Category Archives: Telemedicine

Upon first impact of hurricanes Harvey and Irma, the primary healthcare priority was the physical health of those affected by the disasters. However, in the wake of the hurricanes, the mental well-being of the residents also became a chief concern for healthcare providers. Not only have telemedicine services be used to connect storm-affected persons to traditional healthcare providers, they are also being used as a vital method for catering to behavioral health needs.

“Once the immediate physical danger has passed, then people start to experience the traumatic feelings of realizing that perhaps they’ve lost their home or maybe they’re in great financial distress,” Dr. Sylvia Romm, medical director at American Well, pointed out. “That’s where the therapist can come in and help them move forward with their lives.”

In the aftermath of the hurricanes, behavioral health is one of the free services being provided by American Well and others.

Telemedicine is an appropriate and effective method for the provision of aid to those affected by natural disasters, as many of the victims are displaced from their homes in an emergency situation. “You have such large numbers of people who’ve been displaced,” Romm explained. “Even if they had a therapy relationship, chances are they wouldn’t be able to access them any longer.”

Larry Gleit, executive vice president of specialty care at MDLive, explains that this is so because, in addition to patients, healthcare providers have also been displaced by the disaster. “Part of why telemedicine becomes so important is that all of the providers live in the community have just experienced the same natural disasters.”

In addition, Gleit pointed out that a scarcity of behavioral health providers is already being felt. “In general, there’s a dependency and need to use virtual care,” he stated. “The need becomes compounded in situations like this.” During the weeks following the hurricanes Harvey and Irma, MDLive provided people in affected areas telemedicine visits free of cost.

Drones were also employed by the American Red Cross, for the very first time, to gain an idea about the extent of damage in parts of Texas, and to obtain an accurate assessment about which areas were most in need of assistance.

Integrating current telemedicine techniques into your healthcare practice can provide you multiple advantages. These include reduced costs of healthcare, a more efficient practice, increased revenue, and provision of easier access to healthcare for your patients, all resulting in healthier, more satisfied patients who wish to remain under your care.

Convenience is the magic word in today’s world, and this holds true in the field of healthcare too. The addition of telehealth to your practice will help your patients obtain quick yet customized care, without having to deal with setting appointments, wasting time, and shouldering the cost of in-person visits.

The option of virtual visits can make accessing healthcare easy for patients who are housebound, live in distant locations, or are unable to take time off their jobs.

Virtual monitoring and consultation, along with electronic storage of data, decrease the service costs of healthcare to a great extent, increasing cost-efficiency for healthcare providers and patients, as well as insurance companies. In addition, telemedicine helps cut down on avoidable visits to the ER for minor issues and reduces the transport costs for routine checkups.

By using telehealth, fast and appropriate specialist access can be provided to patients residing in distant or rural areas. The specialist to the rural patient ratio in the United States is greatly imbalanced; for every 100,000 patients in remote areas, there are just 43 available specialists.

As a result of this shortage, patients have a hard time obtaining consultations in life-threatening circumstances or for rare/chronic diseases. In addition, they often have to travel long distances to meet appointments and receive care.

Patients’ commitment to their own care is vital for improving health and reducing costs. As pointed out by Jan Oldenburg (Ernst & Young Senior Advisory Services Manager) to Healthcare IT News, “[t]he high cost of disengaged consumers affects everybody.” Telemedicine compels patients to contribute a higher level of involvement in their own care, and this can push them to be more regular are careful about meeting appointments and adhering to schedules. This increased involvement can also help lower the rates of obesity and use of tobacco, by motivating healthier lifestyles among patients.

Telemedicine is focused primarily on the benefit and convenience of the patient – e.g. the provision of appropriate and timely care. This is essential, in order to ensure that the care provided is high in quality. Using telemedicine, patients are able to obtain urgent consultations as and when they experience any health issue and gain information on options for treatment in no time.

A recent study reveals that patients who receive care via telemedicine display lower rates of stress, depression, and anxiety, in addition to having 38% fewer admissions in hospitals.

There are multiple treatment options for BPH, and when selecting a method, it is important for men to deliberate on the pros and cons of each. The option of prostate surgery has widely been considered the most effective method of treating BPH, but it is also the treatment option involving the greatest number of risks.

Treatment of BPH through medication is suitable for men who display major symptoms. Medicines for the treatment of BPH include alpha-blockers, which work to relax the prostate muscles and the bladder neck, consequently relaxing the urinary obstruction which occurs owing to an enlarged prostate in BPH.

Side effects of such medication include fatigue, headaches, lightheadedness, or difficulty with ejaculation. The most common types of alpha-blockers used for treating BPH include alfuzosin (Uroxatral), tamsulosin (Flomax), and medication that is older including silodosin (Rapaflo), terazosin (Hytrin), or doxazosin (Cardura).

The enlargement of the prostate in BPH is directly linked to DHT, so these medicines and help decrease the prostate size by 25% over 6-12 months. As a result, it takes this long to see betterment in urinary symptoms of BPH.

Transurethral resection of the prostate (TURP) is another procedure that has long been used for the treatment of BPH. Following the administration of anesthesia, a specialized instrument is inserted into the urethra via the penis. The instrument is then used to cut away parts of the inner prostate, thereby allowing for easier, unobstructed flow of urine from the bladder.

Laser treatment: There are many laser procedures available, and some of these can be administered in a doctor’s office with little to no anesthesia required. They focus on removing the tissue in the prostate that is causing obstructions. In these procedures, there is generally less bleeding involved and the recovery time is shorter than that for TURP.

Microwave therapy:
This type of therapy is usually delivered in the doctor’s office and is centered on using microwave energy to kill some cells in the prostate, which leads to its gradual shrinking.

Telemedicine has had profound implications on doctor-patient interactions and the provision of treatment and healthcare. However, despite its multiple benefits, the healthcare world has been slow in accepting and implementing telemedicine, and the entire process has been interspersed with complications. All this leads up to the big question – is telemedicine the healthcare of the future?

What are the implications for traditional healthcare organizations?
The hesitation to adopt telemedicine in clinics and hospitals is motivated, in part, by the apprehension that it might take the place of in-person contact and consultations between providers and patients. If patients can access their healthcare providers from the comfort of their homes, why would they bother coming to hospitals and clinics? However, this is nothing more than a misconception.

Instead of fearing the change, healthcare providers need to realize that telemedicine can be a great way to increase revenue. Setting up a system which allows patients remote access to doctors for virtual consultations will keep losses from skipped appointments to a minimum. Even if patients are unable to travel to the hospital/clinic for some reason or the other, they can still keep their appointment by arranging a virtual visit and then submitting payment for it online.

Therefore, the solutions provided by telehealth should be seen for what they are – effective growth opportunities for businesses, without incurring extra costs or utilizing excessive amounts of resources.

What are patients’ opinions on telehealth
Patients’ views on telehealth solutions are divided. Some patients are of the opinion that it is impossible to provide complete and thorough health care, diagnosis and treatment without an in-person visit and a physical examination. Patients who reside in rural or remote locations, however, feel that it is an effective and convenient solution, as it gives them the ability to consult specialists, which would be very difficult for them otherwise.

A global revenue forecast for telemedicine (2013-2018)
On a global scale, an increase has been detected in telehealth services and devices, suggesting that adoption of telehealth is on the rise. In light of this, the market is estimated to be worth $4.5 billion USD by 2018.

This growth and prediction suggest that despite the suspicions about telehealth and the quality of the care it provides, it is gradually gaining acceptance among providers and patients, as it increases convenience and ease of access to care, consequently leading to better healthcare results.

The growing pervasiveness of telemedicine software usage is also due, in part, to the increase in mobile phone usage, and changes in the behavior of patients, who are now connected 24/7 through smartphones and wearable gadgets such as smartwatches. In addition, the growing adoption of telemedicine can also be attributed to the ease it provides to chronically ill patients and those living in remote areas where they have little to no access to specialists.

The advantages and pros of Telemedicine are becoming increasingly hard to ignore, and these positive indications are not based on talk alone. Rather, they are backed by numbers – research and statistics indicate that Telemedicine shows huge potential for growth in the future, and added benefits for both providers and patients. Research shows Telemedicine is on a steady upward track and is likely to become more widespread and mainstream in the near future.

Globally, in 2014, the worth of the telemedicine market was pinned at $17.8 billion, and it is estimated to be far more than that by 2020. According to an estimate by ATA President Dr. Reed Tuckson, 2015 will see roughly 800,000 virtual consultations in the United States alone.

These promising signs are also echoed by healthcare systems, legislators, doctors, and patients – a current survey revealed that 90% healthcare executives were working on the creation/implementation of a telemedicine program. In addition, 84% of these executives believed in the importance of such a program.

Detractors of telemedicine claim its greatest drawback is lack of in-person visits, which they believe are not as effective as virtual visits. However, 76% of the patients in a survey claimed that being able to access a healthcare provider was more important to them than in-person visits with doctors.

In addition, just 16% of the patients said they would prefer going to the ER for a minor health issue if they were able to obtain treatment through telemedicine instead. Given the overwhelmed capacities of primary healthcare providers and the constant lack of open slots for patients, these numbers displaying patients’ openness to using telemedicine are a promising trend.

Owing to its relative newness, research on telemedicine and its impact is still in its nascent stages; however, various surveys have shown promising results. Following the implementation of telemedicine for patients with a history of heart attacks, the Veterans Health Administration found that hospital readmissions owing to heart failure were reduced by 51%.

Another research, conducted on the Geisinger Health Plan, found that telemedicine led to a 44% drop in 30-day readmissions to the hospital. Furthermore, on the patients’ end, a recent survey of 8,000 patients who received care through telemedicine found that they reported no difference between in-person care and virtual sessions, in terms of the results of their treatment.

Telemedicine is steadily cementing its position as an effective method for providing healthcare. A survey of healthcare executives revealed that the main motivation behind their implementation of telemedicine was the aim to enhance the quality of care being provided to patients.

Another research found that healthcare providers reported that the greatest advantage of telemedicine was being able to provide care 24/7. Close to half of the patients also responded that telemedicine compelled them to become more involved in their care and treatment.
Telemedicine is on an upward track toward a promising future.

By this point, you must be familiar with the concept of telemedicine. But what exactly is the procedure for the delivery of telemedicine systems? What are the technologies used to establish digital connections between doctors in metropolitan hospitals and patients living in distant, rural locations? Given the widespread proliferation of the internet, the methods for the delivery of telemedicine have undergone a change.

Now, all patients in rural areas need is a basic internet connection, and they can use it to avail at least some of the benefits of telemedicine. These are some of the types of connections that are used for telemedicine.

Networked Programs
The prime purpose of networked connections – such as high-speed internet lines – is to link small health centers in distant, rural locations with central hospitals in urban areas. As per the ATA, there are currently close to 200 networked programs for telemedicine in the United States, which provide over 3000 rural locations access to telemedicine.

Point-to-point Connections
Point-to-point connections use the high-speed internet to establish links between small clinics in remote locations and one large hospital. Telemedicine connections of this sort allow clinics that are small or dealing with a shortage of staff to outsource cases to medical care providers based in other facilities within the system. Point-to-point connections are used particularly for teleradiology, telepsychiatry, and cases requiring urgent care.

Monitoring Center Links
Monitoring center links are utilized exclusively for a single kind of telemedicine, i.e. remote patient monitoring. A digital connection is established between a patient’s home and a medical monitoring facility in a distant location. This connection allows for the measuring of patients’ medical data while they are at home, and the data is then electronically transferred to a medical facility in a distant location. Links of this sort are usually formed via internet, telephone, or SMS connections, and they are generally used for monitoring the data of cardiac, pulmonary, or fetal cases.

Integrating telemedicine with a healthcare practice can seem daunting and is a big decision to make. While there is no doubt telemedicine provides a wide range of solutions and advantages for providers and patients alike, it can be hard to reconcile it with a more practical outlook, and you might find yourself wondering whether telehealth can generate any revenue at all.

However, here are three ways in which telemedicine can help bring down your costs and boost revenue.

1) Reduction of costs at Dept. of VA
The Department of Veterans Affairs provides care to veterans and covers multiple, diverse areas – this means that traveling long distances for appointments often becomes inevitable for service members. To mitigate this problem early on, the Department of VA put a system in place which provides travel reimbursements for eligible patients. This cost can be greatly reduced through telemedicine.

2) Increased Healthcare Efficiency Leads to Greater Revenue
Telemedicine can lead to greater streamlining of the care provided by overcrowded departments of mental health. Mental health hospitals and clinics are usually deluged with a large number of patients’ requests for appointments, and overburdened capacities often mean that patients have to wait up to a year for their appointments. Owing to the extended wait period, most patients either forget their appointments or neglect their care completely – this results in additional costs for the institute, in terms of time, results, and overall efficiency. By offering the option of telehealth consultations to patients, providers have the chance to greatly increase their productivity. Providers can conduct faster and more efficient examinations of patients through customizable care offers, sessions conducted via video conferencing, and hours that are more flexible.

3) Mississippi Pilot Displayed Cost Savings in Diabetes Treatment
As per an article in the Health Data Management, a Mississippi telehealth pilot program reported savings with over $300,000 in the treatment of 100 patients of diabetes during six months. Not only did the results display lowered blood glucose levels and early diagnosis of eye disease linked to diabetes, but there were also reductions in travel expenses, and no instances of hospitalization or visits to the emergency room owing to diabetes.

The situations outlined above occur all over America, and you can also come across them on a global level.

Find out how you can benefit from OurDoctor.

Previously, Medicare’s rules and requirements for reimbursement of healthcare providers for services delivered through telemedicine were very stringent and only limited to a few types of health services.

During the last few years, owing to the expansion of telemedicine, Medicare has extended the list of telemedicine services that they reimburse; however, there are still many rules for how these services need to be provided, in order to meet their criteria for reimbursement.

The following are a few key points of information regarding Medicare and Telemedicine.

Rules for determining Originating and Distant Sites. Medicare provides reimbursement for telehealth services that providers offer from a Distant Site to patients at an Originating Site.

As per the law, Originating Sites can be any of the following:
Hospitals
Offices of physicians or healthcare practitioners
Critical Access Hospitals (CAH)
Rural Health Clinics
Federally Qualified Health Centers
Skilled Nursing Facilities (SNF)
Hospital-based or CAH-based Renal Dialysis Centers
Community Mental Health Centers (CMHC).

The patient needs to be located in an HPSA. According to Medicare’s rules for reimbursement, not only must the beneficiary receive care virtually at one of the Originating Sites specified above, but this setting must also be situated in a Health Professional Shortage Area (HPSA).

Facility fee eligibility. Along with reimbursing services provided via telemedicine, Medicare also pays a facility fee to the originating site. For instance, primary care providers who are dealing with a patient in person, and decide to conduct a telemedicine consultation with a physician present in another location, can submit two separate bills for reimbursement – one for the telemedicine service they provided, and the other for a facility fee (for hosting the virtual visit).

Eligible healthcare providers.
As per the rules of Medicare, only the following providers may offer care through telemedicine:
Physicians
Physician Assistants
Nurse Practitioners
Nurse Midwives
Clinical nurse specialists
Clinical Social Workers
Clinical Psychologists
Registered dietitians or nutritionists.
Telehealth types.

Medicare provides reimbursement solely for live telemedicine, which involves real-time interaction between a healthcare provider and a medical beneficiary (patient) through a protected, private video chat. This sort of virtual visit serves as a substitute for an in-person consultation.

A recent study published in Medical Decision Making outlined a detailed comparison of telemedicine (usage of telecommunications technology for remote consultation, diagnosis, and treatment of patients) with consultation via telephone for pediatric cases in remote-area hospitals. The findings of the study, conducted by researchers at UC Davis in Sacramento, revealed that telemedicine saves upwards of $4,500 per case, which more than makes up for any expenditures on the technology.

Previous studies have already established the advantages of telemedicine for children and their families, as well as doctors – telemedicine is known to decrease errors in medication, and increases satisfaction on part of both patients and parents. However, little research has been done on finding out whether it cuts costs for any of the parties involved.

The study was conducted by researchers belonging to UC Davis’ Pediatric Critical Care Telemedicine Program, and its sample included consultations offered by healthcare providers at UC Davis to 8 emergency departments in rural areas, between 2003 to 2009. Within this duration, the researchers delimited their study to five conditions – dehydration, fever, pneumonia, asthma, and bronchitis.

These conditions were chosen because they can be treated in remote hospitals and do not require the aid of telemedicine.

The researchers compared each rural clinic’s expenses for installation of equipment required for telemedicine to the costs of transport and on-call specialists – the findings revealed that each cost around $3,640 but also saved $4,660 on average. The cost of telemedicine consultations, in fact, reduced patient transfers (and costly transfers via air ambulance) by 31%.

Physicians based in California are paid for consultations via telemedicine but providers in various other states do not enjoy the same advantage. James Marcin, interim head of pediatric critical care medicine at UC Davis, stated that owing to the varied benefits of telemedicine, it is prudent to work on creating incentives for physicians to adopt this model, by ensuring that they are paid for implementing and utilizing this technology.

The savings that can be obtained via telehealth are not solely limited to a decrease in healthcare costs. The implementation of telehealth in the workplace also leads to minimal time wastage, decreased nonattendance rates, and increased productivity among workers.

As with all other forms of technology used in the sphere of healthcare, telemedicine also needs to ensure compliance with HIPAA, for the purpose of protecting the privacy of patients. Apps such as Skype might provide a platform which doctors can use to provide virtual sessions to patients, but employing the app for this purpose is not an HIPAA-compliant practice. Any form of technology employed for the purpose of telemedicine must provide fool-proof security and guarantee the safety and privacy of patients’ personal information.

A number of states in America have laws of this sort, which make it mandatory for parties such as developers of telehealth apps to ensure their compliance with various rules for security and privacy, regardless of whether or not their company is subject to HIPAA.

Some laws in California decree that apps must have the “do not track” feature. Florida completely revamped its law for reporting data security breaches the previous year and passed a law this summer which requires that detailed contact information is made available on websites and digital services online.

It is vital for present health apps, telehealth apps, and developers of consumer-targeted tools for health to take these laws into account. States are working on extending the scope of laws for ensuring privacy and security, and developers of health apps need to comprehend these laws and adhere to them.

However, as pointed out by the National Policy Telehealth Resource Center, “Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is more complex than simply using products that claim to be ‘HIPAA-compliant.” It is not enough for the platform being used for telemedicine services to be compliant – the patients, providers, and staff members utilizing the tool also need to make sure that they are HIPAA-compliant.

For example, in addition to creating a product that guarantees security, telemedicine software designers will also need to make sure that their companies are in compliance with HIPAA.
Compliance with HIPAA involves a structured set of safe practices which include stringent documentation and monitoring, between parties whose privacy is ensured.

Products in themselves cannot guarantee compliance – however, certain products might have components which permit users to employ them in a way that is in accordance with the HIPAA.