C3O Telemedicine and Meridian Neuroscience commence new telestroke program

imgresC3O Telemedicine’s new telemedicine program to improve access to stroke care

 Ventura, CA, October 8, 2016C3O Telemedicine is pleased to announce the successful launch of if its latest telehealth program, a partnership for 24/7 stroke care with Meridian Neuroscience, now part of the Hackensack Meridian Health family, the most comprehensive and most integrated network in the state of New Jersey.


C3O’s Acute Neurology Telemedicine Program, designed to improve access to specialists for stroke patients and other neuro-critically ill patients, was successfully implemented at all Hackensack Meridian Health hospitals in Monmouth and Ocean counties. The hospitals are Riverview Medical Center, Ocean Medical Center, Bayshore Community Hospital, Southern Ocean Medical Center, and Jersey Shore University Medical Center, the only hospital in the region to be both a state-designated Comprehensive Stroke Center and a nationally accredited Primary Stroke Center.


Utilizing technology from InTouch Health, based out of Santa Barbara, the program allows C3O’s board-certified neurologists and neurointensivists to work closely with the emergency department teams at the network’s hospitals throughout the region and Jersey Shore’s neurosurgical interventionalists who are available 24/7 to provide access for mechanical retrieval of clots during an acute stroke.


Dr. Herb Rogove, president and CEO of C3O Telemedicine, and past board member of the American Telemedicine Association states, ”C3O is honored to have been selected as the first provider of telehealth for Hackensack Meridian Health hospitals in Monmouth and Ocean counties. We are already seeing patients and the onsite teams have been very enthusiastic and engaged in supporting the program. Meridian Neuroscience is an outstanding program that offers the most advanced treatment options when interventional procedures and surgeries may be needed. We are excited to partner with them in this new program and continue our company’s growth.”


“Telestroke is a significant advancement in how we provide health care and treatment for stroke patients,” says Alan Colicchio, M.D., medical director of Meridian Neuroscience.  “Because strokes occur at all times of day, Telestroke ensures that a patient is assessed immediately rather than having to wait for a neurologist to arrive at the hospital. Since we started using it in the emergency department, we have been able to diagnosis and treat patients faster, helping to reduce the amount of recovery time a patient faces and decreasing the length of time they must remain in the hospital. It’s been met with rave reviews by patients, families, and care teams alike, and we have been extremely pleased with how seamlessly the tele-neurologists have blended with our medical staff. It’s been a great partnership so far.”
According to the National Stroke Association, stroke is the third leading cause of death in the United States, and stroke-related healthcare costs total $73.7 billion. Expediting the presence of a skilled neurologist to the bedside to assess the appropriateness of the lifesaving medication tPA can dramatically improve healthcare outcomes. Telemedicine technologies have been proven clinically and cost-effective methods for supplying the care these patients need.


C3O Telemedicine and its physicians have been providing tele-neurocritical care services to hospitals and health systems since 2008.


About C3O Telemedicine

C3O Telemedicine is an innovative provider of virtual presence clinical coverage solutions to metropolitan and rural health facilities. As a physician owned and operated organization with renowned, board-certified specialists, C3O Telemedicine delivers flexible, easily implemented, and highly supported telemedicine services to its clients with exceptional clinical quality.   C3O’s physicians and engaged physician-led management have developed programs at multiple facilities with demonstrated value through rapid response times, enhanced patient outcomes and immediate definitive care and discharges, with an accompanying improvement in hospital financial performance. .


About Hackensack Meridian Health

Hackensack Meridian Health is a leading not-for-profit health care organization that is the most comprehensive and truly integrated healthcare network in New Jersey, offering a complete range of medical services, innovative research, and life-enhancing care.  There are 13 hospitals in Hackensack Meridian H, including two academic medical centers, two children’s hospitals and nine community hospitals, physician practices, more than 120 ambulatory care centers, surgery centers, home health services, long-term care and assisted living communities, ambulance services, lifesaving air medical transportation, fitness and wellness centers, rehabilitation centers, and urgent care and after-hours centers. Hackensack Meridian Health has 28,000 team members, more than 6,000 physicians and is a distinguished leader in medical philanthropy, committed to the health and well-being of the communities it serves.


The Network’s notable distinctions include having one of only five major academic medical centers in the nation to receive Healthgrades America’s 50 Best Hospitals Award for five or more consecutive years, the number one hospital in New Jersey as ranked by U.S. News and World Report, consistently achieving Magnet® recognition for nursing excellence from the American Nurses Credentialing Center, recipient of the John M. Eisenberg Award for Patient Safety and Quality from The Joint Commission and the National Quality Forum, a six-time winner of Fortune’s “100 Best Companies to Work For,” one of the “20 Best Workplaces in Health Care” in the nation, and the number one “Best Place to Work for Women.”  Hackensack Meridian Health is a member of AllSpire Health Partners, a regional consortium of leading health systems, to focus on the sharing of best practices in clinical care and achieving efficiencies.


The hospitals of Hackensack Meridian Health include: academic medical centers – HackensackUMC in Hackensack, Jersey Shore University Medical Center in Neptune; children’s hospitals – Joseph M. Sanzari Children’s Hospital in Hackensack, K. Hovnanian Children’s Hospital in Neptune; community hospitals –  Ocean Medical Center in Brick, Riverview Medical Center in Red Bank, HackensackUMC Mountainside in Montclair, Palisades Medical Center in North Bergen, Raritan Bay Medical Center in Perth Amboy, Southern Ocean Medical Center in Manahawkin, Bayshore Community Hospital in Holmdel, Raritan Bay Medical Center in Old Bridge, and HackensackUMC at Pascack Valley in Westwood.


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Posted by: C3O Telemedicine News

Posted on: October 8th, 2016

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Telehealth interventions for reducing waiting for specialist services

imgresCaffery LJ1, Farjian M2, Smith AC3.

Abstract from PubMed

We undertook a scoping review of the published literature to identify and summarise key findings on the telehealth interventions that influence waiting times or waiting lists for specialist outpatient services. In this report, searches were conducted to determine relevant articles. In this review articles were included if the telehealth intervention restructured or made the referral process more efficient. We excluded studies that directly increased capacity. Two categories of interventions are – electronic consultations and image-based triage. Electronic consultations are asynchronous, text-based provider-to-provider consultations. Electronic consultations have been reported to obviate the need for face-to-face appointments between the patient and the specialist in between 34-92% of cases. However, electronic consultations are appropriate in less than 10% of referrals for outpatient care. Image-based triage has been used successfully to reduce unnecessary or inappropriate referrals and was used most often in dermatology, ophthalmology, and otolaryngology (ENT). Reported reduction rates for face-to-face appointments by specialty were: dermatology 38-88%, ophthalmology 16-48% and ENT 89%. Image-based triage can be twice as efficient as non-image based triage in reducing additional appointments.

Telehealth interventions can be used to reduce waiting lists and improve the coordination of specialist services.


Posted by: C3O Telemedicine News

Posted on: October 1st, 2016

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Safety and efficacy of thrombolysis in telestroke: A review

imgresNeurology. 2016 Aug 26. pii: 10.1212/WNL.0000000000003148. [Epub ahead of print]



The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of IV thrombolysis (IVT) with tissue plasminogen activator (tPA) delivered through telestroke networks in patients with acute ischemic stroke.


We conducted a systematic review and meta-analysis according of prospective randomized controlled and nonrandomized studies comparing telemedicine-guided IVT to IVT administered at stroke centers and were published from the earliest date available until April 1, 2015.

  • Outcomes of interest were symptomatic intracerebral hemorrhage,
  • mortality, and functional independence (modified Rankin Scale scores 0-1) at 3 months.


  •  1,863 patients fulfilled our eligibility criteria.
  • Among these, thrombolysis was largely restricted to the 3-hour time window.
  • Symptomatic intracerebral hemorrhage rates were similar between patients subjected to telemedicine-guided IVT and those receiving tPA at stroke centers
  •  There was no difference in mortality or in functional independence  at 3 months between telemedicine-guided and stroke center thrombolysis.


Our findings indicate that IV tPA delivery through telestroke networks is safe and effective in the 3-hour time window. Lack of prospective trials, however, emphasizes the need to further substantiate these findings in the 3- to 4.5-hour time window.

© 2016 American Academy of Neurology.


Posted by: C3O Telemedicine News

Posted on: September 3rd, 2016

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Telehealth growth accelerates

imgresPREVIEW: Telehealth trending growth for HIMSS 16

Telehealth growth accelerates as challenges in workflow, interstate licensing and reimbursement continue to be addressed . Dr. Naomi Watts of Biogen Idec says “patients clamoring for physician access”.

Dr. Roy Schoenberg, CEO of AmWell says telehealth is providing the right way of getting in front of a physician.”The value of seeing a patient – visual is key” says Schoenberg.

Jason Sibley of Flare Cap Parnters believes telehealth’s business is to build a system that meets the needs of specific group of patients. One group that comes to mind is the large number of patients with chronic diseases such as Diabetes, Heart Failure, and Hypertension.

John Moore, MD, PhD of Twine Health noted that patients want to have “a low friction channel to access physicians particularly when they are experiencing an emotional need”.

This has been a preview of what’s to come at HIMSS at the end of February and is reported by Brian Dolan of Mobihalth News.


Posted by: C3O Telemedicine News

Posted on: February 23rd, 2016

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ICU Telemedicine in Syria: a remarkable story

One story which neveimgresr made the mainstream press is  the humanitarian gesture of a group of ICU Telemedicine specialists providing civilian ICU care in war-torn Syria. Reported in the February issue of the Annals of American Thoracic Surgery, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The program utilized inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Launched in 2012 and within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. What would normally take numerous committee meetings including budgetary constraints was done on an all volunteer basis at a much lower than expected cost.

The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country.

The critical care community and the world will be waiting to see data from this extraordinary and courageous endeavor. Congratulations to Drs. Moughrabieh and Weinert from the University of Minnesota Medical School, Minneapolis, Minnesota.


Posted by: hrogove

Posted on: February 8th, 2016

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Telemedicine for home health care for ventilator patients

J Telemed Telecare. 2014 Dec;20(8):441-9. doi: 10.1177/1357633X14555620. Epub 2014 Oct 14.

Researchers from Boston Childrens/Harvard reported:

 WHAT? Was telemedicine  feasible in patients with special care needs on home ventilation, whether it affected the confidence of families about the clinical management of their child, and whether it supported clinical decision-making?
HOW? Videoconferencing software was provided free for 14 families who had a computer and webcam. Families completed questionnaires about clinical management before the addition of telemedicine and 2-3 months after they had used telemedicine. They also completed a questionnaire about their experience with videoconferencing. There were 27 telemedicine encounters during the 9-month study.
WHAT? Families reported:
  • Higher confidence in clinical care with telemedicine compared to telephone.
  • They also reported that the videoconferencing was high-quality, easy to use, and did not increase their telecommunication costs.
  • The telemedicine encounters supported clinical decision-making, especially in patients with active clinical problems or when the patient was acutely ill.
  • The telemedicine encounters prevented the need for 23 clinic visits, three emergency room visits, and probably one hospital admission.

Although the study was small, videoconferencing appears useful in the management of medically fragile patients on home ventilator support, producing high levels of family confidence in clinical management and value to clinicians in their decision-making.


Posted by: C3O Telemedicine News

Posted on: October 9th, 2015

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Telemedicine for Pediatric Transport

imgresA group of pediatric intensivists at the duPont Hospital for Children in Wilmington Delaware published the results of evaluating telephone versus telemedicine evaluation of pediatric patients with moderate to severe critical illness being transported between hospitals. Findings were as follows based upon the opinions of the medical command center physicians:

  • Connection and audio quality were equivalent and there were no dropped calls.
  • Average call duration in the phone group was 186 versus 139 seconds in the video group (P = 0.055).
  • The MCO survey results were the following: 100% found video intuitive, 92% felt that disposition based on phone report was difficult, 80% felt that video provided better understanding of patient condition, 70% felt that video assisted disposition, and 80% believe that video should be used for transport.
  • The iPad system offers a significant savings when compared with conventional telemedicine.

This was a prospective randomized study of a total of 50 patients divided between call only versus video conferencing. An iPad tablet was the technology used which the authors conclude is much more cost effective than other technologies.


Posted by: C3O Telemedicine News

Posted on: September 6th, 2015

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Robotics in Telemedicine

In the just released itmj.2015.21.issue-9.coverssue of Telemedicine and e-Health, Doan and Merrell’s editorial addresses robotics in telemedicine. The editors write “Telemedicine, telehealth, and robotics are a few innovative approaches to alleviating the stress on an overburdened system. While technology continues its march forward, often unabated, the culture of medicine has not changed as rapidly. There are many individuals and health systems across the United States and the world that are reticent to change. Perhaps it is a lack of understanding or a fear of change or even a level of trust in the technology. Clearly a robot in a nursing facility that is driven by a remotely located physician who is in contact with the on-site nursing staff can add tremendous value. Robots have added value both in clinical settings and in the educational setting.”


Posted by: C3O Telemedicine News

Posted on: September 1st, 2015

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Telemedicine Decreases ER Use by Seniors

imagesTelemed J E Health. 2015 Aug 7. [Epub ahead of print]


The failure to provide timely acute illness care can lead to adverse consequences or emergency department (ED) use. We evaluated the effect on ED use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents.


  • We performed a prospective cohort study over 3.5 years.
  • Six SLCs cared for by a primary care geriatrics practice were intervention facilities, with the remaining 16 being controls.
  • Consenting patients at intervention facilities could access telemedicine for acute illness care.
  • Patients were provided patient-to-provider, real-time, or store-and-forward high-intensity telemedicine (i.e., technician-assisted with resources beyond simple videoconferencing) to diagnose and treat acute illnesses.
  • The primary outcome was the rate of ED use.


  • We enrolled 494 of 705 (70.1%) subjects/proxies in the intervention group;
  • 1,058 subjects served as controls.
  • Control and intervention subjects visited the ED 2,238 and 725 times, respectively, with 47.3% of control and 43.4% of intervention group visits resulting in discharge home.
  • Among intervention subjects, ED use decreased at an annualized rate of 18% (rate ratio [RR]=0.82; 95% confidence interval [CI], 0.70-0.95), whereas in the control group there was no statistically significant change in ED use (RR=1.01; 95% CI, 0.95-1.07; p=0.009 for group-by-time interaction).
  • Primary care use and mortality were not significantly different.


High-intensity telemedicine significantly reduced ED use among SLC residents without increasing other utilization or mortality. This alternative to traditional acute illness care can enhance access to acute illness care and should be integrated into population health programs.

COMMENT: A very nice introductory cohort study on a very pertinent topic. Hopefully to follow will be a prospective randomized study looking at both outcomes and financial data. Additionally, for those seen through telemedicine, following the ED admission course would be important. 


Posted by: C3O Telemedicine News

Posted on: August 9th, 2015

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Reflecting upon ATA 2015 Annual Meeting


Drs. Sanjay Gupta and Herb Rogove


Drs. Herb Rogove and Patrick Soon-Shiong

At ATA 2015 (American Telemedicine Association), held in Los Angeles,  a milestone was achieved as over 5,000 attendees from around the world stormed the LA Convention Center. The content of the symposium keeps getting better, ranging from lightening rounds to superb plenary sessions. What particularly struck me was that the keynote speakers, both physicians in different areas of medicine both understood and support telemedicine as an integral part of healthcare delivery. Dr. Sanjay Gupta, chief CNN medical correspondent, had previously done a story on telemedicine featuring Yulun Wang, CEO of InTouch Health. Dr. Patrick Soon-Shiong, an entrepreneur and brilliant visionary, has already embarked upon ways to treat cancer utilizing mobile health. The exhibit hall allowed one to roam a roomy exhibit hall to see new and established medical product and software companies display and explain their technology. Based upon the opinion of those in attendance, the ATA is striving toward increasing the content experience. Looking optimistically to another high level meeting in Minnesota for ATA 2016.


Posted by: C3O Telemedicine News

Posted on: June 19th, 2015

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