West Virginia considers expanding prescription medication via telemedicine

The West Virginia legislature has been considering a new bill to expand the range of medications that may be prescribed in a telemedicine encounter. The bill was passed by the House of Representatives last week and sent to the Senate for consideration.

The House Bill 2509 proposes to amend the West Virginia Medical Practice Act to enable physicians to prescribe certain controlled substances when using telemedicine technologies. According to Mobihealthnews this would specifically include medication for mental and behavioral health, although bill itself does not refer to these conditions. A note at the end of the bill states “The purpose of this bill is to permit a physician to prescribe certain controlled substances when using telemedicine technologies.”

It seems that the legislation in the US dealing with telemedicine is fragmented and becoming more so. There was the issue of whether health insurance companies would cover telemedicine consultations, then the issue of medicare and medicaid covering the telemedicine consultations, then the state medical boards refusing cross border telemedicine and now issues on individual medications that can or can’t be prescribed. This will make it increasingly difficult for those practitioners who decide to enter the telemedicine arena.It is not a sustainable approach to pass a new law on every issue relating to telemedicine. Telemedicine is merely medicine practiced via a different route and regulation and standardisation of processes associated with telemedicine should be divested to a suitably established agency overseen by the legislature, similar to how the medical boards operate. In fact, this could easily be an additional responsibility given to the medical boards.

Idaho legislature begins repeal of telemedicine abortion ban

An agreement reached in the U.S. District Court in Idaho in click to enlargeJanuary this year overturned Idaho’s ban of prescription of abortion-inducing drugs during a telemedicine consultation (see our previous article).

The settlement of the case before Chief District Judge B. Lynn Winmill, brought by Planned Parenthood of the Great Northwest and the Hawaiian Islands, required the Idaho legislature to repeal the laws that made such prescriptions over telemedicine consultations illegal. The repeals have to be carried out by the end of the 2017 session, else Judge Winmill will declare the laws unconstitutional and unenforceable, according to Mobi Health News .

Idaho legislature has accordingly started the process of removing the single line from the Telehealth Access Act which bans the prescription of abortion inducing drugs and repealing the law requiring the doctor to be physically present at the consultation when prescribing the drugs. This is to be achieved via the new House Bill 250, sponsored by the State Affairs Committee, named simply An Act relating to Abortion. The bill was introduced last Friday.

The wording of the bill emphasises the the view that the state believes that abortions induced by medicines prescribed via telemedicine consultations constitute “substandard medical care and that women and girls undergoing abortion deserve and require a higher level of professional medical care”. Planned Parenthood has said that it objects to this statement that telemedicine provides substandard care according to Boise Weekly.

The bill has made rapid progress having had its second reading yesterday and is currently filed for the third reading.

Utah telehealth expansion bill passes Senate and House

The bill to expand telehealth in Utah, which was amended by a click to enlargeUtah Senate committee on February 14th (see previous TTA article) has now been passed by both the Senate and the House of Representative in the state. The amended bill was passed by the Senate on Thursday last week and by the House the next day according to the Utah government website.

The original bill, HB154, sponsored by Rep. Ken Ivory, had a controversial clause restricting the prescription of abortion medication during a telemedicine consultation. The amendment removed this restriction on the basis that such restrictions have been successfully challenged in the courts in other states.

The bill is now being “enrolled” and is expected to be signed into law in due course.

Utah Senate removes telehealth bill abortion restrictions

The controversial topic of abortion has been the centre of discussion of a new telehealth bill in Utah. The bill, HB 154, introduced by Republican Rep Ken Ivory, primarily addresses the issue of insurance coverage for telehealth in Utah and proposes to amend two previous acts and the Utah Insurance Code to achieve this. However, the bill also contained a controversial final clause which stated “A practitioner treating a patient through telehealth services, as described in Title 26, Chapter 59, Telehealth Act, may not issue a prescription through electronic prescribing for a drug or treatment to cause an abortion, except in cases of rape, incest, or if the life of the mother would be endangered without an abortion”

Last week it was reported (in Healthcare IT News) that the bill was discussed in the Public Utilities, Energy and Technology Standing Committee. Similar restrictions on prescribing abortion medication following telemedicine consultations were legally challenged in Idaho by Planned Parenthood resulting in the ban being lifted at the end of January (mobilehealthnews, mhealthintelligence). Earlier, in June 2015, another legal challenge, this time in Iowa, went all the way to the Supreme Court which rejected a state requirement for doctors to see abortion patients in person and ruled that the regional Planned Parenthood unit  could continue to provide abortion inducing medication using remote video consultations.

According to data published by the Guttmacher Institute, as of February 1, 2017, there are 19 states which require a physician to be physically present when abortion inducing medication is prescribed (see Medication Abortion).

This week, when the Utah bill was discussed in the Senate Health and Human Services Committee an amendment proposed by Republican Senator Brian Shiozawa removing the above abortion clause was accepted. Shiozawa expressed fears that a constitutional challenge could give negative publicity to  telehealth as a whole. The bill now moves to the Senate for consideration.

Telestroke continues to expand (US)

Telestroke has expanded over the years and one of the most recent click to enlargeimplementations 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.

21st Century Cures and Telehealth (US)

Just before the signing ceremony of the 21st Century Cures Act in click to enlargethe South Court Auditorium of the Eisenhower Executive Office Building President Obama made special mention of his Vice President Joe Biden and his wife Jill who had spoken of the death of their son due to cancer. Obama also mentioned his own mother who had also died of cancer when she was two and a half years younger than he was himself now. The Act provides $1.8 billion for cancer research according to the Washington Post although the allocation is for biomedical research and is not specifically for cancer research.

What was unsaid at the ceremony was that the Act also has a section on telehealth. The telehealth section of the act requires the Centers for Medicare and Medicaid Services (CMS) to report within one year to Congress on populations of Medicare beneficiaries whose care may be improved by expansion of telehealth services. CMS is also asked to report on the telehealth related work already funded by CMS Innovation, make suggestions on the type of services which might be suitable for telehealth and indicate barriers to expansion. The Medicare Payment Advisory Commission (MedPAC) is asked to identify, by March next year, services for which payment is available through private health insurance plans but not under Medicare. MedPAC is then asked to recommend how to incorporate these into Medicare.

These measures look to expanding the role of and accessibility to telehealth for Medicare beneficiaries. Further, a note entitled “Sense of Congress” states that “It is the sense of Congress that eligible originating sites should be expanded …”. However, unlike the key elements of the 21st Century Cures Act, such as biomedical research, no specific funding has been allocated for the implementation of any telehealth related recommendations. Although some optimism has been expressed about the expansion of telehealth as a result of this Act (see, for example, comments from URAC in HIT Consultant and Healthcare IT News.), with the lower priority on health that is possible from the incoming Trump administration, only time will tell if such optimism is justified.

Using telehealth to improve night-time ICU care

Intensive Care Units treat the most sick people in a hospital and requires round-the-clock staffing by doctors and nurses. 24-hour staffing, however, means shift working and an inevitable night shift. To make it fair on all staff the shifts are usually rotated so any doctor or nurse would do a period on one shift and then move to the next shift.

It is not surprising that the more senior staff manage to have less night work than newer, less experienced ones. On the other hand night shifts may have attractions such as extra pay and this may be more important to the lower paid less experienced staff than to the higher paid senior ones. Also, the cost of staffing nights with less experienced staff may prove cheaper for the hospital. Nevertheless, the patients’ needs are no less important at night than during the day. Another aspect of night-time care is the possibility that a doctor or nurse may not be as alert at night as they would be in the day-time.

Looking at these downsides of night-time ICU care staffing, an hospital in the US has come up with a novel idea – move the doctors and nurses to a zone where it is day-time when it is night-time at the hospital and use telehealth to connect them. This is counter intuitive and has its own drawbacks.

Georgia’s largest healthcare provider Emory Healthcare is sending some ICU doctors and nurses to Sydney, Australia, for tours of six to nine weeks at a time, in a trial to staff ICU at night with health staff in a daylight zone using telehealth. The six month trial in collaboration with Philips and Australia’s Maquarie Health has been underway for 3 months.

The reason this is counter-intuitive is that telehealth was invented to overcome the problems associated with healthcare professionals and patients not being at the same location and here the two are being artificially removed to two ends of the world. While telehealth is a good solution to the diagnosis and treatment from afar, most professionals are likey to agree that it is inferior to being face to face with the patient. So it will be good to see the conclusions reached by this trial on how any drawbacks of distance balances out with having more alert doctors and nurses.

See also mHealth Intelligence article here.

US: Telemedicine to be used during disasters

The American Red Cross has entered into a partnership to pilot the use of telemedicine during periods of disasters in the US. During the pilot a nationwide network of physicians will be available for consultation via video calls.

Through this pilot collaboration, physicians working with Red Cross partner Teladoc will be available to people helped by the Red Cross whose access to health care providers has been limited or is unavailable after large-scale disasters. Teladoc’s virtual physician visit services will be made available via web, Teladoc’s mobile app and phone to address the primary health care needs of individuals affected by disasters.

Teladoc is reported to have donated remote medical care during the recent Hurricane Matthew. This partnership is positioned as an expansion of such disaster relief efforts rather than an expansion of its commercial activities.

Use of telemedicine in disaster relief has been implemented previously in the US by the Department of Veterans Affairs (VA). In 2014 the Office of Emergency Management of the VA awarded a contract to use the JEMS Technology disaster relief telehealth system. Going back much earlier, following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa, a satellite based audio, video and fax link, known as the Telemedicine Spacebridge, between four US and two Armenian and Russian medical centres,  permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems. Last year NATO tested use of telemedicine in disaster situations in a simulated disaster scenario in Ukraine.

Another system, Emergency Telehealth and Navigation, is deployed in Houston for helping with 911 calls. The Houston Fire Department has agreements with doctors so they have access to a doctor at any time to take calls from crew at emergency sites. They find that this avoids having to take some people to hospital when a doctor is able to determine that a condition is non-emergency where a paramedic may well have taken the patient to an Emergency Department.

Broadband and health in USA

The Federal Communications Commission (FCC) has been investigating click to enlargethe relationship between broadband and health in the US through their Connect2Health Task Force and this week it has released an online tool “Mapping Broadband Health in America”.
It is an interactive map that allows users to visualise, overlay and analyse broadband and health data at the national, state and county levels.

This tool allows easy access to existing health and broadband access data to anyone who wants to look at the possible influence of broadband access on health over a period of time or to identify gaps which may provide opportunities to develop or expand online health services.

The interactive tool allows the user change the broadband availability measure (by say proportion of coverage or download speed for example) and select a health measure such as say obesity rate or preventable hospitalisation days and shows where the selected broadband measure is satisfied, where the selected health measure is satisfied and where both are satisfied. The types of health measures are currently limited but if users find the tool useful and feedback to the FCC there may well be further expansion.

Have a play with the map here.

State by State report on telehealth laws and policies (US)

A comprehensive scan of telehealth laws and Medicaid click to enlargeprogram policies is available from the recently released report from the Center for Connected Health Policy, part of the Public Health Institute, a California based non-profit. This fourth annual review, State Telehealth Laws and Medicaid Program Policies,  provides a current summary of telehealth policies and laws in all the states and the District of Columbia.

As we have covered in many previous articles, states are actively pursuing legislation to implement their own set of telehealth policies. This report is supposedly an up to date summary of these laws and regulations as of March 2016.

Some significant findings highlighted by the authors are
– 47 states and Washington DC provide reimbursements for some form of telemedicine video conferencing. This number is unchanged from last year.
– 9 states reimburse for store and forward services (e.g. medical images, documents and pre-recorded videos. Primarily sent between medical professionals)
– 16 states offer reimbursement for remote patient monitoring, unchanged from last year

The report is complemented by an interactive map located here.

Mississippi to get VA telemed pilot amid controversy

Mississippi has led the way in telemedicine projects in southern USA for some time with the University of Mississippi Medical Center’s various successful projects click to enlargeattracting well deserved funding. Now the US Secretary of Veteran’s Affairs has announced that a new pilot programme to use telemedicine to reduce wait times for new patients at VA hospitals will take place in Mississippi.

This pilot programme comes in the wake of the highly criticised wait times reported for new patients at VA hospitals in 2014. A CNN report based on internal VA documents claimed that thousands of veterans had to wait more than three months to see a specialist.

(more…)

HealthSpot closes the doors, shuts kiosks in Rite Aid, Cleveland Clinic (updated)

As we reported last July, HealthSpot, the Dublin, Ohio, based telemedicine health kiosk business which was click to enlargecarrying out a retail trial with Rite Aid since November 2014, started commercial operations in 25 locations in three Ohio areas.

In October reports emerged of a patent infringement claim that has been ongoing since April 2014 against HealthSpot by Nevada-based Computerized Screening. (More on this ongoing series of lawsuits in Ohio and Nevada is here.)

According to reports in Columbus Business First, HealthSpot has now informed Rite Aid that it would cease operations as of 31 December last year and its telemedicine kiosks are reported to have shut down in Rite Aid pharmacies. HealthSpot has also notified Cleveland Clinic that it has discontinued operations, which shuts its pilot with Cleveland Clinic in northeast Ohio.

HealthSpot’s website remains live but the last entry in the press releases section is from September 2015 and is on events at which HealthSpot was to participate in September and November. The blog page on its website is well out of date with the last update dated as far back as March 2015. (Links for locations and patient log in were inoperable–Ed. Donna)

One recent news report stated that attempts to contact CEO Steve Cashman went unanswered.

In November 2014, HealthSpot received a major investment from Xerox on top of a $18.3 million springtime round [TTA 13 Nov 14].

Updated 13 Jan (Editor Donna)

The Columbus Business First articles that Editor Chrys has linked to, as of this point, are the most informative. Neil Versel and Stephanie Baum also have related articles in MedCityNews. They also chewed it over with HealthcareScene network’s John Lynn last Friday on video (starts at 26:30) with a surprising revelation that Mr Cashman had been in touch with Mr Lynn, to be published in one of their blogs (but not yet as of this update.) Thus the mystery remains.

Xerox has issued a statement of their continued interest and support of the healthcare sector which is covered in MedCityNews above. We also noted their diverse interests in healthcare quality management, data and analytics through through their Midas+ division here last year.

According to CrunchBase, HealthSpot received $43.81 million in financing since 2011, not including the undisclosed support from Xerox, with the most recent raise debt financing of $11.56 million in January 2015. One year ago, HealthSpot looked so promising. (more…)

Federal Court denies TMB application to dismiss Teladoc case

Readers may have read our article in April this year “Can State medical boards legally prevent telehealth activity?”. click to enlargeIn that article we examined the potential impact of a case brought by the Federal Trade Commission against the North Carolina State Board of Dental Examiners. The case went all the way to the Supreme Court which determined that the State Board of Dental Examiners was not protected by immunity from anti-trust law.

Teladoc is now locked in a case with the Texas Medical Board (TMB) that is very similar to the North Carolina case and it too has gone along a similar path so far. In the latest development of this case, last week a Federal Court, the US District Court in Texas, denied the application by the TMB to dismiss a case brought by Teladoc that claims that the TMB broke anti-trust law.

What has brought Teladoc and the TMB to court in this way? (more…)

White paper identifies potential and challenges of telehealth

Telehealth is a rapidly growing field that has the potential to help states leverage a shrinking and maldistributed provider workforce, increase access to services, improve population health and lower costs says a report published a few days ago. Called “Telehealth Policy Trends and Considerations”, the white paper from the National Conference of State Legislatures (NCSL) focuses on three areas: reimbursement of telehealth encounters, licensure for telehealth providers and patient privacy, safety and security.

This white paper is the result of a year’s work by a group brought together by the NCSL consisting of state legislators, legislative staff and private industry. The white paper provides options for state policymakers in these areas.

The paper also covers recent research into cost-effectiveness of telehealth, the impact of telecommunications connectivity and some specific examples of telehealth/telemedicine usage. Examples of effective use of telehealth includes the use of telehealth/telemedicine by the Veterans Health Administration. Another example cited is the telemedicine usage by the Unversity of Mississippi Center for Telehealth about which we have reported previously

The full 28-page report, is available to download here.

Report analyses published reporting of telehealth

An agency of the US Department of Health and Human Services, the Agency for Health Research and Quality (AHRQ), has published, for peer review, a draft of a new report (a “technology assessment”) entitled “Telehealth: an Evidence Map for Decision making”. AHRQ, the report explains, “through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public and private sector organizations in their efforts to improve the quality of health care in the United States.”

The purpose of this new technology assessment is given as creating a review of the evidence available (essentially a literature review) so as to inform decision makers. The authors had identified 1,305 citations about telehealth of which 44 had been selected for this review. Unsurprisingly, the report says ” comparatively large volume of research reported that telehealth interventions produce positive results when used for communication/counseling and monitoring and management for several chronic conditions and for psychotherapy as part of behavioral health.”

It recommends additional primary research be carried out on topics such as telehealth for triage in urgent/primary care, management of serious paediatric conditions and the integration of behavioral and physical health. Finally, it recommends that telehealth research should be integrated into evaluation of new models of care and payment so that the potential of telehealth can be assessed in organizations that are implementing these reforms. (more…)

Senate Veterans Affairs Committee takes evidence on VETS Act (US)

Further to our report in October on the introduction of the Veterans E-Health & Telemedicine click to enlargeSupport Act (“Veterans eHealth & Telemedicine”, 10 October 2015), Sen. Joni Ernst’s website reports that Sen. Ernst was the first witness to testify in front of the Senate Veterans Affairs Committee on Wednesday (19 November 2015) about the proposed legislation.

“The VA has been practicing telemedicine since 2001, and they are largely cited as leaders and innovators in the field. Their efforts in telemedicine have saved money and veterans’ time by eliminating often an hour or more long drives to the VA, and reducing bed days at the VA” Ernst is reported to have said.

“For example: According to the VA, in Fiscal Year 2014, telehealth reduced bed days of care by 54%, reduced hospital admissions by 32%, and saved $34 in travel savings per  consultation. (more…)