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Telemedicine for Mental Health Treatment

While Texas as a state has been suffering from a shortage of physicians, the same issue applies in prison. This is unfortunate since the need for mental health care is increasing rapidly. Fortunately, there is an alternative for healthcare services. Telemedicine has made everything easy for both the prisoners and physicians.

Take a situation where the healthcare provider is seated on one end, and the prisoner is seated on another, miles away, with a screen, yet the patient can receive the mental treatment required. Telemedicine brings the two parties together without an actual face to face meeting. Before the introduction of telemedicine in prison in Texas, psychiatrists would spend a lot of time in jail which was not easy for them. This is because they have to adapt to the sense of the environment of the prison.

The diagnoses

The telepsychiatry provided to Texas inmates focuses mostly on diagnoses and managing medications, putting less focus on therapy. Telepsychiatry has improved access to continuous care, and it is time-saving allowing the physicians to attend to the patients timely.

There are few problems that physicians face when providing care in person. One of them is transportation. These are potentially dangerous individuals, and they can easily escape once they are let outside the prison which poses a danger to the community. Telepsychiatry minimizes those risks.

Moreover, some physicians feel threatened to be close to the inmates. Seating on the other side of the screen offers them a sense of safety since the patients cannot do anything terrible to them once they feel offended or they do not like the treatment. There have been cases of clinical staff being assaulted and, therefore, having them sitting next to the inmates is dangerous.

Texas has had this program since 1994. The psychiatrists get a list of the patients they are supposed to see virtually before the encounter day. The physician goes through the patients’ records to get prepared for the session ahead of them.

Growth in California

Just like in Texas, California has also been providing mental health through telepsychiatry, and this has proven to be of many benefits to the state. It has helped in eliminating staff shortage while at the same time ensures the provision of quality healthcare services.

Some people are afraid that this program hinders the inmates from experiencing the human touch which could lead to loss of connectivity. This has made some people hesitant in adopting the practice. Also, if the connectivity is reduced, the physician might have to cancel the session due to audio issues. However, most inmates love the program, and in some ways, it creates a secure connection between them even if they do not have a face to face interaction.

Asthma is one of the most common childhood chronic diseases in the United States. In fact, about 10% of all children in the United States have asthma. Although asthma, once diagnosed, can be managed by taking the necessary medication regularly, minority children from low-income families may not have access to these medical interventions. Consequently, such children can end up suffering from life-threatening flare-ups necessitating costly emergency room visits and even hospitalization.

According to the research study that expanded a study previously done by URMC and published in JAMA Pediatrics, asthmatic children taking medication in school under the care of their school nurse are less susceptible to severe asthma attacks.

The study further indicated that the telemedicine component of the program makes it more sustainable and effective since it allows children’s primary care providers to more readily get involved in the children’s care.

The research study involved some 400 children aged between 3 and 10. The researchers divided their sample into two groups. The children in the first group were given an initial asthma assessment and given medication by school-based nurses. The children in this group then received follow up primary care via telemedicine. The children in the second group were only given the necessary recommendations for primary care.

They were not enrolled in the school-based care, and there were no follow-up visits through telemedicine. After the study, it was established that children in the first group were less susceptible to the symptoms of asthma. In fact, only 7% of them required hospitalization or emergency room visit in the course of the study, compared to 15% in the second group.

Jill Halterman, Chief of the Division of General Pediatrics at URMC, indicated that although researchers and clinicians around the country are making deliberate efforts to reach the underserved asthmatic children in their communities, there are still children who suffer from dangerous asthma issues for failing to take their medication regularly.

Fortunately, the integration of telemedicine with the school-based care is significantly enhancing the consistency and effectiveness of asthma treatment among children. This model can, therefore, be employed to children all over the country to ensure that they get adequate asthma treatment at the minimum cost possible.

The New Oklahoma Law about Telemedicine Expands Availability but Raises Questions

With time, telemedicine is increasingly growing in popularity as an excellent option for individuals to receive health care services. It involves an indirect meeting between patients and health caregivers. Recently, the Oklahoma Legislature has passed a new law aiming at making telemedicine more available to individuals across the state.

What is telemedicine?

Oklahoma law defined telemedicine as a means of providing healthcare, diagnosis, treatment, provision of consultation and medical education through real-time interactive communication between the patient and the physician. The services are offered after the doctor has access to and reviews the patient’s essential medical information before the telemedicine visit.

What are the requirements for telemedicine providers in Oklahoma?

The newly initiated law allows telemedicine visits between the physician and a patient in Oklahoma even if it is the first time contact as long as the telemedicine provider fulfills all the requirements of the state. Some of the requirements are;

The provider must be certified and permitted to provide the services in Oklahoma. The provider must show the license document. The provider can be in another state during the telemedicine, but the patient must be in the state of Oklahoma during the encounter.

The telemedicine healthcare providers should provide the patient with their full identity and credentials to prove that they have the required experience. On the other hand, the patients have to submit their identity and location showing that they are in Oklahoma.

The provider must have a system that fulfills all the requirements to conduct telemedicine. A system that only offers means for audio phone calls, texts messages and electronic mail are disqualified.

What restrictions are made by the new law?

The new law has brought up some restriction on telemedicine especially on some drugs such as opiates, synthetic opiates, carisoprodol or benzodiazepine. There has to be a face to face meeting between the patient and the physician for the provider to prescribe such drugs. However, opioid antagonists and partial agonists can be prescribed without a prior face to face encounter between the two parties.

This new law does not specify who else is allowed to provide telemedicine services other than medical or osteopathic doctors. This way, although the law is expanding the availability of telemedicine across Oklahoma, it has left people with some unanswered questions.

Teledoc Drops 2011 Lawsuit as Texas Passes New Telemedicine Bill

Telemedicine, which is the latest medical technology trend, recently got a boost from some of the biggest technology and health firms. Among the companies that have outlined their plans to use this virtual consultation plan in their services are Apple Inc., CVS, and Aetna. With these giant companies on board, telemedicine can now safely take off.

Telemedicine or virtual medicine as it is commonly known consults patients by video or phone, and it has been one of the milestones the industry has achieved. Lack of awareness has been one of the setbacks that this technology has faced over the years. Aetna has merged with CVS to deliver the best in this sector. Aetna’s strategy is not only to enable this technology looks after patients from home, but also to introduce more apps that will help patients when their levels of glucose are low.

Apple, on its part, has great plans for its new heart-health study. In what can be seen as a well-calculated move, this giant electronic company opted to work with American Well, an established telemedicine startup to give access to those who aren’t able to get to the doctor’s office. Apple Inc. through its COO, Jeff Williams had earlier advocated for a virtual medicine when he unveiled their plan for a new heart-health study.

This Apple/Aetna deal has been applauded by various key players in the sector especially the developing crop of venture-driven firms who specialize in home-health monitoring, virtual consultation as well as the creating of digital health apps. This new development has made people aware of a particular technology that has been in existence for quite some time. It provides a cheaper alternative as compared to driving for long hours to reach a health center.

The challenge, however, lies with the adoption. Even though several doctor’s offices and hospitals may begin providing this service, they {services} still remain unknown to quite a number. In addition to that, very few will also find their employers or insurance firms to see if the whole service is a benefit.

Telemedicine is a new concept in the world of internet but it is developing at a very high speed. Doctors running a virtual medical practice is not simple as it encompasses more than just technology. According to Micheal Nochomovits, MD, chief clinical integration and network development officer at NYP the concept of telemedicine is growing and there is need to come up with a sophisticated approach. The execution of the idea is not as simple as it sounds. According to Micheal Nochomovits, telemedicine started out simple handling common diseases such as coughs and colds but it has been rapidly expanding to handle even more serious diseases. This comes with its own set of challenges.

A telemarketing visit is no ordinary video call and should not be taken lightly since it involves serious medical interaction between the patient and the medical practitioner. There are a few standards that have been put in place by different individuals but there has not been an agreement on the basic standards for which to stick to. It telemedicine is successful, there will be people who will solely depend on telemedicine for income. That will be their career. Their typical day at the office will not involve the traditional way of doing things where the patient has to be physically present in the office. However to make this work there is need to have a set of core competences in place. Medical virtualist is the term they have come up with but it is not set since they are still playing around with the name.

Telemedicine idea is new and some fear that this new technology will be disruptive. While the path ahead is unclear, it would not be wrong to say that it is exciting to see the impact that telemedicine will have on the health care system.

OIG’s November Plan on Opioid Prescribing and Telemedicine

Following the previous two work plan publications this year, OIG has come up with another strategy where it will be updating its work plan on a monthly basis. In November, the four plans are;

• OIG will be evaluating the prescriptions for opioids to Medicaid. Their observation was that Medicaid beneficiaries mostly the disabled are more vulnerable to abuse of opioids since they tend to suffer from conditions that require pain relief. OIG will be examining the issue by considering both the prescriber and the beneficiary side. The prescriber may include doctor or pharmacy. The study aims to come up with a baseline of beneficiaries receiving extreme amounts of opioids and identify the prescribers who are giving excessive or too much of opioids to recipients.
• OIG wants to study if Medical payments made for services provided through telecommunication systems fulfilled the requirements of Medicaid. The OIG will determine if all the telehealth services that may be delivered through audios and videos and any services that beneficiaries get through interactive transmissions are all paid for in the required manner.
• The Medicaid Managed Care Organizations (MCOs) will be examined by the OIG to check if it is using Medicaid funds to offer proper care to the Medicaid MCO enrollees. These are funds that MCOs receive inform of capitation payments which come from over 40 percent of federal Medicaid expenditures. The OIG aims to ensure that the capitation rates are set appropriately so that they can provide adequate services to the beneficiaries.
• OIG will be determining the way hospitals are billing for severe malnutrition. The condition is common among the elderly especially those who are seriously ill. Malnutrition can be as a result of inadequate treatment, treatment of a different disease, negligence or general worsening of the patient’s health. Hospitals are expected to bill for the treatment of this condition based on how serious the state is, which can be mild, moderate and severe. Severe malnutrition is a significant complication and increases Medicare reimbursement. OIG will be reviewing the precision of the claims to Medicare for the treatment of acute malnutrition.

There exists a potential to reshape the health system by use of telemedicine. The modern society has allowed consumers to access almost everything online which includes healthcare. Telemedicine is a comprehensive type of healthcare. It can be used to enhance the treatment of emergency care patients through its convenience, increased efficiency, and accessibility.

The various incidents where telemedicine comes in handy, especially to patients requiring urgent care include load balancing, satellite, and hub and spoke models. These services are provided by both the government and non-profit oriented organizations who offer some online healthcare facilities for those seeking to expand their telemedicine program.

Telemedicine is both safe and effective for the evaluation of any manageable conditions in the urgent care environment. Furthermore, there exists growing evidence that affirms the audio and video-based intervention for the different acute conditions that manifest in the pediatric care. For example, using telemedicine can make the diagnosis of common severe illnesses much more comfortable than before. Also, patients with trust issues would feel more comfortable being diagnosed online rather than in-person.

The evaluation and consequent treatment of urinary tract infection and sinusitis have also been enhanced using tele-visits where most physicians purpose to offer prescribed antibiotics to their online patients. These means that telemedicine is not any different from one on one diagnosis. There also exists no difference in the number of patients that may be required to make a follow-up to their treatment either online or in-person. These imply that there is a consistency in patients’ satisfaction with telemedicine attributable to the convenience provided as well as the reduced cost of medication.

The urgent care patients can, however, be given the option to either be treated at home or through telemedicine. Alternatively, patients in need of physical emergency rooms are also given the opportunity to choose from one on one treatment or receiving treatment through telemedicine. Indeed the introduction and use of telemedicine for emergency care have helped reduce the average time and money spent on medication.

Virtual medical consultations, or telemedicine, are soon going to be offered by Aetna and Apple. With CVS joining in as well, telemedicine is facing a large increase in consumer awareness. Although telemedicine has been around for years, getting the information to customers has been difficult. Now that fortune 500 companies are promoting the service, virtual medical consultations are set to become more normal.

The chief executive of Aetna, Mark Bertolini detailed the plan to incorporate glucose level readings. With technology becoming such an intricate part of everyday life, it is no surprise that medical services are being digitalized as well. Patients having the ability to help themselves at their fingertips is a step towards healthier lives for many. With the ability to connect apps to Bluetooth to get instant readings coupled with a lower cost of healthcare.

Along with lowering the cost of healthcare, patients are now able to be more independent. The technology being introduced has the ability to monitor the patient from home. This means that the CVS, Aetna, and Apple medical merger could allow people to go home and not remain stuck in a clinic or hospital. There is no set in stone apps or technological specifics being mentioned thus far, but this is progression in America’s healthcare system.

This plan sets out to ensure the patient has the independence that they want, while also remaining affordable. A large issue with America’s healthcare system is the amount of money it takes to have any medical procedure or test. Doing it remotely, from home, eliminates some of those costs that traditional medicine incurs.

Telemedicine sets to make leaps and bounds within healthcare. Gaining exposure so that patients can utilize the service has been an obstacle, but that is changing quickly. Providing people with a less expensive, easy access way to medical treatment is groundbreaking.

Diabetes is a growing epidemic, brought on by unhealthy choices, and demanding medical care unlike any disease before. Telemedicine, allowing physicians to remotely monitor patients with diabetic retinopathy, can help meet that growing demand.

Noted physician Dr. Zimmer-Galler has stated that the DR telemedicine programs have been quite helpful to treat patients. They are highly effective, but because of the anticipated rise of diabetes cases in the next 15 years, they may not be enough. Her concern is that there will not be appropriate or adequate resources to properly evaluate and treat the rate of diabetic patients.

The lack of resources to properly treat diabetic patients isn’t the only concern Dr. Dimmer-Galler and other physicians have, however. The question of the validity of telemedicine practices is another. Presently, the American Telemedicine Asociation has 4 different levels of standard validity, starting with the presence of limited of minimal DR; presence of vision-threatening DR; the ability for providers to make clim=nical recommendations, and the Early Treatment DR Study photograph star=ndard (the highest level).

This validation is how telemedicine is judged to be a standard of care – currently, DR is determined by an in-person evaluation. Each DR treatment program, including telemedicine, must be evaluated to see how well it works, based on the “gold standard” of ETDRS photographs.

Telemedical treatment of diabetic retinopathy is expected to become more common in clinical practice. This should include primary-care automated image analysis using Nonmydriatic fundus cameras. With these, the images will be able to be transferred to readings centers for viewing, and then returned to the primary care physicians for diagnosis.

There is a concern that the rate of upgradeable images may affect telemedical treatment of DR. Currently, the minimum acceptable value for upgradeable images is 5%. There is no way with the current level of telemedicine, however, to diagnose diabetic macular edema (DME), which will require office visits. As the technology of telehealthcare improves, though, this may also be a viable option for remote diagnosis.

As it stands, telemedicine cannot be fully relied upon to treat DR or DME, although the technological improvement is increasing.

The Centers for Medicare and Medicaid announced on Thursday the final rule for Medicare Physician Fees in 2018. Part of the numerous changes and payment increases is the decision of CMS to pay for a greater number of individual telemedical services. As technological capabilities increase, as well as demands on physician’s time, telehealth is increasingly a viable alternative to traditional office visits. Many of the approved telemedicine codes include instances concerning lung cancer, health risk assessments, psychotherapy, chronic care management and interactive complexity.

According to the press release provided with the document, access to telemedicine for those living in rural areas will strengthen the care available to them. In addition, the changes to Medicare telehealth coverage will make it easier for these providers to bill Medicare.

This is part of the process to modernize Medicare payments and promote innovations that enhance patient care. In addition, changes to patient monitoring via virtual treatment is also in the process of being finalized.

Morgan Reed, the Connected Health Initiative Executive Director, is very supportive of the efforts from CMS to encourage physicians to embrace remote patient treatment and monitoring. He praises the new rules from CMS as an important, yet necessary step forward to a more connected healthcare system in America. With approval for many types of telemedical treatment, connected health technologies are now accessible to those utilizing Medicaid and Medicare services. Until now, participants in those health care plans have been effectively locked out from telehealthcare.

Prior to the 2018 changes, CMS rules essentially discouraged doctors from considering newer technologies to treat Medicare and Medicaid patients. Working in conjunction with the Connected Helth Initiative Adsivory Board, the newly updated rules make telehealth and other new technologies more accessible to both doctors and patients alike.

Speaking for the American Hospital Association, Executive Vice president Tom Nickels confirms support for the CMS agency’s policies. While the support is present, this association encourages a more expansive approach to telehealth coverage available.