Telestroke continues to expand (US)

Telestroke has expanded over the years and one of the most recent [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/emergency-2.jpg” thumb_width=”150″ /]implementations is in New York at a group of hospitals in Hudson Valley. Health Alliance of Hudson Valley announced last week that its Kingston Hospital is now operating a telestroke service provided by Neurocall that uses a team of 40 “tele-neurologists” based in New York, Texas and Florida.

Stroke is one of those medical emergencies where the speed of diagnosis – usually within minutes of symptoms appearing – can have life-long impact on the patient’s ability to return to an independent life. What is particularly complicated in a stroke is that it can be caused by a blood clot or a burst blood vessel and the treatment for the two types are very different. When a specialist who is able to identify the type of stroke quickly is not available at the hospital, as is commonly the case, the ability to use telemedicine has proved to be a great boon.

A survey in 2012 identified 56 telestroke programs across the US and no doubt this has grown over the years with many well known health service providers such as the Mayo Clinic, Massachusetts General and Cleveland Clinic operating a telestroke service as well as acting as a hub to regional and rural hospitals.

Stroke is the fourth leading cause of mortality in the USA and the leading cause of serious long term disability according to the American Heart Association. With only 1100 stroke specialists in the US, half of US hospitals do not have a stroke specialist on the staff and nearly half the US population live more than 60 miles from a stroke centre according to “Telestroke—the promise and the challenge“, a paper published last year in the British Medical Journal. These factors have led to telemedicine being firmly established as an important part of acute stroke treatment.

What it takes to make telehealth really work

In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.

Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:

“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”

This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.

Another major driver of course is cost saving, as demonstrated by (more…)

Apps and wearables – developments over the summer

Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.

We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.

This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)

Fitbit accurate in measuring energy expenditure: AHA presentation

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/05/acitivity-trackers_wellocracy_chealth-blog-kvedar.jpg” thumb_width=”150″ /]The current judgment on commercial fitness monitors is that they are worthwhile directionally, but accurate–not so much [TTA 10 May 14]. This may be changing, albeit on a specific, non-clinical measurement. A Columbia University Medical Center (New York, NY) team tested the Fitbit One and Fitbit Flex for tracking energy expenditure during treadmill walking and running exercise, versus energy expenditure assessed by indirect calorimetry, and found themto be valid and reliable devices. Correlation between measurements was 0.95 – 0.97. These devices were interestingly placed on wrists and hips; perhaps a user can enlighten me.  Poster presentation/Abstract MP11 published in the American Heart Association’s journal, Circulation.

Powerhouse DC lobbying for telehealth, telemedicine

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]The Gimlet Eye observes from a houseboat anchored at a remote Pacific island, with coconuts and occasional internet to Editor Donna.

Telehealth and telemedicine have reached a US milestone of sorts: the formation of a Washington, DC-based ‘advocacy’ (a/k/a lobbying) group constituted as a business non-profit. The Alliance for Connected Care is headed by three former Senators (two of whom were ‘amigos’) from both sides of the aisle and backed by a board including the expected (giants Verizon, WellPoint, CVS Caremark, Walgreens)–and the surprising (much smaller remote consult provider Teladoc and HealthSpot, the developer of the HealthSpot Station kiosk–hmmm, must be a fair chunk of their marketing budgets there) flanked by six well known ‘associate members’ including Cardinal Health and Care Innovations (another hmmm). There’s also a hefty ‘advisory board‘ including the American Heart Association and the NAHC (home care). The leadership team members are all members of major Washington law/lobbying firms. Tom Daschle is recognized as one of the most influential former Senators in town via DLA Piper, though himself not a registered lobbyist (OpenSecrets.org). Trent Lott and John Breaux hung out their own shingle and were recently bought by mega-lobbyist Patton Boggs. To put a fine point on it, more high-powered one does not get. The Eye sees that the time is prime for the Big Influence and…

What the Eye sees is Big Financial Stakes: Private insurers are required to cover telehealth in 20 states, as does Medicaid in most. The VA is a major user. But the great big trough of Medicare is new territory; covering 16 percent of the population, the use of telemedicine and telehealth is limited to certain geographic areas. (MedCityNews) This marks the infamous tipping point: the clarion call to ‘build significant and high-level support for Connected Care among leaders in Congress and the Administration’, ‘enable more telehealth to support new models of care’ and ‘establish a non-binding, standardized definition of Connected Care through federal level multi stakeholder-input process’ (whew!) Big companies want in, insurers want reimbursement, and they want it from somewhere as well. Toto, we’re not in the Kansas of Small anymore with ‘connected health’–we are now in the Oz of Big Money and Power Players. Alliance release (Oddly the website looks preliminary despite the big announcement and backing.)

More on this strategy: It’s called ‘soft lobbying’ and it is the latest thing in the Influence Wars. The Alliance for Connected Care is a 501(c)6 non-profit, similar to a business league like the Chamber of Commerce, and this has become a popular tactic. It’s also a less regulated, less transparent way to shape coverage, public opinion and exert influence on legislators. See this well-timed examination from the Washington Post on the corn syrup versus table sugar wars. ‘Soft lobbying’ war between sugar, corn syrup shows new tactics in Washington influence