May 24, 2016

Telemedicine and Psychiatry, Part 3

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the third in a three-part series looking the past, present and future of “telemedicine.” First, we looked at the early roots of telemedicine. In the second installment, we explored the exciting prospects for its future. In this, the final blog, we talk about one of the most popular forms of telemedicine, “telepsychiatry.”

Doctor Talking on Webcam

After the brother of Navajo Nation member Haley Laughter died from substance abuse, she wanted to do something to improve the availability of mental-health services to the nation’s remote and often impoverished Indians.

Suicide, sexual assaults and domestic violence are well-documented on the nation’s Indian reservations. But health-care services lag demand because the Indian Health Services has a hard time keeping and attracting professionals. The Gallup Indian Medical Center in New Mexico, for instance, serves the area’s approximately 173,000 Navajos with just one psychiatrist.

So Laughter turned to telemedicine, which has some of its earliest roots in serving remote native populations, and opened a company that works with Indian Health Services to provide so-called “telepsychiatry” services across its behavioral health system network.

Formed just this year, the goal of her company, MorningStar Behavioral Health Services, is to bridge the gap in services with counselors who are sensitive to the needs of native cultures. She currently works with two New Mexico-based counselors and a psychiatric nurse practitioner in Oregon, each of whom consult with patients through a secure video link.

In addition to opening access to health care from remote locations, some say telepsychiatry breaks down the stigma and embarrassment that prevent many from seeking treatment.
According to a report by the American Psychological Association, a 2009 Substance Abuse and Mental Health Services Administration survey found that less than one-quarter of the estimated 45 million American adults who have a mental illness receive treatment.

Eve-Lynn Nelson, assistant director of research at the University of Kansas Center for Telemedicine and Telehealth,, says one major reason for the low number is that these patients are avoiding the stigma and embarrassment associated with contacting a therapist. Telehealth, whether by phone, email or video conferencing, can help break down those barriers.

Laughter says patients often are less inhibited and more likely to open up because they are not face-to-face with a caregiver but “protected” by a screen.

Like any area of medicine, telepsychiatry requires special training and guidelines. But when done right, experts agree that it holds huge potential.

The Arizona Telemedicine Program at the University of Arizona, which provides telemedicine services in more than two dozen states, says its “e-Psychiatry’s Telepsychiatry” program for health-care facilities is its most popular service.

“The shortage of psychiatrists makes it difficult for mental health clinics and other behavioral health facilities to recruit, staff and retain a psychiatrist,” the university says. “Most of the time, behavioral health organizations turn to recruiters to staff a psychiatrist. This can be very time-consuming and expensive. We provide facilities a way to avoid all of the overhead costs associated with recruiting and hiring a full-time or part-time psychiatrist.”

The university also reports that 95 percent of those who try telepsychiatry like it.

May 18, 2016

Telemedicine and Telemonitoring, Part 2

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is second in a three-part series looking the past, present and future of “telemedicine.” First  we looked at the early roots of telemedicine. In this, the second installment, we will explore the exciting prospects for its future. In the final blog, we talk about one of the most popular forms of telemedicine, “telepsychiatry.”

Patient Communicating with Doctor on Cell Phone

Imagine that the next time you’re sick, instead of having to drag yourself out of bed and into the doctor’s office, you can just roll over, grab your smartphone and have a video chat with your doctor about whether it’s a bad cold or something more serious.

Or, if instead of making regular visits to monitor a chronic illness, you and your doctor can keep up with your vitals through a wearable device that sends regular updates from your phone or computer.

These are just a few of latest advances already in use or on the horizon as a form of medical care called “telemedicine” moves into the mainstream. Health-care companies and providers already are looking to leverage our everyday technology to make everything easier and less expensive, from scheduling and managing appointments to getting test results and expert critical care, from just a few or thousands of miles away.

In New Mexico, for instance, the Presbyterian Health Plan now offers video visits for most members, 24 hours a day, seven days a week, without a copay.
Dr. Daniel Landau, an Orlando Health, medical oncologist and hematologist at the University of Florida Health Cancer Center, reports great success using telemedicine to monitor patients who recently have undergone chemotherapy.

Using a website that patients can access from a phone or computer, the cancer center can monitor side effects and follow up on abnormal lab results or blood work outside of scheduled visits.

This enables doctors to proactively manage symptoms before they become severe enough to require hospitalization and to quickly address problems or questions that arise after an in-person visit, Landau said.

In the future, the goal is to use this service to help patients who need second opinions, have transportation issues or have other reasons they can’t make it to the office, he said.

While the American Telemedicine Association reports that more than half of U.S. hospitals now offer some form of telemedicine, experts say we still have a long way to go.

According to GlobalMed, which develops telemedicine platforms, the U.S. is among the slowest to realize the widespread benefits these methods can deliver.

The company reports that more than 2,000 research studies have been conducted about telemonitoring, with conclusions that show telemedicine can reduce hospital readmissions by 83 percent, decrease home nursing visits 66 percent and lower overall costs by more than 30 percent. Also, it says research shows patients and caregivers using “telehealth” technologies have reported increased satisfaction with their treatments.

Still, economics could be an impediment to telemedicine’s growth in the U.S., according to Jon Pearce, CEO of the telemedicine platform provider Zipnosis, who says that despite estimates that wide adoption could produce savings of as much as $25 billion, cost containment “does not a healthy market make.”

“Currently, most clinicians doing video visits handle about 100 to 500 a year, and the overall volume in the market is insufficient to keep clinicians working at their capacity, let alone earning the pay they would otherwise make through in-person consultations,” he wrote in a 2015 blog.

May 12, 2016

The Rise of Telemedicine, Part 1

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the first in a three-part series looking the past, present and future of “telemedicine.” First, we look at the early roots of telemedicine. In the second installment, we will explore the exciting prospects for its future. In the final blog, we talk about one of the most popular forms of telemedicine, “telepsychiatry.”

Doctor Communicating with Patient on Laptop

One of the greatest advances in modern-day health care may well be the rise of “telemedicine.”

Consider the routine transmission of electrocardiograms, or EKGs, by paramedics to emergency-room doctors; robotic surgery; and the use of wearable vital sign monitoring devices that enable doctors to keep close but remote tabs on their patients. The Internet and other modern communication networks undoubtedly have saved countless lives and opened access to better and often lower-cost health care for both rural and urban patients.

What many people don’t know, however, is that telemedicine has been around for nearly 50 years and first was envisioned nearly 100 years ago, long before most people even dreamed of television, let alone home computers and the World Wide Web.

According to the book book Telemedicine: A Guide to Assessing Telecommunications in Health Care, in 1924, the magazine RadioNews in 1924 foreshadowed telemedicine in its depiction of a “radio doctor” linked to a patient not only by sound but also by a live picture. This was just as radio had just begun to reach into American homes and three years before the first experimental television transmission.

It was another 25 years before telemedicine began to really develop. The book notes that one of first references to telemedicine in medical literature appeared in a 1950 article describing the transmission of radiologic images by telephone between West Chester, Pennsylvania, and Philadelphia.

Two Canadian doctors built on that technology to develop a “teleradiology” system that was used to transmit images in and around Montreal. By the end of the decade clinicians at the University of Nebraska were the first to use video communication to send medical information across campuses.

The 1960s and 1970s brought a stream of advances. In the 1960s, the Miami Fire Department and University of Miami School of Medicine first used radio channels to transmit EKGs from the field, a practice still widely used by paramedics responding to emergencies.

As more and more innovations were being developed, the U.S. government spotted the potential and began developing projects of its own. Among the first were programs to monitor astronauts in space and to provide health-care services to remote Native American tribes.

While emergency applications and serving remote patients is still a focus of telemedicine, its use has spread rapidly across the health-care system.

According to the American Telemedicine Association, there currently are about 200 telemedicine networks, with 3,500 service sites in the United States. Telemedicine includes everything from the use of robots or other technology that lets experts guide intricate surgery from thousands of miles away to so-called telepsychiatry and remote monitors.

More than half of all U.S. hospitals now use some form of telemedicine, according to the association. Around the world, millions of patients use telemedicine to monitor their vital signs and remain healthy.

With the rise of smartphones, consumers and physicians now also increasingly communicate through health and wellness apps.  And one can only guess what technological advances will bring this field over the next 50 years.

In my next blog we’ll take a look at some of the more exciting new applications now being developed.

May 6, 2016

End of Life, Part 4

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

This is the last part of a four-part series exploring end-of-life issues. Part I looked at how religion, cultural shifts and the doctor’s role influence attitudes and choices about death. Part II explored how and where people die and the controversy over physician-assisted suicide. Part III covered options for end-of-life care, from assisted living to hospice. This part provides a guide to taking control over the last phases of life through health directives.

Are You Ready? Roadsign

It’s human nature to seek some measure of control over our lives. How can we better plan for ourselves and our loved ones to face old age, terminal illnesses and death?  An important answer can be found in the legal documents designed to communicate our wishes to doctors and family in case of severe illness, impairment or very old age.

With a “seniors population explosion” just around the corner, advance planning is becoming a hot topic. By 2040, the number of Americans aged 65 and older will be 21.7 percent of the population. By 2060, this demographic will represent about 100 million people.

This will unleash a number of unprecedented medical and economic challenges. According to the Centers for Disease Control and Prevention, 30 percent of those 85 and older will have some form of dementia, a catch-all term for diseases that share a common main symptom: cognitive decline.

Alzheimer’s will affect more than 16 million Americans by 2050 and millions of those tasked with caring for them. One in three seniors die with Alzheimer’s or another kind of dementia.

Who makes medical decisions for people who are not capable of making decisions themselves? What happens when a parent suffers severe dementia and cannot manage the nursing home bills?  What happens when Alzheimer’s patients outlive their caretakers?  How can someone in a vegetative state communicate their wishes about life support?

As overwhelming and frightening as all this sounds, the solution may be found in legal documents called advance directives that spell out various scenarios and give relatives, friends and doctors instructions based on your wishes, expressed when you still are able to think clearly.

You do not need to spend a fortune to have a lawyer draw up some of these documents. A power of attorney, for example, allows you to give authority to a trusted person to make decisions for you. These powers can be very broad – covering financial as well as medical issues. They don’t expire. They can be as specific and restrictive as you wish.

Typically such advance directives total one or two pages. You can find templates, written specifically to conform with the laws of your state, on the Web. You may be able simply to fill in the blanks and ask a friend or relative to serve as your witness and sign the document in front of a notary.

Make sure the party you name as your power of attorney understands your instructions and has agreed to be your representative. If your health outlook changes or your life takes an unexpected path, such as through divorce, you may wish to update your advance directive.

“Put it in Writing,” a booklet from the American Hospital Association, is a good place to start. It specifies the issues that can be addressed by advanced directives. It also explains the difference between a living will and a power of attorney for health care. You also will find answers to the questions, “What does the hospital do about end-of-life decisions?” and “What if I change my mind?”

The National Institute on Aging offers a deeper dive into specific detail about end-of-life medical choices. For example, a living will can spell out whether you want health-care professionals to pursue life-extending procedures including CPR and artificial respiration.

The National Hospice and Palliative Care Organization offers information about ethical and practical issues including end-of-life choices, “do not resuscitate” orders and organ donation.

Nursing homes and elder institutions usually request advance directives, although they are not required for admittance. The best time to prepare these documents is when you are in good mental and physical health. Sometimes a big change like a serious illness or moving to an assisted living facility is just the wake-up call needed to take action – before it is too late.

(Living wills and health-care proxies may need to be written by a lawyer.  Go online to The American Bar Association website to find tips on estate planning and elder law.)

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