Telemedicine Studies

Telemedicine via video conferencing is comparable to face-to-face doctor-patient encounters:

Study finds virtual doctor visits satisfactory for both patients and clinicians, May 2009 issue of the Journal of Telemedicine and Telecare
"There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues," says Ronald F. Dixon, MD, an internist at Massachusetts General Hospital
"Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time."

Benefits of Telemedicine for Stroke care in ERs

New evidence demonstrating the benefits of telemedicine based stroke care is cited in the recent Journal of the American Heart Association.
The current physician shortage, is creating new opportunities for showing telemedicince's value.

Stroke care is a narrow application for telemedicine. The use of TPA treatment for acute stroke and the need for an urgent evaluation of a stroke patient within 1-2 hours in order to administer TPA for the treatment an acute stroke has created a market for telemedicine for stroke care.

Hospital emergency rooms already have a dificult time finding neurology coverage. The need to have a neurologist available to make a thorough patient evaluation within 1-2 hours of an impending stroke has exacerbated the shortage. As a result, hospitals have been willing to pay for this service even though there is no payer coverage, including Medicare.

The benefits of telemedicine do not stop with stroke care. Any situation or setting where there's a paucity of phyician access, is ideal for telemedicine. We have found that nursing homes are such a setting. There are too few physicians following too many nursing homes. Telemedicine can solve this problem. See Fierce HealthIT for more.

INTERACT: Reducing avoidable hospitalization of Nursing homes

Here are some presentations from the Care Transition Conference held recently this past April in the Boston area. There was a presentation on reducing hospital readmission from nursing homes.
The INTERACT project concluded that effective communications and the use of disease specific protocols are essential for reducing readmission rates. On site physician availability was also specifcally mentioned as beig another critical factor.

Care Transitions
Re-admit in Nursing homes

INTERACT - Reducing Avoidable Hospitalizations of Nursing Home Residents

Connected Health Framework

Microsoft's "vendor agnostic" architecture for healthcare applications.
New version: Microsoft Connected Framework version 2

This set of documents details an approach for designing interoperable health care applications using a Service Oriented Architecture or SOA. There is a lot of sophisticated health care domain knowledge contained within this document set, which tells me that Microsoft has done their homework, My guess is that Microsoft is working on a universal healthcare development platform. Sort of like a "Healthcare development operating system" on which to build all other healthcare applications. They started this approach already with Healthvault.

Telemedicine Legislative Watch

House Resolution 2068: Medicare Telehealth Enhancement Act,
This bill will expand mediciare reimbursement to urban and suburban area. Currently telemedicine reimbursement is limited to rural areas, which essentially excludes 80% of the population.

Telemedicine has been shown to increase access to healthcare. This is especially important given the current physician shortage. Used effectively, telemedicine can improve efficiency and reduce costs. It also has the potential to improve quality, especially in reducing re-admissions, avoiding needless emergency room visits and inpatient admissions. This bill may actually help in making telemedicine more mainstream.

Nursing HomeTelemedicine Videos

We have put together several videos demonstrating the use of telemedicine in the care of nursing home patients:

Reducing 30 day Hospital Readmission rates

The Institute of Healthcare Improvement or IHI, has launched a grant funded initiative for reducing Rehospitalizations. It is supported by the Commonwealth fund. The goal is to reduce the 30-day rehospitalization rate by 30%. Another stated goal is to improve patient and family satisfaction with transitions of care and with the coordination of care.

IHI recommends these 4 elements at the time of hospital discharge:

1. Enhanced assessment of post-discharge needs;
2. Enhanced teaching/learning;
3. Enhanced communication at discharge; and
4. Timely post-acute follow up

IHI states that success is dependent on active partnerships with providers across the continuum of care: hospitals, skilled nursing facilities, home health, ambulatory settings and patient/caregiver.

The focus of this project will have implications in healthcare payment reform, so it will be important to follow the progress of this project. There's a strong emphasis on improving care transitions and to identify those important services that will enhance this process. Unfortunately, many of these services are currently not reimbursed. It will require an out-of-the-box thinking beyond the current fee-for-service payment model in order to finally develop solutions that really work.