Norton Healthcare implements a mobile application that allows doctors to monitor patients, especially expectant mothers

 

Norton Healthcare is the first health-care provider in Kentucky to implement a patient monitoring system that allows obstetricians to monitor expectant mothers while they're in labor via the physician's smart phone or tablet. The real-time application uses wave-form technology and works with iPhones, Androids, BlackBerrys and a variety of Windows Mobile devices. Its use has been cleared by the U.S. Food and Drug Administration.

The implications are vast for doctors in busy urban settings as well as for those in rural areas where doctor shortages may limit a physician's personal attention to individual patients. According to Norton Healthcare press materials and their obstetrician spokesperson, Dr. Reed Netter, the application allows the doctor to view "the same patient information that he or she would see at the patient’s bedside, looking at the monitor for heartbeat, contraction patterns, or signs of distress." This could save valuable time when a fetus is in trouble or if nurses see something that worries them.

The applications of the technology are evident for use in ambulances, in intensive care units, operating and emergency rooms, said Steve Heilman, Norton's system vice president and chief medical information officer for Norton Healthcare. (Read more)

Tenn. study suggests rural residents have as much access to care as anyone, if they're insured and don't mind the drive

A health-care study in Tennessee, which started with the premise that people in rural areas have less access to care than urban dwellers, ended with a rather surprising conclusion: They don't. Not if they have health insurance. "When it comes to commercially insured patients, there’s little disparity in access to health care between residents of rural communities and urban areas in Tennessee," said Dr. Steven L. Counter, president of the BlueCross BlueShield of Tennessee Health Institute.

How can this be? The study found that almost half of rural residents pass up the hospitals closest to their homes to go to larger urban hospitals, even if the same services are available locally, writes Getahn Ward of The Tenneseean. "The conclusion we came to is that we’re living in a very mobile society, and the distance is not necessarily a determinant factor in whether people get care or not," said Coulter.

Because the survey did not include consumers, it's only a guess about why they chose to take the time and trouble to go to the big town, but experts says it's a combination of services not being available or a perception that they aren't, even if they are. This raises, again, age-old questions about the viability of rural hospitals, some of which often don’t have the money for capital-intensive technology and services. However, Coulter told the Tennessean that "a recent increase in alliances between rural hospitals and larger hospitals and urban health systems raises hopes that non-urban hospitals may be able to expand their menus of services."

Such partnerships between non-profits and for-profit chains are becoming more common, reports Ward, and some say those efforts will change the perception of those in far-flung regions that great medicine is being practiced close-by. This could be especially important, said Wes Littrell, chief strategy officer and president of Nashville-based Saint Thomas Health, in the new world of health reform. “We expect that when you get more into population management that you need to take care of the patient closer to home in the lower-cost setting,” he said. (Read more)

Dr Topol to med students: "When I was in medical school, the term "digital" was reserved for the rectal examination"

Here are some excerpts from the Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute, delivered yesterday, May 22, 2012. This should be a required reading for everyone involved in healthcare, which is basically everybody because each and every one of us will be a patient one day.

Eric Topol to medical students: "When I was in medical school, the term "digital" was reserved for the rectal examination."

"You sleep with your cell phone and prize it right up there with food and water. We have evolved to a new species of man. We are Homo distractus!"

The benefits of digital medicine are clear to Dr. Topol who shares the story of a patient he saw last week: "I asked him to put his fingers on the 2 sensors on the back of my iPhone case so I could do his electrocardiogram—ECG—that was normal. And free, by the way. Then instead of using a stethoscope to listen to his heart, I used a portable pocket-sized high-resolution ultrasound device and within a minute I could see every heart structure—the heart muscle thickness and function, the valves, the size of the 4 chambers. Why would I ever listen for lub-dub when I can see everything? I haven't used a stethoscope for over 2 years to listen to a patient's heart."

From Baylor College of Medicine (BCM) YouTube channel: 2012 Commencement Speaker, Dr. Eric Topol, spoke on May 21, 2012:



Here is Eric Topol's presentation at Health at Google:



References:

Baylor College of Medicine commencement address by Dr. Eric Topol, director of the Scripps Translational Science Institute

Comments from Twitter

Quoc-Dien Trinh, MD @qdtrinh: Makes it sound cool. “@DrVes: Dr Topol to med studs: When I was in med school, the term "digital" was reserved for the rectal examination"

Online training could help rural doctors offer better mental health care

More than half of all U.S. mental health care takes place at the primary-care level, and that percentage is even higher in rural areas, where mental-health doctors are often hundreds of miles away, reports Newswise, a research-reporting service. A new online training program could help rural primary-care doctors better treat patients with mental health issues, and that could be important in Kentucky.

The Behavioral Health Education Center of Nebraska, a part of the University of Nebraska Medical Center, designed the program. Educational Director Howard Liu said primary care doctors are overwhelmed by the amount of mental health care they must provide. Newswise reports "the goal is to help primary care providers get more comfortable as they prescribe medications and refer patients to psychiatrists and therapists." The adolescent version of the program was released last fall and is being used by doctors worldwide. The adult and geriatric version will be released this spring.

Primary care doctor Angie Brennan estimates 35 percent of all visits to her practice have been mental health related. She said there are specific rural challenges to treatment, including "reluctance to see a counselor and a lack of mental health insurance coverage – combined with an intensified fear that someone in the community will find out a patient has mental health issues." (Read more)

Doctors use telemedicine to help patients with dementia, Alzheimer's

Following a nationwide trend, Kentucky doctors are turning to telemedicine to help patients with memory problems such as those associated with Alzheimer's disease and dementia, reports Allison Elliott with the University of Kentucky.

"State-of-the-art memory evaluations should not be limited to persons that are able tom ake the often long and arduous trip to Lexington," said Dr. Greg Jicha, neurologist at UK's Sanders-Brown Center on Aging. "Taking advantage of Internet technologists to bring expert care into even the smallest of rural communities is a blessing for many families across Kentucky that simply cannot bring a loved one with dementia to Lexington.

Several times a month, physicians with the Sanders-Brown Center will connect to patients in clinics throughout the state. Participating clinics include Harlan Appalachian Regional Health; the Hazard Center for Rural Health; T.J. Sampson Hospital in Glasgow; Trover Clinic in Madisonville; Western Baptist Hospital in Paducah; Owensboro Medical Center; and St. Claire Regional Medical Center in Morehead. (Read more)

Rural folks have more chronic conditions and less access to health care, and Kentucky is one of the more rural states

Though rural Americans have more chronic health conditions than those who live in urban centers, they have poorer access to health care, a working paper released last month confirms. Health experts are pointing to technology, including telemedicine, to help bridge the gap.

The paper was compiled by the UnitedHealth Center for Health & Reform Modernization, an arm of the nation's largest health insurer. It found "there are only 65 primary care physicians per 100,000 rural Americans — 40 or so less than the 105 per 100,000 urban and suburban Americans," Molly O'Toole of Reuters reports. "Already five million rural residents live in 'shortage areas' defined by the government as counties with less than 33 primary care physicians per 100,000 residents." The problem intensifies when it comes to specialists, with rural areas having fewer than half the number of surgeons and other specialists per capita.

Kentucky is one of the more rural states, with the latest U.S. Census numbers showing that about 42 percent of its population lives in rural areas.

The study incorporated results of a survey of about 3,000 patients and primary-care physicians. It found drug abuse and teen pregnancy are bigger concerns in rural areas than in cities. Rural people tend to think their local health care is lower in quality than in urban centers. In many instances, they're right. "UnitedHealth confirmed this 'equality deficit' is supported by data showing that in 70 percent of markets, rural quality of care was measurably worse than in urban areas," O'Toole reports.

To remedy the situation, the report advises expanding the role for nurse practitioners and incorporating more mobile health clinics, technology such as telemedicine and preventive care into health care. (Read more)

Kentucky looking at 'telecare' for Medicaid patients to cut costs

Kentucky is considering making tele-caregivers — off-site guardians who provide care by monitoring cameras and sensors in a patient's home — available to some disabled Medicaid patients. The move is expected to save money by requiring less onsite care, The Courier-Journal's Patrick Howington reports. Because they are being monitored remotely, such as by telecaregiver David Crowe (C-J photo by Jordan Kartholl), it also allows patients to stay in their own home, rather than go to a nursing home.

The service is offered by Rest Assured, a subsidiary of ResCare, which is based in Louisville. The Cabinet for Health and Family Services "has asked permission from federal officials to use Medicaid funds for 'telecare' services like Rest Assured, as is allowed in Indiana and at least one other state," Howington reports.

Electronic monitoring is about half as expensive as in-home care and far less than the $5,000 or more a month it costs for a Medicaid patient to live in a nursing home. Rest Assured charges about $10 an hour for its service, resulting in $2,400 a month for eight hours of daily care. Though not expected to solve the state's Medicaid budget shortfall, "anything we can save at this juncture is wonderful," said state Sen. Julie Denton, R-Louisville.

Rest Assured has about 375 clients nationwide "Depending on clients' needs, the system can provide limited services such as medication reminders and food-preparation guidance for an hour or two a day or comprehensive monitoring for up to 24 hours," Howington writes. Telecaregivers use video and sensors that monitor temperature change, carbon monoxide levels and how long a patient is in the bathroom. (Read more)

Foundation matches Social Innovation Fund money to create grants for improving health services in seven Kentucky counties

The Foundation for a Healthy Kentucky today announced four equal Social Innovation Fund grants totaling $1 million to improve access to health services, reduce health risks and disparities, and promote health equity in Jefferson, McCreary, Wolfe, Powell, Montgomery, Bath and Menifee counties. The projects are expected to serve nearly 9,000 people in the next year.

Home of the Innocents in Louisville will establish a dental clinic at the newly opened interdisciplinary Hockensmith Pediatric Assessment Center. The program will provide dental services to children in state care, children with special health care needs, and other children and families served by the Home and its partner agencies.

St. Joseph Health System, based in Lexington, will establish primary care clinics in Powell and Wolfe counties, both rural and low-income. These satellite clinics will be staffed by nurse practitioners and will utilize telemedicine to collaborate with physicians and specialists at a central location.

Cumberland Family Medical Center, based in Burkesville, will establish a nurse-managed health center and rural training program for nurse practitioners and physician assistants. Funds will be used to expand the scope of services provided in McCreary County to include x-ray and utilize health IT to connect with other CFMC sites. This will be the county's first x-ray, reducing travel for local residents who previously had to travel ouside the county for x-ray services.

The Montgomery County Health Department in Mount Sterling will establish a health education and navigation program to serve a low-income population in Montgomery, Bath and Menifee counties. Four full-time health navigators will be employed to serve the community by assessing individual needs and linking patients with services.

Each $250,000 grtant includes $125,000 from the Foundation for a Healthy Kentucky. As an endowed public charity, the foundation was able to provide the matching funds that were required to secure the Social Innovation Fund award for Kentucky. Learn more about the grants here.

The Stroke Robot Will See You Now - Mayo Clinic Video

Mayo Clinic — April 30, 2010 — Imagine this: you're eating dinner with your family and suddenly your left arm feels numb. Your speech is slurred. It could be a stroke, so you've got to get to the hospital fast. But what if your hospital doesn't have a stroke specialist or what if that doctor is out of town? The answer may be telemedicine. Doctors at Mayo Clinic are using a telemedicine robot that allows them to be face to face with patients who are miles away.

Robot Doctors - Neurologist stays in Chicago but sees patients across the globe

From NBC Chicago:

Neurologist John Wapham lives in downtown Chicago, but he can see patients anywhere in the world ... from his apartment. And he does. He's an expert in treating strokes, and with the help of a robot and a broadband connection, he's able to be at a patient's bedside instantly.


"This brings specialists to to the remotest parts of the country, and the world. I've popped open my laptop on Michigan avenue and treated patients in another state, " he says. And in the not too distant future, these robot doctors could be on the battlefield, or at the scene of a horrible car accident: instantly.

Some critics fear that telemedicine may not be accurate enough. For example, the accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis in a recent study: http://bit.ly/8A4oiu

References:
Robot Doctors: Future of Medicine? NBC Chicago.