Category Archives: Telemedicine

A leading innovator in telemedicine technology, Arizona has made many advances in telemedicine that has saved lives, lowered health related expenses and improved outcomes for patients all over the world. Pivotal advances that have come from telemedicine include:

GlobalMed: Recipients of the W.P. Carey Spirit of Enterprise Award for Innovative Leadership in 2012 and an industry leader in telemedicine, telehealth hardware, software, research and design, GlobalMed is based out of Scottsdale, Arizona. Their transportable exam stations have been used in countries like Chile and the island nation of Cape Verde.

T-MedRobotics: Specializing in robotized tele-echography systems, their robotized system MELODY would become commercialized in 2013 after years of intensive research. Based out of Scottsdale, AZ, their tele-ecography system is showing 90% concordance with a regular echography.

Recognized as an innovator in telemedicine expertise, Arizona telemedicine professionals include over a thousand graduates who have done their training in telemedicine and have worked with affiliate programs like the SouthwestTeleHealthResourceCenter and the Northern Arizona Telemedicine Alliance. Pioneers in their field, these top leaders include:

• Dr. Ronald S. Weinstein, President and Founding Director, and known as a pioneer in telemedicine, he successfully runs the Arizona Telemedicine Program (ATP). He has completed many publications and received several awards for his work in telemedicine and the development of virtual slide telepathology systems.
• Elizabeth A. Krupinski, PhD, Vice Chair of Research in Radiology, she is a Professor at the University of Arizona and works as the Associate Director of Evaluation at the American Telemedicine Association

Arizona telemedicine has also been in the news for the many advances they have been making with successful programs which include:

The Mayo Clinic telestroke program: What started as a trial in 2007 has led to the development of 11 remote sites and networks in Arizona, Florida and Minnesota.

The Banner Health eICU program: This telemedicine program has helped to decrease hospital stays and offer better, more affordable care. Located in Mesa, AZ, the iCare center keeps track of 430 ICU patients from 20 different hospitals located in 5 states. It works successfully in conjunction with the doctors and nurses at their locations.

Telemedicine Training: As Arizona continues to make successful strides in telemedicine, we look for more news in the future on their endeavors. If you’re interested in finding out more about telemedicine school and training, the Arizona Telemedicine Training Program has been running its program now for over 17 years with programs offered in Tucson and Phoenix.

Telemedicine Directory: For more information on Telemedicine providers in your area, be sure to look for the ATP National Telemedicine Telehealth Service Provider Directory that has over 25 telemedicine companies with services offered in Arizona and other areas.

Startups have blended telehealth reality for both healthcare providers and patients. However, unlike other industries, telehealth applications may come into contact with HIPAA data protection since HIPAA defines health care rules. It is, therefore, important for developers to familiarize themselves with certain rules before coming up with these apps.

HIPAA (Health Insurance Portability and Accountability Act) is a law that regulates the management, storage, and transmission of PHI by healthcare professionals and their business associates (vendors or subcontractors who have access to PHI). PHI (protected health information) refers to any information in a medical record created, used, or disclosed while providing health care services that can be used to identify an individual.

Although the September 2013 Omnibus Rule Update clarified HIPAA, developers find it difficult to interpret its technical specifications. One of their primary concern is how to add HIPAA compliant video to a healthcare app. To address this, developers need to understand how this law works.

HIPAA compliance for Telemedicine Video Doctor Visits

There are two major sections that govern HIPAA; the Privacy Rule and the Security Rule. The Privacy Rule applies to PHI in any form. It requires covered entities to set up physical, technical, and administrative safeguards to protect PHI.

The Privacy Rule compliance is only applicable if your app creates, maintains and transmits PHI: If it does, then it is imperative for you to meet the requirements of the Privacy Rule and obtain satisfactory assurances.

Security Rule closely affects developers as it applies to E-PHI (protected health information in electronic form). The rule discusses acceptable ways to implement necessary security measures to protect E-PHI from unauthorized access, deletion, alteration, and transmission. It addresses video conferencing concerns in a straightforward way, stating that E-PHI excludes information that did not exist in electronic form before transmission such as video teleconferencing, paper-to-paper faxes and messages left on voicemail.

HIPAA defines electronic media as transmission media used to exchange information that is already in electronic storage. It means that your telemedicine app only need to meet the requirements of the Security Rule only if it has capabilities to record the consultation between the doctor and a patient.

A number healthcare apps often rely on another party to power the video calling feature making the other party a business associate as well. In such a case, you must obtain satisfactory assurances that the third party meets the requirements of the Privacy Rule.

How can telemedicine app developers reduce the burden of HIPAA compliant?

Choosing a video conferencing service that does not require PHI access can contribute to reducing this burden.

The health information of a patient is considered to be PHI only if it belongs to someone who can be identified. To reduce the burden of HIPAA compliance, telehealth app developers can use opaque user IDs to authenticate users to the video call anonymously.

Ensuring that you are not sharing PHI with a third party is also a vital factor to consider since it helps you avoid extending HIPAA applicability to the other party

Remember that all these are applicable in cases where there is no storage of conversations. Security measures set by HIPAA may not provide the level of privacy you aim to have for your app, and it is, therefore, important to consider other measures such as end-to-end encryption.

HIPAA compliance is ultimately the responsibility of telemedicine app developers, and they are required to take the necessary security and safety measures. However, developers should be in a position to determine if a telehealth app needs to be HIPAA compliant or not.

Telemedicine is a favorable mode of treatment for the rural population as it gives them a chance to access physical consultation as well as specialty health services without having to travel long distances. Telemedicine is the ideal equalizer for the people living in the rural areas who usually have to make do with inadequate services and less than ideal health outcomes in comparison to the urban populations that have large medical centers at its disposal.

Diabetes control is one of the most affected areas in Rural Arizona. Patients suffering from the illness have to take frequent trips to visit their specific healthcare providers and may spend between 1 to 2 hours one way on the road. Overall, doctors prefer to see diabetes patients regularly for not less than four times in a year. Diabetes patients must also have a regular appointment with a nutritionist, get tests done on their eye and feet every year, get their blood sugar regularly screened as well and get their medication supplies refilled. As much as the trips are necessary and may mean the difference between life and death, they can drain the patients’ resources due to the transport costs and time spent.

We will be launching a new project dubbed Tuba City Regional Healthcare Corporation or simply (TCRHCC) in the fall of 2015 in Tuba City to facilitate the expansion of telehealth services for diabetes care which will include screening and telenutrition services. The project will avail these crucial services to communities in the remote areas of Navajo Nation. It will involve using a telehealth vehicle to bring healthcare such as telenutrition visits, screenings and routine blood pressure tests closer to the people. This project was financed in 2014 by a lump sum grant from the charitable Special Diabetes program set aside for the Indians. It will enable people to get quality diabetes care through telemedicine while making fewer trips to the clinic. However, they will still have to visit the doctor occasionally for personalized care, but they can now go to the Chapter Houses for general check-ups like screening, eyes and foot tests and nutrition advice.

Limitations for the Rural Telehealth
Despite the fact that telehealth is an excellent way of easing health problems for rural patients, it is not without its share of challenges. The main challenge is the inadequate infrastructure in the rural Arizona in terms of internet reach, and impassable roads. The scattered population further compounds the problem, and the poor WIFI signals make video conferencing difficult.

Future prospects
TCRHCC plans to increase its telemedicine services in future with the help of the grant that has enabled the acquisition of better facilities. We are in the process of setting up a telestroke program in collaboration with the Arizona-based Mayo Clinic. We are also hoping to duplicate the ECHO project of the University of New Mexico in Northern Arizona that will offer specialized treatment like rheumatology, and pulmonology.

For those who have been living under a rock like myself, a Fibit is a physical performance tracker that you wear on your wrist that monitors all of the activity you do each day. The idea is for you to track progress toward a weight loss or fitness goal in increments, to show you that even with the littlest step you’re making progress. Now it seems that President Barack Obama is going to give the Apple Watch App Fitbit a try.

When recently interviewed President Obama announced that he would consider using the Apple Watch to track how he is progressing on his fitness goals, citing that it might be a good companion to his workouts. Although he wouldn’t endorse the product before he had tried it, he did acknowledge that it had gotten favorable reviews. The Apple Watch was shipped out in April 2015 and includes a built-in heart rate monitor and accelerometer operated through optical sensors.

President Obama has always had an interest in technology-driven communication. His notorious refusal to give up his Blackberry when he took office is proof of that. Now he has revealed that he stands behind mobile health programs like telemedicine or telehealth, and of course the FitBit. During his 2011 State of the Union Address Obama stated that he wished to have 98 percent of Americans covered by high speed wireless networks within 5 years in order to connect all parts of the country to the new digital age. While we are still a year from reaching his anticipated deadline, according to the Mobile Technology Fact Sheet, as of October 2014, 64% of Americans owned a SmartPhone.

It remains to be seen how President Obama reacts to the FitBit and its fitness benefits. As a wearable device that is both tech-savvy and sleek he should have plenty to talk about. And for the Fitbit, that means there will be plenty who will jump onto the Mobile Health bandwagon, including the use of telemedicine or telehealth to diagnose and treat illness.

Within stroke telemedicine, also called telestroke, doctors neurologists (or nerve specialists) distantly evaluate patients, who’ve experienced a possible stroke and make diagnostic and therapy recommendations in order to assist emergency room doctors. They communicate utilizing digital camcorders, Internet telecoms, robotic telepresence, smartphones along with other technology.

Possessing a prompt nerve evaluation boosts the chance you might receive thrombolytics (or therapy that dissolves clots) or some other method that find clots in time to lessen the chance of disability as well as death caused by the stroke. Within stroke telemedicine, the neurologist will offer care locally trying to avoid your transfer to a different medical center. This particular focus on local care frequently allows you to get quality stroke care in the area.

Stroke telemedicine usually operates in a large metropolitan medical center that serves as the main hub. Remote control locations, generally smaller local rural or even underserved private hospitals, serve as the actual spokes in this hub. Numerous regional private hospitals don’t have neurologists on call in order to recommend the best care. Therefore, the neurologists at the hub consult remotely with physicians and people that have had severe strokes.

Within telestroke, there is teamwork including a system manager, the clinical planner, vascular neurologists, neurosurgeons as well as radiologists in the hub, and unexpected emergency medicine physicians and other personnel. Radiology technicians, educational technology personnel, researchers, nurse practitioners, nurse professionals and other personnel also are essential team members of the stroke telemedicine team.

In telemedicine, if your doctor suspects an severe stroke, she or he will contact the stroke telemedicine hotline at the hub, with a dedicated hotline and team paging program with neurologists available 24 hours a day and throughout the year. The hub’s on-call neurologists usually reacts within 5 minutes. The neurologist works together with your doctor to look for the most appropriate therapy and transmits the treatment suggestion electronically.

Having a quick evaluation boosts the chance that which treatments that thrombolytics could be delivered quickly so as to reduce stroke-related disability. To work effectively, this treatment must be given 3-4. 5 hours once you experience stroke symptoms.

Technology has led to the advancement of service delivery in almost all industries and sectors of product and service delivery. In the medical field, this progress has resulted in the invention of telemedicine. That is a program that assists medics to monitor their patients remotely. According to statements made at the American Telemedicine Association 2015 Annual Meeting, telehealth has been significantly effective. This remote monitoring has minimized the readmission rate of patients quite alot.

Readmissions lead to increased costs that may hinder the efficient operations of medical facilities. Currently, this telemedicine program is in its initial test stages and so far it has posted successful results. Telehealth technology is highly reliable in the reduction of value-based billing. A majority of the patients are incorporated into the program while they are in the hospital. On discharge, the patients are continuously monitored via this telemedicine and catered for incase of slight deviations from their anticipated recovery.

The program ensures that there is constant communication between patients and clinicians. A majority of patients are comfortable and fully satisfied with this program. Since inception, the rate of readmissions has reduced with cases of hip and knee injury readmissions almost being eliminated entirely. Though this program requires many staffs in a medical institution, when implemented it significantly decongests the hospital. Telemedicine has solved the problems that arise as readmission penalties.

This program transmits electronic medical data records to a platform from which the clinicians may access them in real time and assess the recovery of the patients enrolled in the program. Within a period of just 30 days, the readmission rate at the University of Virginia Centers for Medicare and Medicaid had decreased. Through this test program, doctors and clinicians alike are confident that this remote monitoring technology will reduce costs and readmissions in hospitals all over the world. This remote monitoring ensures full recovery of patients without the need for any readmissions and other avoidable hospital expenses.

When it comes to telemedicine, the Apple Watch heart monitor may be one of the best products on the market today. Heartbeat monitors in watches and fitness tracking bands are not necessarily a new thing, but they are not always accurate. The Apple Watch stands out because it is creating clinical-quality results. What makes these watches so different are the biometric sensors built into them.

Accuracy Matters

Apple originally designed the watch to offer high-end, every accurate measurement tools for blood oxygen levels as well, but pulled back on this after accuracy concerns. However, when it comes to heart rate, it seems to be right on point. One engineer from SonoPlot, a plotting instrument company compared the watch’s heart rate monitor to that of the Mio 2, which creates EKG-quality results in a device worn on the risk. The results tracked very closely. The Mio 2, which has been scientifically proven to be accurate, seems to match the same quality in terms of functionality and accuracy.

Why Does It Work So Well?

While other heart rate monitors seem to provide high quality results, the Apple Watch stands out. It uses two LED lights and light-sensitive photodiodes to pinpoint the amount of blood flowing through the veins at any given time. The green LED lights pulse right down through the skin hundreds of times each second. Since a heartbeat creates a higher amount of blood flowing through the veins, the device senses the heart rate. The higher amount of blood absorbs less of the LED light than the lower amounts of blood, giving the device information. From this, the watch calculates the beats per minute.

As far as the oxygen sensors, the company was unsure if it could achieve the same level of accuracy due to hair, sweat, and dirt factors, and therefore does not guarantee its accuracy.

When it comes to telehealth, it is more efficient and effective than ever to not just know that your heart rate is changing on that run, but also that it is being monitored very accurately. Not only could this be effective in terms of fitness goals, but in telemedicine, where technology is leading the way in helping to diagnose, monitor, and treat a variety of medical conditions. With EKG-quality results, this is a device likely to be used in telehealth for years to come.

Healthcare given via telemedicine will be paid similarly to the physical doctor visits in 24 states as reported by the American Telemedicine Association during its annual meeting. Reasonable progress has also been observed in telehealth regulations over the last six months.

During its annual conference in Los Angeles this week, the ATA announced that 24 states including Washington, D.C. have endorsed equality laws obliging similar coverage of and payment for services offered via telemedicine akin to in-person services by state-accepted private insurance policies, state worker medical programs, and Medicaid. Last September three more states had similar laws in operation.

Pediatrician James McElligott the medical director for telemedicine at the Medical University of South Carolina (MUSC) Health said in an interview that in South Carolina Ninety percent of the private insurance is Blue Cross Blue Shield and they had each year made little or no progress in telehealth payment with this being the reason they will not go the parity legislation way.

Medicare payment for telehealth services, the only type not covered by the ATA investigation, is a still a challenge to states with a particular kind of topography, for instance, South Carolina.

According to Mark Lyles the MUSC which is operated and owned by South Carolina State, was still able to acquire over $31 million in the face of these hardships in two years time to craft a statewide telemedicine scheme. Lyles is the MD and chief strategic officer at the clinical enterprise of MUSC. MUSC then procured complementary funding from the Duke Endowment and others; Lyles told an ATA meeting.

Lyles further added that they are presently engaging with key lawmakers to escape from the one-time apportionment procedure, which makes it difficult to plan for the future and as a result they are soliciting for some of the future aid to be integrated into the base budget.

The report of ATA Coverage and Reimbursement ranked Rhode Island and Connecticut at the bottom. The Report evaluates telemedicine implementation for each state in the U.S. based on 13 pointers. Ever since the release of the initial in September 2014, the District of Columbia and five other states have maintained the very high composite score signifying an obliging strategy landscape that promotes telemedicine acceptance while Mississippi and Maryland have dropped from an ‘A’ to ‘B’ owing to further constraints being placed on telemedicine coverage in their Medicaid system.

The report had discrepancies from the preliminary report released in September. With procedure modifications made to house out-of-state physician-to-physician discussions via telehealth, the only state that improved from ‘A’ was Massachusetts. Twenty-two other states received the maximum composite grade, which implies that an exceedingly encouraging policy landscape is present in these states for adoption and usage of telemedicine.

Idaho, West Virginia, and The District of Columbia dropped from an ‘A’ to ‘B’ in ATA ratings owing to the formation of new telehealth clinical practice rules in their states. Alabama is joined by Texas as the only two states with the slightest composite score, ‘C,’ due to adjustment of telemedicine policies.

UnitedHealthcare, the largest health insurance in the country is partnering with three telemedicine companies to put telehealth at par with a regular trip to the doctor’s office via video chat. UnitedHealthcare will cover virtual doctor visits offered through NowClinic, American Well and Doctor on Demand. The initiative is intended to give people enrolled in self-funded employer health plans 24-hour online access to a physician using real-time audio and video technology, whether at home or on the go.

Access to Affordable Health Care Options

The platforms will connect thousands of patients with doctors making telemedicine more accessible in most parts of America especially in rural areas where subspecialty care is often lacking. Video based virtual visits cost less than $50, but members will only have to pay their usual co-pay, making telehealth more affordable. The coverage for virtual care provider is available to self-funded employer customers and is set to expand to individual plans participants and the UnitedHelthcare employer-sponsored customers in 2016. This will give more people expanded in-network care options.

Innovative Telemedicine Solutions

UnitedHealthcare is an influential player in the health care industry and its partnership to telemedicine is a strong sign that technology is entering the mainstream in the medical care. Telemedicine has many benefits including convenience, immediacy, and easy access, and this groundbreaking initiative is a significant step for the healthcare industry to expand telehealth coverage. The initiative validates the approach of telemedicine giving access to quality medical care.

Telehealth companies will use technology to eliminate most overheads that contribute to the high cost of health care. Video- based virtual visits will also help care centers offload some of the easily treated cases. The participants can obtain diagnosis and necessary prescriptions for minor medical needs like flus, cold, sinus, allergies, bruises and bumps out of the offline settings freeing up the waiting rooms so that doctors can focus on patients who really need in-person care. The value-based initiative plans to deliver excellent patient experience giving them access to reliable and cost efficient access to medical care whenever they need it.

Teladoc, a healthcare provider through phone and video appointments in the Dallas area, filed a federal antitrust lawsuit on Wednesday to stop enforcement of new curbs on telemedicine services in the Texas state.

On April 10 the Texas Medical Board approved some rules barring doctors from giving telemedicine care to patients not previously seen personally. Telemedicine will only be authorized to patients without a prior visit if they are at a medical center, for instance, a clinic, hospital or even a pharmacy. Mental health appointments are ineligible from these regulations, which are to be enacted in June.

The lawsuit indicts the board for unlawful limitation of competition and requests a preliminary ruling to stop the policy pending a jury trial to determine the row. Jason Gorevic the CEO of Teladoc said in a statement that the medical board was claiming that the new policy is meant to protect the patient’s wellbeing, but the board did not have any substantial evidence jeopardizing the patient’s safety due to telemedicine.

The lawsuit held that the new regulations would increase prices and trim down access to healthcare in Texas causing Teladoc a tragic and irreversible damage, making the company close shop in Texas and probably countrywide. In 2014, Teladoc’s activities in Texas fetched $10 million or 23 percent of its entire revenue. The case was filed a day after Teladoc filed for an IPO of its stock.

If the rule is endorsed, Texas and Arkansas will be only states requiring a face-to-face visit before telemedicine engagements. The suit asserts telephone discussion without previous in person meeting risks the patient health and that the panel provided major pharmacies with copies describing the policy.

The American Telemedicine Association CEO Jonathan Linkous said that other forms of telemedicine like remote monitoring would not be affected by the Texas regulations.

Other unions within the healthcare sector have questioned whether the policy would stop doctors from taking patient calls when sitting in for other physicians. The scheme specifically consents to one section of the regulations, although the board did not revise another sub-division of the laws as demanded by the Texas Medical Association to shed light on the matter.