Telemedicine/Telehealth News

A popular phrase known as ‘working in the cloud,’ has been tossed around the medical community for quite some time now; however what sort of weight does that phrase carry in the field of Radiology? Professor of radiology at Washington University in St. Louis, Fred Prior, PhD, explained the concept at an RSNA 2013 session; firstly describing what a cloud is and how it works. “Think of it both as a set of services delivered over the internet as well as hardware and systems that provide those services which you don’t necessarily own. The services are provided through remote data centers that you will never see. Many of the services are free, but for those that aren’t, you pay for what you will use. For example I can temporarily use 1,000 machines from the Amazon cloud, use them for 10 minutes and give them back. I don’t have to actually buy 1,000 computers,” he said. To view the Cloud, Prior discussed how the model runs on a software that is supplied on a provider’s infrastructure where “you don’t know anything about it, you don’t manage it, but you simply “lease” it for a reasonable fee.” Prior notes that he utilizes the software tools in the private cloud so they can support several applications on the same hardware; for private clouds can be shared by a group of organizations. While public clouds can be used by any individuals either free or on a pay-as-you-go system. During the session, Prior explained why a health institution might apply the Cloud computing technology. First off it significantly lowers IT costs, “You can make better use of a small number of physical resources. If you’re having someone else manage your computing hardware in their data center with their IT staff, it could go a long way in reducing costs,” said Prior. Second, it automates storage management i.e. a physician can make the necessary adjustments to storage as they see fit, rather than paying for fixed storage. Third, it vastly improves scalability, permitting access to hundreds of servers in mere seconds. And finally are very user-friendly and easy to navigate. When asked how it serves radiologists and radiology as a whole, Prior noted the following, “There are cloud versions for services including PACS, RIS, and EHR. Cloud computing evolved from the application service providers in the early 2000s that sold deep storage and enterprise archiving. In the ‘60s and ’70s, a large insurance company might have a huge mainframe and use only a small portion of it and they offered “time sharing,” to help cover the costs. What makes cloud computing different is that now we’re all wired and we’re used to being able to stream information to our devices. As the amount of data that needs storage multiplies, physicians are seeking better and cheaper ways to manage it.” However, Prior asserts that one has to ask themselves these three questions, when dealing with the challenges encountered through the Cloud technology; 1-     Does your network support cloud-based imaging services? Moving images from a PACS requires extensive bandwidth. “When you sit down at a PACS system and you say ‘display a case,’ you expect something will be on that screen in under two seconds. Even our institution [Washington University] that has very high bandwidth connections, we don’t have enough bandwidth to move data rapidly in and out of our institution. That’s because the network is internally focused rather than designed to move information externally. Know how yours is set up,” stated Prior. 2-     Can you protect patient privacy and security at the HIPPA level on a cloud? If a health institution puts data on a cloud, it must be encrypted and must comply and meet with HIPAA. The cloud provider should be in the same agreement. “If we do violate patient privacy the penalty is up to $25 million per incident… Make sure your risk is shared with your service provider,” said Prior. 3-     Will this save you money? “Some financial advantages include no major capital investment and you can manage obsolescence. If you buy a physical computer, it is quickly obsolete. If you give that problem to someone else, it saves you money. Software licensing may or may not save you money because you still have to license the cloud software and it depends whether it’s a usage-based software or how it’s set up,” said Prior. “The biggest savings may come in system administration. You still have to have an IT staff, but it can likely be smaller. Financial literature suggests that it may be a cost-effective storage model if you need 10 terabytes of space and use it for up to nine years. That formula however, is not specific to radiology practices,” Prior continued. “It basically comes down to — it may make sense for a smaller institution, but for a very large institution like ours, it makes more sense to keep it internally. If you trust all of your data to a cloud service provider, and you are legally required to maintain that data for 30 years, what happens if the provider goes out of business? How do you get it back and what are you going to do with it?” he ... Read more

Based on a new market report published by Transparency Market Research "Teleradiology Market (X-ray, Ultrasound, CT, MRI and Nuclear Imaging) - Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013 - 2019," the global ... Read more

With the ever growing advancements in mobile apps and devices that have and continue to lead to increasing, revolutionary forms of providing high quality physical care, more and more technology is being designed to focus on aiding patients struggling with mental illness. "Health IT is being increasingly recognized as an effective way of reaching people who are really hard to reach," said chief operating officer of ORCAS, a health technology company based in Eugene, Ore, Theresa Mulvihill. Mulvihill also mentioned that despite the overall progress society has been able to make, in recognizing, identifying, and ultimately treating mental illness. However, there is still much more to do and much to overcome as a shadow still looms over the subject, which often negates or causes individuals diagnosed with some form of mental illness hesitant about seeking and getting help. Therefore easy to use apps such as ORCAS' recently released by MoodHacker, which is designed to aid people suffering from depression identify and deal with their condition, are often considered easier to engage with than an actual person.  “Apps can offer three benefits to both mental health caregivers and patients,” said Mulvihill. For one, patients may use apps for personal use, because unlike physicians, mental health-based apps can be accessed and utilized at any given time, from any given location. “Moreover, they're not limited to being used solely for depression situations, but also in cases where a person wants to improve his or her moods on a consistent basis or develop new mental habits,” said Mulvihill. Mulvihill also points out how these mental health apps can be utilized and equated to as a personal trailer, but for the mind. Through apps an individual can assume full responsibility and control and serve as their own personal trainer or health coach. Through the use of apps users can pay close attention to their daily health needs by encouraging them to walk more, including more fruits and vegetables in their diet, or even begin to meditate. "We recommend working with no more than three habits at one time," she noted. And while IT can be used to help with what might be considered "every day" or "low grade" problems, Mulvihill points out that the initial and prime focus of ORCAS remains depression, serving as a form of counseling. Additionally, she pointed to the correlation between depression and other chronic conditions. "The research shows that when depression occurs in conjunction with other chronic health conditions, neither gets treated to the extent that it should,” she said.“With the goal of addressing that situation, IT is increasingly being used to help with screening patients for depression, and, if necessary, to provide the information and encouragement necessary to get them to seek further help,” noted Mulvihill. And on that note, ORCAS is in the process of developing a "coaching hub" that will allow patients and health coaches, including mental health counselors, to create online profiles. Once the suitable therapeutic relationships are set for both patient and provider, additional support can be discussed and developed either online, or by email or telephone. "Mental health and physical health need to be put together. Increasingly, the technology is available to do that,” Mulvihill ... Read more

A new research states that telemedicine consultants can assist rural emergency rooms supply better care to critically ill or injured young patients. “Rural hospitals and doctors' offices are increasingly using telemedicine to gain access to specialty care. It's a great way to leverage technology to improve the quality of care that we provide,” said senior author of the new study Dr. James Marcin of the University of California, Davis Children's Hospital in Sacramento. Marcin and his peers collaborated with five different rural hospitals to put in dedicated videoconferencing systems in each rural hospital ER and in the UC Davis Children's Hospital pediatric intensive care unit. To determine whether the telemedicine consultations were improving care, the researchers observed data on pediatric patients who arrived at the rural ERs in the highest triage category, for the two years prior to installation of the telemedicine modalities and for at least two years following the installation. They examined records for 320 patients, including 58 who had telemedicine consultations, 63 who had phone consultations and 199 who had no form of consultation. After retrieving and reviewing data that revealed whether a consultation had taken place was removed from the records, two specialists in pediatric critical care separately rated the quality of care provided for each patient. The overall median of quality of care score was 5.76 on a scale of 1 to 7 for patients who were assigned telemedicine consults, as opposed to 5.38 for patients who received phone consultations and 5.26 for those who were given no consultation. Moreover, according to data published online in Critical Care Medicine, parents were more content with the care provided to their child when they receiving a telemedicine consultation as opposed to a phone consultation. Marcin added that real-time videoconferencing supplies consulting doctors with much more information about a patient than a telephone call can. “We tend to spend more time on the videoconferencing calls than we do on the telephone. When I'm on a videoconferencing call I can see the child moving, I can see the monitors. There's a lot more information that we're gathering when we use videoconferencing than when we're relying on what the doctor is telling us." Furthermore, Marcin explained how improving the quality of care through telemedicine can sometimes lower other superfluous costs too. For instance an expert consultant can have play a big part in deciding whether a patient may need a helicopter transport to a higher-level trauma center or not. “Many times if we're able to see the kids, we can say, 'We can use an ambulance, we can help you watch that kid, he can also be admitted locally.’ Sometimes we'll recommend that they go to an intermediate community hospital as opposed to the big city children's hospital,” he ... Read more

A new state of the art telemedicine program at the University of New Mexico Health Sciences Center is providing a much needed neurological and neurosurgical specialists to rural and smaller-based hospitals across New Mexico, including Cibola General Hospital. UNM Hospitals, with the assistance of Albuquerque-based technology firm Net Medical Xpress, lately established a network of high-definition cameras and audio-visual conferencing equipment that enables specialists at UNM Hospital to interact directly with patients and their providers at 13 different hospital locations across New Mexico. The number is likely expected to double, as more equipment is installed in surrounding hospitals. Neurosurgeons and neurologists at UNM are now able to offer real-time, face-to-face consultations over the internet with physicians, patients, and their families who live in communities that have typically been considerably deficient in acquiring or accessing this sort of specialized care. “For stroke care, you really have to see the patient. You have to look at the patients’ pupils and watch their movement, alongside viewing the MRI or CT scan images,” stated stroke specialist and the chair of the UNM Department of Neurosurgery, one of the only neurosurgery facilities in the state, Howard Yonas, MD. The UNM departments of neurosurgery and neurology only started using telemedicine technology five years ago. This has enabled remote hospitals to send high resolution MRI and CT scans to UNM through a protected imaging capture system. Additionally, due to advances in audio-visual technology, the program has now evolved to allow UNM specialists to consult with other doctors and their patients in real-time, through secure, remote control cameras that have been installed in emergency rooms across the state. “The driving force behind our interest in the telemedicine technology is to quickly diagnose the patient and either get them to the higher level of care they need as soon as possible or keep them locally and keep an eye on their condition,” said Cibola General Hospital CEO Mike Makosky. “Strokes need to be diagnosed quickly so treatment can begin to prevent permanent damage. Using the telemedicine technology and tapping into the neurologists at UNM help our clinicians do just that.” Furthermore, in accordance with supplying instant specialist care to patients, the program also thwarts any pointless and costly medical transports to Albuquerque. Because of the low number of specialists in rural hospitals and potential severity of brain injuries, many patients had to be flown via helicopter or plane to UNM Hospital to receive treatment from a specialist. Although these modes of transport are sometimes justifiable, UNM discovered that almost 40 percent of these patients were not in need of emergency treatment and could have remained at their local hospital, preventing the difficulty and strain of such transport and cost. Helicopter transportation from a rural hospital to UNM can cost around $30,000.   “We can prevent some of these unnecessary transports. And if the patient really has an emergency, then we can expedite things and get them here quicker. We can even start their care at the other hospital before they travel. So better information leads to better decision-making, better triage,” said Yonas. This telemedicine program is part of a bigger plan at the UNM Health Sciences Center to improve brain and behavioral health in New Mexico, a proposal made possible by the UNM Brain and Behavior Health Institute (BBHI). “In a large, primarily rural state like New Mexico, delivering specialized healthcare to all communities is a challenge. The BBHI is bringing together regional hospitals, local small businesses, medical specialists and researchers from UNM to engage our community partners throughout the state and create solutions for improving healthcare access statewide,” said faculty member in the UNM Department of Neurosciences who is leading the effort to establish the new center, Bill Shuttleworth, PhD. Depending on the success of the program, Cibola General Hospital is looking to integrate the system into other specialties such as Cardiology and ... Read more

Around 15,000 children and family members in the United States are in dire need of healthcare. Therefore, in recent developments, South Florida mobile medical clinics operated by Children's Health Fund, which operates the mobile clinics for children in homeless or low-income families, will be able to connect with specialists from the University of Miami Health System all in part to a new telemedicine upgrade provided by the Verizon foundation; giving children and their families’ access to healthcare benefits. The Miami pediatric mobile medical clinic allows underserved local patients to confer with specialists from the University of Miami Health System, using UM's advanced telehealth program.  The Verizon Foundation is providing the mobile clinic with a high-speed 4G LTE wireless broadband connection and upgraded telecommunications equipment that facilitate the clinic to supply telehealth services from any of its numerous delivery sites. "Children's Health Fund has been operating mobile medical clinics for 26 years, but these sophisticated technology upgrades from Verizon are helping us to create the next generation of mobile care, with real time connectivity that enables doctors, patients and resources at our hospital affiliates like the University of Miami Miller School of Medicine to communicate like never before. The potential for better care is exciting as we work with Verizon to develop this telemedicine capacity here in Miami, and as we collaborate on other innovative programs across the country,” said Children's Health Fund chief information officer, Jeb Weisman, PhD. As previously mentioned, millions of children and their families are deprived of healthcare due to a number of socioeconomic and geographical conditions. "For many families, a long trip to a doctor means a day without work for the parent and puts their paycheck, and potentially their employment, at risk.  As a result, medical conditions that could be prevented or cured are left untreated, and the only healthcare many of these children receive is at the emergency room,” said medical director of the pediatric mobile clinic and assistant professor of pediatrics at the Miller School, Dr. Lisa Gwynn. This is why the Verizon Foundation has agreed to supply the mobile clinic with a high-speed 4G LTE wireless broadband connection and upgraded telecommunications equipment to connect to the University of Miami's advanced telehealth program. Verizon has also vowed to provide 15 of the Children's Health Fund's mobile medical clinics in several locations including Dallas, Detroit, New York City, and San Francisco. The equipment also comprises of enterprise-grade routers and small antennas in the mobile clinic to enhance connectivity. Previously, staff members in the mobile clinic could not easily access or connect to patients' electronic records and telemedicine wasn't even considered a viable option. The new telemedicine technology also provides a secure, safe, and dependable platform for sharing patient information, as well as the hastening of doctor response times and the delivery of life-saving treatments. The mobile clinic staff schedules telemedicine patient visits with specialists on specific days; for instance dermatology on Tuesdays so care is coordinated.  In the future, cardiology, endocrinology and nutrition experts will eventually be included to the available ... Read more

Based on a recent study carried out by the National Practitioner Data Bank that looked at 25 years worth of malpractice payments, it found that diagnostic errors are the leading cause of death due to medical errors. It approximated that 40,000 to ... Read more

According to a study published this week in the Journal of Medical Internet Research, it was found that patients who use the Internet more often than those who don’t are highly likely to involve themselves in patient-centered healthcare efforts and participate in their own care. For the study, researchers from the University of Texas at Austin, the University of Florida and the University of Maryland monitored Internet usage of a series of patterns of 438 individuals. The study group was then asked two questions: 1) Is there a significant relationship between Internet use frequency and the overall preferences for obtaining health information and decision-making autonomy? 2) Does the relationship between Internet use frequency and information and decision-making preferences differ with respect to seven different aspects of health conditions--diagnosis, treatment, laboratory testing, self-care, complementary and alternative medicine (CAM), psychosocial aspect and healthcare providers? Based on the subjects’ responses, researchers determine their answers will dictate how healthcare efforts are developed and improved in the coming years. "When medical professionals attempt to gauge how much information to provide patients or try to decide how much they should involve patients in medical decision-making, they may be better off if they base their decisions on patients' Internet use frequency rather than age, per se," noted the study. All 438 case-studies were split into two groups; as 226 university undergraduates with an average age of 20 made up one group, while 212 older adults with an average age of 72 made up the other. It was found that of the two groups, the younger group showed significantly more Internet usage than the older group. Additionally, research published last week in the Journal of Medical Internet Research confirmed that online health communities were useful tools for addressing chronic care issues as the number of patients suffering from such diseases is gradually rising. Further research also shows that patients with online access to their medical records and could exchange e-mails with physicians had more communication and active participation with their doctors and their healthcare than those who didn’t. Researchers have been calling on healthcare providers to determine how best to allocate resources to online access services. "Our findings suggest that the relationship between online access and utilization is more complex than the simple substitution of online for in-person care suggested by earlier studies," the researchers wrote. It has been an arduous task of trying to get patients to use online access and equipping healthcare providers the essential tools that allow them to accomplish just that. Accordingly, a recent study in the Journal of Medical Internet Research, noted that the distinguished worth of online access is vital to the adoption of personal health records, an element that could string those patients’ rising use of clinical services ... Read more

Based on a study coming from the Cincinnati Children's Hospital Medical Center, inner-city pediatric clinics could better communicate with difficult to reach demographics by utilization of digital platforms such as e-mail and smartphones. Published this week in the journal Pediatrics, the study surveyed caregivers bringing children to two inner-city pediactric main care centers in Cincinnati during the spring of 2012. The study observed and questioned the centers’ use and access to digital technology and their concern of receiving health information in such a way. All in all, 257 caregivers, with an average age of 28, were asked. Seventy-three percent were black and 19 percent white. The average age of their children was 2.9 year old. Ninety-two percent were publicly insured, and more than half lived in a governmentally definied poverty area, according to Medscape Medical News. For the most part, such caregivers are difficult to get in contact with due to their frequent mobility and their phones being either disconnected or temporarily out of order. Respondents were allotted a score between 0 and 4 representing their daily access to such digital technologies as home Internet, smartphone, email, and social media. Ninety-seven percent scored at least 1, and nearly half (49 percent) used all four technologies. Eighty percent reported having home Internet access, while 71 percent said they had smartphone access, 91 percent had email and 78 percent were on Facebook. Only 27 percent of those surveyed used Twitter. It was also noted that over 70 percent of caregivers said they would be inclined to use healthcare information transferred digitally from their healthcare provider. They displayed interest in information about common infections (77 percent); immunization schedules (73 percent); age-appropriate activities (73 percent); healthy eating tips (71 percent); infant child care (67 percent); well-child visits (65 percent); and links to community resources (62 percent). A current report from a coalition of advocacy organizations, which includes the Asian & Pacific Islander American Health Forum, the California Pan-Ethnic Health Network and The National Council of La Raza, cautioned that health IT, while demonstrating the possibility of further development and improvement in care, could also marginalize poorer demographics. It is obvious that while cell phones are hastily growing in numbers and usage, it is considered the most preferred choice of technology for low-income individuals, who usually work several other jobs and need more flexibility than a landline can provide. The study also acknowledges and lauds the efforts of services like Text4baby, which supplies a text messaging service about newborn care and is also made available in Spanish.In addition, a survey from the University of California San Francisco found that while low-income patients of public health clinics would like to communicate with their doctors online, such "saftey-net" services doesn't offer the needed patient portals or secure messaging ... Read more

UCLA to test telehealth program for pediatric behavioral issues. The American Telemedicine Association this week published best practices for providing mental health services through personal computer webcams and other devices with interactive ... Read more

What if there were a Meaningful Use program for telemedicine? Ryan Spaulding, director of telemedicine and telehealth at the University of Kansas Medical Center, posed that scenario during a public policy discussion at the American Telemedicine ... Read more

'It's got everything to do with expanding access to healthcare in Wyoming. It's something we get to do for our community.' In the rural West, neighbors often come in handy. And nowhere is that probably more true than in Wyoming. With a mere 5.8 inhabitants per square mile – only Alaska is more "open," with 1.2 inhabitants per square mile – Wyoming has a tradition of neighbor helping neighbor on just about everything that matters. Take health IT, for example. Sheridan, Wyo.-based Ptolemy Data Systems doesn't consider itself part of the healthcare sector, but since 2009 the data storage and managed services provider has been increasingly involved in connecting healthcare providers across the state. According to Ryan Mulholland, Ptolemy's president and CEO, "The company sees its role as being a facilitator. We house technology and work with clinics across the state, helping them make their connections. It's a very different arrangement than a hospital providing telemedicine services." This willingness to pitch in has enabled Ptolemy to contribute to Wyoming's burgeoning telemedicine movement, which, Mulholland said, "began to get serious attention about four years ago." Since then, three programs have stood out among Wyoming's myriad efforts. 1.Converged Management Application (CMA). Not a specific program, but a multi-faceted technology, Polycom's CMA video conferencing technology has enabled providers across the state to exchange information with unprecedented ease. According to a 2011 report from the Wyoming Telehealth Consortium, CMA "allows desktop units to be able to connect in a secure, HIPAA compliant manner with other desktops and also with video conferencing systems already present" in hospitals and clinics across the state. Cardiologists, mental health specialists and nursing homes have all taken advantage of CMA in order to share information with colleagues. 2.Prison health services. Using telemedicine capabilities, the Wyoming department of Prison Health Services has been able to dramatically increase the range of clinical services, including mental health and specialist services. In 2011, approximately 2000 physician visits were conducted via remote connection. 3.Wyoming Telepsychiatry Project. For Ptolemy, a point of pride is its involvement in a state-funded pilot project for which the company was engaged to create a statewide telemedicine network to bring much-needed medical and psychiatric care to isolated communities. Largely as a result of this work, the Wyoming Department of Health recently awarded Ptolemy a contract to expand its support of telemedicine services for all state-funded healthcare facilities and public health offices. As Ryan Mulholland sees it, Ptolemy's involvement in telemedicine services "isn't about the money. It's got everything to do with expanding access to healthcare in Wyoming. It's something we get to do for our ... Read more