Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life


While not under the sign of telemedicine, the Institute of Medicine just released a report on preferences at the End of Life.


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C3O Telemedicine News

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September 17th, 2014

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Growth of telemedicine: new studies reviewed by CTel

 From CTel

As The Robert J. Waters Center for Telehealth and e-Health Law (CTeL) and others have previously reported, seemingly countless studies of recent have projected tremendous growth in the use of telemedicine in the years to come, particularly in the areas of remote monitoring and mHealth.  Yet still others have been more measured in their estimations, highlighting hesitancy among some providers and patients to adopt telehealth technologies.

The past few weeks have seen the release of several studies that have come to somewhat discrepant conclusions, including one from HIMSS Analytics, which points to somewhat limited provider adoption; one from Deloitte that forecasts a rise in telemedicine visits in the coming year; and still another from Towers Watson, which identifies an increased willingness among large employers to offer telehealth services to their employees, though utilization so far has been low.  Below, CTeL offers an overview of the three studies and their conclusions; essentially, based on this body of research, telemedicine—despite past and projected future growth—still has some maturing to do.

In its “2014 Telemedicine Study,” which surveyed health care providers, executives, and IT staff, HIMSS Analytics found that “telemedicine is becoming increasingly important to organizations both tactically and strategically,” including as a way to deliver cost savings and improve care coordination.  Yet only about half of providers are taking advantage, and the landscape remains complicated.  “The study found that organizational needs will vary based upon provider type while the numerous technologies under the telemedicine umbrella will add to the complexity of the market,” HIMSS Analytics Research Director Brendan FitzGerald explained in a news release.  FitzGerald, however, is optimistic about expanded utilization: “Regardless of these challenges, organizations will continue to look for and utilize technology to fill gaps and enhance initiatives in patient care.”

The Deloitte study, which focused on North America, also projects growth in telemedicine this year, estimating “up to 75 million telehealth visits in 2014, representing an increase of 400% over 2012 levels.”  Worldwide, the number may reach 100 million, fueled by provider shortages, expanded use of smartphones, and a number of newly insured patients.  “With 110 million office visits a year related to low-level conditions like sore throats, earaches, and skin rashes, these quick and efficient remote interactions could ease the burden of overworked primary care providers with little time to spare,” EHR Intelligencer’s Jennifer Bresnick sums up in her discussion of the researchers’ findings, pointing also to new legislation designed to address regulatory barriers.  However, “providers will need to be educated about the value of remote consults if telehealth is to succeed.”

Finally, the Towers Watson researchers highlight the potential savings that telemedicine can deliver, noting also that more and more large employers are choosing to embrace it.  “Thirty-seven percent of employers surveyed said that by 2015 they expect to offer their employees telemedicine consultations as a low-cost alternative to emergency room or physician office visits for nonemergency health issues, and another 34% are considering offering telemedicine for 2016 or 2017,” the company said in a news release accompanying its study of large U.S. employers.  Yet currently, “utilization is low,” often coming in at “less than 10%.”

Still, employers appear increasingly enthusiastic, given the potential to save money.  As health care consultant and blogger Jane Sarasohn-Kahn sums up of the study’s results, “Employers could save over $6 billion if industry replaces virtual health consultations with face-to-face visits at doctors’ offices, emergency rooms, or urgent care centers.”  For her part, Sarasohn-Kahn appears to be a firm believer in telemedicine.  “The beauty of telehealth, from a health-economic standpoint, is that it scales from [one] to many,” she asserts.  “As we seek to conserve health costs in a resource-constrained health environment, telehealth can scale primary care—which is needed for bolstering the American primary care infrastructure.”



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September 3rd, 2014

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The New Face Of Healthcare Innovation: 7 Ways Telemedicine Changes The Healthcare Landscape, And What It Means For You

From:  Jeff Boss of FORBES


It’s no secret that the healthcare space is broken. A 2013 study conducted by the Journal of Patient Safety estimates that between 210,000 and 440,000 patients die in the US each year from accidental practice. To put this into perspective, an estimated 600,000 Americans die from heart disease each year and another 565,000 from cancer (source:, which puts healthcare incompetence as the third leading cause of death in the United States.

The pool of entrepreneurs in the race to offer mobile health consulting is growing larger by the day. With telemedicine, users have the power of accessibility in their hands with apps such as TouchCare and iBluebutton (see below). While the concept of telemedicine isn’t anything new, having the accessibility to one’s doctor is. Here are seven ways telemedicine changes the healthcare landscape—for the better:

1. Stronger relationships. Relationships are everything. If there was ever a person not to make angry, it’s your doctor. More important, your relationship with your doctor is everything, which is why mobile healthcare is so ideal. It offers the luxuries of personalization and convenience without exposing yourself or your child to the 15 other sickly patients normally waiting in your doctor’s office.

2. Convenience. TouchCare takes mobile healthcare to the next level as it creates an entirely new user experience for the customer. Rather than having to trek into the doctor’s office for a consult, you can now do so from the comfort of your own smartphone for follow up visits, after hours calls, or while traveling. Additionally, parents gain a stronger piece of mind because they can immediately reach their doctor for relatively benign symptoms such as a cough or runny nose.

3. Reduced complexity. Complexity is defined by the speed at which industries change and the interdependence of relationships therein. Telemedicine reduces both.

4. Greater awareness. iBlueButton is perhaps the most comprehensive app for telemedicine as it allows users (currently only for active duty military and veterans) to carry their own medical records  with them in their smartphone. For physicians, pop-up windows alert the provider of possible medication side effects for greater drug reconciliation.

5. Shared purpose. The focus of healthcare today appears to be more towards earning a profit rather than serving its purpose of patient care. The purpose of an organization is (ideally) to serve as a value differentiator to its customers because of what they (the company) stand for. Whatever a company’s flavor, its purpose is defined by a certifiable element that distinguishes it from all else, and that element is what attains and retains customers and fulfills a societal need. Bettina Experton, MD, MPH, and President & CEO of Humetrix, which is the company behind iBluebutton, believes that “collaborating for a higher purpose is a key corporate value… We work to empower patients and make them more informed healthcare consumers, and we think about ways to make life easier for parents, caregivers and families in an increasingly complex healthcare environment.” (source:

6. Improved efficiency. Smaller practices get bought out by larger organizations, which means new regulations and more bureaucracy are added into their daily routine. Nancy Zimmerman, head of Marketing for TouchCare, cited one practice in North Carolina who was recently bought out by a larger company who needed to scale back from seeing their normal 60 patients per day to 20 due to the added bureaucracy. Telemedicine eliminates phone consults and the addiction to answering emails.

7. Enhanced flexibility for physician. The immediacy of telemedicine provides direct access to the customer. iBlueButton users can directly share critical parts of their medical record with their doctor via secure messaging.

The changing landscape of healthcare offered through smartphone apps allows doctors to build stronger relationships with their patients rather than be just another MD—critical to the “patient” component of “patient care.”

–follow Jeff on Twitter

–Jeff’s upcoming book “Navigating Chaos: How to Find Certainty in Uncertain Situations” will be out in 2015. Read about it here.



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August 23rd, 2014

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TelePharm gets $2.5M to help pharmacists be in two places at once

By: Jonah Comstock | Aug 12, 2014

from MobiHealth News

Iowa-based TelePharm has raised $2.5 millionfrom venture capitalist John Pappajohn and Bruce Rastetter, president of the Iowa state Board of Regents. The company, which is also a member of the Rock Health accelerator, will use the funds to scale its business, which connects pharmacists to one another and to patients via cloud-based mobile apps.

“I think the pharmacists’ position is changing,” TelePharm CEO Roby Miller told MobiHealthNews. “Instead of just counting pills and dispensing drugs, they are repositioning themselves to become more of a provider of healthcare and I think we’re trying to help them and enable them to become healthcare professionals.”

TelePharm has several different businesses that help pharmacists spread their expertise across multiple pharmacies. This allows local chains with spaced out rural pharmacies to reduce their overhead significantly. One business, TeleCheck, allows for remote verification of medications, one of the most important and time-consuming jobs pharmacists do.

“What a pharmacist does is, they have two different responsibilities: verifying it’s the right drug for that patient and basically making sure the patient will be safe with that drug, and making sure what the technician dispensed was the right drug,” Miller said. “What TeleCheck does, is it takes that workflow and puts it in the cloud. So a pharmacist has an image of the drug they’re dispensing, the label on the bottle, and the [prescription] as well. So they can compare those images and make sure the drug is the right prescription for that patient.”

The other service, which actually allows pharmacists to virtually interact with the patient directly, is called TeleCounsel. It’s used by hospitals with a pharmacist on staff to provide discharge counseling for patients leaving the hospital. Talking with a pharmacist before leaving the hospital leads to better adherence, Miller said, but is again often difficult to facilitate because it requires one pharmacist to be in so many different places in a large hospital or hospital system. With TeleCounsel, a pharmacist can talk to many different patients and even counsel patients after they go home.

This is the first round of funding for the company, which was founded in August 2012. TelePharm’s software is currently in eight small, regional pharmacy chains in three states: Iowa, Illinois, and Texas.

“We’re trying to prove that you don’t have to be on the East or West coast to make a company successful,” he said. “You can do it in a smaller midwestern setting.”

In an era of large chain pharmacies like Walgreens and CVS, which use mobile and web to add to the convenience of their many locations, it can be challenging for small local pharmacies to stay relevant. McKesson’s Health Mart franchise service, which went mobile last fall, is another effort to help those small chains keep pace with new technology.


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August 16th, 2014

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ATA Applauds Congressional Push for Federal Telemedicine Improvements

According to Jon Linkous, CEO of the ATA “On Thursday, Sens. Cochran and Wicker, both Mississippi Republicans, introduced the Telehealth Enhancement Act as S. 2662, which is a companion bill to a House version, H.R. 3306, introduced by Rep. Gregg Harper (R-MS). S. 2662 includes several provisions that may be budget savers, building on recent payment innovations such as accountable care organizations, and other incremental budget-sensitive proposals. H.R. 3306 already has 20 bipartisan co-sponsors. These bills are instrumental in demonstrating widespread congressional support and in prompting the Congressional Budget Office to provide a budget estimate.”IPRqUxyy_normal


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July 29th, 2014

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European telemedicine conference in Rome

European Telemedicine Conference 2014
7 – 8 October 2014, Rome, Italy.
The European Telemedicine Conference (ETC) 2014 will combine the efforts of several leading European Healthcare Organisations into one powerful event. The conference will collaborate with prominent healthcare delivery organisations, governmental leaders, clinicians, researchers and university faculties to address and discuss the following: How telemedicine is working to improve healthcare; Evaluate applications of telemedicine and telecare; Assess the sustainability of services; Learn how research will be translated into real improvements in the delivery of health and care; Understand what infrastructure is needed to enable cost-effective telehealth and telecare delivery.The Italian Presidency of EU and Ministry of Health’s strong support for the upcoming European Telemedicine Conference and HIMSS Europe CIO Summit, held on 6-8 October in Rome, will demonstrate the emphasis on eHealth in the healthcare agenda of the Italian Presidency.

At the European Telemedicine Conference, Minister of Health Beatrice Lorenzin will be presenting on the continuity of care enabled by telemedicine, which is also the main theme of the Conference.

Join other European stakeholders in the health debate and take part in outlining the roadmap for continuity of care in Europe.

“We are very happy with the support and collaboration we have had so far from the Italian Ministry of Health and we hope that both events [CIO Summit and ETC] become a great success,” says Rainer Herzog, HIMSS Europe Managing Director.

For further information, please visit:



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July 26th, 2014

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FSMB updates April compact for state medical licenses

According to FierceHealth IT

July 25, 2014–The Federation of State Medical Boards, a national nonprofit representing the 70 medical and osteopathic boards of the U.S. and its territories, issued the following statement today after unveiling an updated  draft interstate compact for physician licensure during its recent board meeting. The proposed changes to the draft compact would strengthen patient protections and streamline requirements for physician licensure.

“The goal of the Compact is to ensure that qualified physicians are able to practice medicine in a safe and accountable manner and that the strongest health care consumer protections are maintained,” said Dr. Humayun J. Chaudhry, president and CEO of FSMB. “The revised compact helps ensure that as the practice of telemedicine continues to expand, patient protection remains a top priority. We look forward to sharing the revised compact with state medical boards across the country and look forward to working with them to achieve implementation.”

The Compact, which offers a streamlined alternative pathway for state-based licensure, would create a new process for faster licensing for physicians interested in practicing in multiple states, including those who practice telemedicine, and reaffirms the location of a patient as the jurisdiction for oversight and patient protections. Those physicians ineligible for the compact may still use the current pathway to acquire one or more state medical licenses. The changes unveiled during FSMB’s board meeting would strengthen the requirements for licensure eligibility for physicians and help ensure patients are safe when they’re in the care of physicians. Specifically, the revisions to the draft compact would:

  • Require physicians who wish to participate in the compact to submit to fingerprinting or other biometric background checks to be eligible for licensure in additional states;
  • Alter specialty board certification requirements of the compact to clarify that those with time-unlimited certification are also eligible under the compact; and
  • Require that physicians who wish to participate in the compact pass each component of the U.S. Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medicine Licensing Examination (COMLEX-USA) within three attempts.

The new interstate compact system is expected to significantly reduce barriers to the process of gaining licensure in multiple states, helping facilitate licensure portability and telemedicine while widening access to health care by physicians, particularly in underserved areas of the nation. Although the Compact doesn’t establish standards for telemedicine practice, it is expected to enhance telemedicine by significantly expediting multi-state licensure.

 A copy of the draft can be found here.



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July 25th, 2014

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Congressman Mike Thompson is a strong advocate for telemedicine: Medicare Telehealth Parity Act of 2014

Congressman Thompson, who has introduced other telemedicine legislation, is on the verge of introducing the Medicare Telehealth Parity Act of 2014. Check it out.


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July 24th, 2014

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AAN Legislative Position Statement on Telemedicine

The American Academy of Neurology’s position paper on Telemedicine:

Background Information
The American Academy of Neurology (AAN) is a professional organization of
more than 28,000 practicing neurologists and neuroscientists with a deep
and abiding interest in assuring the best possible care of patients with all types
of neurologic disorders. With policymakers at the state and federal levels
considering new policies regarding telemedicine, and with many neurologists
moving to include telemedicine within their practices, it is important for the
American Academy of Neurology to have an official position on the issue in
order to advocate appropriately for its members.
Description of Issue
With telemedicine rapidly emerging as a form of patient care, it is important
that policymakers consider access issues, reimbursement, liability issues, and
licensing across state borders when discussing telemedicine policy.
AAN Position
While telemedicine cannot replace many of the hands-on skills and in-office
assessments neurologists provide, patients in all US states, territories, and the
District of Columbia should have access to telemedicine, regardless of location,
and should have telemedicine services included in all subscriber benefits
and insurance plans (Medicare, Medicaid, and private insurance). Physicians
should be reimbursed equitably for telemedicine services and have access
to a streamlined state medical license process. Comprehensive malpractice
insurance policies are also needed.
Definition of Telemedicine
Telemedicine involves the use of electronic communications—telephone, email,
videoconference, digital imaging, and other forms of Internet technology—
to practice medicine from a location that is remote for the patient. It is an
effective and efficient form of health care delivery, instantly connecting
patients and physicians. The telephone and email are commonly used forms of
communication to address patient care issues and are often used to develop
or share a fairly detailed assessment of the patient’s condition, including
ordering tests, starting or changing medications, with discussions of side effects,
expected effects, etc. Telemedicine is a rapidly developing field, evolving as
communications technologies change. It is enabling high-quality care, often
allowing patients to avoid transfer to another facility while also improving the
financial viability of the hospital that receives the service. Rural populations and
military personnel in combat are increasingly using telemedicine to overcome
barriers of distance and delay by bringing the physician and patient together in
real time. It is used in the inpatient setting to provide care to patients who are

seen in a remote emergency room, or are admitted to a remote hospital for an
acute illness or chronic disorder.
Access Issues
Telemedicine for neurologic care, often called teleneurology, is most often
applied to emergency stroke care and neurocritical care (Ganapathy, 2005). But
it also has evolved to include long-term care for chronic neurologic conditions
such as epilepsy (Ahmed et al., 2008), Parkinson disease (Samii et al., 2006),
multiple sclerosis (Kane et al., 2008), dementia (Loh et al., 2007), and migraine
headaches (Cottrell et al., 2007).
Patients should have access to telemedicine in all states, the District of
Columbia, and US territories, as it is well-suited to provide medical care in
both rural and urban locations lacking access to physician specialists such as
neurologists. Access issues also can affect patients residing in nursing homes
and rehabilitation facilities, as well as those unable to drive due to physical
Legislative action is recommended at both state and federal levels to include the
benefits of telemedicine to populations with limited access to care regardless of
location and the health insurance coverage they might have.
Cost-effectiveness and Reimbursement/Payment Parity
Telemedicine has been shown to be cost-effective, efficient, and equal in
therapeutic value to face-to-face encounters. However, the technical costs and
incongruent physician and hospital reimbursement have been a barrier to further
dissemination. Telemedicine costs include the increased workforce of dedicated
network program managers and personnel, higher estimates of inpatient care,
inter-hospital transfer, rehabilitation, long-term care, caregiver costs, and a
wider range of spoke-to-hub hospital network transfer rates.
Present data support the cost effectiveness of telemedicine for stroke from both
the societal and hospital perspectives. For example, researchers at the Mayo
Clinic have found that rural patients treated for stroke care via telemedicine
incurred cost savings of $1,436 per patient, while also increasing their quality of
life, when compared with seeing the stroke patient in person (Demaerschalk et
al., 2013).
These results demonstrate that an upfront investment in telemedicine
technology, connectivity, infrastructure, and stroke network personnel can
be justified in our health system. The AAN supports the reimbursement of
telemedicine consultations in the same fashion as face-to-face, telephonic, and
email clinical encounters.
Liability and Multistate Licensing
Risk management is an important consideration in telemedicine practice, as
physicians could be legally liable across state borders. The major issues include
defining what constitutes telemedicine malpractice and determining where
and against whom claims can be brought, because the care provided as part of
telemedicine may be across state borders.
For example, the decision to administer or not administer thrombolysis for
acute stroke is a prominent source of malpractice claims for neurologists, and
telemedicine physicians managing acute stroke patients may be exposed to FOR MORE INFORMATION
(800) 870-1960 • (612) 928-6000
©2013 American Academy of
Neurology – All Rights Reserved
AAN Legislative Position Statement on Telemedicine 3
complex liability issues. Legislative policies are needed to clarify liability issues in
the practice of telemedicine as well as to protect patients from adverse events.
Broad, comprehensive malpractice insurance policies and clear telemedicine
practice guidelines are required to protect physicians.
Standards for the engagement, training, and supervision of telemedicine
providers are necessary. Advocating for appropriate competency of telemedicine
physicians in evaluation and management; readily available technological
support; careful and detailed informed consent discussions; and detailed,
accurate chart documentation may best protect telemedicine physicians and
patients alike. Guidelines for protecting patient confidentiality and following
HIPAA regulations are important aspects that should be standardized to be
applicable to telemedicine services.
The AAN also supports efforts to streamline state medical license processes for
those physicians looking to practice across state borders and use telemedicine
to treat patients living in rural areas.
Position Statement History
Drafted by Vernice Bates, MD; Pushpa Narayanaswami, MBBS, MD, FAAN; Sarah
Song, MD; Jeffrey A. Switzer, DO; Jack W. Tsao MD, DPhil, FAAN; Tim Miller (AAN
Reviewed and approved by the following AAN Committees: Government
Relations, Medical Economics, Practice, and the AAN Board of Directors.
Ganapathy K. Telemedicine and neurosciences. Journal of clinical neuroscience: Office Journal of the
Neurological Society of Australia 2005;12:851-862.
Ahmed SN, Mann C, Sinclair DB, et al. Feasibility of epilepsy follow-up care through telemedicine: a pilot study


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July 22nd, 2014

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This month in telemedicine: ATA webinar

IPRqUxyy_normalJon and Gary gave another outstanding summary of the world of telemedicine:

  • FSMB small steps forward with Interstate Compact but not the total fix.
  • AMA more welcoming to ATA and current president and president-elect with strong IT backgrounds.
  • ACO wants the HHS to mitigate rules for allowing them to use telemedicine.
  • H.R. 3306 and 3077 still alive and Rep. Harper will introduce new bill in July related to telemedicine.
  • FDA proposed to remove requirement for 510K process for medical device data systems and storage devices for imaging
  • Twelve states are currently discussing telemedicine legislation.
  • ATA is preparing a packet of information for physicians to speak to their own state medical licensure boards to inform them of the need for reform.
  • Charlie Rangel’s HR 2001 is important as it adds VA physicians along with DOD physician’s the ability to have one license to practice in all 50 states. Was to be discussed last evening at VA health subcommittee but it wasn’t.
  • Closer ties with the American Hospital Association and the ATA are being addressed.



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Posted on:
June 24th, 2014

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