Patients referred to the programs are battling congestive heart failure symptoms, which often require many trips in and out of the hospital for treatment. The frequent travel can become problematic for anyone who lives far away, and it also puts additional distress on patients who are already in physical discomfort.

Telemedicine’s Ability to Bring Comfort
The solution has been to bring comfortable, quality care to patients’ homes. Telemedicine has enabled home monitoring services that allow these patients to cut their travel times significantly, among many other benefits in the rehabilitation process, as well as the time required for recuperation.

Dr. Jon Rahman, the chief medical officer at St. Vincent Health, has expressed his gratitude for the program, saying it allows patients to maintain a better quality of life through “proper rehabilitation,” which helps make sure that patients don’t have to return to the hospital. According to Dr. Rahman, studies have shown that 30 to 47 percent of patients who are hospitalized for heart failure have to return to the hospital within six months. As you might imagine, it’s extremely beneficial to have at-home care that lowers the return rates.

St Vincent’s Support and Other Uses of Telemedicine
The St. Vincent Home Care Telemedicine program is supported by a $50,000 grant from St. Vincent Indianapolis Foundation, and another $50,000 grant from the Regenstrief Center for Healthcare Engineering, which is also funded as a strategic partner by Ascension Health and St. Vincent Health.

St. Vincent has been a leader in telemedicine growth in other areas as well, offering programs that promote distance learning for rurally isolated physicians and clinical staff.

St. Vincent also uses telemedicine to provide doctor-to-patient videoconferencing, often for the use of telepsychiatry. The program has specifically been used to help children and adolescents. As Rahman said, the remote connection for telepsychiatry between hospitals “Meets a dramatic, unmet community need in this northern Elwood market.”

The programs of St. Vincent have also led to suggestions that Indiana’s technological infrastructure be expanded, allowing for more programs to be implemented statewide. It’s because of pioneering programs like St. Vincent’s that telemedicine has continued to expand so far, and reach so many lives.

The telepharmacy programs have been particularly useful for rural hospitals because these hospitals operate on smaller budgets and sometimes treat only a couple dozen patients, and they often can’t afford to pay a full-time pharmacist to do the work they require. In fact, because of the small amount of work available, many pharmacists aren’t even interested in working in rural areas.

The comparative lack of pharmacy services in rural hospitals has created a specific niche where telemedicine programs can step in, and that growing industry is referred to as telepharmacy.

What is Telepharmacy?
You might have some questions about what exactly telepharmacy involves.

Essentially, this branch of telemedicine integrates pharmacy software with remote-controlled dispensing units, and uses telecommunications technology to allow a licensed pharmacist to coordinate and oversee prescribing activity from a distance.

Many organizations or companies have been created to promote the spread of telepharmacy in the United States, some of them in coordination with state governments, who have full legislative control of pharmacy activities.

Telepharmacy in Action
North Dakota, for example, has created an intensely growing outreach program in the form of the North Dakota Telepharmacy Project. The NDTP’s goal is to restore and retain pharmacy services in all North Dakota communities that have lost or are at risk of losing their pharmacy access.

The difference in rural communities throughout the state has been significant. Of the 47 general care hospitals in the state, 39 of them are small rural hospitals, and therefore are at some risk of losing their pharmacy services.

But now, because of the work of NDTP, there are 73 additional pharmacies in the state, and 22 of them are hospital-based pharmacies. According to North Dakota State University, which hosts a website offering information on the program, approximately 40,000 patients have had pharmacy services restored, retained, or established since the start of the program.

In addition, the NDTP has added a $500,000 per year business to rural communities, established an estimated 50 new jobs in the rural marketplace, and added over $12 million to the state’s rural economy.

The program has worked to increase local access to pharmacists, which can make a huge difference in the lives of rural communities. According to NDSU data, the following benefits are fostered by telepharmacy, and they’re all important to the community:

• Increased local access to a pharmacist and pharmacy services
• Safe, timely, and affordable delivery of medications
• Enhanced economic development through new businesses and added jobs
• Better climate for recruiting and retaining health care providers
• Increased potential for attracting new businesses and families to the community

The system integrates multiple imaging capabilities into a single data feed that is designed for near-diagnostic quality videoconferencing. The TeleSynergy system is now being used in over twenty institutions worldwide. Many of these institutions are using grant money to deliver cancer treatment to geographically isolated communities, and all of them are using the new technology to enhance collaborative research efforts.

The dream of the organization developing TeleSynergy is to achieve a world where regional, national, and international expertise is pooled together into one easy-to-access resource. With today’s technology, their goal is certainly within sight. Geographic location and travel time do not need to be deterrents to cancer research and treatment.

An amazing example of the work being done is that the medical staff of Belfast City Hospital has been able to receive aid from the National Cancer Institute in Bethesda, Maryland. The staff received expert advice that assisted diagnosis and treatment for a patient with an exceedingly rare form of cancer. Other examples abound, such as poor rural community on the southern border of Texas receiving expert medical advice for their cancer patients.

TeleSynergy’s Background
The TeleSynergy system is a telecommunications solution developed by the Partnerships in Science initiative, which was formed by the National Cancer Institute to help develop virtual integration. Development began in the late 1990’s at the Center for Information Technology in Bethesda Maryland.

When development first started, the system was designed to support the planning of treatment in a radiation oncology environment. Since then, however, TeleSynergy has continued to develop and improve it’s functionality, constantly adapting to the latest medical devices and technologies.

As newer versions of the system have developed, additional applications have emerged, including general cardiology, all ultrasound, nuclear medicine, otalaryngology, opthamology, dermatology, mammography, and histopathology.

The system is now being used throughout Europe and the United States to effectively address the issues of growing cancer-related illness.

One additional benefit of the system, among many not receiving attention in this week’s article, is that TeleSynergy is compatible with other systems and databases through the use of Windows PCs, and also that it is fully HIPAA (Health Insurance Portability Accountability Act) compliant, meaning that all information is safely and securely stored, and can be removed from the rest of a hospital’s network either physically or by means of a firewall.

However, a telemedicine center has been established that provides a link between the University of the West Indies and SickKids, a center for pediatric health specialists. The center is partially funded by the Herbie Fund, an allocation that is provided through the generosity of SickKids.

The technology will allow real-time consultations between the two centers, which will provide the local health care professional at Eric Williams Medical Sciences Complex in Mount Hope Hospital with instant access to the specialists at SickKids. The link will be used for the purposes of patient consultation, education, and research, and will help improve care in both Trinidad and Tobago.

The work of organizations like SickKids, who are being further empowered by telemedicine every year, is indispensable to global health, especially for young ones around the world. Pediatric care addresses the needs of some of the world’s most vulnerable patients, and these patients are the future of humanity. These patients are also typically not capable of providing for their own access to healthcare. Instead, they rely on the rest of the world to bring them access to quality pediatrics.

More About SickKids
SickKids is using telemedicine to address more than the probems of Trinidad. They are now connecting their team of health care professionals with patients and other doctors both nationally and internationally. The benefit is enormous for rural families, who might have to travel wide expanses of land simply to be seen by a doctor. In many cases, these families might not have access to healthcare for their children at all.

Medical professionals at these rural locations are also receiving a better education through the systems that SickKids is providing. All of these services are considered an valuable extension of their basic commitment: “Healthier Children. A Better World.”

Some of the locations they’ve been able to assist include Buenos Aires, Argentina; Wuhan, China; Brisbane, Australia; Aukland, New Zealand; Tokyo, Japan and Kuwait. This organization, through the empowerment of telemedicine, is now touching lives all over the world. Organizations such as these are credits to the name of the healthcare industry, and they deserve our continued support in every way.

This already-primitive situation has been exacerbated over the last three decades by on-going war, which has devastated the country since the Soviet Invasion of 1979. In such a torn, relatively dangerous country, most health professionals aren’t even willing to visit, much less try to maintain a practice.

However, there is a governmental development network working in Afghanistan that is working to expand the healthcare system. The results so far have been 3 working hospitals, 37 clinics, and 230 basic health posts.

Telemedicine Integration
Recently, the network has introduced telemedicine to facilitate better medical training in rural communities. Afghanistan’s leading telecommunications company has also jumped on board, providing the technical expertise and funding to get the project off the ground.

Many of the most common telemedicine functions are carried out by this system, including remote patient diagnoses in rural areas, as well as patient referrals to larger hospitals whenever necessary. But in addition this system will be used for delivering medical training to workers at clinics and remote health outposts, increasing the number of staff with medical qualifications in rural areas.

Many patients are being drawn into more hospitals and clinics now because they can feel that the quality of care has gone up dramatically.They come for check-ups and leave satisfied with the care they’ve received.

Of all the benefits, however, the staff training has turned out to be the most significant. Many of these remote rural areas would have under-qualified, under-trained staff, if they had any staff at all, but now the telemedicine system delivers lectures and other classroom-style learning across the country. The teachers based in more populated areas are actually able to teach 30 to 40 people at one time, a massive increase in the available training for these remote health staff.

The Support Infrastructure for This Project
Interestingly, the Afghan government has taken considerable assistance from the private sector, and has formed a synergistic relationship between non-profit and for-profit entities to make this system work.
The Aga Khan Development Network is the main coordinator for the project, though, and they’re leading this initiative to bring a a new era of public health support to the people of Afghanistan. Telemedicine’s involvement is part of what has made this possible, and it’s exciting to imagine how many other ways it might change the world in the years to come.

The program is officially called the Distance Learning and Telemedicine Grant Program, and while much of the money is going toward distance learning initiatives, there will also be a significant number of states and medical service organizations who benefit.

Where Will the Money Go?
The money, the USDA says, will serve several different functions, but the programs will be focused on rural area. For example, some of the money will be used to increase network connectivity in rural areas, which will allow doctors in rural areas to use videoconferencing. This enhanced connectivity will be crucial for rural specialists who need assistance in providing advanced medical diagnoses or who want to consult with other specialists in hospitals and universities.

The expanded network will provide so much enhanced coverage that it will actually encourage more doctors and nurses to offer services in small towns, thereby fostering strong, healthy rural communities.

What Are Some More Specific Uses?
Because the grants go to organizations and state programs who have found innovative and efficient ways of using the money, the USDA funding will be used in a relatively large number of ways.

Oklahoma, for example, will be using nearly $500,000 to replace outdated videoconferencing systems, which are a common tool for new telemedicine services. But this videoconferencing network will actually be used to connect over rural schools and other health centers, in addition to hospitals. The new system will not only serve functions like connecting physicians and patients for telestroke services, but it will also be used for continuing education for medical professionals, and to teach a stroke recognition program to train students to spot the early signs of a stroke.

In Ohio, the Holzer Clinic will be using the money to create a hub for healthcare training services, which will ultimately reach over 19 clinics and hospitals in rural countries across Ohio.

In North Carolina, the money will create a school-based telemedicine program that will treat students in two different counties. This program will take effect in 11 schools, where the students, administrators, and faculty will have access to not only primary healthcare, but also mental healthcare and nutritional counseling.
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As you can see, these USDA funds represent a significant branching out of telemedicine services in the United States. The overall impact for these populations will be pronounced, as telemedicine will help ensure the health of these communities. The fact that the government is now moving telemedicine into the school systems of our country also shows how widespread its acceptance is becoming.

At conferences like the “Health Care Innovations Summit” that is hosted by CMS, West Wireless Health Institute, and Health Affairs, people from leading healthcare organizations are brought together, and each team’s best problem-solvers are put to task on several major new initiatives.

Conferences like the HCIS are invaluable not only for spurring competition and innovation through the giving of prizes, but also for helping develop teams across the nation set goals. Sometimes breakthrough ideas are sparked just because a healthcare organization has an important issue brought to their minds by one of these conferences.

The Initiatives at HCIS
There were several issues brought up at HCIS this month, on January 26th. One of them included a $5000 prize for the best response to a “Health IT Challenge to improve car transitions for hospital-discharged patients,” as Farzad Mostarshari M.D., ScM, National Coordinator for HIT, explained.

The goal is for health information technology to be used to schedule follow-up appointments and post-discharge testing for patients before they leave the hospital. These practices are designed to help patients make a safer transition to their homes. The award for this particular initiative also included a three-day visit to a pilot community for further discussions of implementation.

Last year’s initiative was even more directly related to telemedicine. The similarly titled program, “Ensuring Safe Transitions from Hospital to Home,” called for developers to create a web-based application that help patients and caregivers navigate and manage the transition from the hospital into their homes.

Initiatives like these happen all over the country, and are offered by many entities in the private sector, from Pfizer to Janssen Healthcare Innovation.

Kaiser Permanente has instituted an “HIV Challenge,” for example, which is designed to increase access to HIV care for people who are living with the disease. One of the main ways to effectively improve HIV treatment access is to put into place quality-improvement programs that are capable of measuring gaps in testing, prevent, and treatment.

Overcoming this challenge with HIV, along with many of the other obstacles that have been encountered by organizations like The Alzheimer’s Challenge 2012, will almost certainly involve more efficient and insightful use of electronic administration, data keeping, and patient communication. These areas, of course, are where telemedicine offers unprecedented opportunities.

Few people know that many employees in the telemedicine industry are capable of working from home. Nurses, pharmacists, and even some other health-care professionals can provide their advice and services right from the comfort of their own homes, either through telephone, Internet, or video conference.

These at-home professionals can be contacted for their expert advice on many different situations, especially those that don’t require urgent care. And for those who are unsure whether the prospect of these at-home professionals seems, well, professional, we’re going to take a look at the benefits of telecommuting.

Many employers, as well as other business people, have understandable questions and concerns about working from home. But many of them are easily answered with a few simple facts about telecommuting.

Benefits for Everyone Involved

For one, some employers are concerned about their employee’s productivity. But many surveys have shown that telecommuters are more productive, on average, than their in-office counterparts.

Though there aren’t official research results to prove it, one would think that the personal comfort, quietness, and peace of one’s own home can do wonders for an employee’s state of mind. There’s also the possibility for an employee to take more refreshing breaks and have healthier meals than he or she would while at work. The overall result is a more satisfied, more productive employee with fewer stress-related issues. An added benefit is that a less stressed employee is more focused, and makes fewer mistakes.

Employers also sometimes have concerns about not being able to contact their staff because of the lack of face-to-face interaction. But technology such as chatting, email, and cell phones are so commonplace that this concern need not be a problem either. Employees at their home desks can be just as easy to contact as employees at their work desks.

Employers can also be satisfied that telecommuters aren’t just saving money for themselves in gas prices, food, and other transportation- and time-related costs. Telecommuters also cost the company less, overall, than other employees. Some of the perks for employers include fewer administrative costs, as well as the easing of relocation costs.

Because employers are becoming more comfortable with telecommuters, and because more and more employees are realizing their jobs can be done as effectively from home as at an office, we can certainly look forward to more opportunities for all of us to take advantage of this type of work.

Perhaps someday, each of us will consider it more common to work from home, just as we can certainly expect to order all of our medication — and visit our doctors — from home as well.

The Expense Issue
First and foremost, the technology involved in a telestroke network certainly isn’t as expensive as some hospitals or care providers initially suspect. As mentioned in this week’s previous article, a telestroke system includes a “hub” of specialists that communicates with the “spokes” of the system, which are individual hospitals.

At the hub end, the only technology needed is that required to provide videoconferencing and CT scan transfers. Simply put, the specialist needs to be able to see and hear the patient clearly, and he or she also needs to acquire and view the CT scan, and that’s all.

Medical videoconferencing systems need to use encrypted transmission systems, but besides that special consideration, the videoconferencing technology required at both ends is simply a computer, monitor, echo-cancelling headphones, speakers, and a broadband Internet connection.

At the spoke end, each hospital needs a CT machine for the scans, the aforementioned videoconference setup, and the ability to transfer the scans to the hub, which is easily provided.

All of the equipment needed for a telestroke network is usually either already at a hospital, in the case of the spokes of the network, or it can easily be installed and operated at the hub. Not only is the initial capital investment relatively small, but the return on the investment, in the form of better and more affordable stroke care, is significant.

Reimbursement Issues
Medicare, it seems, is not providing coverage for stroke victims that sufficiently covers the cost of their treatment, which is causing the hospitals to lose the difference, in many situations. The result of this gap between reimbursement and costs is that fewer hospitals are able to staff a stroke treatment center. Although this difference between cost and coverage is reducing overall stroke care, it also provides a place where telemedicine has enhanced benefit as a cost-cutting measure.

Administrative Burdens
Though some more research is necessary, perceived administrative burdens with telemedicine systems tend to be a result of unfamiliarity and reluctance to adjust to change. In many ways, greater integration of digital information and more efficient long-distance communication of medical expertise can reduce administrative burdens, although there is an initial period of adjustment.

There are also some legitimate concerns about insurance coverage and liability, but these issues have been sorted out with much more experimental systems, and the results have often proven to be worthwhile.

In addition to telestroke networks having demonstrated their effectiveness, the equipment necessary to put a system in place is decidedly cheaper than people expect it to be. However, there still remain some barriers to its widespread adoption, which we will discuss later in this week’s articles.

The Importance of Fast Treatment
First, let’s cover the reasons telemedicine has proven so effective in stroke treatment, and how we can expect it to benefit us as patients.

Telemedicine’s ability to help patients in rural areas receive specialized treatment from a neurologist is the main reason that telestroke networks are so effective. Recent studies have discovered that clot-busting medications such as tPA are capable of significantly reducing the changes of long-term brain damage in stroke victims, but only in the time period immediately following a stroke, which lasts about three hours.

This data highlights how important it is for patients to receive attention from a neurologist or other specialist care provider as quickly as possible following a potential stroke. Telemedicine networks set up specifically for stroke victims can significantly cut down the amount of time it takes for a patient to reach a capable care provider, because a full stroke clinic is an expensive investment for a hospital to make, and many rural areas in the US can’t afford have a qualified neurologist on staff. The increased access to specialists that telemedicine provides can prove vital in reducing the tremendous long-term consequences of a stroke.

The Enhanced Design Elements
Telemedicine is also enhancing the prospects of stroke victims by making stroke care more affordable for the hospitals that strive to offer it. When a telestroke network is installed, it also has some very specific features that cut down on the cost of maintaining the system, and it also allows for an efficient, profitable endeavor on the developer’s behalf.

A telestroke network is based around a “hub,” which hires specialists to answer calls from the “spokes,” which are hospitals and clinics. With such a hub in place, any hospital that lacks a neurologist can become a spoke for a fraction of the cost of an in-house neurologist. The hub, in turn, makes money and increases efficiency by focusing on one particular aspect of healthcare, and by reaching many different hospitals, allowing for income to flow in from a wider variety of sources.

Although it can be tough to face the realities of healthcare as a business, those realities do exist. It’s hopeful, however, that with increased adoption of technology, those business realities will allow increasingly effective care for stroke victims, at an increasingly lower cost.