’s licenses.

Even the most pro-telemedicine states have not yet taken a stand. The compact, which was developed by a task force of 22 state medical boards, may represent the first step. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation,” she said. “We’ll see in April.”

The federation’s compact is modeled on an agreement adopted by the National Council of State Boards of Nursing in 2000. That compact has been adopted by 24 states. Legislation is pending in Illinois, Massachusetts, Minnesota, New York and Oklahoma.

In addition to reimbursement and licensing, proponents say states need to define what types of telemedicine may be practiced, whether patients need to sign special consent forms and when doctors can prescribe medications remotely. Several state legislatures are considering those issues this year.


Since its beginnings in the mid-1980s, the number of patients cared for through telemedicine has risen from a few thousand to an estimated 10 million people in rural as well as urban settings. The vast majority of the growth has occurred in the last decade, according to the American Telemedicine Association.

Market analyst IHS estimates U.S. telemedicine spending will grow to $2.2 billion in 2018 from $240 million this year. A new lobbying group, the Alliance for Connected Care, formed last month to promote federal and state policy changes to spur the industry’s growth, led by former U.S. Senate Majority Leaders Tom Daschle, Democrat from South Dakota, and Trent Lott, Republican from Mississippi. The group’s members include health care and technology giants Verizon, WellPoint, CVS Caremark and Walgreens, as well as smaller companies Teladoc, HealthSpot, Doctor on Demand and MDLIVE that offer online access to medical services.

Widely considered an effective way to reduce overall health care costs, increase patient access to care and improve overall health, telemedicine has broad support within state governments and Congress. At least five bills designed to further its use have bipartisan sponsorship in Congress.

“Until we are able to attract more physicians to rural communities and tighten the access gap,” one bill’s sponsors wrote, “the next best alternative is to use technology to connect health professionals with underserved populations – rural and urban – through telehealth networks.”

Four of the bills under consideration would allow doctors who provide services under Medicare and TRICARE (the insurance plan for military personnel), and accompany sports teams when they travel from state to state to have just one state license. The U.S. Department of Veterans Affairs, a vigorous proponent of telemedicine, already considers a medical license in one state sufficient to provide services in all 50 states.

For soldiers returning from Iraq and Afghanistan, telemedicine is the primary way they’ve been receiving medical care already.

“We’re fast becoming a 24/7 world,” said Capistrant. “People don’t just get sick 9 to 5. Many work at night. For some, finding a doctor that speaks their language can be a problem. Technology can help deal with some of those issues and we should use it.”


The biggest issue at the federal level is that Medicare reimburses only for telemedicine services on a limited basis. To qualify, patients must meet a narrow definition of residing in a rural area, and even then the federal health plan for the elderly and disabled will pay for only certain types of services.

The other huge government health program, Medicaid, pays for a wide range of telemedicine procedures for the poor, according to the Center for Connected Health Policy, in all but Iowa, Massachusetts, New Hampshire, New Jersey and Rhode Island, where health care plans for the poor do not currently cover telemedicine services.

Only 21 states and the District of Columbia require private plans to cover telemedicine, despite strong support from employers who want to see the cost of premiums go down as telemedicine is used more often to keep people out of hospitals. An added benefit for employers is that telemedicine allows workers to receive care without taking time off from work to go to a doctor’s office.

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.



Posted by: C3O Telemedicine News

Posted on: March 7th, 2014

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Daschle, former senators form alliance to lobby for new telehealth rules

Thomas A. Daschle, former Democratic senator from South Dakota, is now focusing on rural health care delivery. Senator Daschle, now a senior policy adviser at the law firm DLA Piper, has become a supporter of telehealth . Using remote tools such as an iPad his rural state and others like it can now have access to healthcare that is normally reserved for urban areas.
But until state and federal health-care laws address telehealth, the thought of a national network of virtually accessible doctors is only a dream. The barriers include:
         – Medical licenses vary by state, and some prohibit physicians from treating patients or prescribing medicine without an in-person visit.
         – And there is the issue of reimbursement under current regulations.
So Daschle, along with former senators Trent Lott (R-Miss.) and John Breaux (D-La.), created a coalition of healthcare and technology companies  to push for changing regulations governing telehealth. Current members of the Alliance for Connected Care, which launched publicly last month, include Verizon, WellPoint, CVS and Walgreens, and others.Daschle is concerned that after fifteen years, we don’t have a regulatory environment or policy environment that accommodates the new technologyThe strongest opposition to changing telehealth regulations comes from those concerned that telemedicine will be of a lower quality than in-person visits and Daschle believes the alliance will disprove such perceptions by demonstrating the systems to physicians, medical boards and legislators.

In addition to pushing legislators to address telehealth, the alliance plans to encourage tech companies and network providers outside the group to install high-speed networks in underserved areas. Daschle believes this will mollify the disparity that currently exists between urban and rural areas.

Commentary: The Alliance is another indication of how quickly telehealth is becoming an integral part of healthcare as more and more people are understanding the value and potential to provide access to care that has been unavailable until the introduction of telemedicine.


Posted by: C3O Telemedicine News

Posted on: March 4th, 2014

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Florida Medical Association Opposes Telemedicine Legislation

Modern Healthcare’s Andis Robeznieks  reports the Florida Medical Association, seeking to bolster its case against a telemedicine bill being considered in the state Legislature, released results of a survey showing Floridians are opposed to doctors licensed in other states treating Florida patients via telemedicine.

“Florida patients are strongly opposed, as is the FMA, to allowing out-of-state physicians and practitioners who are not licensed in Florida to not only practice telemedicine, but to prescribe drugs and controlled substances over the Internet,” Timothy Stapleton, FMA executive vice president, said in a news release. “The FMA supports the use of telemedicine and will work tirelessly to ensure that high standards, protections against fraud, and patient privacy are addressed in any legislation.”

Of the poll’s 606 respondents, 57% strongly oppose and 13% somewhat oppose allowing out-of-state doctors licensed in other states to treat Florida patients via telemedicine. Ten percent strongly favored allowing the practice and 16% somewhat favored it.

Tomball, Texas-based Voter Consumer Research conducted the survey Feb. 1-5. Other findings included Floridians overwhelmingly oppose out-of-state doctors prescribing medicines or controlled substances. They also oppose having nonphysician healthcare practitioners practice telemedicine.The Florida Telemedicine Act would create licensure and registration requirements and regulate private insurance andMedicaid reimbursement.“The FMA is opposed to the bill as drafted,” said Erin Vansickle, FMA spokeswoman. “We look forward to working with lawmakers to craft legislation that protects patient safety and privacy, and ensures fair reimbursement for physicians.” She did not detail which provisions of the bill the association opposes.

Vansickle said the FMA’s opposition was not directed toward the state’s annual influx of winter snowbirds, residents who move south for the season but who may stay connected to their home state doctors via telemedicine.

“The FMA has major concerns about the impacts of telemedicine on all Florida patients, regardless of how long they reside in or visit our state,” she said.

The FMA, in its Five Pillar program (PDF) for addressing primary-care physician and nurse shortages, states that it supports telemedicine services for patients and physicians with established relationships and informed patient consent; that it wants physicians practicing telemedicine on Florida patients to hold a state license or telemedicine certificate and to be subject to discipline by the Florida Board of Medicine; and that it supports parity in Medicaid and private insurance reimbursement for face-to-face and telemedicine consults.

In explaining reimbursement, the association document states that “the physician expends the same amount of time, skill and expertise in both.”

Twenty-two states have telehealth bills before their legislatures, according to the American Telemedicine Association.

Telemedicine laws went in effect last month in Arizona and Mississippi. Legislation allowing reimbursement for pediatric mental health services delivered via telehealth technology was signed by Wisconsin Gov. Scott Walker on Feb. 6 and immediately enacted into law.

Commentary: What is not explained are the details of the bill that has pushed the FMA into opposing the legislation. This is another state who has embarked upon the long overdue and much needed portability of medical licensure. The Federation of State Medical Boards is in the process of pushing forward an expedited medical licensure policy. Additionally it would be interesting to see how the 600 plus person survey was obtained and how the questions were presented. Keep in mind that the state of Florida have over 19 MILLION citizens. Somehow 600/19,000,000 does not seem like a statistically significant reason to represent the entire state.



Posted by: C3O Telemedicine News

Posted on: February 21st, 2014

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Cleveland Clinic: Telemedicine Grows

According to Dr. Peter Rasmussen, neurosurgeon and champion for telemedicine at the Cleveland Clinic, “over 200 stroke consults are provided to rural and surrounding hospitals in Ohio”. Rasmussen believes the accuracy of stroke consults has dramatically increased using telemedicine. The telestroke program has been in existence for four years and it appears that other areas for deployment of telemedicine is in store at the Clinic.

Alumni Connection, Issue I, 2014Screenshot_2_15_14__5_02_PM__2_15_14-2

CCF telestroke


Posted by: hrogove

Posted on: February 15th, 2014

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Cost utility of hub-and-spoke telestroke networks from societal perspective.

imgresJust released in the American Journal of Managed Care the authors Dr. Bart Demaerschalk, Switzer, Xie, Fan, Villa, and Wu looked at the hub-and-spoke telestroke model and evaluated the societal implications. Their findings were:

  • Compared with no network, patients treated in a telestroke network incurred $1436 lower costs and gained 0.02 QALYs over a lifetime.
  • Incremental costs decreased from $444 for the first year to -$1436 over a lifetime;
  • incremental QALYs increased from 0.002 for the first year to 0.02 over a lifetime.
  •  A telestroke network became less cost-effective with increasing spoke-to-hub transfer rates
  • Conclusions: A telestroke network is cost saving and more effective compared with no network from the societal perspective in most modeled scenarios.


Posted by: C3O Telemedicine News

Posted on: February 15th, 2014

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The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations


Importance  Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings can find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology may provide a valuable mechanism for dermatologists to triage inpatient consultations and increase efficiency, thereby expanding access to specialized care for hospitalized patients.

Objective  To evaluate whether a store-and-forward teledermatology system is reliable for the initial triage of inpatient dermatology consultations.

Design, Setting, and Participants  Prospective study of 50 consenting adult patients, hospitalized for any indication, for whom an inpatient dermatology consultation was requested between September 1, 2012, and April 31, 2013, at the Hospital of the University of Pennsylvania, an academic medical center. The participants were evaluated separately by both an in-person dermatologist and 2 independent teledermatologists.

Main Outcomes and Measures  The primary study outcomes were the initial triage and decision to biopsy concordance between in-person and teledermatology evaluations.

Results  Triage decisions were as follows: if the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist.  The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.

Conclusions and Relevance  Teledermatology is reliable for the triage of inpatient dermatology consultations and has the potential to improve efficiency.


Posted by: C3O Telemedicine News

Posted on: February 15th, 2014

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Study: Younger, Richer, Newer Patients Most Likely to Use Telemedicine

In Becker’s Hospital Review and Written by Helen Gregg

According to this article,hospital-logo telemedicine is more often used by younger and by the more financially sound and are less likely than the general population to have an established relationship with a primary care provider or other healthcare provider, according to a study in Health Affairs.

  • This was a RAND Corporation study of Californians using Teladoc.
  • It included an analysis of 3,701 telemedicine encounters.
  • Telemedicine was most often used for acute respiratory conditions, urinary tract infections and skin problems.
  • Telemedicine patients were less likely to have a follow-up visit than patients who had visited a physician’s office or the emergency department.
  • One of the authors suggested that telemedicine may be expanding care access to patients not already connected to a healthcare system.



Posted by: C3O Telemedicine News

Posted on: February 10th, 2014

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Pediatric Telehealth: Opinions from CTeL

from the CTelogoL website

“For many working parents, finding the time to take a sick child to the doctor can be a challenge.  But with the rise of telemedicine, including in pediatrics, busy parents are able to connect with providers on demand.  Along with more “traditional” telemedicine, which incorporate two-way video, diagnostic equipment, and laboratory tests, many providers are offering treatment to patients via telephone and e-mail—particularly after normal working hours.

This new iteration of “telemedicine” has gotten people’s attention.  Patients get instant access to a doctor with virtually no long lines or wait times. And, all from the convenience of the patient’s home.

But, is it safe and is it compliant with state laws and regulations?

The Robert J. Waters Center for Telehealth & e-Health Law (CTeL) explains, to get to that one answer you need to begin by asking more questions.  Can the practitioner accurately diagnose over the telephone or web camera?  Does diagnosing and prescribing without a laboratory test lead to unnecessary prescribing of antibiotics?  Does prescribing without an in person examination and laboratory tests violate state laws and regulations governing practitioner conduct?”

Who is CTel?

The Center for Telehealth and e-Health Law (CTeL) has established itself as the “go-to” legal and regulatory telehealth organization – providing vital support to the community on topics such as: physician and nurse licensure; credentialing and privileging; Medicare and Medicaid reimbursement; and private insurance payment policies.



Posted by: C3O Telemedicine News

Posted on: February 3rd, 2014

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