Clinical Telemedicine Blog

Amy Levitt

Recent Posts

SOC Teleneurology Team Thanks EMS Personnel

By Amy Levitt

Medical equipment on isolated black background, horizontal.jpeg

It’s National EMS Week and Specialists On Call would like to take this opportunity to thank all Emergency Medical Services personnel for their vital public service and positive impact they have on the survival of anyone who experiences sudden injury or illness. We’d like to especially say thank you for their contributions to early recognition of stroke. For more than half of all stroke patients EMS is the first medical contact they have. These patients are dependent upon EMS personnel’s ability to accurately and quickly recognize the signs of stroke and get them to a neurology specialist who can prescribe life-saving treatment.

Due to the short eligibility window for administering tPA, EMS responders and SOC’s TeleNeurology service are essential to the quality of stroke care.  Since there’s almost no way for EMS personnel to know precisely when the symptoms started, it’s even more critical that they transport the patient to a hospital that can guarantee a neurologist available for consult. Specialists On Call is the largest provider of teleneurology care in the world, with over 4,000 patients treated every month and more than 200,000 consultations performed to date. In many instances, even with a 15 minute response time, we still wouldn’t have had the opportunity to see and save a patient were it not for the expertise and fast thinking of the EMS responder.

To all Emergency Medical Services personnel: thank you. We recognize and honor you during National EMS week as well as the remaining 51 weeks a year.  We look forward to continuing our collaboration in improving stroke care.

Contact us to learn more about how we can help improve stroke care in your hospital.

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, stroke awareness, Emergency Medicine, Neurologic Emergency, Neurologic Emergencies, SOC, emergency departments

Telemedicine Fosters ACO Readiness

By Amy Levitt

In every service area there are new incentives for large and small hospitals—plus outpatient facilities, home health agencies and community practices—to work in greater harmony than ever before. Some of those incentives are based on the Accountable Care Organization (ACO) paradigm, which is steadily gaining ground as a collaborative, patient-centered standard of care.


The ACO model is intently focused on collaboration to improve patient outcomes, and telemedicine is already playing a key role in the transition. Telemedicine lets large hospitals begin building relationships with smaller hospitals and health organizations in the community, and it can dramatically improve outcomes—from initial diagnosis to long-range results.

Take, for example, the treatment of strokes. Here’s a hypothetical scenario that illustrates how telemedicine can build ACO-style relationships:

A patient goes to the emergency room at Northern Hospital of Surry County or Davis Regional Medical Center in North Carolina suffering stroke-like symptoms. The small community hospital doesn’t have a staff neurologist, but it can rapidly set up a telemedicine consultation with a top neurologist from SOC, obtain expert diagnosis and treat the patient quickly with the clot-busting drug tPA if needed or if necessary, send the patient for a higher level of care and possible intervention at Forsyth Medical Center.

To use a well-worn phrase, it’s a classic win/win/win scenario for both the smaller community hospital, the medical center and the patient. It’s a matter of leveraging telemedicine to provide clinical expertise to smaller facilities, ensuring that each part of an ACO is able to offer patients the optimum care available.

The benefits are even greater when telemedicine is combined with EHR technology. In most healthcare settings today, stroke therapists don’t communicate well with each other. The hospital therapist’s clinical notes are rarely shared with the home health staff. And when a stroke patient has recovered enough to go to an outpatient facility, therapists there make a brand-new assessment. Yet each provider at every stage is required to have the neurologist’s approval for a plan of care. And in the ACO model, they’re all accountable for the desired patient outcome.

Clearly, telemedicine can foster the teamwork needed for success as ACOs coalesce in each community. Many large hospitals are looking for a way to “break the ice” with potential ACO partners in their areas—and telemedicine provides the perfect entrée. By putting these partnerships in place now, hospitals both large and small will soon enjoy the benefits: greater quality of care and the financial results that accompany it.

Topics: telemedicine, Stroke, hospitals, telestroke, ACO, Accountable Care Organizations

Telemedicine Made Personal

By Amy Levitt

Most televised reunions are gimmicky and superficial, but there was nothing trivial about the reunion of Sandra Bowden and Todd Samuels, M.D., at this year’s American Telemedicine Association (ATA) annual meeting in Tampa.

What the “Human Touch of Telemedicine” conference video crew captured that day was a vision of our medical future: a teleneurology advocate and stroke patient from Texarkana, Texas, getting to meet the neurologist who assessed her from his office in Baltimore, Maryland—and helped improve her outcome and recovery time. Here, in her own words, is Sandra Bowden’s account of her very personal introduction to the benefits of teleneurology.

Telemedicine Made Personal

There are many ironic moments in life, but few that compare to my stroke assessment last year.

I am director of medical post-surgical services at Christus St. Michael Health System in Texarkana, Texas—a city perhaps best known for being the hometown of one-time presidential candidate Ross Perot. Although our facility includes a 312-bed acute care hospital, Texarkana is still a fairly small city—ranking 288th in the latest U.S. census. We don’t have as many local neurologists to call as do hospitals in Boston or Los Angeles. For that reason, teleneurology has played a key role in our hospital’s campaign to become a certified stroke center.

In 2010, during an early morning meeting with the Christus stroke team, I began to feel a tingling sensation in my ear and face. It spread down my left arm, and a colleague noticed that the left side of my face was starting to droop. She quickly escorted me to the ER, where the doctor ordered a CT scan. By the time I returned to the ER, Specialists On Call, our recently implemented teleneurology provider, had been notified and neurologist Todd Samuels was speaking with my physician.

With the help of the attending nurse, Dr. Samuels began a complete neurological assessment. Throughout the entire consultation, I was the center of his attention. He answered all the questions my husband and I had, and made us both feel comfortable during a very difficult time.

Dr. Samuels told me that he believed I was having a stroke that would respond well to the clot-busting drug called tPA. He also explained the risks and benefits of the therapy. I assumed he would order the drug and be done, but he stayed and checked in on me. In a short time, I started having resolution of my symptoms—and Dr. Samuels seemed very pleased with the outcome.

I was soon transferred to the ICU, where my condition steadily improved. The left side of my face continued to droop for a few days, and I had some minor issues with gait and balance. But physical therapy resolved those conditions, and today I live a normal life with no deficits.

So when I attended the ATA annual meeting earlier this year, I had no idea that I would be meeting Dr. Samuels in person. It was a complete surprise to me. I knew I’d never forget his face, and it was wonderful to express in person how grateful I was. I couldn’t have asked for higher quality care.

I have long been a teleneurology advocate, but it wasn’t until I was the recipient of this innovative approach to care that I completely understood its importance. This is the way that medicine is going. We already have far too few specialists to meet the growing needs of people in areas of the country like mine. But I’ve experienced first-hand how teleneurology can help solve the specialist shortage and offer wonderful, life-saving care. After my encounter with SOC, I more firmly than ever see telemedicine as the wave of the future.

--Sandra Bowden, RN-BC, MSN

Topics: telemedicine, Stroke, neurology, teleneurology, emergency neurology, hospitals, telestroke, Uncategorized

The High Cost of Psychiatric Misdiagnoses

By Amy Levitt

A relatively recent European study documented the high cost of psychiatric misdiagnoses in emergency departments (EDs). What it found: misdiagnosed panic attacks were costing hospitals a small fortune.

Because they’re not psychiatric specialists, ED physicians often were baffled by patients’ symptoms, unable to tell if they were having bad reactions to illicit drugs or having a problem requiring immediate psychiatric intervention. In many cases, on-call cardiologists and endocrinologists were summoned—and both time and money were lost.

The problem is arguably even worse in the U.S., where most psychiatric practices haven’t implemented electronic health record (EHR) systems. Remember that meaningful use incentives weren’t extended to behavioral healthcare in the original HITECH legislation; as a result, psychiatry lacks some of the financial incentive driving other specialties toward EHRs. Since there’s very little interoperability between most hospitals and nearby psychiatric practices, the case for telepsychiatry is a compelling one.

In the case of panic attacks, for instance, hospitals can waste precious hours and countless resources investigating a patient’s cardiac and glandular health. A wide cross-section of people experience these attacks, including celebrities like Johnny Depp, Barbra Streisand, and football Hall of Famer Earl Campbell. Yet most EDs don’t have rapid access to highly trained, board-certified psychiatrists who can quickly identify mental problems masquerading as physical ones.

For example, depression often appears to present as a sleep disorder—which means an ED patient could be sent home with medications that can deepen depression. With a telepsychiatrist as the ED’s first line of defense, these kinds of critical misdiagnoses can be prevented.

There are other advantages to on-call telepsychiatry as well. Beyond panic attacks and depression, an ED is often required to handle a myriad of psychiatric evaluations to address suicide attempts, substance abuse, physical abuse, mental illness, and psychiatric medication issues. Further complicating an ED’s ability to treat patients are the complexities of state psychiatric systems—often something in which an ED physician is not fully versed. A highly qualified telepsychiatrist can ensure complete compliance with state mental health regulations. Rapid response time is another huge plus. Many communities have a shortage of psychiatrists, especially those willing to be on-call throughout the night.

This can be especially problematic when a patient has been placed on a psychiatric hold. Without the proper assessment from a psychiatrist, the patient must remain in the hospital, but often times given the proper medical attention it becomes evident that the patient can be released early. The hospital can then free up a bed space and lessen overcrowding in the ED.

Sigmund Freud had a lifelong struggle with panic attacks. It’s fitting that the profession he launched can now accurately pinpoint the condition far better than most generalists in today’s emergency departments. And in the case of telepsychiatrists, far faster, too.

Topics: telepsychiatry, emergency departments, Uncategorized, psychiatric misdiagnoses, panic attacks

THE KEY IS COLLABORATION

By Amy Levitt

Medicine, like most human endeavors, is all about collaboration. The EHR is one tool currently being touted as a way to aid collaboration by making patient data more accessible. But how does the data benefit a patient if the right specialist isn’t available to use it to guide care? EHR technology and data management are helpful only when they speed and simplify the collaborative process.

To illustrate the point, let’s take an example from the movie business. There’s a process called “looping” in movie post-production. It’s a way to add dialogue after the film has been shot. Thanks to technology, a movie director in Los Angeles can communicate with an actor in New York and a sound editor in Chicago. They watch a scene together, and the actor adds dialogue that might have gotten muddied during filming. It’s a perfect example of long-distance collaboration aided by technology.

But that type of seamless collaboration is in short supply in modern medicine, according to Ken Congdon, editor-in-chief of Healthcare Technology Online. In a recent article, he notes that the U.S. has spent some $32 billion on EHR technology, but has done little to solve an underlying problem: shortages (and uneven distribution) of health professionals. Congdon’s point is that the finest EHR system in the world achieves nothing if it doesn’t bring health professionals closer together in genuine collaboration.
Without universal access to specialists, for instance, a gap in care still exists.

This is particularly true in America’s emergency departments – and not just in remote places like Coldfoot, Alaska. In a recent survey of California hospital CEOs, more than
half are finding it difficult to obtain enough on-call specialists to meet the state’s legal requirements.

That’s why Congdon is so enthusiastic about the benefits of teleconsultations, which let ED professionals and on-call specialists transcend the most daunting geographic and financial barriers. An ED at a small critical access hospital in Idaho, for example, might find it difficult and costly to attract a full-time, on-call neurologist. Why should it have to shoulder that burden, when its physicians could speedily collaborate with a top-quality neurologist who happens to be in Boston?

Teleconsultations make sense financially and they’re achieving better outcomes as well. In one study reported in Archives of Internal Medicine, teleconsultations reduced ICU deaths by 20% and shortened the average length of stay in the ICU by more than a day.

In a wide range of industries, tele-collaboration is crucial to success. If Steven Spielberg can collaborate long-distance with his colleagues to improve something as non-essential as a movie, why shouldn’t the medical community start doing the same to close existing gaps in care and better our nation’s health?

Topics: telemedicine, healthcare, emergency department, Uncategorized, shortage of specialists

SOC and UCLA Present New Stroke Data at the International Stroke Conference

By Amy Levitt

The 2011 ISC in Los Angeles marked the first time that SOC data has been highlighted at international meeting and the first time that our vast collection of data has been mined and presented in poster form and submitted for publication. Latish Ali and colleagues from UCLA and SOC presented a poster entitled,  A National US Telestroke Delivery System: Patient Characteristics and Frequency of Thrombolytic Therapy Delivery. All SOC hospitals in 2009, were plotted on a map and the population within 30 minute driving time was calculated. Over 34 million people had access to our teleneurology hospitals, representing 12% or the US population.  This number is only growing as we continue to contract with more hospitals in multiple states. It's amazing to realize that when I'm on call for SOC that, from my home office, I could potentially provide emergency Neurology care to over 12% of the US population!

 

Topics: Uncategorized, thrombolytic therapy, International Stroke Conference

Florida Hospital CIO Offers Insight at HIMSS

By Amy Levitt



HealthData Blog, Providers' Perceptions, offered an exciting view from Senior Vice President and CIO, Andy Crowder, of Florida Hospital, one of the busiest hospitals in the state and part of the Adventist Health System.   In it, Andy says that the "Effective use of evidence-based practice across all of the hospital's continuums is on his HIT to-do list".   Although the discussion centered around EMR systems, his way of thinking truly brings "meaningful use" to the technology world by connecting technology initiatives to clinical outcomes. 

We applaud Andy's thinking  and the initiatives of Florida Hospital - using technology to deliver evidence based medicine to the community is exacting what SOC has been able to accomplish with our teleneurolgy service.  (and as a point of disclosure, exactly what we are doing  for Florida Hospital).  The SOC way has effectively decreased the 17 years it typically takes for evidence based medicine to make its way out of academia to the community hospital setting to zero - yes - zero. 

Through our clinical expertise, robust operations center, infrastructure, and EMR, each one of our 45 plus physicians are effectively up to date on any new clinical guidelines and evidence based practices and, more importantly, are able to bring this knowledge and evidence based medicine to hospitals and thousands of patients throughout  the country immediately via telemedicine.  This is truly remarkable in the world of patient care and an accomplishment we at SOC are truly proud of.

Click here to read more of the discussion with Andy;

Providers’ Perceptions: a Conversation with Florida Hospital CIO Andy Crowder

Topics: Uncategorized

SOC Participates in the Cisco Collaboration Summit

By Amy Levitt

Author: Joe Peterson, M.D.

This past November, Joe Peterson, MD, CEO and John Moynihan, CTO were invited to participate in the Cisco Collaboration Virtual Launch Experience on the new Cisco Collaboration Website.

Enjoy!

Specialists On Call "In their words"

Topics: telemedicine, hospitals, On Call Coverage, Telepresence, Specialty Physician Shortage, Uncategorized, Cisco

Emergency Medicine Excellence Award Goes to 7 Top Performing Florida Hospitals

By Amy Levitt

Author: Joe Peterson, M.D.

The First Annual HealthGrades Emergency Medicine in American Hospitals Study examined more than 5 million Medicare records of patients admitted through the emergency department at 4,907 hospitals from 2006 to 2008. It then identified hospitals that performed in the top 5% in the nation in emergency medicine. Healthgrades is the leading independent healthcare ratings organization.

The study was based on risk-adjusted mortality outcomes for patients admitted through the emergency department for 11 of the most common life-threatening diagnoses in the Medicare population, including stroke. Comparing the group of hospitals in the top 5% with all the others, HealthGrades found that the top group had a 39% lower risk-adjusted mortality rate.

Florida had the second highest number of facilities to win the award, including 28 top performing hospitals in-state—a quarter of them employ Specialists On Call’s teleneurology service. The 7 Florida hospitals are Bethesda Memorial Hospital, Florida Hospital Orlando, Jupiter Medical Center, Ocala Regional Medical Center, Wellington Regional Medical Center, West Marion Hospital and Wuesthoff Medical Center Rockledge.

Carole DiFlorio, the chief nursing officer at Wellington Regional Medical Center commented, “We introduced teleneurology many years ago to our community and it’s been a welcome addition to the services we’re able to provide. Specialists On Call delivers a methodology by which we can bring the best services to our community in the most timely fashion and immediately help our patients suffering any neurologic emergency. It’s a big part of why our emergency department has had so much success in receiving, evaluating and treating emergency patients.”

Congratulations to our Florida winners!

For more information on HeatlhGrades, visit www.healthgrades.com.

Topics: Stroke, teleneurology, Emergency Medicine, Neurologic Emergency, hospitals, Uncategorized, HealthGrades

Teleneurology as a Model for Telemedicine Growth: Part 2

By Amy Levitt

Author: Joe Peterson, M.D.

Teleneurology as a Model for Telemedicine Growth
The old lessons that have proven true in this new medium called telemedicine are primarily clinical ones. Quality, as Ford once said, has to be job #1. It has to be built into operating systems and managed as, or more aggressively with, distributed groups of physicians, as it does in traditional bricks and mortar institutions. There should be no reason that providers of physician services at a distance enjoy any holiday from the same accepted quality and privacy standards that traditional institutions are held to: Joint Commission accreditation, HIPAA compliance, etc. Of note, the fact that connecting to physicians remotely requires an electronic flow of information does give telemedicine a leg up in managing quality. As every patient’s case has to be committed to a system in order to be communicated to a distant facility, then that data is by definition accessible for real time review and monitoring. For example, adherence to best practices and accepted protocols are simple to measure in patient care decisions being communicated real-time through a single data system. Similarly, the logging of real-time actions into a single data system allow the review and measurement of the time required or delayed during progress against a diagnostic or clinical plan—it’s a great way to define the actionable inefficiencies in a clinical operation.

Like quality, patient satisfaction remains a prerequisite not only for good care but also for the most efficient care. Investments in telemedicine-based efficiency actually allow telemedicine-based interactions to devote more time to the patient interaction—always a factor in patient satisfaction—simply because local logistical factors have been washed from the physician’s day. This has been a happy and unexpected side effect of telemedicine. A well organized service leaves the physician with more time to speak to patients and a better ability to remain “on schedule” throughout the day, leading to many more “thank yous” than physicians working over this new medium were accustomed to receiving in the course of their traditional practice.

Teleneurology has taught new lessons about the actual role of technology in the patient interaction; enough patients have been seen that there is a body of experience now built directly from thousands of patient care interactions. One is the clear lesson that technology alone is not a solution, it’s a component. Despite the great potential of telemedicine as an adjunct to traditional care strategies, there’s a very large amount of videoconferencing equipment that was purchased with grant money and now sits in a closet covered with a dusty ER blanket. This happens because there’s a great deal more steps required to efficiently connect patients and physicians, in real time, than a couple of videoconferencing endpoints.  Teleneurology has taught us that real people and technology infrastructure—not isolated equipment purchases—are what’s required to capture the efficiencies promised by the concept of telemedicine.

Another lesson learned from these thousands of patients is that they are much faster to accept change than the physician community. As long the quality of the technology ‘connections’ are good and the service is executed with obvious professionalism, patients are accepting this new delivery mechanism and have moved on in their internal review and acceptance of telemedicine as a delivery vehicle for good care.

I was reminded very directly of this earlier this month while interviewing a family about their telemedicine experience. The daughter that was with her father during his acute stroke, was telling the other family members about the experience: “and so the emergency doctor then got the neurologist, who talked to dad and me, and he told us that dad should get this new medicine which he did, and he could move his arm and leg again before I left the hospital.”  At no point did this daughter mention to her family the qualifier that the neurologist appeared by video. She had already accepted the medium and moved on to what was important to her, that her father get better. Tens of thousands of patients have accepted this new medium, and now the traditional care system is charged with catching up.

Teleneurology has reminded us also that change is hard in clinical medicine but that with telemedicine, great speed can be obtained in capturing the numbers of patient and clinical encounters required to prove the case of this new care delivery tool. Clinical results, financial results, subject populations for clinical trials, all can be accumulated faster with 100 hospitals connected through a single telemedicine system than can be through traditional research collaborations between bricks and mortar providers. In this regard, the growth of telemedicine as a delivery mechanism will be fueled more each month by the accumulation of patient experiences.

To date, of these new and old lessons derived from the experience of teleneurology, many will form the basis for the successful expansion of telemedicine into new clinical venues.  From this regard, teleneurology has, and continues to, plow an important path for the growth of telemedicine. At the same time, teleneurology reminds us of the oldest lesson of change: all the hype over gadgets and the newest and greatest doesn’t overcome the reality that financial considerations drive many changes in healthcare. If financial models are developed that incorporate the same obvious wins for hospitals, patients, neurologists and payors that are intrinsic to the teleneurology model, telemedicine will grow. This lesson from teleneurology is perhaps one of the most important legacies that early teleneurology programs will leave in the unfolding story of telemedicine.

Topics: telemedicine, teleneurology, Physicians, Patients, Efficiency, Uncategorized