Clinical Telemedicine Blog

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

Teleneurology as a Model for Telemedicine Growth: Part 1

By Amy Levitt

Emergency teleneurology and telestroke care—the importation of stroke and emergency neurology specialists to the patient’s bedside using videoconferencing technologies—is growing steadily in magnitude, impact and validation. Early in the decade some hundreds of patients each year were connected to specialists by video conferencing; in 2010 literally thousands of acute stroke patients will have a distant specialty neurologist involved in the critical phases of their care. The typical associated conclusion is that the evolution of technology has allowed the growth of telemedicine in general, and specifically teleneurology and telestroke. Nothing could be further from the truth, and it’s time the word gets out that the breakthroughs driving the successful growth of this one dimension of telemedicine are financial, not technical.

Today, both university-based and private telemedicine efforts bring good neurology to the bedside of the patients who most need the benefits of evidence-based best practices. Patient acceptance has proven to be high, technology supportive of good clinical results, and distance-based practice capable of great, measureable clinical impact. Increasingly, local physicians are realizing that telemedicine can be used to enhance, and not burden, their practices, and in the case of on-call coverage, can help them focus upon their core practice and prevent burnout while actually expanding their patient population. The successful evolution of teleneurology is providing an operational model for the effective distribution of other specialty services by telemedicine. And it’s all due to the fact that hospitals who lack effective neurology call coverage are financially worse off, and at a competitive disadvantage to those hospitals that have good call coverage.

The model for hospital-supported teleneurology has been relatively easy to define because about 70% of emergency neurology cases referred to expert neurologists by telemedicine are acute strokes and other neurovascular events. In this narrow collection of diagnoses, it’s been possible to build a reasonable predictive model for hospital returns-on-investment against the costs of imported specialty neurologists. And on that basis, telestroke and teleneurology services have grown, and are demonstrating the values that telemedicine has always seemed to promise but never deliver: efficiency, distribution of talent free of geographic restraints, and real benefits for patients and hospitals.

Not all specialties lend themselves to the financial model that supports teleneurology and telestroke care…But all telemedicine strategies that deliver combined efficiency and quality will eventually find support from a party at-risk for the costs of poor care, and this will spark the attention of telemedicine providers ready to deliver clinical care at a distance. And there will, of course, be technology involved; it will be less expensive than today’s technology; and its reliability will be critical to the effective use of the system, but it will not have started the next push in telemedicine. Finances will drive that. As a model for care, teleneurology has explored interesting ground that will serve as a foundation for other telemedicine specialties. It too has lent some new lessons, and reinforced the importance of some that are old.

Topics: Stroke, teleneurology, Physicians, Patients, neurologists, Efficiency

3rd Annual Specialists On Call Physician Conference

By Amy Levitt

Author: Joe Peterson, M.D.

SOC again embarked on the beautiful grounds of the Cypress Villas Golf Resort in Orlando Florida for our third annual Physician Telemedicine Conference. This Continuing Medical Education (CME) conference, held October 15-16, at the Grand Cypress Resort in Orlando, Florida, was designed for healt care professionals to gain familiarity with new technology, treatment techniques and diagnostics for patients with neurological emergencies.

In addition to the lectures and discussions, several awards were given out at the conference in recognition of milestones and hard work achieved by Specialists On Call customers and physicians.

    • The Nurse Champion awards were presented to both Debra Motz, BSN, MS, regional stroke coordinator, Baptist Health System, TX, and Tammie Stefenko, RN, stroke coordinator, Baptist Hospital of Pensacola, FL, for their personal dedication and championship of stroke, neurology care and telemedicine program.

    • The System Partner Award was presented to Bon Secours Health System for advancing patient care in the treatment of acute illness using telemedicine services.

    • The SOC Clinical Excellence Award went to Dr. Carlos Villar, MD, for his creativity, drive and devotion, which has helped define the new and emerging field of emergency neurology.


Other highlights of the conference include:

    • Keynote Speaker: Michael De Georgia, MD, FACP, FAHA, FCCM, discussed theories from his book Struck Down: The Collision of Stroke and World History.

    • Stephan Mayer, MD, FCCM, presented “StepWise Management of Elevated of Intracranial Pressure: Modern Thoughts on an Ancient Problem ”

    • Albi Penalver, MD, discussed  ”The World of Emergency Psychiatry”

    • Anne Leonard, MPH, RN, CCRC, FAHA, presented “Primary Stroke Centers: The Current Opportunities and Remaining Barriers to Universal Implementation”

    • Evan Allen, MD, MBA, discussed “Telemedicine and Emergency Neurology: From Vision To Reality”


Plans have already begun for the 4th annual conference. Information will be updated as it becomes available.

Topics: telemedicine, Stroke, Primary Stroke Centers, Neurologic Emergencies, Emergency Psychiatry, Uncategorized, Continuing Medical Education