• Telemedicine
  • Telemedicine does it for chronic diseases

    Remote outpatient consultations that avoided long and costly journeys were often seen as a major role for telemedicine. It’s changed considerably since then, extending into telemonitoring. A USA study shows benefits of telemedicine for chronic disease management (CDM). It’s published in Telemedicine and e-Health.

    It evaluated three telemedicine used for three conditions:

    Congestive Heart Failure (CHF) Stroke Chronic Obstructive Pulmonary Disease (COPD).

    Each of these has its own care model, so not a generic telemedicine model. The main findings are that long-term telemonitoring  is the most efficient and effective model for CHF management. Telestroke has the most impact for prompt interventions leading to optimal treatment. Telepulmonology for COPD using remote measurement of lung function through telespirometry and teleconsultations between care providers and pulmonary specialists offers the best treatment.

    Benefits include fewer hospital admissions and readmissions, shorter lengths of hospital stay and fewer emergency department visits. Patients are more engaged in their care too. There were also some reductions in mortality. Patients, carers, health workers, clinics, hospitals and third party payers all benefit.

    This seems to confirm the progress in telemedicine over the last few years. The study provides evidence for African countries to use in their case for telemedicine investment.

  • TelePharm helps pharmacists be in two places at once

    Iowa-based TelePharm uses cloud-based mobile apps to connect pharmacists to each other and to patients. It’s raised US$2.5 million to help scale its business.

    TelePharm has several different businesses that enable pharmacists to spread their expertise across multiple pharmacies. This allows local chains to reduce their overheads significantly. One branch under the TelePharm umbrella is TeleCheck. The platform allows remote verification of medications, an important and time-consuming job for pharmacist.

    “They have two different responsibilities: verifying it’s the right drug for that patient and basically making sure the patient will be safe with that drug, and making sure what the technician dispensed was the right drug,” TelePharm CEO Roby Miller said to MobiHealthNew. “What TeleCheck does, is it takes that workflow and puts it in the cloud. So a pharmacist has an image of the drug they’re dispensing, the label on the bottle, and the [prescription] as well. So they can compare those images and make sure the drug is the right prescription for that patient.”

    TeleCounsel is another TelePharm service. This actually allows pharmacists to interact virtually with patients directly.  It’s being used in hospitals which have pharmacists on their staff and supports pharmacists in providing discharge counselling for patients leaving the hospital. The counselling is informal, and talking with patients before they leave hospital leads to better medication adherence. Counselling is often difficult to facilitate because it needs pharmacists to be in many different places simultaneously. TeleCounsel allows pharmacists in one location to talk to many patients and even counsel them when they’re at home.

    TelePharm is relatively new. It was founded in August 2012. Its software is in eight small, regional pharmacy chains in three USA states: Iowa, Illinois, and Texas.

    Similar technology could be used in other parts of the world. It could be especially valuable in countries where there’s a shortage of healthcare professionals. Many African countries could benefit from this or similar technology.

  • Allegheny paves a way for telemedicine

    When an emergency medical practitioner needs to get a doctor’s opinion, the patient usually needs to be moved. Now Allegheny Health Network in Pittsburgh, Pennsylvania has begun a one-year pilot of a telemedicine tool that helps to avoid unnecessary patient transport. The iPad video chats connect the emergency practitioner to a doctor to review the patient’s condition. Director for the Bureau of Emergency Medical Services, Richard Gibbons said “The benefits of telemedicine to the patient are innumerable, offering direct in-home access to a physician who can see them and talk to them.”

    Emergency services crews have already used the technology on one patient, a 59-year-old woman with diabetes who called 911 after experiencing anxiety, sweating and shakiness. After the emergency crew provided her with orange juice and a glucose solution, the woman felt better and told the emergency crew that she didn’t want to go to the hospital. They offered her a telemedicine visit, via iPad, and after a short interview the doctor cleared her to stay home.

    Evidence is building for telemedicine’s value across many disciplines. An example is that specialists are able to diagnose some stroke patients using video, nearly as well as in person. This opens the possibility of making decisions early and starting treatment.

    This Pittsburgh study should help to quantify the range of the gains possible when using telemedicine in increasingly complex healthcare situations.

  • Telemonitoring helps to lower blood pressure

    Living in remote mountain areas might have splendid views, but it can limit the reach of healthcare. A study from Italy in BMC Medical Informatics and Decision Making shows that a combination of a physician-nurse approach supported by remote telemonitoring of blood pressure (BP) is likely to improve outcomes in patients with uncontrolled hypertension.

    There were two groups, Home-Based Telemedicine (HBT) and Usual Care. At the start of the study, there was no significant difference in BP values between the groups, but there were at the end of the study. The out-of-range BP differences were:

    Systolic BP: 26% (HBT), 81% (Usual Care) Diastolic BP: 8% (HBT), 62% (Usual Care)

    The mean changes in blood pressure were about:

    Systolic BP: 15% (HBT), 5% (Usual Care) Diastolic BP: 15% (HBT), 4% (Usual Care)

    The results were a combination of the impact of healthcare professionals and telemonitoring. The study says that “Many epidemiological studies have shown that the treatment and control of blood pressure (BP) is inadequate in more than 50% of hypertensive patients in spite of availability of several classes of well tolerated and effective antihypertensive drugs.” In this context, the healthcare professional and telemonitoring seems to offer a way forward in some circumstances.

    The report says that the cost analysis used in the study considered only the services provided to the patient in the HBT group. It didn’t evaluate the cost effectiveness of the service. More importantly, the study makes no exaggerated claims for benefits. It’d be valuable to know the medium and long term benefits for patients, carers and health services.

  • Telemedicine's small diagnostic differences

    Are telemedicine’s diagnoses better, worse or the same as face-to-face diagnoses? A study reported in the Journal of American Medical Association (JAMA) says they are about the same for the dermatology services.

    The findings are “If the in-person dermatologist recommended the patient be seen the same day, the teledermatologist agreed in 90% of the consultations. If the in-person dermatologist recommended a biopsy, the teledermatologist agreed in 95% of cases on average. When the teledermatologist did not choose the same course of action, there was substantial diagnostic agreement between the teledermatologist and the in-person dermatologist. The teledermatologists were able to triage 60% of consultations to be seen the next day or later. The teledermatologists were able to triage, on average, 10% of patients to be seen as outpatients after discharge.”

    Another important finding is that differences in diagnosis and treatment recommendations is linked to remote physicians proposing more conservative treatment or requesting more biopsies.

    Researchers at the University of Pennsylvania produced these results from their analysis of 50 hospital patients who had skin conditions that needed evaluation.

    The study is valuable knowledge for African countries proposing telemedicine initiatives for dermatology services.

  • Telemedicine growth forecast still up

    A report by Research and Markets, a market research and data company based in Ireland, is forecasting a compound annual growth rate (CAGR) for the global telemedicine of more than 18% over 2012 to 2018. The estimated value of the market in 2012 was US$ 14.2 billion.

    The forecast increase correlates with telecommunication development. The dearth of physicians in rural and remote areas continues to provide the opportunities for telemedicine to increase services to millions of patients. The prevalence of chronic diseases and the increasing number of elderly in the population are other reason for continuous telemedicine investment to achieve improved service quality.

    African countries planning telemedicine initiatives can rely on the growth in supply side of the market. They still need to assess carefully the range of options available and potential changes in future technology as mHealth apps expand into telemedicine and clinical solutions. In parallel, some specialties may need expanded clinical teams to deal with the increased workload from latent demand for healthcare. The strategic benefit is still there for patients.

  • Telehealth takes more than a baby step forward

    A new telemedicine initiative for neonatal intensive care units (NICU) in Texas is due to start soon. Business Wire has reported The Children’s Medical Center announcement about the Children’s Medical Center TeleNICU, a new service to provide physicians at other hospital NICU’s with 24-hour access to highly trained neonatologists caring for very sick babies.

    The program will use secure broadband transmission for real-time communication between hospitals and neonatologists at Children’s Medical Center.  Christopher J. Durovich, president and chief executive officer said that “As the first telemedicine program of its kind in Texas, the Children’s Medical Center TeleNICU program exemplifies our deep commitment to innovation and the use of proven technology to extend the reach of our expertise beyond the boundaries of walls and geography.”

    This is a major step for telemedicine. African countries have an opportunity to review their telemedicine programs and prepare to expand into these critical care services.

  • Telemonitoring evaluations can be better

    Research published in the Journal of Medical Internet Research claims that many telemonitoring appraisals do not comply with recognized guidelines and standards. Some methodological limitations identified in the study results affect the results and conclusions of some evaluations.

    The research team concluded that, “Despite the availability of methodological guidelines that can be utilized to guide the proper conduct of systematic reviews and meta-analyses and eliminate potential risks of bias, this knowledge has not yet been fully integrated in the area of home telemonitoring.

    The study found that the number of published reviews has increased substantially over the years, but the focus was mainly on home telemonitoring of patients with congestive heart failure. Other chronic diseases such as diabetes, hypertension, chronic obstructive pulmonary disease (COPD), and asthma have less emphasis.

    The study’s findings are that many reviews appear to lack optimal scientific rigor due to methodological issues and their overall quality does not appear to have improved. Evaluations did comply with several criteria satisfactorily, such as establishing an a priori design with inclusion and exclusion criteria, use of electronic searches on multiple databases, and reporting studies characteristics. But, other important areas need improvement, including duplicate data extraction, manual searches of highly relevant journals, inclusion of grey and non-English literature, assessment of the methodological quality of included studies and the quality of evidence.

    It seems that progress on evaluations may be slow. Criticisms go back to Whitten’s review on telemedicine evaluations in 2002.