Telehealth, Telemedicine, & Telephone Triage
News Overview 5.0
Telehealth and telemedicine typically deliver medical services via remote monitoring, store-and-forward, and/or videoconferencing technologies. Telephone triage and nurse advice phone lines help patients decide whether an emergent condition requires intervention by a medical professional. Corporate, program, and technology developments are highlighted below.
Telehealth News (December 2009)
For home-bound and other patients, health and medical services can be conveniently delivered through technologies that electronically “connect” them with care providers. Remote health monitoring has become more widely available over the past two decades to improve access to care, disease management, and medication compliance. Annual treatment costs are often significantly reduced, as summarized below.
National Spotlight: Corporate Developments / Technology Report
Two Minneapolis companies highlighted in recent news articles are GE Healthcare and Nonin Medical Inc. In early December 2009, GE Healthcare announced the acquisition of Living Independently Group (LIG) and its QuietCare infrared sensor monitoring system, which has not yet been commercialized. The remote monitoring solution was originally intended for aging-in-place (homes, senior housing, etc.) and health care use (hospitals and health care systems). In a previously announced agreement, GE Healthcare and Intel Corporation are committing $250.0 million to develop wireless sensors, in anticipation of strong growth and an estimated $7.7 billion home health monitoring market in 2012. [The original article was published by MobiHealth News and Modern Healthcare News.]
In late November, Nonin Medical Inc. received the 2009 North American Product Line Strategy Award In Remote Patient Monitoring from Frost and Sullivan in recognition of Nonin’s accurate, innovative, secure solutions and leadership role in telemedicine. Recipients are chosen by Frost and Sullivan analysts, based on interviews conducted with end-users, industry participants, and suppliers to identify the product that “best addresses market needs and dynamics.” Frost and Sullivan is a “growth partnership” company. [The original press release was issued by PR Newswire.]
The Center for Technology and Aging released a new report entitled: “Technologies for Optimizing Medication Use in Older Adults.” The report once again highlights patient non-compliance with physician-directed prescription medication routines. An estimated 12.0% of the 3.0 billion prescriptions written each year in the United States are not obtained by patients. Among those patients who fill their prescriptions, 40% do not take the medications correctly. The report identifies the cost benefits of greater compliance (as much as $290.0 billion in savings) with use of technologies and tools that are already available but underutilized. A key factor is reducing “medication non-adherence” hospital and/or nursing home admissions, which can be partially addressed through medication monitoring technologies (e.g., portable electronic dispensing devices, mobile phone applications, “talking” pill bottles, etc.). [The original article was published by Fierce Healthcare and Center for Technology and Aging.]
State Spotlight: Mississippi
A program at the University of Mississippi Medical Center (UMMC) demonstrates how remote monitoring technology can help extend the services a limited number of nurses and physicians provide in an intensive care unit (ICU). Demand is high for qualified “intensivists,” but the current work force provides only 20.0% of the total personnel needed nationwide for round-the-clock care. UMMC’s solution is the Philips’ VISICU remote monitoring system, which uses two-way audio and video equipment to enable nurses and physicians working off-site to have a virtual bed-side experience. With assistance from a room-based team member, remote site practitioners can check vital signs, communicate with and evaluate patients, review lab data, view digital diagnostic images, etc.
To date, the system has reduced patient mortality by 25%. A single nurse can monitor up to 40 patients throughout the day and night, and on a 12-hour shift, one physician can monitor 100 patients. UMMC is the first of its kind nationally to implement such a system, which currently serves 83 beds and is being expanded in June 2010 to include 24 ICU beds at Delta Regional Medical Center.[The original article was published by The Clarion Ledger.]
Health Technologies (November 2009)
Regardless of how the U.S. health care system is reformed, competitors continue to bring health information technology solutions to market. Recent product announcements range from agreements to develop “personalized health records” to strategic corporate acquisitions. Some of the activities are highlighted below.
International Spotlight: Electronic & Software Solutions
By year-end 2009, two companies will join forces to develop and implement an electronic medical record system in China. The partners are MMR Information Systems Inc. (MMR; Los Angeles CA) and the Unis-Tonghe Technology Co., Ltd (UNIS; Zhengzhou, China) subsidiary of Unisplendour Corporation Ltd.
China currently lacks a system to acquire, store, and/or transmit electronic health records among the 18,000 public hospitals and approximately 10,000 private hospitals located throughout the country. MMR will contribute its proprietary personal health record expertise to the project. Company representatives from MMR and UNIS also met with MMR’s Asian technology partner, Nihilent (Pune, India). The goal is to develop portable Personal Health Records that Chinese individuals can deliver to hospital-based health care providers, and the MMR platform is scheduled for launch by the third quarter of 2010. [The original article was published by MMR Information Systems Inc.]
A new cost-benefit methodology has been developed by the Institute for Quality and Efficiency in Health Care (IQWiG), which will provide price and medical intervention recommendations to the Federal Joint Committee and other German agencies. The evaluation methodology represents the best proposal for the German system, which differs significantly from the system used by the United Kingdom but is similar to the one used in Australia. The goal is to establish a “maximum reimbursable price” for health insurance funding for new drug costs, based on two legislated conditions: 1) Additional benefit over other therapies, and 2) Exclusion of drugs for which there is no viable alternative therapy. A two-step process ensures the conditions are met, using evidence-based medicine methods and scientific cost-benefit comparisons. An IQWiG budget impact analysis will also be performed before payments are made. [The original article was published by Institute for Quality and Efficiency in Health Care.]
In mid-November 2009, Nova UCD (Dublin, Ireland) announced an awards event showcasing fifteen candidates in its Campus Company Development Program (CCDP), which promotes commercial development of entrepreneurial research ideas. A total of 140 ventures and 210 individuals have competed in the program to date, and more than 750 people have been employed by successful participants, such as BiancaMed and ChangingWorlds (acquired by Amdocs in 2008).
Short presentations were pitched to industry, research, and state agency participants. The NovaUCD 2009 Start-up Award and 5,000 Euros were awarded to Equinome, which develops genetic tests for decision-making optimization in breeding and racing Thoroughbreds. The commercial launch of Equinome is planned for the first quarter of 2010. Second and third place prizes were awarded to respectively to Novocept, a bioinformatic software company, and bettieTM, a communications device developer. [The original article was published by NovaUCD.]
National Spotlight: Acquisitions & Software Licensing
Home Health Market:
In late November 2009, Mediware Information Systems, Inc. (Mediware; Lenexa, KS) announced plans to complete its acquisition of Healthcare Automation Inc. (HAI) and Advantage Reimbursement Inc. (ARI) by mid-December 2009. The two companies will expand Mediware’s home health software and reimbursement service capabilities. Mediware provides equipment, products, and services to a home infusion customer base of more than 450 facilities. The Company is expanding through strategic acquisitions (five in the past two years with HAI and ARI). Integrated Marketing Solutions was acquired in 2007, and Hann’s On Software and its Ascend pharmacy management system were added in 2008. SciHealth (June 2009) and completion of the HAI, and ARI deal will bring Mediware’s acquisition total to five companies in two years. [The original press release was issued by Mediware Information Systems Inc.]
In late November, Quantros (San Francisco CA) announced its licensing of safety and risk management software developed by the University of Michigan (UM), using Agency for Healthcare Research and Quality data. The software helps hospitals identify and reduce the incidence of potential adverse events, as demonstrated in the UM Health System during the past year. Quantros will refine and implement the technology in its products. [The original press release was issued by Quantros.]
Telehealth & Telemedicine In Rural Communities (October 2009)
A recent presentation on National Public Radio (NPR) discussed population declines that may adversely affect several small mid-western communities in the near future. The following abstracts highlight some issues and trends that have made the news.
National Spotlight: Federal Funding / Coverage Discrepancies
A report issued by the U.S. Department of Health and Human Services in early October 2009 forecasts the importance of information technology for delivering better health care in rural communities. More than 50 million Americans may benefit. One organization, the Columbia Basin Health Association (CBHA), was highlighted as an example of how electronic health records and information technology can enhance efficiency (e.g., continuity of care) and reduce the amount of time that health care professionals spend completing paperwork. CBHA is one of the first centers to switch completely from traditional charting to an electronic system. [The original articles were published by the U.S. Department of Agriculture and TMCnet.com.[
A blog posted on an affiliate NPR web site suggests that the structure of the U.S. Senate may contribute to inequities in future health care reform legislation. Equal representation for each state creates an even playing field that is not linked to population. The editorial points out that a “small population” state like North Dakota effectively has “72 times more voting clout, per constituent” than California. In addition, the most influential senators within the health care reform debate represent states with a total population of approximately 8 million people. High density metropolitan areas are not only urban but multi-ethnic, too. The blog notes that rural states often have more “federally supported” citizens, such as the elderly, government workers, military, and retirees. [The original article was published by North Country Public Radio.]
South Carolina’s Telemedicine Review
In early October, a Federal Communications Commission (FCC) meeting was held in Charleston, South Carolina, where members addressed the need for improved widespread high-speed Internet access. Telemedicine was highlighted as one of the benefits, which enables digital consultations between rural medical practices and urban medical centers and often eliminates the need for patients to travel long distances for specialist care. Success stories suggest that FCC approval or endorsement of additional telecommunication system development could serve greater numbers of patients in rural communities. [The original article was published by the Post and Courier.]
Nurse Advice & Telephone Triage Services (August 2009)
Since the mid-1990’s, various “decision support” service systems have been established to provide nurse advice and telephone triage services. Several companies remain in operation, despite administrative and economic challenges. One example is Sykes Assistance Services, an Ontario telehealth company which celebrated its 10-year anniversary in May 2009. The basic premise for such services is to help patients make informed decisions and choose appropriate resources to meet their emergent health and medical needs. Article abstracts describing current applications and recent developments appear below.
Canadian Spotlight: Sykes Assistance Services
In mid-May 2009, Sykes Assistance Services reached its tenth year of providing telephone triage. The Direct Health pilot program began May 13, 1999 in North Bay with funding from the Northern Ontario Heritage Fund. Services are still provided today under the name TeleHealth Ontario by five of the 12 original nurses. Sykes Assistance Services now operates five locations, employing approximately 300 registered nurses who handle more than 100,000 calls monthly. [The original article was published by Sykes Assistance.]
National Spotlight: Emergency Services / Influenza / Telehealth
An article published in August 2009 by the Associated Press described the potential scenarios for increased use of emergency room (ER) services this fall by patients who may or may not have influenza. Hotlines and triage systems are being developed to help patients decide whether an ER visit is necessary. The Centers for Disease Control is offering guidelines for hospitals and state agencies. A comprehensive government system is also being considered, following a prototype developed by Emory University and the Georgia state health department.
Another issue is how to minimize spreading the flu in ERs, especially since many patients who came for treatment in Spring 2009 had mild rather than severe cases. Preliminary discussions suggest that the best option is for patients to stay home and in bed if symptoms are manageable. [The original article was published by AP.]
Companies also offer decision support solutions. In an August 2009 press release, StayWell Custom Communications announced its strategic alliance with Self Care Decisions LLC to provide payor and provider organizations with internet and mobile consumer health care applications. Examples include HouseCalls Symptom Checker (a “care advice” tool) and SymptomMD (an iPhone/iTouch “decision support” tool). The original press release was issued by PR Newswire.]
New Mexico & Texas University — Health Services
In addition to administering benefits for University of New Mexico employees, Lovelace and Presbyterian provide support and wellness programs. Examples include telephone counseling for smoking cessation, as well as alternative medicine and health product discounts, chronic disease management, nurse advice lines, personal health coaching, and prenatal care. Health screenings are also available, along with an annual health fair.
An August 2009 article published by The American Statesman (Forty Acres of Safety Awareness) describes various services provided by the University of Texas (UT) to its students. From campus safety to contact resources, numerous resources are available to parents, students, and workers on UT’s web site. Three key departments can be reached by phone: Dean of Students’ Office, UT Police, and University Health Services, which operates a nurse advice line and pharmacy and also provides mental health counseling and women’s exams. [The original articles were published by the University of New Mexico and the University of Texas.]
International Telemedicine News (April 2008)
Even with support through federal grants, video-conferencing based telemedicine services have not made a significant impact in the U.S. health care system. A recent online review of Google News reveals that telemedicine is doing better in other countries (Australia, India, Malaysia, the United Kingdom, etc.). The following abstracts offer an overview of recent news.
Doctor Shortage In Australia?
As reported in The Australian, enrollment in Australian medical schools is expected to increase substantially in the coming years. A larger number of doctors, however, does not address demographic and geographic demand. Rural areas, where General Practitioners (GPs) may be in short supply, are likely to remain under-served. Overseas-trained physicians have filled the gap, but officials with the National Rural Health Alliance cite lack of incentives as a major barrier to meeting future needs. According to the Australian Medical Workforce Advisory Committee (AMWAC), the current number of GP placements in medical schools (600) accounts for approximately 55% of actual demand in 2007 (1100 GPs).
Telemedicine may offer a viable solution by enabling patient-physician consultations via audio or video links over long distances. AMWAC is being replaced by Health Workforce Australia, with the goal of increasing transparency and improving projections for health worker supply and demand. [The original article was published by The Australian.]
Home-Based Telemedicine In India
Apollo Hospitals Ltd. is offering a unique service to residents of homes built by Mantri Developers Pvt. Ltd. Quality health care monitoring, diagnosis, and treatment services will be provided by a panel of Apollo Hospital physicians via videoconferencing-based telemedicine consultations that enable patients to be “seen” in their homes. The Apollo Telemedicine Networking Foundation (ATNF) is the largest and most established network in India, with 103 peripheral units. During the past seven years, the system has provided 36,000+ tele-consultations. [The original article was published by Express Health Care Mgmt.]
Telemedicine Initiative Implemented In South Africa
A telemedicine program is being established in Limpopo, South Africa. The goal is to eliminate the need for rural patients to travel great distances to be seen by physicians in provincial medical centers or clinics. High-tech computer and video equipment is used by health care professionals to observe patients and conduct question-and-answer sessions. Medical conditions are diagnosed, and patients receive prescriptions that can be filled in nearby locations. The videoconferencing systems are also used for education and training.
The three primary telemedicine bases include Mokopane regional hospital, the George Masebe district hospital and the Rebone clinic. Other health centers that are served by the provincial hospital will be added to the network. [The original artile was published by www.sowetan.co.za.]
Telemedicine Competitors, Devices, & Programs (July 2007)
Rural communities are a priority target for federal funding of telehealth and telemedicine initiatives to provide services to populations with limited access to the full range of medical services.Videoconferencing enables general practitioners in geographically remote or sparsely populated areas to consult with specialists in metropolitan-based hospitals and medical centers.
Federal Legislation To Improve Rural Health Care:
Members of the House Rural Health Care Coalition introduced a bill to reauthorize a rural outreach and network grant program that originated in Montana and was expanded through the United States. Known as the Health Care Access and Rural Equity Act of 2007, the legislation would increase Medicare payments for rural health clinics and also establish grant funding of $20.0 million to $30.0 million annually to encourage rural care providers to incorporate health information technologies. Other provisions call for:
- Authorization for licensed counselors and therapists to provide mental health services
- Establishment of a rural health quality advisory commission
- Extension of rural health components of the Medicare Modernization Act and Deficit Reduction Act
- Prompt reimbursement to rural pharmacies for Medicare prescription drug plans.
One example of a funded program enables American Indians and hospitals in Montana to provide medical care for diabetes and other health needs via telemedicine networks. Rural physicians can also use the technology to obtain continuing education credits without leaving their practices. [The original article was published by the National Rural Health Association.]
PhoneDoctorX Employs Teleconferencing Technologies:
Over the next few months, St. Luke’s Health System (Kansas City MO) plans to extend telemedicine technology from cardiology, pulmonology, and psychiatry departments on the main campus to two other locations: Wright Memorial (Kansas City MO) and Hedrick Medical Center (Chillicothe MO). Telemedicine services will be provided by Neurological Consultants of Kansas City Inc. (Kansas City MO) in anticipation of an increasing need that isn’t sufficient to support a full-time employee on site. In 2006, St. Luke’s physicians served 454 patients using telehealth and telemedicine technologies, which resulted in reduced patient travel and other expenses. For the first quarter of 2007, St. Luke’s cost-savings were approximately $40,000. The original article was published by St. Lukes.]
British Research Examines New Emergency Care Model:
A new form of community-based services is being explored by British researchers. Health care professionals known as Emergency Care Practitioners are likely to bridge the gap between hospital health workers and paramedics in a program developed by Loughborough University (Leicestershire, United Kingdom). The goal is to take emergency and urgent care from hospitals into local communities and move ambulance services beyond the current “treat and transport” model. If successful, standard ambulances will be upgraded with different equipment that better accommodates the kinds of extensive care that are performed in hospital environments. The Emergency Care Practitioner program is using grocery delivery and roadside assistance services to understand some of the basic components.
In the future, researchers anticipate that vehicles and response teams may use portable, modular equipment that can be taken into patients’ homes. Remote monitoring using telehealth technologies is also likely to be incorporated for after-treatment care. British statistics suggest that between 30% and 40% of patients don’t actually need emergency room visits for treatment. [The original article was published by Loughborough University.]
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