Category Archives: Telemedicine

Medical technology has made enormous advances in recent years, resulting in shorter patient stays and less invasive procedures. It is even used to keep patients from being admitted to the hospital. How? Through the use of telemedicine.

Telemedicine, or telemedical platforms, uses an audiovisual software platform for video chat between clinicians, nurses, and patients. With this, a physician or nurse practitioner can perform follow up visits with patients without the need for an in-person appointment. The patient gets the face to face time with the clinician and is able to show and tell any symptoms or improvements since the last clinic visit.

What are the benefits of this type of technology? Clearly, a video conference cannot replace physical exams or lab testing. What it can replace, however, are mandatory post-hospital visit checks, checks that are required by many insurance companies, and that doctors themselves desire, to ensure that the patient is healing correctly. For patients in assisted living, or without reliable transportation, these video appointments can make the difference in their quality of healthcare.

Under the current healthcare system, patients may be released from the hospital and then have to be readmitted because of a lack of post-acute follow-up care. With telemedicine, patients are able to be professionally evaluated, with at-home post-hospital care recommended. The repeat trips to the hospital can be even more unhealthy for the patient, and telemedicine removes that risk.

The need for transportation to and from the hospital, such as with an ambulance, is reduced, making those vehicles available more readily for acute emergencies. Providers from the clinic or hospital can evaluate patients around the clock, as long as the staff is available, and recommend at home care, rest, or that the patient is readmitted through the video conferencing. Best of all the telemedical platform is able to retain a patient history report, for easier access to the patient’s history if they access a different provider.

Technology has helped create a more efficient lifestyle in many ways. Now, it can create a more efficient medical system, also. Reducing the number of patients readmitted to hospitals can enhance both the patient wellbeing and streamline hospital treatment for other patients.

The second round of revisions to the Telemedicine rules released in 2016 (revision one was in July of 2017) occurred today in the District of Columbia. The rules from the District of Columbia Department of Health were revised after telehealth industry advocates submitted comments and amendments to the initial rules.

These changes were based in part on the above-mentioned comments, as well as Telemedicine Workgroup recommendations. The DC Board of Medicine made the changes in order to reduce barriers to care and clarify some aspects of the Telemedical Health ruling from 2016.

Several of the changes addressed the validity of doctor-patient privilege and clarified the circumstances under which this is valid. Currently, video and audio consultations will be considered treatment. The new rules also both established that a “real time” consultation would be considered treatment, as well as delineated the parameters of “real time.” Another change was replacing “face to face” with “in person” in order to define the relationship between doctor and patient.

Further, these rules established that if the patient seeking treatment is located in DC, the doctor must be licensed to practice medicine in DC.

Here are the key points for Telemedical Providers:

• Telemedicine has been redefined as care via remote technology
• The rules have flexibility, and video conferencing is not required
• A valid patient-provider relationship can be established remotely, without first requiring an in-person exam. The doctor may provide real-time treatment and exchange protected health information.
• Regulations regarding exams and patient evaluations were further defined. Specifically, the provider must establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient.
• Regulations regarding informed consent, practitioner licensing, and standard of care were further clarified. Patients also must establish alternative forms of communication with the providers in urgent care cases.
• Rules regarding prescribing medications were established
• Medical record requirements were established

These rules and revisions are not exhaustive, or complete. Please be advised that more revisions may occur.

Telemedicine encapsulates the use of the different types of online communications by medical institutions and physicians. By employing technology, telemedicine makes it possible for healthcare providers to remotely care for patients either due to distance, convenience, or home location. It equips caregivers with the ability to transfer and collect essential medical data including photos, videos, and audio. A live Internet connection backs this transfer of information.

In the past couple of years, telemedicine has been a significant proponent in the field of cardiology, psychiatry, radiology, and oncology. Tele-surgery and patient indication are also possible thanks to video conferencing.

The History of Telemedicine

Even though the influence of the Internet is a relatively new phenomenon in the field of medicine, it has a unique history. For some, the advent of telemedicine goes all the way back to 1906, when Willem Einthoven first utilizes the electrocardiogram transmission over telephone lines. In the current day, telemedicine has become more immersive, with a few hospitals experimenting with telemedicine to reach patients who happen to live in remote locations. The potential for telemedicine has amplified as a tool to help alleviate healthcare shortages and to share medical consuls and healthcare records almost instantaneously.

Benefits of Telemedicine

Remote diagnosing. The majority of patients prefer easy access to services over in-person interactions. Telemedicine galvanizes practicality and convenience, allowing medical institutions to offer in-demand care without the wasted time and cost of in-person visitations.

Referrals and specialists. For the patient, they spend less time traveling to medical specialists. For doctors, some are charging less for the convenience of telemedicine consultation versus in-person evaluations.

Remote monitoring. Telemedicine allows physicians to be in tuned with vital signs, enabling them to notice if there is a change in health.

Remote health education. Telemedicine can also be used to convey messages. Since it is closely related to the videos and images – media that can express a lot of information in a compressed format – then it is expected to use telemedicine as a platform to deliver these messages.

Amazon has a secret health tech lab called 1492 which explores various areas such as telemedicine, medical record data and health apps for devices like Amazon Echo. The secret skunkworks is dedicated to opportunities in new areas in electronic medical reads and has a headquarter in Seattle. The project focuses on both software and hardware.

Amazon is increasing its interest in exploring new businesses in healthcare. For instance, it has another unit exploring the sale of pharmaceuticals. The new team is looking at opportunities involving pulling and pushing data from electronic medical record systems.

When the project is complete, Amazon will make information available to doctors and their patients. It is a means of building a platform for telemedicine which can make it easier for people to enjoy virtual consultations with their doctors.

The group is exploring other health applications for existing Amazon hardware such as Dash Wand and Echo. Most hospitals and doctors have already dabbled in developing skills for the voice assistant Alexa which is a great opportunity for e-commerce.

It remains unclear whether the company is building any new health devices. However, sources have already ruled out that option. Amazon has been advertising new roles for the stealth operation which people can search on the jobs websites under the keyword “a1.492.” some job posts have described the position as a special projects team or the Amazon grand challenge.

The unit has been posting ads for UX Design Manager for the new vertical and the machine learning director with healthcare IT experience, knowledge of electronic medical records and analytics. Some members of that team have an affiliation with a1.492 on LinkedIn. Some of the people already involved include two strategic initiative leads, two machine learning experts, and a UX designer. The experts are running projects in the group, eg. Cameron Charles and Kristen Helton.

Other teams are working in life and health sciences in Amazon. The cloud operation has a team of health experts to match Google and Microsoft for contracts with large pharmaceutical vendors and hospitals. Amazon has invested in startup companies like Grail that has a special interest in the cloud business.

The company is taking advantage of opportunities in the $3 trillion sectors and is directly involved in the sale of medical supplies for years. The market has many opportunities, and Amazon will capitalize on the efforts to digitize health operations.

The in-person care services telemedicine reimbursement bill aims to make telemedicine reimbursement equal to in-person care services. Senator Elder Vogel brought the bill to the Pennsylvania Senate on June 28, 2017 to define major components of telemedicine and to set telemedicine licensing requirements. Pennsylvania is bound to be the next state to allow complete telemedicine reimbursement equality for care services. The legislation requires all healthcare payers to provide telemedicine reimbursement if the same services are paid in person.

The bill will ensure that all telehealth services provide reimbursement under the ancillary service plans. The group or individual health insurance plans provide exclusive coverage for vision and dental services. The healthcare services a person purchases through the ancillary plans cannot be absent from the coverage because they were done through telemedicine.

Pennsylvania Department of Human Services will offer medical assistance for reimbursement of the fee for service, medical assistance and managed care programs or general healthcare done through telemedicine under Medicaid.

Healthcare providers must follow strict guidelines set to enable them to receive payments for telemedicine. Providers must establish a provider-patient relationship using appropriate diagnostic tests and virtual exams to give an accurate diagnosis. The provider can use an interactive audio without video IF after carefully reviewing the medical records of the patient.

The provider will give equivalent healthcare to the person. The bill also states that the provider must have an emergency action plan during the telemedicine consultation. Apart of the emergency action plan includes verifying the location of the patient and disclosing the identity of the providers. It also includes obtaining informed consent and establishing a diagnosis and treatment plan. The healthcare provider can create an EHR record using the records of the visit.

The legislation will enhance statewide care delivery using proper payment providers that include Hospital and Health system Association of Pennsylvania (HAP). HAP will ensure the technology provides greater access to quality care irrespective of where the patient is living in the commonwealth.

HAP supports telemedicine as a way of improving healthcare delivery and encourages other hospitals to support the bill so that telemedicine can become a viable care solution. Telemedicine reimbursement gives providers the financial support to enable them to pursue telemedicine care as a means of delivering care to under-served and remote communities in the state.

Similar legislation is before other state legislation and has been passed by other states as well to empower providers to consider telemedicine. The bill offers numerous benefits to patients across the country and strengthens the US Healthcare system.

When Hurricane Harvey caused flooding throughout Houston, it displaced hundreds of thousands of citizens. It is estimated that more than 27,000 homes were destroyed by the savage water, resulting in an extreme number of now-homeless people who lost access to vital prescriptions and medical treatments they need to stay healthy. The field of telemedicine provided displaced patients with the immediate care that they couldn’t get from their local physicians, in addition to medication and treatments for chronic conditions.

Displaced Houston residents with chronic or flood-related conditions can receive the medical care through technology-driven, virtual office visits provided at local disaster shelters through the cooperation of local hospitals such as Children’s Health. It is estimated that for every adult patient there are three children who need medical attention, and a shortage of pediatricians available for 24-hour care means some of these patients could not be treated without telemedicine services.

The use of telemedicine in the aftermath of Hurricane Harvey is made possible by the passage of SB 1107, a law passed in May that allowed Texas residents to see a doctor remotely without an initial visit in person. Texas is the last state in the country to implement this new law, and state physicians were still getting used to a higher influx of new patients even before Harvey struck.

They expect to see patients from Harvey who have been exposed to mold and bacterial infection from clean-up in addition to diagnosing new cases of anxiety or depression as families face an uncertain future. The use of telemedicine in post-disaster situations is relatively new. When Hurricane Katrina blasted through New Orleans in 2015, emergency personnel were often stretched to the limit with the constant traveling between office, hospital and shelters.

Telemedicine allows physicians to “see” dozens of patients a day using just a computer monitor and simple machines to measure vital signs. It is hoped that telemedicine can become the new normal for those who need medical treatment after going through a natural disaster.

Telemedicine has the potential to transform the delivery of mental health care by allowing healthcare providers to connect with patients better and increase their flow. According to a report by the National Institute of Mental Health (NIMH), an estimated 43.8 million adults in the US (1 in 5 people), experience mental health illness every year. Many of these individuals may also be struggling with multiple chronic conditions, phobias, substance use disorders, and suicidal tendencies, and need specialized care from several providers.

Unfortunately, these needs are met with a national shortage of mental health providers, which results in delayed appointment times and missed consults. Many of these people go untreated leading to deterioration in mental health with serious consequences.

Video conferencing and remote monitoring technology can help alleviate the backlog in appointment schedules and provide mental health patients with faster and convenient services. It is saving both hospitals and patients thousands of dollars each year by making consultation with healthcare professionals available from anywhere. This has increasingly supported patient’s access to psychological services at the time they need it the most, without the potential barriers of having to travel to see a healthcare provider or counselor.

By making consultation with healthcare professionals available from anywhere, psychologists can improve continuity of care and follow-up between visits and establish an emotional bond and rapport with the patient in a more private setting. Patients feel more comfortable and safe when care is delivered in the privacy of their homes as they can avoid the perceived social stigma associated with seeking behavioral health support.

Through the virtual visit model, psychiatrists are able to reach more mental patients in distant locations with even shorter appointment times. Patients should plan ahead of their appointments with any relevant records and information, including prescriptions, and a list of questions to address.

Medicaid programs reimburse for some telepsychiatry services in 48 states. Medicare and several other private health insurance companies also cover telemedicine.

As adoption of the technology grows and consumers’ awareness increases, telemedicine companies need to ensure that the systems they provide allow greater operational efficiencies through appropriate reporting and scheduling options.

The phenomenon of telemedicine has taken the American and international health care systems by storm. Research shows the manifold benefits of this kind of medical advancement, which delivers online diagnosis and treatment of patients via video conferencing and other specialized technologies. From efficiency, to convenience and cost-savings, telemedicine has all the hallmarks of a win-win for both patients and health-care providers.

Particularly when it comes to stroke neurology monitoring care, telemedicine stands out in the state of Massachusetts. In 2012, the Massachusetts General Hospital/Brigham & Women’s Hospital Tele-Stroke network, which continues to operate today, saw impressive results with its 24/7 acute stroke neurology services provided to emergency rooms in 11 counties across the state. This amounted to timely and efficient care for more than 700 patients who may not have otherwise received immediate care due to the many inefficiencies of in-person treatment. A deeper analysis of the Tele-Stroke network’s results in 2012 confirmed its effectiveness in curtailing approximately 400 would-be patient transfers to the state’s university hospitals, saving the Massachusetts health-care system upwards of $2 million. Which state couldn’t benefit from millions in savings?

With positive outcomes like these, some lawmakers are energized to expand telemedicine services in the state. Such is the case with Massachusetts State Senator Jason Lewis, who enacted legislation designed to do just that. Lewis said the law “will ensure parity in insurance coverage for telemedicine services at equivalent payment rates as in-person treatment; streamline the credentialing process for Massachusetts licensed clinicians using telemedicine services within the state; and ensure a uniform and consistent approach when defining telemedicine services.” The legislation has gained widespread support across a broad spectrum of health-care organizations, including the American Heart Association/Stroke Association, AARP Massachusetts, and the Massachusetts Health and Hospital Association, to name a few.

If the results of Massachusetts’ 24-hour Tele-Stroke Network says anything is that more health-care providers (and patients) would do well to get in on it. You’ll be happy you did.

Telemedicine on Vacation Better than Urgent Care or a Hospital Emergency Room for Minor Medical Conditions

The perfect situation for receiving medical care is when you see your doctor in person. However, if your family is away on vacation and one of you falls ill, a telemedicine visit can salvage the vacation for the rest of the household. Telemedicine is usually a substitute to a hospital emergency room or urgent care center for minor medical conditions.

This alternative allows those people on vacation to visit a qualified doctor if they need to address a health dilemma for their children or themselves. Telemedicine, also referred to as remote medical care is a situation where the patient and the health provider are in two different localities connected by a secure video or telephone link.

Univera Healthcare officers predicted that the residents of New York State are expected to use remote medical care over 50,000 times by 2018. The emergence of user-friendly applications for all computerized gadgets, developments in clinical management and many people having health insurance policies that are high-deductible are the primary reasons propelling the remote medical care trend.

Telemedicine services are accessible to anyone, irrespective of having a health insurance or not. However, simple platforms are being established by most health insurance providers to make it easy to arrange for a telemedicine visit. The Univera Healthcare also found that ten medical conditions represented over 2 million annual visits to emergency rooms in the state of New York, and nine out ten appointments could have been avoided or taken care of elsewhere, including a telemedicine appointment.

If you are away from home for a family vacation this summer and one of you falls sick and is in need of medical attention due to minor illness, telemedicine offerings can address most natural conditions and also recommend medication once medically indicated.

Having a simple telemedicine app in your smartphone can salvage your family’s trip this summer. This app will give you access to a certified telemedicine doctor from your place of vacation in case of any medical eventualities.

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.