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Telehealth is Growing Exponentially – PSN Rheumatology Site Goes Live

Becker’s Hospital Review recently reported a study of 29 billion private healthcare claims showed provider-to-patient telehealth use increased 1393% between 2014 and 2018. (Fair Health, 2018).

There are many creative ways in which telehealth is being used to improve access to healthcare services and information. Here are a few examples:

  •  A New York nursing school developed a telehealth training program for nurses located in rural areas
  • A West Virginia Hospital has launched a telehealth program for diabetic patients
  • A North Dakota organization has launched therapy telehealth services for child abuse victims
  • A North Carolina healthcare system allows patients to sign into its electronic healthcare record and engage in a telehealth encounter with selected primary care and specialty care providers
  • A Pennsylvania medical center has a telehealth connection with 13 smaller hospitals seeking to improve care for patients with infectious diseases
  • An Indiana hospital offers virtual care visits to local elementary school students for treatment of various conditions including colds and eye issues

These telehealth programs serve as examples of the myriad ways in which technology can be used to improve the health and well-being of a community.

We are pleased to announce the recent implementation of a PSN rheumatology telehealth clinic. The client is a small, rural Kansas hospital. The circumstances surrounding it are part of the beauty of the story. A highly respected, well liked and productive rheumatologist is forced to leave due to relocation  to another state with her spouse. Rather than close the clinic or go through the lengthy process of finding her replacement, the hospital will continue to provide rheumatology services through a telehealth connection with the doctor. The patients will get the care they need from a physician they know and trust.

Although rural folks often prefer face to face encounters with their practitioners, telehealth is a valid solution to access to care issues in rural areas. Mr. Gordon Alloway is the PSN expert on telehealth. He is a former President of the Kansas Telehealth Network. If you have any telehealth questions, he can be contacted at

Telehealth Delivers Benefits for Rural Women

Telehealth is a modern-day solution to health problems both old and new. Though it presents benefits to a variety of patients, rural patients likely experience the richest benefits. As Health Resources & Services Administration (HRSA) notes, it can sometimes be difficult to determine whether an area is urban or rural.1 In fact, the term “rural” is not even defined by the Census Bureau—it is considered to encompass “all population, housing, and territory not included within an urban area.” Essentially, according to this definition, whatever is not urban is considered rural. There are two types of urban areas identified by the Census Bureau: 1) Urbanized Areas (UAs) of 50,000 or more people and 2) Urban Clusters (UCs) of at least 2,500 and less than 50,000 people.1Generally, rural areas are characterized by low population and lack of access to critical resources such as medical care.

Rural individuals face many health disparities compared to urban individuals. Poverty and poor access to healthcare contribute greatly to these disparities. Overall, rural communities are in poorer health than others. According to the Centers for Disease Control and Prevention, rural Americans are at higher risk of death from five leading causes: heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke.3 In addition, rural areas have higher rates of preterm births and infant mortality.

Telehealth has helped combat these rural disparities through the following four modalities:

  • Live video, which uses audiovisual telecommunications technology;
  • Store-and-forward, which involves transmission of health information such as x-rays and other images through a secure electronic communications system to a healthcare provider;
  • Remote patient monitoring, which involves electronic transmission of health data from a patient in one location to a provider in another location; and
  • Mobile health (mHealth), which includes healthcare and education supported by mobile devices such as tablets and cell phones.
  • Although there are some barriers to successfully implementing telehealth, it is generally regarded as a convenient and cost-effective way to provide subspecialty healthcare that is not available locally. This is true in obstetrics and gynecology. In obstetrics, telehealth can be used for both low-risk and high-risk pregnancies, and in gynecology, it is used for both routine and specialty examinations.

Telehealth benefits and considerations

Healthcare in America is becoming too expensive for companies, individuals, and taxpayers. Technology offers the potential to offer increased access to care at a better value. In utilizing telehealth, the overall healthcare system benefits from lower costs, less travel, improved health outcomes, and reduced emergency room utilization.9 Although there are numerous benefits to telehealth, there are also many things to consider when beginning or expanding a telehealth program or clinic, including for obstetrics and/or gynecology (see box below).


Gordon Alloway Joins PSN as Telemedicine Consultant

Gordon AllowayGordan Alloway, healthcare delivery expert, has recently joined PSN as a telehealth and telemedicine adviser. Gordon has served as the Project Director for the Heartland Telehealth Resource Center, one of 14 federally-funded Telehealth Resource Centers across the U.S. coordinating assistance provided in Kansas, Missouri and Oklahoma.

He has also served as a staff member at the University of Kansas Medical Center, a research associate and project manager for the KU Center for Telemedicine and Telehealth in Kansas City, KS and has managed multiple grant-funded projects.

“Telemedicine” is most commonly used to refer to two-way, interactive video conferences that allow patients to “see” their doctor without being in the same room. This helps increase access to medical care, especially for patients living in rural areas.

As with many other technologies, additional devices can be attached to the videoconferencing system to enhance the patient experience. Some of these devices include a digital stethoscope or a dermatology camera that can record a patient’s vitals or health information so that a doctor can assess from a distance.

However, telemedicine is not limited to video conferencing. Remote patient monitoring, store-and- forward and mHealth are other common types of telemedicine.

Through PSN, Alloway will be providing both healthcare providers and facilities with education and assistance to get up to speed on the rules, regulations and technology information that is needed to start or expand telemedicine programs.

PSN’s goal is to show how to make these programs sustainable and assist with providing hands-on training designed to help a practice, clinic or organization provide the best care for patients via telemedicine.

According to Alloway, integrating telemedicine into the everyday workflow is essential to assuring that the technology will be used to the fullest.

“We’ve seen cases where a facility invests the time and start-up costs in the technology, but then the people who are trained on it move on to other jobs and after that it collects dust,” Alloway shared. That’s why it’s important to create a work plan and get everyone using the technology as part of the culture. Using telemedicine should become as routine as making patient referrals.

Mr. Alloway earned both his Bachelor’s and Master’s degrees in Journalism from the University of Kansas and possesses considerable experience as a long-time marketing executive and health care entrepreneur. He resides in Overland Park, KS.

American Telemedicine Association (ATA) 2017 Annual Conference and Tradeshow Wrap-Up

Last month, I (Lisa Thomas, MD, Director of Psychiatry and Telepsychiatry) attended the American Telemedicine Association (ATA) 2017 Annual Conference and Trade Show which was held in Orlando, Florida from April 22 through the 25th.  The venue was just a portion of the Orange County Convention Center, however, it was still a huge space to navigate both for the conference offerings and the Exhibit Hall.  There were an astounding 4500 attendees and 275 vendors!

My goal in attending this event, as a new ATA member and first time attendee, was to learn as much as possible about the latest in telemedicine practice and to engage in extensive networking as well as recruiting.

The conference and vendor exhibits offered information ranging from the basics of getting started with telemedicine, to available hardware and software, to unique niches in which to deploy telemedicine, the challenges of reimbursement, and current as well as future legal issues.   In order to maximize my experience at ATA, I signed up for the pre-conference in addition to the regular conference, and upgraded to the “platinum” package which in another week or 2 will allow me as well as my PSN colleagues access to essentially all of the lectures from the entire event.  Given the format of concurrent sessions, I was only able to attend a small portion of the scheduled talks so by definition there will be much that is new in the “platinum” package.

It should be noted that several of the sessions I was present for are particularly relevant to current PSN practice and issues so will bear re-listening to (esp regarding regulatory and billing issues).

I came away from the conference with new knowledge but also questions to pursue, companies to followup with for potential partnerships, and a few leads on potential clinicians to affiliate with PSN.  It was comforting to learn that the telemedicine issues we at PSN have identified are common in this growing industry and that solutions are being developed in rapid fashion.

Reaching Patients Who Lack Access to Care

Across the country, more rheumatology practices are employing telemedicine to treat patients, particularly physicians at academic medicine centers that have the resources to launch comprehensive units.

The technology is a way to bridge the shortage of rheumatologists in rural areas and reach patients who cannot access specialty care for rheumatic conditions, proponents say.

A 2013 study in Arthritis & Rheumatism found that many towns and small cities with populations up to 50,000 have no practicing rheumatologists, with some patients having to travel more than 200 miles to get specialty care.

Telemedicine is growing by leaps and bounds, and rheumatology is a key specialty in which to use the technology, said Jonathan Linkous, chief executive officer for the American Telemedicine Association.
“Telemedicine is expanding both in terms of the number of consultations and the breadth of services involved,” he said. “Tele-rheumatology was certainly not a big area to be looked at in years past, but it’s one more area that is starting to expand.”

For most of doctors and patients involved in the study, tele-rheumatology visits were positive and aided patient access.

Tele-rheumatology: Is it effective?

Research is lacking regarding how prevalent tele-rheumatology has become in the United States and whether it’s as effective as face-to-face visits.

In a recent analysis of 1,468 potentially eligible tele-rheumatology studies and literature, only 20 addressed direct provider to patient contact that influenced or had the potential to influence clinical care, according to a November 2016 review in Arthritis Care & Research.

Of the 20 studies, the majority of articles involved tele-rheumatology use in Europe or Great Britain, said study author John Allen McDougall, MD, a postdoctoral fellow at Yale University, New Haven, Conn.

“The first major finding was that there’s really not much out there as far as high quality research that supports or contradicts the use of tele-rheumatology in wide distribution,” Dr. McDougall said. However, “in general, the conclusion of the authors was a qualified, ‘Yes,’ that [tele-rheumatology] has potential and should go forward.”

According to the literature, the most common condition treated through telemedicine was rheumatoid arthritis. Little information existed on telemedicine use for gout or the treatment of connective tissue diseases, Dr. McDougall said.

Best uses of technology for Tele-rheumatology

In order for more practices to consider tele-rheumatology, more research about cost-effectiveness and best uses of the technology use would be useful, Dr. McDougall said.

“The main question that policy makers are going to want to answer is, ‘What’s the return on investment? Does this make sense for my practice?’ ” he said. “The methods reporting in tele-rheumatologist [literature] is lacking.” But regardless of barriers, telemedicine experts say the technology will likely continue to expand and transform the way rheumatologists are practicing and patients are receiving care.

“Tele-rheumatology will never replace an in-person exam,” Dr. Ferucci said.

“But my vision is that it will be able to improve the quality of care for patients living in rural and remote locations, by allowing for more frequent visits and adjustment of medications, which are necessary to achieve the goal of treat-to-target for RA and other rheumatologic conditions.”

The Rheumatologist has an excellent article online that compliments this story.

Telemedicine to Ensure 24/7 Access in Rural Germany

Using telecommunications to connect stroke experts to stroke patients in rural areas continued to improve and sustain stroke care, according to new research in the American Heart Association’s journal Stroke.

This is the largest and longest evaluation of telemedicine for stroke and took place in rural Bavaria, Germany.

With the tele-medical linked Stroke Units, patients in regional hospitals had around-the-clock access to consultations with vascular neurologists at stroke centers, including evaluation of brain imaging and patient examination via videoconferencing when needed.

Researchers reviewed the use of telemedicine for 10 years and found:

  • The number of patients receiving the clot-busting drug tissue plasminogen activator  for ischemic (clot-caused) stroke rose from 2.6 percent to 15.5 percent.
  • The median time between a patient’s arrival at a regional hospital until tPA was administered fell from 80 minutes to 40 minutes; exceeding American Heart Association/American Stroke Association’s “Target: Stroke” goal of treating at least 50 percent of patients within 60 minutes.
  • The median time between onset of stroke symptoms and receiving tPA fell from 150 minutes to 120 minutes.

“Cooperation within medical networks can be a huge benefit for patients. Telemedicine is a wonderful option to support the close cooperation of physicians from regional hospitals and tertiary stroke centers,” said Peter Müller-Barna, M.D., lead author and consultant in the department of neurology at the Agatharied Hospital in Hausham, Germany.

In 2003, TeleStroke Units were introduced to 12 regional hospitals lacking neurology and neurosurgery departments in Bavaria, Germany. Telemedicine linked them with two neurological stroke centers with vascular neurologists and other neurological experts. By 2012, there were 15 TeleStroke Units that had provided 31,864 consultations.

Between the first year of implementation and the end of 2012, the percentage of patients with stroke or mini-stroke who were treated at hospitals with telemedicine units rose from 19 percent to 78 percent.

“This illustrates the growing acceptance of the TeleStroke Units by emergency services personnel and general physicians, and also by the population and their political representatives. Still, the goal should be closer to 100 percent and we are now setting up further units in administrative districts that lack one,” Müller-Barna said.

“In my opinion, the improving thrombolysis rate and door-to-needle times can mostly be attributed to growing experience, practice and continuous quality management. The extended time window for thrombolysis also had an influence,” Müller-Barna said.

The researchers also found from 2003 to 2012, the proportion of patients transferred to stroke centers from regional hospitals fell from 11.5 percent to 7 percent.

“Telemedicine can accelerate the emergency transfer of patients in need of neurosurgery. At the same time, it helps avoid unnecessary transfers because expert vascular neurologists are involved in remote patient assessment by video examination and the interpretation of CT scans,” Müller-Barna said.

The benefits of TeleStroke Units should also be applicable in the United States in any region without direct access to a stroke unit or local stroke expertise, researchers said.

The use of telemedicine to ensure 24/7 access to consultation and care in rural areas is one of the major recommendations of the AHA/ASA in the organization’s  2013 policy statement on systems of care.

For more information:

Telemedicine Emerging as Rural ICU Solution

While the high startup costs associated with telemedicine programs have presented a barrier to many rural hospitals, data suggests they contribute to lower costs and lower mortality rates.

Since the first programs were launched in the early 2000’s, telemedicine has become a staple of nearly every area of care in the healthcare industry. But one area where it is just beginning to carve out a niche is intensive care.

ICU beds account for about 7% of total acute care hospital beds in the United States but generate 13.4% of total spending, with the cost of an inpatient stay ranging from $2,500 to $4,000 per day, According to the Society of Critical Care Medicine.

The evolution of tele-ICU programs is detailed in a report from the New England Healthcare Institute (NEHI), a health policy group that promotes the expansion of telemedicine. The report notes that, as of late 2012, there were 54 civilian and government tele-ICU monitoring centers in the U.S. While most were operated by academic medical centers, others were run by a mix of providers that included “regional hospitals, health plans, commercial firms, and the Veteran’s Health Administration.”

While tele-ICU programs have shown promise, however, high startup costs associated with the plans have presented a barrier to many rural hospitals that could benefit the most from such programs, the report suggests.

But “most indicators suggest that use of tele-ICUs is on the threshold of major change” and increased competition among providers is likely to “push tele-ICU care toward a more scalable and potentially more widely available technology,” the report says.

Tele-ICUs are also being promoted as a way to expand the ICU capacity of hospitals to accommodate an aging U.S. population. “It could go a long way to addressing a major problem in that there are not enough incentives in the health system to care for an aging population of baby boomers,” says NEHI’s Nick King, one of the authors of the report.

Startup costs an issue 

Like most ventures rooted in high tech, tele-ICU programs can be expensive. The NEHI report estimates that per-hospital startup costs range from $100,000 to $200,000, with added expenses for equipment such as mobile carts.

“The upfront costs can be an issue, but we’ve demonstrated that health systems can see a return on investment from tele-ICU programs in as little as nine months,” says NEHI president Wendy Everett.

Standard tele-ICU systems use a central monitoring station staffed by clinical staff around the clock. Each ICU room is equipped with a high-definition video camera and an audio hookup to allow physicians and nurses in the monitoring station to visually check on patients and communicate with nurses in the room.

Physicians also make their standard rounds between rooms each day to check on patients. Everett says round-the-clock monitoring of patients allows physicians and nurses to catch minor problems before they become major health issues.

Lower mortality rates

“If you have someone sitting in front of a screen monitoring a patient’s vital signs 24/7, you’re going to catch things other hospitals might miss,” she says. “It’s like flying a plane manually compared to flying a plane with instruments.”

UMass was able to reduce its ICU patient mortality rates by 30% during the first year of its program; it also reported a reduction in hospital-acquired infections and other complications that often result in longer hospital stays.

You can read more of this article, in full detail on the Health Leaders website.