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Telehealth-news

Dr. Emanuel believes telemedicine is a critical component of ACA


According to MedCity News:

ezekiel emanuel

Dr. Ezekiel Emanuel, a healthcare economist and bioethicist at University of Pennsylvania and an Affordable Care Act architect presented a pretty dramatic vision of how the hospital landscape and healthcare delivery will change in response to healthcare reform. He also shared some insights into the law’s design at New York eHealth’s Digital Health Conference this week.

20 percent fewer hospitals Emanuel estimated that 1,000 acute care hospitals will close and be converted into outpatient facilities and physician offices. Top tier hospitals will focus on complex procedures such as fetal surgery and organ transplants.The emphasis will be on patients recovering from home and using telemedicine and home visits for follow-up care.

Leaner hospitals He also pointed out that hospitals needed to take a hard look at operational improvement to make them more efficient and less costly to run.

Telemedicine as a critical component He pointed out that telemedicine will be critical to achieving goals of ACA because it will expand the ability of physicians to treat more people beyond traditional office hours. It will also help address the physician shortfall.

Behind the scenes of ACA Emanuel shared some insights on developing ACA. He said that he wanted a 10 percent readmission penalty on Medicare reimbursement for hospitals instead of the agreed upon 1 percent to 3 percent because it would have made more of a difference to hospitals.

VIP care for patients with chronic conditions and mentally ill The big goal is to reduce healthcare costs for the people who tend to use it the most by devoting more resources to helping people with multiple chronic conditions manage their condition.

Digital Health To control healthcare costs, one element will involve mining claims data and electronic medical records to micromanage doctors to ensure that they are adhering to best practice guidelines and not over ordering tests.

Emanuel dismissed the defense that doctors were frequently driven by fear of malpractice suits to over order tests rather than medical judgement. A report last month found that two states with malpractice reform saw no change in the number of medical tests being ordered.

 

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Posted by: C3O Telemedicine News

Posted on: November 19th, 2014

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In an ideal world: a slice just arrived – Stroke Mobile + Telemedicine


We are told “time is brain” so get that patient to the ED STAT. Well now, the Cleveland Clinic makes stroke treatment house-calls including a CT scanner and telemedicine evaluation in the ambulance. The European community has been doing this before and Israel was giving tPA via their paramedic systems years ago. Welcome to the real twenty first century and congratulations.CCFMobileStrokeUnit

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Posted by: C3O Telemedicine News

Posted on: November 18th, 2014

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Teleneonatology: a major tool for the future.


Abstract

 The neonatal intensive care unit (NICU) at Utah Valley Regional Medical Center in Provo, Utah, began an aggressive redesign/quality improvement effort in 1990. It became obvious that our care processes were designed for health care deliverers and not for the families. An ongoing revamp of our care delivery processes was undertaken using significant input from a parent focus meeting, parental interviews, and development of a parent-to-parent support group. As a result of this work, it became obvious we needed a new model to truly empower parents. The idea of “NICU is Home” was born. We elected to make a mind shift, not to focus on what families think, but rather on how they think. Web cams and other video apparatus have been used in a number of NICUs across the country. We decided:

  1. Our equipment requirements would need to include high-resolution cameras, full high-definition video recording, autofocus, audio microphones, automatic noise reduction, and automatic low-light correction.
  2. Our conferencing software needed to accommodate multiple users and have multiple-picture capabilities, low band width, and inexpensive technology.
  3. It was recognized that a single video camera feed was insufficient to adequately capture the desired amount of information.
  4. Verbal communication between parents and their babies’ principal care providers is critical.
  5. Parents loved the idea of expanding the remote NICU web cam of their baby to a two-way physician-parent communication bedside monitor.
  6. Doctors at Utah Valley Regional Medical Center now have a mobile desk using a WiFi computer/camera/audio to communicate with the family in real-time or leave a recording.

Copyright 2014, SLACK Incorporated.

 

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Posted by: C3O Telemedicine News

Posted on: November 18th, 2014

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STATE MEDICAL BOARDS MEET OVER TELEMEDICINE


According to Politico

The boards that license physicians in Tennessee and North Carolina meet this week to continue redrafting rules for how doctors can and can’t treat patients through telemedicine. The Tennessee Board of Medical Examiners convenes this morning in Nashville. The board drafted rules this spring that drew harsh criticism from telemedicine providers, and has been reworking them to better satisfy advocates. The North Carolina Medical Board meets Wednesday and is expected to finalize rules it issued for public comment in September. We’ll be following both.

 

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Posted by: C3O Telemedicine News

Posted on: November 17th, 2014

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Telemedicine screening for diabetic retinopathy (DR) finds condition in one in five patients


 
A telemedicine program to screen for diabetic retinopathy (a leading cause of blindness) at urban clinics and a pharmacy predominantly serving racial/ethnic minority and uninsured patients with diabetes found the condition in about 1 in 5 people screened, according to a study published online by JAMA Ophthalmology.

About 29 million people have diabetes in the United States and  (DR) is the leading cause of new blindness in working-age adults. Preventing and treating DR includes tight blood sugar and  along with routine dilated comprehensive eye exams. The rate of eye examinations is low among racial and ethnic minority populations. Studies suggest DR screening results that use nonmydriatic cameras for retinal imaging through telemedicine meet the standard criterion of dilated photos. These screenings, because they do not involve dilation, can be less burdensome for patients with diabetes who may face barriers in transportation and cost in seeking comprehensive dilated , according to background information detailed in the study.

Cynthia Owsley, Ph.D., of the University of Alabama at Birmingham, and her fellow co-authors examined the use of a noninvasive DR screening with a nonmydriatic camera and telemedicine review at three urban clinics in Birmingham, Miami and Winston-Salem, N.C., and a pharmacy in Philadelphia.

The Innovative Network for Sight (INSIGHT) study included 1,894 people (average age 53 to 55 years) who were screened across the sites; 21.7 percent of the individuals were found to have DR in at least one eye, according to the study results. Background DR was the most common type of DR and it was present in 94.1 percent of all participants with DR. About half (44.2 percent) of the sample of people screened had eye findings other than DR and 30.7 percent of these other findings were cataract.

“The rate of self-reported dilated eye care use in the past year was low for the overall sample (32.2 percent), suggesting that DR screening in these settings could fulfill a critical role for patients with diabetes not routinely accessing annual dilated  care,” the authors note.

More information: JAMA Ophthalmol. Published online November 13, 2014. DOI: 10.1001/.jamaopthalmol.2014.4652

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Posted by: C3O Telemedicine News

Posted on: November 13th, 2014

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Utilization of telemedicine in the U.S. Military in a deployed setting.


A recently released study in Mil Med. 2014 Nov;179(11):1347-53. doi: 10.7205/MILMED-D-14-00115.

Hwang JS1, Lappan CM2, Sperling LC3, Meyerle JH3

This article is a  retrospective evaluation of the Department of Defense teledermatology consultation program from 2004 to 2012 was performed, focusing on clinical application and outcome measures such as consult volume, response time, and medical evacuation status. There were 658 teledermatology cases reviewed to assess how the program was utilized by health care providers from 2011 to 2012. As high as 98% of the teledermatology consults were answered within 24 hours, and 23% of consults within 1 hour. The most common final diagnoses included eczematous dermatitis, contact dermatitis, and evaluation for nonmelanoma skin cancer. The most common medications recommended included topical corticosteroids, oral antibiotics, antihistamines, and emollients. Biopsy was most commonly recommended for further evaluation. Following teleconsultation, 46 dermatologic evacuations were “avoided” as the patient was not evacuated based on the consultants’ recommendation. Consultants’ recommendations to the referring provider “facilitated” 41 evacuations.

Telemedicine in the U.S. military has provided valuable dermatology support to providers in remote locations by delivering appropriate and timely consultation for military service members and coalition partners. In addition to avoiding unnecessary medical evacuations, the program facilitated appropriate evacuations that may otherwise have been delayed.

Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

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Posted by: C3O Telemedicine News

Posted on: November 9th, 2014

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Telemedicine kits available for shipboard use


Nov 07 2014 from Tanker Operator

 

DigiGone, a communication solution provider specialising in secure video transmission, has introduced remote telemedicine kits for marine and other applications.

 

Based on the company’s proprietary SecureChat video encryption and compression software, the new DigiMed kits provide real-time teleconferencing with emergency medical service professionals using satellite, or terrestrial wireless links, enabling a face-to-face consult between patient and doctor.

“The low-cost portable DigiMed kits, packaged with our SecureChat software, will revolutionise telemedicine, enable superior remote doctor-patient consultation services and potentially provide huge cost savings to companies,” said Michael Dunleavy, DigiGone president. “DigiMed provides a must-have affordable medical lifeline for people who live, work or travel in remote areas.”

The DigiMed telemedicine kits are ideal for ships as when used with commercial satellite networks, the coverage is virtually worldwide.

The portable telemedicine kits are available in three versions – DigiMed Mini, DigiMed Vital and DigiMed Plus.

The DigiMed Mini contains a Windows tablet with built-in camera, Bluetooth headset with microphone, Wi-Fi macro camera and power adapter contained in a small soft case.

DigiMed Vital includes the same components, plus an EKG sensor in the same size case and also included is the DigiMed Access dashboard software to stream the device information live to the physician.

DigiMed Plus includes all the above components, as well as other Bluetooth sensors, including digital thermometer, blood pressure cuff, blood glucose meter and other medical devices in a slightly larger soft case to assist the physician in remote analysis of the patient’s vital signs.

All three kits come with a DigiGone SecureChat teleconferencing software license and are offered at a very low price, the company claimed.

The SecureChat software makes it possible to send encrypted high-quality real-time video over satellite channels, or mobile links, using a fraction of the bandwidth needed for other commercial video services.

This makes the DigiMed telemedicine service easy and inexpensive to use at sea, the company said.

DigiGone offers the portable DigiMed packages bundled with a Digi+Doc subscription to the Maritime Medical Access (MMA) service operated by The George Washington University Department of Emergency Medicine.

Resellers of the DigiMed kits may also offer subscriptions with other medical service providers.

 

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Posted by: C3O Telemedicine News

Posted on: November 7th, 2014

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Not definitive: Effect of telemedicine follow-up care of leg and foot ulcers: a systematic review.


BMC Health Serv Res. 2014 Nov 6;14(1):565. [Epub ahead of print]

Abstract

BackgroundLeg ulcers and diabetes-related foot ulcers are frequent and costly complications of their underlying diseases and thus represent a critical issue for public health. Since the population is aging, the prevalence of these conditions will probably increase considerably and require more resources. Treatment of leg and foot ulcers often demands frequent contact with the health care system, may pose great burden on the patient, and involves follow-up in both primary and specialist care. Telemedicine provides potential for more effective care management of leg and foot ulcers. The objective of this systematic review of the literature was to assess the effect of telemedicine follow-up care on clinical, behavioral or organizational outcomes among patients with leg and foot ulcers.MethodsWe searched Ovid MEDLINE (1980¿), Ovid EMBASE (1980¿), Clinical Trials in the Cochrane Library (via Wiley), Ebsco CINAHL with Fulltext (1981¿) and SveMed¿+¿(1977¿) up to May 2014 for relevant articles. We considered randomized controlled trials, non-randomized trials, controlled before-after studies and prospective cohort studies for inclusion and selected studies according to predefined criteria. Three reviewers independently assessed the included studies using the Cochrane Collaboration risk-of-bias tool. We performed a narrative synthesis of results and assessed the strength of evidence for each outcome using GRADE (grading of recommendations, assessment, development and evaluation).ResultsOnly one non-randomized study was included. The study (n =140) measured the effect of real-time interactive video consultation compared with face-to-face follow-up on healing time, adjusted healing ratio and the number of ulcers at 12 weeks among patients with neuropathic forefoot ulcerations. There were no statistically significant differences in results of the different outcomes between patients receiving telemedicine and traditional follow-up. We assessed the study to have a high risk of bias.Conclusions There is insufficient evidence available to unambiguously determine whether telemedicine consultation of leg and foot ulcers is as effective as traditional follow-up.

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Posted on: November 7th, 2014

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Telemedicine rules create a double standard


The Des Moines Registrar reported:

Every day in Iowa, health care providers use technology at one location to connect with patients at another location. A doctor can oversee a procedure elsewhere using real-time videoconferencing. Psychiatrists can evaluate, diagnose and decide what drugs to prescribe for a patient they’ve never met in person. Specialists at the University of Iowa can treat burn and stroke victims remotely.

So-called telemedicine provides Iowans access to health services they may not otherwise have. Veterans, prison inmates and elderly residents do not need to travel long distances. This method of delivering care is especially important in a rural state, providing access to experts across the state and has been used in Iowa for many years.

Now the Iowa Board of Medicine is trying to catch up. For the first time, it has crafted administrative rules providing telemedicine standards for all physicians it oversees.

Unfortunately, board members are unable to reconcile the need to create basic guidelines with their fixation on driving abortion providers out of business by state rules.

The proposed rule rightly gives discretion about patient exams to doctors. The doctors must “ensure” patients undergo an exam “when medically necessary,” but the board acknowledges that “may not be in person.” Patients must also have “access” to follow-up care, but it does not need to be provided by the same doctor.

This guidance is at odds with another rule passed by the same board last year that imposes onerous requirements on Iowa doctors using videoconferencing to dispense abortion-inducing drugs. That rule, which is being challenged in court, requires the same physician who dispenses a drug to perform an in-person exam. Not a nurse. Not a physician’s assistant. Not even another doctor. The doctor also must be in the same room with a woman when she swallows the pill and schedule a follow-up exam at the same location.

Such requirements not only defy the very idea of telemedicine, but when combined with the newly proposed rule, create two sets of guidelines for Iowa doctors: one that applies to all physicians using technology to connect with patients and another for the three physicians now providing remote abortion services for Planned Parenthood of the Heartland.

Board members cannot have it both ways on telemedicine. They cannot recognize technology as a “useful tool” that can “provide important benefits to patients” and then refuse to extend those benefits to women seeking a medical service board members don’t like. The rules acknowledge a doctor does not need to be in the same room with a patient to provide quality care — unless that doctor is dispensing a specific drug that poses little risk to a woman. While the board recognizes telemedicine can provide Iowans “increased access to health care,” they don’t want that care to involve terminating a pregnancy.

The proposed telemedicine rules are a reminder of the hypocrisy of the current medical board. Members have made a mockery of a state entity that was previously a respected voice in medicine. They have used their positions to further a political agenda instead of remaining focused on patient care and safety.

RULES CREATE PROBLEMS FOR SOME PATIENTS

Years after Iowa health providers began using telemedicine to treat patients, the Iowa Board of Medicine is crafting administrative rules to provide guidance to those physicians. In addition to attempting to cement in place onerous requirements only on abortion providers, the proposed rules raise other questions that could cause problems going forward for many Iowa doctors and their patients.

The proposed new rules require, for example, a physician treating a patient to be licensed in the state of Iowa. This could make it difficult for Iowans seeking telemedicine care from a doctor at the Mayo Clinic in Minnesota, one doctor told The Des Moines Register editorial board.

That doctor also raised questions about a provision in the rules requiring physicians using telemedicine to ensure other health providers they work with remotely are qualified “by personally assessing” those individuals’ education, training and experience.

“When we are using telemedicine to help a patient and working with staff at another location, the last thing we ask about are the credentials of that worker,” said the doctor.

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Posted by: C3O Telemedicine News

Posted on: October 28th, 2014

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ATA Launches First China Telemedicine Meeting


From the ATA:

ATA kicked off the Opening Ceremonies of the First China International Telemedicine Technology Meeting today in Tianjin.  Dozens of distinguished Chinese government and industry officials joined ATA leadership to launch the meeting and extend their support for the partnership.  The meeting is being covered by major media in China and is being followed closely by health professionals and the medical technology industry at large.

The government of China is beginning to show increased attention to telemedicine technology. Apart from the support of national policy, national leaders are advocating the implementation of medical reform.

Over 3000 attendees and 200 exhibitors are expected to be at this three-day meeting which features presentations from telemedicine experts from around the world.

Those representing ATA include ATA President Yulun Wang, PhD, Chairman and CEO, InTouch Health; CEO, Jonathan Linkous; COO, Alice Watland; Past President Jay Sanders, MD, President and CEO, The Global Telemedicine Group, and Professor of Medicine, Johns Hopkins University School of Medicine; Past President Edward Brown, MD, CEO, Ontario Telemedicine Network; and Past President Bernard Harris, MD, MBA, President and CEO, Vesalius Ventures.

ATA Member Companies who will be doing business on the exhibit hall floor include AMD Global Telemedicine, Ideal Life, InTouch Health, JSA Health Telepsychiatry, Remote Eye Diagnostics, Telehealth International Partnership, Treatment and Vidyo.

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Posted by: C3O Telemedicine News

Posted on: October 28th, 2014

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