Policy

The 115^th Congress (2017-2018) took big steps forward for telehealth.

First, members introduced 119 bills that included the term “telehealth” or “telemedicine,” a 42% increase over telehealth legislation introduced in the 114^th Congress.

Second, the bipartisan Congressional Telehealth Caucus formed to “discuss how best to improve remote care to Americans who need it most.” Yes, you read that right: Bipartisan! There is enormous bipartisan support for telehealth in Congress.

In 2010, the U.S. Department of Health and Human Services signed an agreement with the U.S. Department of Agriculture to form a partnership to support healthcare access in rural communities.

As a result, since 2012, Leila Samy, Rural Health IT Coordinator, HHS Office of the National Coordinator, has worked with rural communities around the country, organizing statewide meetings to address issues such as healthcare financing, telehealth infrastructure, broadband demands and other topics relevant to establishing and maintaining healthcare access in rural communities.

I recently had the opportunity to speak at “Georgia’s Health Care Reform Task Force” with other members of the Emory Virtual Patient Care team headed by Greg Esper, MD. Dr. Esper is a neurologist and Director of New Care Models at Emory and champion for expanding Emory’s telehealth footprint in GA (https://www.emoryhealthcare.org/physicians/e/esper-gregory.html).

In the beginning…

Using the strictest definition, telemedicine has been around since the ’60s. Initially it was medical professionals with a phone and a video screen consulting with one another. Since the users in question were both regulated and overseen by state boards of medicine, this use often didn’t require many additional rules or regulations.

Telehealth is offering improved access to healthcare services across America. Information and communication technologies are now becoming more affordable, easier to use, secure, and applicable to a broad spectrum of healthcare services, providing the right care, at the right time, and the right place. In light of these advances in telehealth, developing new state legislation that facilitates the meaningful use of telehealth is becoming even more important in order to appropriately address barriers and gaps in care to all citizens. Successful legislation should address, at least in part, the Triple Aim: 1) Improve the patient’s experience with the health system that is more patient centered, 2) Improve health outcome, community and public health, 3) Decrease costs without sacrificing quality.

Several weeks ago I was presented with a CT scan on a new patient, a young woman with a severe headache who had been transferred overnight by air ambulance from another hospital. As a center that specializes in diseases of the nervous system, my facility, the Barrow Neurological Institute (BNI), routinely accepts people from around the country. And since this woman had been sent to us because the CT scan from the outside facility was interpreted as her possibly having blood in the brain, no further questions were asked. Sounds like responsible and compassionate healthcare, right? But there was a hitch: The patient didn't need to be transferred at all.

Are you thinking about moving data (e.g., patient files, images, telemedicine survey data) from that clunky old Yugo computer or storage system to a brand new shiny Ferrari system? Are those happy thoughts or are they clouded by dread and visions of digital monsters eating up all your data and laughing in your face? You are not alone.

Data migration can be painful but there are ways to lessen that pain with careful preparation. First let’s start with a few basic terms. Legacy data is what you have now and want to transfer. Data migration is the process of importing that data into the new system. Data cleansing is getting the old data ready to move – making it compatible with what the new system requires or expects. It’s this last part that is often the most difficult.

When dealing with the challenges of bringing quality medical care to rural communities, the obstacles are twofold: lack of available resources and the high cost to administer care in rural environments. Combined with cuts to Medicare funding, the obstacles rural patients face begin to mount to unmanageable levels, and often force long-term care (LTC) facilities and Skilled Nursing Facilities (SNFs) to send patients to emergency rooms for treatment if a specialist isn’t accessible in the immediate area within the required timeframe.

It has taken quite a while, but the FDA has finally released a document that may help pave the way for whole slide imaging pathology system approval. On February 25^th they released the “Technical Performance Assessment of Digital Pathology Whole Slide Imaging Devices Draft Guidance for Industry and Food and Drug Administration Staff”.

For years telemedicine has had a significant barrier – interstate licensure. Clinicians regularly see patients in their offices who live out of state, but when it comes to telemedicine they have for the most part been prohibited from doing this. In fact, it is easier to see an out-of-state patient when they actually leave the country by telemedicine than when they stay home. This might all be finally changing.