Health Law

Saying "what's up, doc?" to a physician on the phone instead of sitting around for hours in a hospital waiting room could save the beleaguered health-care system a bundle, a Montreal economic think-tank says.

In a report released Thursday, the Montreal Economic Institute says several studies in the last few years have shown telemedicine can significantly reduce costs, increase health-care service efficiency and boost patients' well-being because they spend less time travelling to and from clinics and hospitals and waiting around to see a nurse or a doctor.

This isn't shockingly new information — a similar study in Ontario in 2007 showed much the same result — but the institute says booming health-care costs make getting a tech upgrade an urgent necessity.

"With a smart phone I can take a picture of a wound on my leg and send it to a doctor," said Germain Belzile, the institute's director of research. "The doctor might say, 'It looks like diabetes; go get a blood test.' Already, we've saved 12 hours of waiting in a hospital emergency waiting room."

One Quebec study, at Maisonneuve-Rosemont Hospital in Montreal in 2003 and 2004, involved 2,400 chronic lung disease outpatients. Some had a device in their homes that gauged their lung capacity, cardiac rhythm and blood pressure and sent the results automatically to the hospital over the Internet. These patients were also consulting more frequently by phone with nurses. Other patients had no such devices in their homes and received regular medical care, including short phone calls and frequent visits by nurses to patients' homes.

Meanwhile, thanks to California's Telemedicine law, a huge initiative is underway:

What Is the Specialty Care Safety Net Initiative?

The Specialty Care Safety Net Initiative (SCSNI) is a telehealth demonstration project that connects safety net clinics across California with medical specialists at University of California (UC) Schools of Medicine at Davis, Irvine, Los Angeles, San Francisco, and San Diego. The SCSNI is a collaborative effort that seeks to discover the policy, statutory and practice pattern barriers preventing wide-spread adoption and sustainability of telehealth programs. Identifying and removing these barriers is essential to the long-term sustainability of telehealth services for the safety net.

Why This Initiative?

Access to specialty care is a major concern in both rural and urban underserved communities. While private and public community-based health centers provide a safety net for primary care, there is no designated safety net for specialty care. Primary care providers whose patients need specialty consults are left to navigate an uncoordinated network of private and university-based providers, many of whom are reluctant or refuse to see Medi-Cal or uninsured patients. Many of the areas in which safety net clinics indicate the highest unmet need for specialty consultations are dermatology, psychiatry, orthopedics, endocrinology, neurology and hepatology. Telehealth technologies can facilitate access to timely, cost-effective care, and these specialties are ideal for delivery via telehealth. While some telemedicine programs are financially self-sustaining, the majority of projects depend on grant support to maintain operations. Work needs to be done on alignment of incentives, reimbursement, and business planning to develop sustainable models of care. This initiative offers that opportunity.

How Is the Initiative Funded?

The California HealthCare Foundation awarded the Center for Connected Health Policy (CCHP) with $2 million to facilitate UC system and safety net community clinic participation in the initiative. The CCHP will:

	Purchase specialty clinic time from the UC medical schools. Specialty telemedicine clinics will be reserved exclusively for the patients of SCSNI partner clinics, allowing access to care for patients regardless of insurance eligibility.
	Contract with Telemedicine.com, Inc. to provide support for each participating site to include: technology assessment; telemedicine technology training; patient presentation training; and high level ongoing technical support and user training throughout the duration of the project.
	Provide limited financial support for participating safety net clinics.

 

What Is the Initiative's Approach?

Through a CCHP-supported laboratory approach, the four UC Schools of Medicine will provide consultation services to primary care providers in SCSNI partner clinics. The laboratory environment will:

	Provide access to specialty services for safety net patients via telemedicine and telehealth technologies. Specialties to be offered in this project comprise those services identified by safety net clinics as high need and include: Dermatology (Pediatric and Adult) Neurology (Pediatric and Adult) Hepatology (Adult) Endocrinology (Pediatric and Adult) Orthopedics (Pediatric and Adult, Non-Operative) Psychiatry (Pediatric and Adult)
	Provide education services (through physician assisted patient consults and continuing medical education presentation) to the safety net providers.
	Determine new and innovative ways to utilize telehealth and health information technologies to improve the quality, safety and efficiency of specialty care.
	Determine what, if any, policies or regulations prohibit wide spread adoption of telemedicine in the UC and safety net clinic environments.

What Are the Goals Of the Initiative?

The goals are to provide an action/advocacy agenda of policy, regulatory, statutory and/or care delivery model changes that will increase the financial sustainability of telehealth services in the safety net; and to identify a sustainable mechanism for UC and other medical specialists to serve safety net patients.

Center for Connected Health Policy The Center for Connected Health Policy (CCHP) is a strategy and planning organization that seeks to increase the use of telehealth services in California. CCHP promotes a policy environment that encourages the adoption of telehealth services, which will improve health outcomes and access to medical care, particularly among Californians who are uninsured or low-income. CCHP conducts policy analysis and research, communicates findings and policy recommendations, and operates telehealth demonstration projects.

 

If you've watched the tele-conferences on 24, you'll recognize Cisco's presence in telemedicine..... And check out use of telemedicine in the airways of UAE:

Cabin personnel taking a paseenger's temperature using the Tempus IC telemedicine system. The data will be transmitted back to an expert medical team on the ground. Credits: RDT

‘Is there a doctor on the plane?' Piping this request over aircraft speakers is the traditional response to a potential onboard medical emergency. But now the availability of expert medical advice can be guaranteed every time.

Key information about the passenger's health can be quickly transmitted via satellite to a dedicated response centre.

The same vital signs which are measured routinely in a hospital emergency room, including blood pressure and sugar levels, temperature and heart rate, are captured to a clinical level of quality.
At the same time, the crew can also talk with the medical specialists and send them still and moving pictures of the situation.

Imagine a long-haul flight passenger complaining of acute shoulder pain

. He may just have strained his muscles lifting too much luggage - or he could be experiencing a heart attack.

The Tempus IC system can transmit the passenger's electrocardiographic readings to the medical team, allowing them to rule out heart problems and preventing an emergency diversion costing many thousands of euros.