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House Bill Would Expand Medicare Funding for Telemedicine Services iHealthBeat, April 27, 2009 A bipartisan group of lawmakers has introduced a bill designed to increase the availability of telemedicine services, the Eureka Times-Standard reports. The Medicare Telehealth Enhancement Act (HR 2068) would expand Medicare reimbursement to telemedicine facilities in urban and suburban areas. About 80% of U.S. residents do not have access to telemedicine facilities because of restrictions that limit funding for such facilities to rural areas, according to Rep. Mike Thompson (D-Calif.), the bill's author. The bill also would allow doctors to monitor patients remotely and would provide $30 million in grant funding to help health care facilities purchase telehealth equipment and expand telemedicine support services. Other sponsors of the bill include: § Rep. Sam Johnson (R-Texas); § Rep. Bart Stupak (D-Mich.); and § Rep. Lee Terry (R-Neb.) (Eureka Times-Standard, 4/27). http://stroke.ahajournals.org/content/vol40/issue5/ Telemedicine helps experts treat stroke from afar USA Today, 5/10/09 htm By Robert Preidt, HealthDay Examining stroke patients via videoconferencing (telemedicine) is as effective as a bedside exam and can increase patient access to stroke specialists, says a scientific statement released this week by the American Heart Association. Stroke patients require rapid assessment in order to determine if they're eligible for time-sensitive treatments such as tissue plasminogen activator (tPA), which can save brain function and reduce stroke-related disability, the AHA explained in a news release. These patient evaluations often need to be done by stroke and brain imaging specialists, but there are only about four neurologists per 100,000 people in the United States, and not all neurologists specialize in stroke, according to the statement. Telemedicine — which uses interactive videoconferencing via webcams connected to a computer or television screen — enables distant stroke experts to see and hear patients, family members and on-site health care providers. Telestroke technology along with teleradiology allows distant doctors to review a patient's brain images. This technology offers a cost-effective and time-efficient method of extending the reach of neurologists. "Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance," scientific statement lead author Dr. Lee Schwamm, an associate professor of neurology at Harvard Medical School and vice chairman of neurology at Massachusetts General Hospital, said in the news release. The scientific statement appears in the May 7 issue of the journal Stroke. Certain policy changes are needed in order to make this type of telemedicine effective, Schwamm said. These include: § Deployment of telestroke systems to bolster resources where 24-hour, local, on-site stroke expertise is insufficient. § Increased Medicare reimbursement for telestroke assessment, diagnosis and tPA use to reflect the greater costs of implementation. § Development of a mechanism whereby credentialing for telestroke providers and national telestroke licensing by state medical boards is uniform and streamlined. § Increased funding sources for telestroke programs. Stroke, May 2009: htm New AHA/ASA Guidelines on TIA Management and Telemedicine in Acute Stroke Released Medscape Medical News, May 8, 2009 htm The American Heart Association (AHA)/American Stroke Association (ASA) has released 2 new guideline documents, 1 advocating urgent treatment for transient ischemic attacks (TIA) and changing the clinical definition and the other giving a green light to the use of telemedicine consults in acute stroke assessment. Along with the 2 scientific statements, a policy statement has also been published to provide recommendations on how best to implement telemedicine in stroke care systems. The TIA and telemedicine stroke documents are published online May 7 and will appear in the June and July issues of Stroke, respectively. New Definition of TIA In the scientific statement examining the definition and evaluation of TIAs, the writing group points out that large cohort and population-based studies reported in the past 5 years have shown that the risk for stroke after a TIA is higher than previously thought. "Ten percent to 15% of patients have a stroke within 3 months, with half occurring within 48 hours," the group, chaired by J. Donald Easton, MD, professor and chair of the department of clinical neurosciences at Alpert Medical School of Brown University and the Rhode Island Hospital, in Providence, writes. Accordingly, the authors recommend that TIAs be subject to the same urgent assessment and care given to acute strokes and, to that end, have changed the clinical definition of TIA. "We think a TIA should be treated as an emergency, just like a major stroke," Dr. Easton said in a news release from the AHA/ASA. "Because we know the high risk for a future stroke, this is a golden opportunity to prevent a catastrophic event." The traditional clinical definition, dating to the mid-1960s, is "a sudden neurological deficit of presumed vascular origin lasting less than 24 hours." The new statement changes this definition to "a transient episode of neurological dysfunction caused by focal brain, spinal-cord, or retinal ischemia, without acute infarction." The presence of infarction has been the main distinction between stroke and TIA, but the advent of more sensitive imaging of tissue damage using magnetic resonance imaging (MRI) has suggested that infarction with presumed TIAs may occur often. "Research around the globe has shown that the arbitrary threshold based on duration of symptoms was too broad, because up to half of TIAs defined this way actually caused sustained brain injury according to an MRI," Dr. Easton noted. Long-Distance Stroke Assessment In the scientific statement on telemedicine, the writing group, chaired by Lee Schwamm, MD, from Harvard Medical School and Massachusetts General Hospital, in Boston, provides an evidence-based review of the scientific evidence supporting the use of telemedicine for stroke care delivery and concludes that high-quality videoconferencing systems can be used by remote stroke specialists to carry out National Institutes of Health Stroke Scale (NIHSS)-telestroke examinations when a bedside assessment is not immediately available for patients who may be having an acute stroke and provide results comparable to the beside assessment. It is recommended that these examinations be supported by the use of a Food and Drug Administration (FDA)–approved teleradiology system, where computed-tomography (CT) and MRI scans can also be viewed by the remote stroke specialist, the authors note. The specialist can then make recommendations to the on-site providers about whether tissue plasminogen activator should be used or not. Similarly, these systems can be used to provide occupational and physical therapy remotely, the document notes. "Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income, or social circumstance," Dr. Schwamm said in news release from the AHA/ASA. Changes in reimbursement for telemedicine activities, though, are required for implementation of a telestroke system and require consideration of a number of other issues, including cost recovery, liability, and training of provider. For that reason, a second document of policy recommendations accompanies the scientific statement. The recommendations include: § Whenever local or on-site acute stroke expertise or resources are insufficient to provide around-the-clock coverage for a healthcare facility, telestroke systems should be deployed to supplement resources at participating sites. § New models and codes for reimbursement of telestroke services should be developed to reflect the increased up-front costs to providers and reduced long-term healthcare costs to insurers. § Organizations providing or requesting telemedicine services should operate by contractual agreements that explicitly deal with such issues as assignment of costs for developing and maintaining the telemedicine network; compliance with relevant federal, state, and local statute boundaries and any existing noncompete relationships; assessment of medicolegal risk and provision of adequate malpractice coverage; and administrative and credentialing requirements for all providers. "Telestroke can enable the initiation of cost-effective interventions proven to reduce complications and stroke recurrence and can identify and facilitate transfer of patients in the community for specific tertiary-care interventions, such as neurointensive care, decompressive surgery for life-threatening, space-occupying cerebral infarction, and prompt surgical or endovascular repair of ruptured cerebral aneurysms," the authors conclude. Stroke. Published online May 7, 2009. htm New Mexico 's Project ECHO Using Polycom Telepresence to Improve Patient Care TMCnet, April 27, 2009, By Patrick Barnard Health care workers serving residents in rural areas of New Mexico, as well as the state prison system, can now deliver improved care to patients with common, treatable illnesses, thanks to the fact that the University of New Mexico's Project Extension for Community Healthcare Outcomes (Project ECHO) is now using telepresence solutions from Polycom . Project ECHO is a telemedicine program run by the university that provides critical information to doctors working in rural parts of the state as well as in the state prison system. These doctors can get information regarding the treatment of common illnesses such as hepatitis C, which is widespread in the state of New Mexico. Using Polycom ( News - Alert ) telepresence, these healthcare workers can communicate "live" via with university healthcare specialists who provide them with important information regarding patient care and treatment. Daily video conferences allow for healthcare education that combines both face-to-face communication with interactive content and the ability to stream, record and rebroadcast the information on-demand. This means that a practitioner can not only sit in on a live video discussion of a pathology or treatment plan, but also can view the recorded educational session at a later date if they need to review. In a release , program founder Sanjeev Arora, M.D., said Polycom's visual communication solutions "provided a way to extend my knowledge to healthcare providers around the state in an efficient and cost-effective way." He said the telepresence program enables him to conduct weekly training sessions with healthcare providers around the state that may not otherwise have access to expertise. "We train primary care providers within our network, and in turn, they use their knowledge to more effectively treat patients in their local communities," he said. "It's a win-win situation because they learn to become experts in their field while also using that knowledge to immediately improve patient care." Currently Project ECHO is using more than 40 Polycom VSX video conferencing systems and a Polycom RMX 2000 real-time media conferencing platform for multi-site conferences. The Polycom RSS 2000 recording and streaming server and the Polycom Video Media Center (VMC) 1000 video content management solution facilitate the recording and on-demand streaming capabilities. The team at Project ECHO also recently added the Polycom Converged Management Application (CMA) 5000, a desktop video conferencing system, to simplify the provisioning and management of visual communication solutions across the entire Project ECHO network. Using CMA Desktop, practitioners are able to see live video training sessions from anywhere over a VPN connection. Wesley Pak, systems and programming manager for Project ECHO, said they are considering extending the project to other states. "Currently, we are working with the state of Washington to implement a similar telemedicine program for their underserved communities, and it's the Polycom solution that makes it all possible," he said. Pak said he chose Polycom because it offers a complete, integrated solution and because Polycom systems are based on open standards. "There is tremendous value in our ability to stream, record and manage our video content as part of the program," added Pak. "It allows us to extend our resources to broader audiences by turning real-time events into repeatable, educational content." Founded in 2002, Project ECHO was launched to help doctors treat diseases that are common yet complex to manage. Some of these illnesses, such as Hep C, require evolving types of treatment. Initially the program focused on hepatitis C, but it was so successful that it has since been expanded to cover cardiovascular risk reduction, childhood obesity, pediatrics, telepsychiatry, chronic pain, high-risk pregnancy, HIV/AIDS, integrated addiction/psychiatry, psychotherapy, pulmonary diseases and rheumatology. "To date, we have enrolled more than 3,000 patients in our Hepatitis C disease management program," Arora said. "Without Project ECHO, these patients would not have had access to treatment for their condition." Polycom made news on TMCnet earlier today when it announced that it was teaming up with Cisco Systems Inc. and Intel ( News - Alert ) to create the first-ever virtual classroom in Turkey. New Videoconferencing Technology Possible for Cell Phones, PDAs Newswise, May 13, 2009 htm A new low-bandwidth, high-frame-rate videoconferencing technology that creates the appearance of three-dimensionality and a strong sense of co-presence without the use of expensive motion-tracking devices or multicamera arrays could eventually become available for cell phones, laptop computers and personal digital assistants, according to a researcher at the University of Virginia. The technology is expected to be presented Friday in London at the International Workshop on Image Analysis for Multimedia Interactive Services. According to Timothy Brick, the U.Va. researcher who will make the presentation, the new videoconferencing system may make high-frame-rate videoconferencing readily and inexpensively available to nearly anyone with small, portable communication devices, possibly within two to three years. Current systems for small devices offer only low-frame rates, resulting in jerky images and a loss of the sense of "co-presence" between participants. Traditional videoconferencing requires expensive equipment and high-bandwidth transmission, making the technology incompatible for small portable devices. The new system instead uses motion parallax, a 3-D simulation created by rotating a 3-D model of a user's face based on the angle of the person viewing the image. "Motion parallax provides a greater sense of personal connection between users than other approaches," Brick said, "and we are able to create this effect without the need for expensive displays, multi-camera arrays or elaborate motion capture equipment, potentially making this technology available to nearly anyone with a handheld communication device." The system uses statistical representations of a person's face to track and reconstruct that face. This allows the principal components of facial expression – only dozens in number – to be transmitted as a close rendition of the actual face. It's a sort of connect-the-dots fabrication that can be transmitted frame by frame in near real-time, requiring considerably less bandwidth for transmission – only a few hundred bytes per frame – than the tens of thousands of bytes needed to transmit a full-face image. "This method makes possible near-photorealistic video-conferencing for small devices, and it has the potential to revolutionize online gaming industry animation technology, as well as other media applications," Brick said. A demonstration video [link to: http://people.virginia.edu/~trb6e/demo/WIAMIS2009.mov] is available online. The technology was developed by a team of psychologists and computer programmers, including U.Va. graduate students Brick and Jeffrey Spies and U.Va. psychology professor Steven Boker of the College of Arts & Sciences; Barry-John Theobald of the University of East Anglia in the United Kingdom; and Iain Mathews of Disney Research in Pittsburgh. The National Science Foundation funds the research. The technology grew out of psychological research seeking to understand how people interact during conversation. The investigators, led by Boker at his Human Dynamics Laboratory at U.Va., needed a way to capture micro facial expressions while people communicate with each other eye-to-eye. They began work on a videoconferencing link to track, record and recreate these micro-expressions to see how people alter their behavior based on the slightest changes in expression of another person. Boker said it is a "mirroring process" of facial coordination that helps people to feel empathy toward each other. Because the researchers needed a technology that would allow participants to look directly at each other, but also wanted to capture the thousands of micro-expressions made by participants, they developed this system, which allows people to look at each other directly, rather than at a monitor off to the side. With current video conferencing technology, a participant looks at a monitor showing the person he or she is talking to, and therefore appears to that person to be looking off to the side. This lack of direct eye contact creates an impersonal appearance and alters the micro expressions that normally would occur in person or in a real-time video conversation. If the person looks instead at a camera, rather than the monitor, he or she cannot read the face of the other person, and again, loses that eye contact. "We wanted to remove that mismatch," Boker said. "This new technology allows us to correct for the mismatch in eye gaze." The system developed by Boker and his team allows people to converse in near real-time while each makes direct eye contact with the other. The effect is a more lifelike conversation featuring all the normal nuances of facial expression. And that technology may revolutionize videoconferencing for small devices. Polycom Telepresence Brings Healthcare to Underserved Patients TMCnet, Apr. 27, 2009, by Michael Dinan htm As with education , IP communications' use in healthcare generally falls into one of two categories: streamlining operations or providing direct services. In education, that amounts to the difference, say, between saving money by allowing school officials to collaborate more efficiently on an IP-based network, and creating a hands-on " virtual classroom " that allows students from different schools to share a science lesson. These days, efforts to streamline operations in healthcare often involve so-called "e-medical records" – a term that surfaced more than once during last year's presidential campaign in the United States. An entire industry is emerging to meet demand for products that will ease transmission of medical information. For example, analysts say the market for wireless medical devices that send and receive healthcare records could grow from $3 billion per year now to $7.7 billion by 2012. Today, a Pleasanton, California-based provider of telepresence, video and voice communications announced that its technology is being used by a "telemedicine" group to help serve patients directly as well as manage visual communication activities and resources, speed deployment and ease integration with existing applications. Specifically, officials at Polycom Inc. say, Clinical e-Health Solutions is using a handful of Polycom ( News - Alert ) video conferencing systems and added the Polycom Converged Management Application 5000 to its network. It's an area that Polycom officials say has tremendous growth potential, due mostly to demographics and the rising cost of providing healthcare. The company's global director of healthcare, Ron Emerson ( News - Alert ), told TMCnet in an interview that with 72 million baby boomers coming to an age where they qualify for retirement benefits – combined with healthcare provider shortages and the anticipated cost of healthcare doubling by 2016 – more and more organizations are turning to telemedicine. Polycom's collaborative solutions are designed specifically with those challenges in mind, Emerson said. "We understand the workflow, the clinical needs and the requirements for maintaining the highest level of patient care, while optimizing resources," Emerson told TMCnet. "We support caregiver communication, telemedicine, medical education and administrative needs in healthcare organizations around the globe." The desktop video systems effectively are bringing equal access to high-quality healthcare, the companies say, by allowing physicians who are gravitating toward more urban areas to still communicate with patients and collaborate with each other through telepresence. The systems do not serve as a substitute for in-person examinations, but they do allow members of Clinical e-Health Solutions' widely dispersed team of clinicians to call anyone else on the network directly from their laptops or PCs. Polycom's conferencing systems are ideal for use in medical care facilities, the company says, because they're space-efficient products whose 17-inch LCD monitor can double as a PC display when not in use for video calls. Dr. Carl Keldie, chief medical officer for Clinical e-Health Solutions, said that the need for telemedicine services in certain communities is evident. His team of physicians noticed several trends were converging to create an opportunity that made perfect sense for a company that knows how to deliver telemedicine cost-effectively. "Our goal was to equip the fast-growing network of clinics that provide primary and specialty healthcare to consumers with the resources and technologies they need to effectively treat these patients," Keldie said. "Our Polycom telemedicine network allows us to leverage a pool of primary care and specialty care clinicians who enable these facilities to provide that level of care, without requiring the patients or the physicians to travel to meet in person." Polycom's solutions have outdone competitors' offerings, he added, and the group has saved money by using Polycom exclusively, standardizing its telemedicine network. From Clinical e-Health Solutions, the telemedicine solutions also save on travel costs and time associated with travel, meaning physicians can pack more direct medical care into their workdays, he said. That's translated into a retention tool for key staffers at the company. "Our oncologist started his practice in Pennsylvania," Keldie said. "When he announced he was moving to Washington State and would need to look for another job, we said, 'You already have a job – with us.' Today he serves our Pennsylvania clients from an office near his home in Washington using Polycom." Science & Technology International ® Launches the UltraSightHD™ Digital Colposcopy System, Revolutionizing Colposcopy and the Early Detection of Cervical Cancer "The UltraSightHD Digital Colposcope is the State-of-the-Art in the Field of Colposcopy" ---- Julie Hess, Women Veterans Program Manager May 06, 2009 CHICAGO--(BUSINESS WIRE)--Science & Technology International, Inc. announced today the global launch of its UltraSightHD™ Digital Colposcopy System with ImageSense™ diagnostic enhancement technology. The FDA cleared and CE Mark certified state-of-the-art system will revolutionize colposcopy through its high-definition imaging, clinical workflow management software and seamless integration with electronic health records systems. Based on proprietary technologies, the UltraSightHD system enables physicians the ability to capture archive quality images with unparalleled clarity and easily annotate clinical impressions during an exam through an intuitive touch screen toolbox. "Today's announcement will have a profound impact on women's health by providing healthcare professionals with 21 st century visual intelligence to identify and detect suspicious lesions of the cervix," said Nicholas J. Susner, President and CEO of Science & Technology International, Inc. "Our UltraSightHD system brings significant value added to the healthcare industry, creating the opportunity for improved clinical outcomes through its integrated telemedicine and electronic health record functionality." Cervical Cancer is the second most common cancer among women worldwide, with an estimated 493,000 new cases and 273,000 deaths per year. These statistics are troubling since, when detected early, cervical neoplasia is almost always curable. "I am pleased to have an opportunity to use the UltraSightHD system," said Dr. Nathan Fujita, OB/GYN Department Head at The Queen's Medical Center, Honolulu, Hawaii. "It represents the latest in digital colposocopy. Its high definition imagery takes wonderful archive quality cervical images, and the ability to perform annotations during the exam on the device's touch screen saves physician time. The device's PACS/DICOM compatibility can integrate directly and easily into a medical center's electronic health records systems, making it possible to use the patient exam information for future reference and side-by-side comparison." Developed with private funding and support from the U.S. Army's Telemedicine and Advanced Technology Research Center (TATRC), the UltraSightHD is quickly finding its way into Federal and commercial healthcare centers. "The UltraSightHD Digital Colposcope is the state-of-the-art in the field of colposcopy, perfectly in line with the (VA) Secretary's statement and our goal. Of special note is the UltraSightHD's compatibility with the federal government's push toward electronic medical records." said Julie Liss, Women Veterans Program Manager and Registered Nurse for the Spokane Veterans Administration. "We can easily download our daily patient list from our VA server to the UltraSightHD and enter patient information on the instrument's touch screen." Ellen Halter, Women Veterans Primary Care Provider for the Spokane Veteran's Administration, said, "The UltraSightHD allows us to easily acquire, save and store archive quality colposcopy images. We find the UltraSightHD will save us time due to its ease of use and ease of integration into our VistA system, and we anticipate higher patient throughput and efficiency hence lower per patient costs." Technology will Expand Support for Northern Cancer Patients Sudbury Regional Hospital , 5/8/2009 htm The Regional Cancer Program (RCP) of the Hôpital régional de Sudbury Regional Hospital (HRSRH) is pleased to announce an expansion of service that will see cancer patients receive necessary supportive care services closer to home and enhance the professional development of caregivers. In partnership with the Ontario Telemedicine Network (OTN), the RCP's Supportive Care Program (SCP) will now be able to attend to the needs of patients across North Eastern Ontario and offer consultations without the need for travel. "The RCP relies heavily on the use of OTN for Radiation and Medical Oncology patient consultations and assessments. Through OTN we are able to the need for patients to travel from our more remote communities to the Sudbury Cancer Centre", says RCP Vice President Bertha Paulse. "Cancer patients, survivors and their families, also require a high degree of specialized psychological, social and emotional support, but in many small communities these professional resources simply do not exist. We can now reach out to our patients where supportive care oncology resources may be scarce or non-existent." According to Sheila Damore-Petingola, MSW, RSW, the Coordinator, Supportive Care Oncology Network NE Region, the benefits of having a visual means of communication are great, and essential. "Although you may not be in the same room, you now have access to those visual cues that we rely on for effective communication. As clinicians, we can see the affect and presentation of our clients. It quite simply provides a form of contact that feels more human." The benefits extend beyond clinical applications for patients to both patient and professional education, and increasing administrative efficiency for a regional program. Paulse also enthuses the new technology can help combat professional isolation and build capacity for care in other communities. "Through technology we can help develop professional expertise in oncology among health care providers in those communities with broader training, and provide support for professionals in smaller locales who do not benefit from the synergy that exists in larger centres with larger groups of people with similar specialties," Paulse states. The Supportive Care Program is located on Level 1 of the RCP at the HRSRH's Laurentian site. Physicians may refer, or cancer patients can self-refer for most services. Family members may also self-refer for social work and psychology services with the understanding that their concerns are related to cancer. For further information, the Supportive Care Program offers bilingual brochures. Information on support groups and educational classes offered on a variety of topics is also available by calling (705) 522-6237, ext. 2175 Thompson introduces telemedicine, PTSD legislation Redwood Times, 04/29/2009 htm North Coast Congressman Mike Thompson has introduced legislation to screen returning soldiers for PTSD and to expand access to telemedicine. The PTSD bill will require every soldier to have a face-to-face mental health screening before they are deployed on a combat mission, upon their return, and every six months for two years following their return. The bill is a companion measure to one introduced in the Senate by Senator Max Baucus of Montana. The Post-Deployment Health Assessment Act of 2009 creates new requirements for identification of PTSD among soldiers. Prior to deployment a soldier will be interviewed in order to establish a baseline against which a subsequent interview upon return from a combat theater could be measured. The telemedicine legislation would provide $30 million in grants to help health facilities pay for telehealth equipment and expand telehealth support services. Currently about 80% of Americans do not have access to telemedicine because of restrictions that limit funding for these types of facilities to rural areas. The Medicare Telehealth Enhancement Act would expand Medicare reimbursement to urban and suburban areas and include more families.
Maine Law Requires Health Plans To Cover Telemedicine Services iHealthBeat.org, Friday, June 12, 2009 htm On Thursday, Maine Gov. John Baldacci (D) signed into law a bill (LD 1073) that requires health insurance plans in the state to cover telemedicine services, the Maine Public Broadcasting Network reports. The measure, sponsored by Maine Rep. Anne Perry (D), covers health care services provided through interactive audio, video and other electronic media ( Maine Public Broadcasting Network , 6/11). In a statement, Baldacci said, "Telemedicine offers opportunities to increase the accessibility of health care, ensure that appropriate medical information is available, reduces medical errors and reduces health care costs," adding, "This bill makes sense and I am pleased to sign it." The new law goes into effect 90 days after the close of the legislative session (Office of the Governor release, 6/11). Telehealth Conference at NIH Federal Telemedicine News, June 14, 2009 htm A two day event "The Future of Telehealth: Essential Tools and Technologies for Clinical Research and Care" will bring stakeholders to the main NIH campus in Bethesda MD to review the state of telehealth and discuss future opportunities on June 25th and 26th. The National Center for Research Resources (NCRR) within the National Institute of Health is collaborating with Internet2, the American Telemedicine Association, Veterans Administration, and with other federal partners to present this conference and workshop. The meeting is free and open to the public. Attendees will gather to hear ideas from government agencies, academic institutions, healthcare organizations, and technology companies. The goal is to review the state of telehealth science and technology, identify gaps in knowledge to be addressed through targeted research and evaluation initiatives, and to explore opportunities to leverage information and communication technologies to advance the field. Interactive panel sessions on the second day will yield specific recommendations to stimulate development, implementation, and evaluation of telehealth applications for clinical care, clinical and translational research, and health education and training, with the ultimate goal to broaden participation in research and to improve health outcomes in medically underserved communities. For more information and to register, go to www.ncrr.nih.gov Telehealth. For logistical questions or for additional information on registering, contact Monica Barnette at 301-650-8660 or email mbarnette@palladianpartners.com. For workshop content, contact Michael H. Sayre, PhD at 301-435-0962 or email sayrem@mail.nih.gov. Local company looks to tech to tamp down health care costs Bozeman Daily Chronicle, June 15, 2009 by Jessica Mayres htm A new telemedicine service aimed at making health care less expensie and more accessible hopes to roll out service in Montana next year, part of a growing tvrend that beams doctors into private living rooms, prisons and rural outposts nationwide. "Welcome to 21st century health care," said Dr. Elliot Justin, founder of the Bozeman-based Swift MD. Most doctor visits are unnecessary, Justin said. Yet health care providers, potentially able to identify that over the phone, often don't because they'd lose income. "Ankle sprains probably cost billions of dollars every year," he said. But telemedicine services can identify and advise folks by phone or the Internet in real time, Justin said, avoiding a pricey trip to the doctor. "If we're really going to change health care, we have to jump from the 19th century to the 21st century," he said. "We have to replace brick and mortar with technology." Efficient and sufficient Justin started practicing medicine in 1979, specializing in emergency care. He has lived in Bozeman with his family for four years and his growing business serves nearly 9,000 subscribers in New York, New Jersey, Alabama, Pennsylvania and, soon, Montana. Throughout his years inside the system, Justin became increasingly dissatisfied with the state of medicine. "I frankly hate the healthcare system," he said. "It's inefficient and insufficient." In his ideal world, healthy people would salt away money in a health savings account to be used for emergencies, and look to Swift MD for help with simple ailments. Swift MD charges $18 to join and $9 per month to access 38 certified emergency medicine specialists. The service links folks immediately to a doctor able to diagnose ailments and prescribe medication. After making sure the patient is not having an emergency, a Swift doctor discusses the condition with them via phone or Internet, consulting an online record kept in a secure portal. Justin said he believes Swift MD is offering viable solutions to this country's health care crisis. "The future of medicine is virtual," he said. In defense of traditional medicine Hospitals are also hopping on the telemedicine train, albeit in a different way, said Dr, James Loeffelholz, Bozeman Deaconess Health Group's medical director. Bozeman Deaconess Hospital is taking steps to link patients with primary care practitioners and in the not-too-distant future patients will be able to interact with doctors, e-mail any questions and have prescriptions renewed with no in-person contact, Loeffelholz said. As it stands now, Loeffelholz said, many doctors will consult with patients over the phone, as he does from his Bozeman practice. "I do an awful lot of that as it is," he said. But he cautioned that while telemedicine is a good way to streamline doctor-patient communication, it works best when patients have an established, in-person relationship with a provider. There's something missing with a purely virtual physician-patient relationship, Loeffelholz said. "I think there's something to be said for a hands-on approach," he said. Increasing access to medical services is a good thing, he said. But if a Swift MD patient became seriously ill, there would be no physician familiar with the patient's history ready to provide treatment. "Who takes care of you?" he asked. "Who has access to your information? These physicians can't do that." Rural patients Even so, telemedicine is an increasingly popular tool. For example, slightly more than half of all state correctional institutions and 39 percent of federal institutions are using some sort of "telehealth" application, according to a study published by the Telemedicine Journal. It's also being rolled out in rural areas, where doctors and specialists are often few and far between. In rural Montana, community clinics are using the Internet more and more to bring urban doctors to rural communities. "It's hard to argue with that access, that's attractive," Loeffelholz said. Justin said part of the criticism coming from traditional health care providers is a result of their feeling threatened by his brand of telemedicine. "The family doctors say, 'You're going to put us out of business,'" Justin said. "They want that ankle sprain coming to them. That's how they make money." But frustrated patients should know that new, easily accessible and often less expensive options are on the way, Justin said. "The truth is people can get what they want," Justin said Epilepsy and Telehealth Grant Catalog of Federal Domestic Assistance Number: 93.110 htm Application: htm Sponsor: Maternal and Child Health Bureau ; Deadline: June 29, 2009 Amount of funding: $500,000; Estimated average size of awards: up to $250,000
Estimated Number of Awards: 2; Purpose : The objective of this project is to demonstrate how existing telehealth programs and networks and sites can improve access to quality health care services specifically for children and youth with epilepsy and their families residing in medically underserved areas, MUAs, and rural areas, and decrease existing challenges that families face in rural areas. EAT grants funded under this provision will support telehealth networks that provide services in different settings, eg, long term care facilities, community health centers or clinics, medical homes, hospitals, schools, to demonstrate how telehealth networks can be used to expand access to, coordinate, and improve the quality of health care services, improve and expand the training of health care providers, and or expand and improve the quality of health information available to health care providers, patients, and their families. These grants will receive technical assistance from The National Center for Project Access, NCPA, which is housed within the National Epilepsy Foundation, EF, and link with existing epilepsy grantees. Eligibility: The applicant can be either a rural or urban non-profit entity that will provide services through a telehealth network. The network must have at least 3 members that can be either profit or non-profit entities, but the lead must be a non-profit organization. Proof of non-profit status must be included with the application. Faith-based and community based organizations are eligible to apply. Tribes and tribal organizations are eligible to apply for these grants. It is strongly recommended that services be provided to rural and medically underserved areas, although the applicant can be located in an urban area. Telecommunications CEO: Broadband Access Key to Rural Health Care iHealthBeat.org, June 10, 2009 htm At a federal advisory committee hearing on Tuesday, Jay Maxwell, CEO of Pixius Communications, said that remote home-based disease management tools and telemedicine can improve rural patients' access to quality care and reduce the country's health care burden, Health Data Management reports. However, Maxwell -- a telecommunications leader who specializes in broadband communication in rural areas -- told the National Advisory Committee on Rural Health and Human Services that "none of this is possible without access to a quality high-speed broadband Internet connection." Maxwell said, "While this access is common in urban and suburban areas, it is almost a luxury in rural America," adding, "Rural America is an area with a population that is aging and placing increased demands on scarce health care resources." Maxwell noted that it is largely unknown where high-speed broadband Internet service is provided. He said, "I urge HHS and all federal departments to work together to determine in greater detail who has service and who needs service. By doing this, you will pave the way toward a more effective means of delivering health care to rural America." Federal Stimulus Funding Maxwell said that federal stimulus funding for the U.S. Department of Agriculture would significantly increase telemedicine and broadband programs in rural areas. In addition, federal stimulus funding administered by the National Telecommunications and Information Administration will focus on more rural broadband programs. Maxwell said, "We urge HHS to coordinate to the maximum extent possible with both USDA and NTIA to maximize the use of broadband funds with an eye to improving rural health care" (Goedert, Health Data Management , 6/10). Maxwell's complete testimony is available online (.pdf). Doctor gets jail time for online, out-of-state prescribing American Medical News, June 1, 2009 htm. The decision could give prosecutors broader reach in pursuing criminal charges in such cases. In a case that could have ramifications for online prescribing, a Colorado physician was sentenced to nine months in jail for prescribing an antidepressant over the Internet to a California teenager who later committed suicide. San Mateo County prosecutors charged psychiatrist Christian Hageseth III, MD, of Fort Collins, Colo., with a single felony count of practicing medicine without a valid California license. The case, believed to be the first of its kind to cross state lines, could set a dangerous precedent, said Carleton L. Briggs, Dr. Hageseth's attorney. "This will destroy telemedicine nationwide, because no one would dare practice telemedicine without being licensed in all 50 states," for fear of criminal charges, he said. San Mateo County Deputy District Attorney Jennifer Ow said her office followed up on an investigation of Dr. Hageseth's conduct by the Medical Board of California, which referred the case to county authorities for criminal prosecution. "The board has in place ways to legally practice telemedicine, and he wasn't doing that," Ow said. She said Dr. Hageseth was not licensed in California when he prescribed fluoxetine to 19-year-old John McKay through an Internet pharmacy. There was no face-to-face evaluation nor an established patient-physician relationship. Dr. Hageseth pleaded no contest to the charges, and is serving the sentence in Colorado. He also was ordered to pay $4,000 to reimburse the Medical Board of California for investigation costs. But Briggs said the issue did not rise to the level of criminal charges. He also challenged what he said was a novel tactic by county authorities to prosecute Dr. Hageseth out of state. The April sentencing stemmed from a May 2007 California Court of Appeals ruling, in which judges allowed authorities to cross state lines to pursue criminal charges against Dr. Hageseth. Judges concluded that, although Dr. Hageseth was not in California, he "could reasonably foresee that his act would produce, and he did produce, the detrimental effect [state law] was designed to prevent," that is, practicing without a California medical license. But that interpretation required proof that Dr. Hageseth intended harm, a factor the court and county prosecutors ignored, Briggs said. He also said Dr. Hageseth had a valid Colorado license, and in September 2007, the U.S. District Court for the Northern District of California found that the antidepressant played no role in McKay's death and dismissed a civil action brought by the boy's parents. Dr. Hageseth did not deny prescribing the antidepressant over the Internet without an in-person evaluation and cooperated with state authorities, Briggs said. "But they didn't charge him with a civil violation. Instead, they reinterpreted a criminal statute to make this a crime," he said. If other states follow suit, "the danger is you're going to have 50 inconsistent sets of regulation such that telemedicine is simply chilled." AMA policy requires that physicians who prescribe via the Internet have a valid relationship with the patient -- including having taken a medical history, performed a physical exam and being available for follow-up -- and appropriate licensure. The AMA also supports creation of uniform state and federal rules for online prescribing. Polycom and AMD Global Telemedicine Inc. to deliver integrated visual and voice telehealth capability to clinicians on-the-go Joint Polycom Converged Management Appliance (CMA) and AMD Aden tm solution offers laptop and desktop-based telehealth capabilities anywhere, anytime Corporate press release. Jun 10, 2009 htm PLEASANTON, CA--(Marketwire - June 10, 2009) - Polycom, Inc. (NASDAQ: PLCM ), the global leader in telepresence, video, and voice communications solutions, and AMD Global Telemedicine Inc. (AMD) today announced an integrated voice and video solution for telehealth providers. The AMD Dynamic Encounter Network, or ADEN™, which allows for capture, control, transmission and management of robust medical device data, now incorporates Polycom's Converged Management Application™ (CMA™) and Polycom CMA Desktop™ client in its on-screen display. ADEN™ is an IP based, publicly addressable, on-demand secure extensible data transmission conduit for the delivery of encrypted medical device information. ADEN™ features embedded EMR integration capabilities, is unified communications ready, requires no special data network configuration, and is designed to work on virtually any network. The Polycom Converged Management Application (CMA) simplifies the provisioning and management of visual communication solutions, and with the CMA Desktop, practitioners are able to see live video sessions from anywhere over an Internet connection. CMA Desktop is a highly scalable and cost-effective video collaboration application for personal computers and an excellent means for clinicians to participate in telehealth sessions regardless of location. This solution offers a secure, easy-to-use, real-time view of the patient being seen, their electronic health record (EHR) and all relevant medical device images and data. The integration of these systems can dramatically streamline a clinician's workflow by offering the lowest cost, highest quality, completely mobile telemedicine offering available today. As long as caregivers have an Internet connection and a browser, they can access the integrated ADEN™/CMA Desktop solutions. CMA Desktop has a low cost of deployment, and the ability to add providers to the network for very little cost, which means telemedicine providers can expand their networks with very little additional overhead. Additionally, the data can be captured, recorded, and replayed when needed. "Polycom is a long-time and very important partner of AMD," said Steve Normandin, president of AMD Global Telemedicine. "The ability to integrate Polycom visual communication solutions into our medical care systems has proven invaluable to our customers. As a Polycom ARENA partner, AMD can leverage Polycom technology, marketing, and sales channels in its telehealth offerings, ensuring that our customers have best-in-class video as part of their overall solutions." Polycom ARENA enables ecosystem partners such as AMD to develop, test and certify interoperability between their solutions and the Polycom platform of voice, video and content collaborative solutions. Ron Emerson, Polycom global director of Healthcare, added, "AMD Global Telemedicine is known in the market for its innovative and high quality systems. AMD Global Telemedicine utilizing Polycom video conferencing in ADEN means our joint customers will have the most flexible, easy-to-use telemedicine solution that the market has long been waiting for; one that can used anywhere, anytime, allowing for ultimate flexibility in telemedicine today." Specialists on Call launches emergency pediatric telemedicine service in California Corporate Press Release/PR Newswire, June 9, 2009 htm WESTLAKE VILLAGE, Calif.-- Specialists On Call, Inc. (SOC) announced today that it is launching an emergency pediatric telemedicine service to address California's growing specialty physician shortage. SOC is the country's largest private provider of emergency telemedicine on-call services to hospitals, having already managed more than 6,000 emergency neurology consultations nationwide. Today, SOC provides hospitals immediate 24/7 access to pediatric intensivists via a dedicated infrastructure of personnel and videoconferencing equipment. All of SOC's affiliated pediatric intensivists are board certified, fellowship trained, academic or ex-academic specialists who are licensed in the state of California and are credentialed medical staff members within the hospitals where they provide consultations. Dr. Kourosh Parsapour, SOC's Pediatric Medical Director, explained, "We are thrilled to provide an affordable, reliable, cutting edge service that extends access to medical care for California's 10 million children. Telemedicine will allow us to reduce pediatric healthcare disparities and to improve emergency transport practices." Prior to joining SOC, Dr. Parsapour developed and expanded the Pediatric Telemedicine Program at UC Davis Medical Center and subsequently founded, Telepeds Inc., a private telemedicine company providing specialized pediatric emergency and critical care to emergency medical facilities that lack access to specialized levels of service. Specialists On Call recently acquired Telepeds in an effort to expand its service offering with experienced telemedicine clinicians. Dr. Joe Peterson, CEO, described SOC's growth plan, "With every chance we get to expand our service line, we get the opportunity to extend access to state-of-the-art care to emergency patients that otherwise have to do without. Since most California hospitals lack both the physical resources and the pediatric specialists needed to treat the state's growing pediatric population, we are able to make a substantial clinical and financial difference for all parties involved. We look forward to collaborating with Kourosh and his team to increase the pediatric emergency resources available to hospitals throughout California." 17 Million U.S. Children Live More Than an Hour from Pediatric Trauma Care Children's Hospital of Pennsylvania Press Release/Newswise, June 2009 htm More than 17 million U.S. children live more than an hour away by ground or air transportation from a life-saving pediatric trauma center, according to a new study by researchers at The Children's Hospital of Philadelphia and the University of Pennsylvania. The creation of a national inventory of pediatric trauma centers may help to identify the locations of gaps and greatly improve access to care for U.S. children, the authors said. The average proximity to a pediatric trauma center varies widely from state to state, with the largest gaps in the most rural areas. Hawaii, Maine, Montana, New Mexico, North Dakota and Wyoming offer almost no access to a verified pediatric trauma center in less than an hour, while virtually all children living in areas such as the District of Columbia, New Jersey, Connecticut, Maryland, Massachusetts and Rhode Island are within 60 minutes of specialized trauma care. Establishing guidelines for the basic resources necessary for designation as a pediatric trauma center and maintaining an inventory of the location of these centers may improve today's fragmented access to life-saving trauma care, the study authors said. Studies show trauma centers provide benefit to severely injured patients of all ages, and timely access to medical care may save lives. In children ages 1 to 14, injury causes more deaths than all other causes combined. While more than 70 percent of U.S. children can be transported by either ground or air to a pediatric trauma center within an hour, vast pockets live in regions that are too far away. Past studies have shown similar gaps in the adult population living in rural areas. "This study shows that access to pediatric trauma centers is variable and inadequate in many areas of the U.S. Timely access to the best possible care is likely to save the lives of more children," said Michael L. Nance, M.D., lead author of the study and director of the Trauma Program at Children's Hospital. "We need to set up guidelines to help hospitals understand what is required to establish a pediatric trauma center where those centers should be." The researchers' article appears in the June issue of the journal Archives of Pediatrics and Adolescent Medicine . The study identified 170 pediatric trauma centers in 40 states and the District of Columbia, which equals about one center for every 358,000 children. The American College of Surgeons Committee on Trauma accredits most U.S. trauma centers. The researchers combined that organization's records with the American Trauma Society's list of adult centers designated as "pediatric capable," and the National Association of Children's Hospitals and Related Institutions' members self-classified as trauma centers. "The lack of a single national accrediting body or uniform standards for pediatric trauma centers has been an obstacle to understanding the resources that exist for the care of our most severely injured children," said Nance, who added, "A reliable inventory of accredited pediatric trauma centers will allow for expansion of resources into areas currently underserved." The study did not look at patient outcomes from injury as it relates to access to a center in under an hour. And, although the care delivered to children in an adult-care setting may be adequate, without reliable guidelines, it is impossible to determine if the best care is being provided to the most severely injured children. Dr. Nance's co-authors, both from the University of Pennsylvania School of Medicine, are Brendan G. Carr, M.D., M.S., from the Departments of Emergency Medicine and Epidemiology; and Charles C. Branas, Ph.D., from the Departments of Biostatistics and Epidemiology. The study was supported in part from the Josephine J. and John M. Templeton, Jr., Endowed Chair in Pediatric Trauma. CTeL Brown Bag Report: Experts Review Telehealth Credentialing Center for Telehealth and E-Health Law Website htm On February 23, 2009, The Center for Telehealth and E-Health Law (CTel) held its February Washington Live Brown Bag luncheon. Seminar participants heard from three panelists on the topic of physician credentialing for telehealth services, including Dr. Karen S. Rheuban, Professor of Pediatrics and Medical Director of the Office of Telemedicine at the University of Virginia; Geneva Harris, of the University of California-Davis and the California Hospital Association's Joint Committee on Accreditation and License; and John Blum, Professor of Law at the Loyola University Chicago School of Law and a faculty member of the Beazley Institute for Health Law and Policy. All three speakers have extensive and diverse experience in the area of credentialing, which has become an increasingly important issue for those in the telehealth arena. The Joint Commission (JC) has issued guidelines permitting one of its accredited facilities to recognize the credentialing process of another accredited facility, a process also known as credentialing by proxy. However, the Centers for Medicare and Medicaid (CMS) require that their own Conditions of Participation must be followed to credential physicians at each remote telehealth site—and as all three panelists noted, this can be highly inefficient. The process of credentialing, explained Harris, is a lengthy and costly one for hospitals. She outlined the multiple steps that typically go into it, beginning with a provider's application, continuing with review by several different committees at the facility and the collection of peer references and records for the provider from various sources, which then must be verified. Finally, the facility's governing body will delineate the provider's privileges. Ultimately, though, the process comes at a high cost—as Harris estimated, approximately $500 per physician when costs like fees to the National Practitioner Databank and fees for obtaining references are factored in. Additionally, every two years, physicians must be re-credentialed, with their clinical competency being assessed. Harris emphasized the importance of credentialing as far as patient safety is concerned, but pointed to the strain that it puts on facilities, particularly smaller ones with limited staff to devote to the credentialing process. She noted that when it comes to telemedicine services, credentialing could be greatly streamlined; in particular, if a provider's home hospital were allowed to act as the credentialer, those involved in the process could avoid costly duplication of their efforts. Other issues that the panel's speakers raised included the impact that the lack of ability to credential by proxy could have on smaller health facilities—in particular, rural clinics and prisons. As Dr. Rheuban stated, "The areas with the greatest need are being negatively affected," with providers often unable to deliver much-needed services via telehealth, due to CMS's restrictive credentialing rules. CMS, she noted, should adopt the JC's standards. Blum agreed, saying that the rules of the JC were "optimal" and would help to reduce the bureaucratic red tape involved in the credentialing process. During the question-and-answer session, the focus turned to the legislative arena, and what overtures, if any, were being made to policymakers. Dr. Rheuban, who noted that her district's House Member is circulating a letter among his colleagues, also spoke of the frustration she often feels at what she called the "misalignment" of the various federal agencies—including CMS, the Department of Agriculture, and the Federal Communications Commission—that play a role in telehealth programs, noting that the failure of agencies to communicate often leads to "roadblocks that tie our hands." She also pointed to the need to educate the future Health and Human Services Secretary about the needs of the telehealth community. All three panelists were hopeful that the appointment of Dr. Mary Wakefield as Health Resources and Services Administration Administrator would prove to be a positive development for those in telemedicine, as Dr. Wakefield, who is originally from North Dakota, is familiar with the importance of telehealth, particularly when it comes to fulfilling the needs of rural areas. An additional question focused on CMS and JC; if CMS were to change their process for credentialing, the participant asked, would facilities have to follow the rules of the JC or those of CMS? Blum explained that "CMS trumps JC." Another participant asked the panelists what they saw as the logical first step in ultimately "streamlining" the process of credentialing. Dr. Rheuban reiterated the need for "a champion at HHS who understands" the process, while Blum noted that ultimately, it will be up to CMS "to create a favorable climate." As of right now, CMS has yet to issue an actual directive regarding proxy credentialing. Currently, CTel is working to develop an assessment for providers about the impact of CMS's credentialing rules on the delivery of telehealth services. Ultimately, CTel hopes to share information from the study with CMS.
Click here to compete the CTeL Assessment on Credentialing | 
