mHealth

It used to be (back in the old days) that “doing” telemedicine (TM) was so new and foreign to everyone that it was considered research, and thus required—at most institutions—human subjects or Internal Review Board (IRB) approval. Patients had to be consented into a study prior to engaging in any sort of telemedicine encounter.

Thankfully, for the most part, those days are gone. While some institutions may still require IRB consent, that number has decreased significantly. Of course, if you are conducting a scientific experiment using a new telemedicine device or some new procedure, that study will have to go through the usual IRB approvals and involved patients will need to be consented.

Gerald Hornbeck is a 73-year-old Veteran who lives with his wife in Gilbert, Arizona, approximately 40 miles from the Phoenix Veterans Administration Health Care System (PVAHCS).

In 2012, after being diagnosed with end-stage heart failure, he was implanted with a Left Ventricular Assist Device (LVAD) at the University of Utah Medical Center. Since then, the LVAD has taken over the task of pumping blood to the rest of his body.

The Telehealth Resource Centers (TRCs) have been in existence for just over 10 years, with the SWTRC for nearly all of that time. In honor of this decade of service to the telehealth community the TRCs released a 10-year report summarizing our group and individual accomplishments and services (available upon request). Periodically it helps to sit back and reflect a bit on what we’ve accomplished as we chart our course for the next few years.

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.

The Southwest Telehealth Resource Center (SWTRC) and its parent organization, the Arizona Telemedicine Program (ATP), launched their Service Provider Directory at their first Telehealth and Telemedicine Service Provider Showcase, in Phoenix in October 2014.

Rural healthcare is suffering, but many communities have yet to swallow the medicine that could make a difference: telemedicine.

Several vectors have led to what the National Rural Health Association estimates is more than 50 rural hospital closures over the past five years, with 12 already closing in 2016 so far. The challenges that rural healthcare face include a high percentage of uninsured and elderly patients, reduced populations, equipment that is not fully utilized, and the lack of lucrative specialty services that help support hospitals financially. There also are the issues of getting patients to rural hospitals in a timely manner due to travel distances, and luring top talent from larger cities.

Telemedicine can address many of these issues if rural communities take the opportunity seriously.

There are meetings that you go to once or twice and never return and others that you just keep going to year after years for decades. The American Telemedicine Association (ATA) Annual Conference and Trade Show falls into the latter category for many of us. I think this year was my 20^th year – but who’s counting! Why do I keep going back? Over the years the meeting has changed in many ways – growing from a small but growing gathering of those already involved in telemedicine to a large and growing gathering of everyone from the seasoned telemedicine aficionado to the green novice just trying to figure out what it’s all about.

$363. That’s how much a single stolen patient health record is worth on the dark market, according to data from the Ponemon Institute, making it worth more than any other piece of data from any other industry. In fact, your medical information is worth 10 times more than your credit card number.

As healthcare becomes increasingly more digital through EHR adoption and telemedicine applications, the information systems the data runs on are becoming more vulnerable to cyber attacks.

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.