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Thomas Lee, MD, Children’s Hospital Los Angeles Uses Telemedicine To Treat Child Blindness

Armenia EyeCare Project

Many healthcare systems and hospitals have decided to leverage telemedicine to connect patients living in underserved locations with health care providers.

A particular group of pediatric ophthalmologists, subspecialists at Children’s Hospital Los Angeles are using technology to provide specialist care in various developing nations. Their main goal is to kick out preventable infant blindness.

Within the Children’s Hospital, Los Angeles, there is the Vision Center, which is a large multispecialty medical group operating within the facility. This facility works as a referral center for children who are suffering from complex eye illnesses and provides expertise in different pediatric ophthalmologic subspecialties.

Vision Center’s director is known as Thomas C. Lee, M.D., who is also a pediatric retina surgeon. He leads an innovative and professional telemedicine project that focuses on offering remote training for eye surgeons in Armenia. This is done in partnership with the Armenian EyeCare Project –AECP.

Together with a team of doctors, Dr. Lee traveled to Armenia to offer assessment, care as well as programming.

Their main aim is to assist in lowering the rates of preventable blindness mostly experienced in infants. This condition is known as retinopathy of prematurity. According to Lee, the condition happens three times as often in Armenia as in the USA and most western states.

Working with Armenian EyeCare Project for eight years has enabled Lee to understand some of the main challenges specialists face in dealing with complex eye illnesses. He began to diagnose and treat this kind of infant blindness through an affordable online remote training program, and the program has advanced with developments in the sector of health IT.

Since this telemedicine program began in 2009, over 4000 infants have been screened with retinopathy of prematurity. The number of procedures that have been completed to treat the ROP exceeds 309. About 40 operations have been performed so far.

In the beginning, Lee observes that there were certain limitations to this form of technology. Most of these problems were connected to latency since the system had first to buffer the signal before it could operate.

One of the reasons why this is the best option for treating infant blindness is because it enables sub specialists to work with other providers in a cost effective and accessible manner.

A diabetic patient will have a hard time trying to reach the city for a medical appointment. On the other hand, a doctor in Mexico requires a specialist in U.S for opinions. These are the just some of the many examples where telehealth can be of help in improving healthcare.

Two health organizations using telehealth technology in San Diego are the Telemedicine Program at UC San Diego Health and La Maestra Community Health Centers and have given positive reports concerning the invention.

Telemedicine is very convenient especially for individuals who cannot reach their physician probably due to lack of funds or due to their severe health condition, as stated by the Telemedicine Program at UCSD Health’s manager, Lisa Moore.

Moreover, considering a situation of busy people like parents, they need to work and also take care of their kids. It gets hard for them to work and take their children to the doctor, and this is where telemedicine comes in. Telemedicine provides them with access to see their doctor at anytime from anywhere.

The primary goal of telemedicine is to make health care more convenient and accessible for all patients. It is the same objective that drives telemedicine at La Maestra. It has four main clinics and two school based sites. They serve patients below the poverty level. Also, they serve patients who speak about 30 languages and dialects and therefore, they are trained cultural liaisons to assist them in the telehealth process.

The two organizations” leaders have overseen telemedicine as a success in healthcare. They believe that it will bring in positive results and will make things much easier for both the patients and the physicians. A study showed that previously, most patients did not turn up for appointments with their doctors. Some gave excuses like language barrier while others complained of the lack of funds, but this was going to end.

With telehealth, patients will have a video visit with a physician who speaks their language, and this reduces the no-show rate. The rate went down from 50% to 13% in the first year which is a great achievement for the health organizations. This will help in both primary and ICU health care where the patient is in severe condition.

According to a new study by TransUnion, two-thirds of hospital patients are not paying their hospital bills in full. TransUnion also suggests that, by 2020, this number may rise to 95 percent. This seems to be mostly due to the increase in deductibles that came with the Affordable Care Act. However, it must be noted that while the act did increase deductibles, it has also given more people access to health insurance.

This could have long-lasting consequences for many hospitals across the country. According to The North Carolina Rural Health Research Programs, 79 rural hospitals have closed between 2010 and the present. According to reports, hospitals in states who chose not to expand Medicare with the Affordable Care Act are under much higher pressure to either expand profits or close compared to hospitals in states that did expand Medicare.

John Yount, the vice president of product within the TransUnion’s healthcare division warn that this number will only increase if more and more patients choose or are not able to pay their bills. Yount believes the healthcare industry should both move to an outcome-based payment structure and help keep healthcare costs down in order to help keep hospital closures from happening, as studies show that the main reason that patients do not fully pay their hospital bills is due to the high healthcare costs. In fact, it has been reported that 99% of patients with hospital bills that total more than $3,000 do not completely pay their bills.

With this said, even though healthcare costs are high, hospitals are not making an overabundance of profit. Currently, hospital profit margins range from two to four percent, and that margin tightens when patients refuse or are not able to pay their bills. Lastly, while the repeal of the Affordable Care Act currently seems dead in the water, future healthcare laws and provisions may increase or decrease the severity of the aforementioned hospital related financial crises.

Telemedicine involves remotely treating and diagnosing patients. A study in the North Carolina Medical Journal has proven that patients who suffer from type 1 and type 2 diabetes benefited from a telemedicine program.

Working with over 10 care facilities in North Carolina, between the years of 2013-2016, the program featured a diverse group of physicians, psychologists and physical therapists who worked alongside the patients. The program also worked with pharmacists at critical steps along the way, treating formerly neglected patients whose type 2 diabetes had been allowed to run its course, without proper medical treatment.

The majority of these patients lived in rural areas and were unable to locate adequate health care practitioners. The Health Resources & Services Administration of United States sponsored the telemedicine program.

The patients engaged in multiple teleconference appointments, working with the health care team using telemedicine systems for various assessments. The patients were studied for adherence, insulin injection techniques and their general knowledge of diabetic conditions. Pharmacy experts were able to analyze the data within the patient’s medical records to further assist patients in knowledge of glucose and proper usage of diabetic medications.

Patients became knowledgeable about specific medications and correct self-management techniques, including addressing proper dietary issues and exercise techniques. The pharmacists worked on improving various aspects of the patients care plan, working on lifestyle interventions and condition monitoring.

Health care practitioners from a multitude of disciples would all focus on a single patient together and indicate effective interventions. Dietitians worked with pharmacists to create effective diet and insulin coordination efforts.

More than one thousand telecare visits were coordinated over the span of the program, and over 350 patients were assisted, with an average of 3 to 4 appointments per patient.

Health information such as weight, hemoglobin counts and lipoprotein densities were reported by the health team. They found that the majority of the patients showed signs of depression. However, towards the end of the study more than two thirds of those same patients noted a general improvement from these symptoms.

The same health care team was able to make comparisons between the telemedicine treatment and personal care. The results were almost identical.

Research has proven that there is no difference between the safety and efficiency of the telemedicine treatment and the official clinic visits for a chronic headache. A headache is one of the most common neurologic disorder, yet most people do not receive adequate treatment. The good thing is that a new technology is now available to diagnose people through telemedicine, but there have been various studies to determine if it is effective like the in office visits.

This study involved 402 individuals who suffered non-acute headaches or a problem that came gradually. These were people who were referred from a primary care physician to a neurologist. Half of the patients had a traditional office visit at a hospital, and the other half went to the hospital but saw the neurologist through a video call. The participants were asked to take questionnaires about the effects of the headache on their daily lives and also about the level of pain at the start of the study and after three months and after a year.

The researchers said that there was no difference between the patients treated via telemedicine and those who had clinic office visits.

This study, known as a non-inferiority study is designed to show that the new treatment is not clinically different from the traditional type. To conclude the safety of using telemedicine, researchers checked whether the participants experienced a secondary headache a year after the practice. A secondary headache means that it is a sign of another underlying condition.

The researchers imagined a situation where a patient has to travel for 40 km to the airport to reach the nearest airport and then take a flight to go for a consultation. There could also be other barriers like weather conditions which would prevent the patient attending the meeting.

The northern England covers a large area covered with mountains and valleys and thus, patients traveling to see a doctor can be challenging and cumbersome and expensive for many individuals. Telemedicine will be helpful and convenient to everyone suffering from headaches and wishes to see a specialist without any hassle. This will help in diagnosing and treatment of the condition before it worsens.

There has been a bill amendment that limits the time needed to create the doctor-patient relationship under the telemedicine technology. The bill states that the doctor and the patient should have a face to face meeting first before moving to the telemedicine platform.

This change was impelled by a group of physicians who do not have enough faith in telemedicine. This change caught the attention of the ERISA Industry Committee (ERIC) which is a national association that supports the large employers on the retirement, compensation and their health policies. The organization presented a written testimony in favor of the bill before the public hearing which was held on June 12, but it later withdrew its support on June 16 after having a thorough review of the amended bill.

The doctor-patient relationship is vital yet very tricky in telemedicine. Some doctors and doctor’s groups’ argued that new patients should meet with their doctors in person before switching to telemedicine. This debate caught people’s attention, and it obstructed the American Medical Association’s efforts to abstract ethical rules for telehealth until last year when the organization agreed to a document that was in favor of telehealth.

After the passage of this bill, Texas became the last state to eliminate the law that requires doctors to first have a face to face meeting with their patients before applying telehealth. Telemedicine advocates were happy with this decision since they argued that in-person meeting requirement limited the under-served communities from accessing telehealth.

Telemedicine is of many benefits to the residents of Texas as it saves time by minimizing the time that would have been spent by patients attending health centers to meet their physicians. It does a great favor to working individuals who strive to balance between working hours and time for family. This applies to busy parents who lack time to take their kids to health centers.

Telehealth also makes it easy for people living in rural areas to access health care. The elderly and retirees, disabled and those experiencing language barrier problems are also among the primary beneficiaries of these services. Individuals suffering from chronic conditions and transport problems are also beneficiaries of telemedicine. These benefits will be eliminated if telemedicine can only be applied to persons with a pre-existing patient-doctor relationship.

However, this bill excludes the use of electronic mail, audio telephone conversation, phone texting from being applied to telemedicine. The two-way communication is only allowed when combined with a store and forward technology; otherwise, people have to use video calls exclusively. The goal of telemedicine is to expand access to easy and affordable health care and ensuring high-quality services to patients.

The capabilities of hospital-based telemedicine and remote patient monitoring have significantly revolutionized the healthcare industry in recent years. Hospitals are rapidly increasing their remote patient programs citing decreased expenses, routine patient visits and hospital admissions.

According to a report by Berg Insight, there are about 7 million patients under some form of remote monitoring, a 44 percent increase over 2015. The use of healthcare remote monitoring systems has enabled physicians to track patients’ vital signs in real time from locations away from the hospital.

Patients use a medical device to track their health progress and forward their responses regarding their illness to health care professionals for remote assessment. The telehealth technology has helped many including the elderly or those recovering from major injury/illness to benefit from the convenience of decreased frequent doctor visits, access to better health and increased quality of life right at the comfort of their homes. Remote monitoring, therefore, ensures full recovery of patients without the need for any readmissions and other avoidable hospital expenses.

Thanks to the telemedicine technology, St. Vincent Hospital has begun to see patients at two new kidney transplant telemedicine clinics located within rural communities in Indiana. “Patients will only have to travel to Indianapolis for their initial transplant surgery and immediate post-transplant follow-up care”, said the hospital’s Abdominal Transplant Program Executive Director Mary Ann Palumbi, RN. Patients can receive care closer to home without having to endure lengthy drives and hospital stays.

Managing chronic conditions like cardiac disease, respiratory issues, and diabetes has become much easier as patients can be continuously monitored and catered for in case of slight deviations from their anticipated recovery. Whether it’s presenting their vital signs, or a graph of trends over time or just a summary of their daily care outlook, remote patient monitoring programs allow a patient to get that daily information and support that can make all the difference in the world in regard to their health outcomes.

More hospitals should be encouraged to embrace remote patient monitoring as it has proved to have the power to change the way we provide and receive healthcare.

Medical Marijuana Bill Gets Support from Florida Governor Rick Scott

In the U.S, Telemedicine and Medical marijuana have long been used to treat certain health conditions. However, for the last five years, the two non-traditional approaches have gained considerable traction in the healthcare arena. In fact, some states have chosen to prevent the use of telemedicine to prescribe medical marijuana as a treatment for patients with serious medical conditions.

Last week, the Florida lawmakers passed legislation to extend the use of cannabis to residents who suffer severe pain that meets specific qualifying conditions. However, one line specifies that any patient who wants to be certified for medical cannabis cannot do so through virtual visits.

Under the new bill to be signed into law by Governor Scott, patients ought to be in the same physical location as the doctor during checkup to determine whether they are eligible for medical marijuana.

These restrictions didn’t happen overnight. Last year, the Florida Board of Medicine signaled an interest to stop doctors from using telemedicine technology for medical cannabis. In December, the Board issued an amendment to proposed telemedicine regulations to pinpoint the restriction on the use of medical marijuana.

It’s quite difficult for states to legalize cannabis because of the patchwork of federal, state, and local laws involved as well as the state-by-state nature of telemedicine laws. For instance, California was the first state to legalize the use of medical cannabis, and better still doesn’t forbid the use of telemedicine to acquire the substance. Colorado, being one of the most liberal states in the nation for legalizing the use of marijuana, for medical or recreation purpose, requires an in-person examination before any virtual visit to get medical marijuana.

One startup is offering telemedicine visits explicitly for marijuana prescription. HelloMD, a service known for employing telemedicine to connect individuals with physicians willing and able to prescribe medical cannabis, lately raised over a million dollars through equity crowdfunding on SeedInvest.

Passing the Telemedicine Chronic Kidney Disease Improvement Research and Treatment Act 2017

About 15% of the adult population is suffering from chronic kidney disease. Some of them suffer from kidney failure, and some are on dialysis. Many of them, however, have already gone through a kidney transplant and they have to go through regular checkups.

Telemedicine is expected to offer a better solution to the patients. The National Kidney Foundation stated that telemedicine provides a better and promising medical alternative to the in-person health care and those in particular delivered at dialysis clinics or doctor’s office. Physicians can monitor the patient’s conditions like blood pressure and other important signs and give them medical adherence and diet plans without having to meet them face to face.

Nurses can, as well, coordinate medical care online with the patient’s care provider and interact with the patient from home. This offers on-demand care between the regularly scheduled office visits. Telemedicine is being termed as a step in the right direction to understand the disease better and find a cure.

The passing of the bill is aimed at improving the lives of the patients suffering from kidney problems. This will be achieved by identification of any transplantation barriers and improving the donation rates. It will also allow the patients to retain the access to private insurance and promote the access to home treatment for those undergoing dialysis.

H.R.2644 is trying to understand the way kidney disease progresses and its reaction to kidney failure treatment in the minority populations. This will help to improve access to treatment for individuals from the under-served rural and urban areas.

The bill also includes;

• National Academy of Sciences to study the Medicare’s cost and payment structure for the dialysis services which include analyzing if there are any adjustments required to advance the development of new therapies.
• Enhance access to home dialysis treatments through telehealth for the patients with end-stage renal disease
• Reduce Medicare restrictions and allow patients to receive treatment from home

CHRONIC Care Act also includes the provision of more and better home dialysis facilities without any limitation. CHRONIC Care Act will expand remote monitoring programs for people suffering from chronic conditions and give the Health and Human Services Department a way to reduce telehealth barriers hence increasing quality and effectiveness of the services.

Texas Law Marks a Turning point in Health Care

Texas Governor Greg Abbott signed a bill that is meant to change the face of telemedicine in the state. With the bill, doctors can now utilize telemedicine services with patients they have not met. This eliminates the previous requirement that the doctor-patient relationship had to be established by an in-patient visit first.

According to Politico, Texas was the last state to still hold onto this need. Now that it has been eliminated, direct-to-consumer telemedicine dealers can now expand their services across the nation. However, there are still limitations on the phone call-based telemedicine in Arkansas and Idaho. The signing of the bill is good news for companies like Teladoc, MDLive, Doctor on Demand and American Well.

The telehealth provider in this State knows as Teladoc is especially cheering this victory as it has been battling with Texas Medical Board for the past six years regarding the issue of telemedicine in Lone Star State. They took the responsibility to preserve telemedicine in the state for more than six years since 2001, and they are gratified to have finally been invited to collaborate with the Texas legislature to accomplish the goal of offering treatment through computers and phones. They are looking forward to showing the nation their video capabilities and end their legal dispute in Texas.

This step is expected to resolve the Texas Medical Board issues with Teladoc and provide people with a means to secure their path to quality, affordable and easily accessible health care. The bill passage is also a win for the Texas’ residents especially those living in rural areas. They do not have to travel all the way to the city searching for health care.

There are potential telehealth patients from all over Texas as everyone will take advantage of this opportunity to get health care from home. This will open the doors to a more convenient health care plan. However, supporters are hoping that its convenience will promote a follow-up by doctors through audiovisual methods. People should understand that this technology is not meant to replace doctors rather it is there to make health care accessible to all.