To address poor health and lack of high quality health care in rural Georgia communities, Georgia Partnership for TeleHealth is proposing a training and outreach program for residents and healthcare providers to improve health and healthcare delivery in the state’s 91 designated “counties of persistent poverty.” Leveraging the strengths of state government agencies, the private sector, and educational and nonprofit organizations, the project proposes targeted outreach to economically vulnerable populations including African American and Hispanic communities, low-income residents, senior citizens, and at-risk youth to address poor health and lack of high quality health care.

The project plans to connect community-serving institutions, like hospitals, schools, public health departments, and physicians’ offices by expanding the applicant’s current open access telehealth network to 67 additional community anchor sites. The partners plan to raise awareness of the benefits of broadband for healthcare through several outreach campaigns and training for rural physicians, non-physician practitioners, and school nurses.

Dr. Michael McConnell at Children’s Healthcare of Atlanta checks in with Justin Smith, 10, and Justin’s mother, Marletti Guest, via video from the Tifton Regional Hospital in South Georgia. Telemedicine allows doctors and nurses to virtually examine patients.
Phil Skinner pskinner@ajc.com Dr. Michael McConnell at Children’s Healthcare of Atlanta checks in with Justin Smith, 10, and Justin’s mother, Marletti Guest, via video from the Tifton Regional Hospital in South Georgia. Telemedicine allows doctors and nurses to virtually examine patients.

Dr. Michael McConnell explains how he uses telemedicine to perform checkups with patients hundreds of miles away. The Georgia Partnership for TeleHealth has become one of the most robust, comprehensive networks in the country.
Phil Skinner pskinner@ajc.com Dr. Michael McConnell explains how he uses telemedicine to perform checkups with patients hundreds of miles away. The Georgia Partnership for TeleHealth has become one of the most robust, comprehensive networks in the country.

A small-business owner and single parent to his great-nephew, Douglas knew taking time off to drive to an Atlanta specialist would cost him hundreds of dollars in lost work, gas and motel expenses. So, despite some doubts, he took the boy to the Berrien Elementary School health clinic in Nashville, Ga., to see a kidney specialist and a psychiatrist using cutting-edge, telemedicine technology that offers parents needed access to top specialists rural areas lack.

“I couldn’t make it without telemedicine,” said Douglas, who repairs restaurant equipment for a living. “It saves me a fortune.”

Georgia has established itself as an innovator in telemedicine technology — using it to expand access to health care, transform the way care is delivered and cut overall costs.

The Georgia Partnership for TeleHealth network has rapidly expanded in recent years to include nursing homes, school clinics, emergency departments, primary care and other providers with 175 physicians in 40 specialties. Statewide, telemedicine sessions have soared from roughly 200 in 2006 to more than 40,000 this year.

Telemedicine offers convenience for patients and can also lower health care costs by reducing avoidable hospital visits and providing regular access to care in remote parts of the state, said Georgia Partnership for TeleHealth CEO Paula Guy.

Patients in nursing homes can be seen by a doctor without a costly ambulance trip to the ER. Trauma specialists can advise doctors in community hospitals on how to care for a patient, avoiding flights to larger facilities. Parents who can’t afford to take time off from work can have their child seen via telemedicine in a school health clinic instead of letting an illness get so bad they end up in the ER.

“If you’re getting access to care … you’re not going to end up in the hospital nearly as frequently,” Guy said.

Saving time, money

On a recent afternoon, Dr. Michael McConnell, a cardiologist, sat in front of a 24-inch, high-definition monitor in Atlanta to talk with a mother roughly 180 miles away in Tifton about her 10-year-old son who has had three open-heart surgeries and has needed new medication evaluated.

Telemedicine technology has vastly improved since McConnell first started using it in the mid-1990s. When meeting with patients, he can hear what the nurse hears via wireless Bluetooth technology that sends a signal to his stethoscope. Nurses can use a special camera to examine a child’s eyes, nose or throat, and the images appear on McConnell’s screen.

“You can almost see better” than looking through the small hole of an instrument in person, said McConnell, medical director of the telemedicine program at Children’s Healthcare of Atlanta. Children’s program includes allergy, orthopedics, neurology and other services.

A telemedicine visit saved 310 miles and nearly six hours of traveling on average, according to a study by Children’s examining 609 appointments in the first nine months of this year. It estimated that 86 percent of patients would have missed school and more than 80 percent of parents would have missed a full day of work to come to Atlanta.

“We can help deliver better care and do it more cost-effectively,” McConnell said.

Telemedicine, however, has its limitations.

It may work well for radiology, where specialists can easily read images from a remote location, said Soeren Mattke, a senior scientist at the nonprofit research group RAND Corp. Performing surgery with robots using a video link is riskier, he said. If something goes wrong, someone will have to be on-site to fix problems, he said.

Some patients also may not feel comfortable or trust the diagnosis, Mattke said.

“You feel more comfortable if you sit in a room together and make eye contact,” he said, adding that telemedicine is still likely a trend that’s here to stay.

‘Before its time’

Across the nation, telemedicine is catching a second wind.

A decade ago, the technology was clunky, unreliable and hard to operate, and broadband Internet wasn’t widely available, Mattke said.

Doctors hesitated about not being hands-on, Guy said.

“It was almost before its time,” she said. “We were begging people to participate in the network.”

In 2005, Georgia lawmakers passed a rule requiring insurers to reimburse doctors for telemedicine sessions the same amount they would for in-house visits — key to the technology being more widely adopted, Guy said.

Today, the partnership runs a Web-based system that allows doctors and nurses to schedule visits and provides marketing, education and training. Providers can electronically share medical records, X-rays and other data. The partnership is working to replicate its system in Alabama and hopes to eventually do so in South Carolina and other states, Guy said.

Demand for the technology is even rising in some urban areas, she said. “Travel in Atlanta, of course, can be a nightmare.”

‘Tip of the iceberg’

For Douglas, whose great-nephew regularly talks with a psychiatrist using a video link, his concerns about telemedicine quickly dissipated once he saw how well the nurses and doctors worked together.

“The doctor can see you; you can see the doctor,” he said. “It’s pretty much like being there.”

The school system in Berrien County, which has two family doctors, uses telemedicine at two schools with plans to expand to all five next year, said Sherrie Williams, director of the MED Clinic for the system.

Students can walk into a clinic and see a doctor within an hour and a half, she said. Local pharmacies deliver medicines to campus. If a doctor orders blood work, which a school nurse isn’t allowed to do, someone from the local hospital will come and do it. The system is already well on its way to surpassing the 300 telemedicine visits it conducted last school year, Williams said.

“I do think we’re at the very tip of the iceberg,” she said.

Certified TeleMedicine Clinical Presenter (available DEC 2, 2011)
Certified TeleMedicine Coordinator (Spring 2012)
Certified TeleHealth Liaison (Spring 2012)

The Certified TeleMedicine Clinical Presenter (CTCP) Certification is designed so that its graduates will have the skills to correctly and confidently present patients during virtual encounters with physicians and a variety of specialists.

These courses are the result of collaboration between the following organizations: The Southeastern TeleHealth Resource Center, the California Telemedicine and eHealth Center, Hometown Helath, LLC, Georgia Partnership for TeleHealth.

As an IACET Authorized Provider, HomeTown Health, LLC offers continuing education units (CEUs) for its programs that qualify under IACET guidelines.

Dr. Kesler has over 20 years of broad clinical and operational experience. He has been responsible for strategic and tactical leadership in the behavioral health domain for the two largest correctional medical companies in the country. Within his organizations, he has been the executive lead on the development and implementation of telemedicine programs.

Dr. Kesler has implemented telemedicine programs in many settings including over 13 statewide criminal justice systems that resulted in improved clinical outcomes, increased access to care, and cost savings. He has spoken numerous times at national conferences on the design, implementation, and administrative tasks when implementing a telehealth program.

“I am extremely excited to have Jeff join our executive leadership team where we will benefit immensely from his experience and proven record of success,” states Paula Guy, CEO. “Jeff’s operational leadership and depth of management experience are key additions to support our aggressive growth plans.”

About GPT: Georgia Partnership for TeleHealth, Inc. is the leading agency in Georgia focusing on increasing access to healthcare through innovative use of technology including telemedicine, health information exchange and telehealth. GPT’s success has been built on providing technical assistance and education to its network partners and has been recognized nationally for its robust, statewide network. For more information on how to become a partner visit our website at http://www.gatelehealth.org.

National Health Information Technology Week is a time to highlight the importance of efficient information systems that protect the privacy and security of personal health information while improving the delivery of health care in the United States.

We encourage you to help promote National Health Information Technology Week by posting one of ONC’s new web graphics on your website, in a blog post, or tweet. Visit HealthIT.gov for instructions on how to use the new web graphics.

This White House proclamation underscores the importance of using technology to transform the nation’s health care system and improve the privacy and security of personal health information.

“In an era of spiraling health care costs, our findings give critical information to medical policy-makers,” said Jennifer Majersik, MD, of the University of Utah School of Medicine in Salt Lake City. “If barriers to using telestroke – such as low reimbursement rates and high equipment costs – are improved, telestroke has the potential to greatly diminish the striking disparity in stroke care for rural America.”

Researchers used existing data from previous telestroke studies as well as data from large multi-hospital telestroke network databases at the University of Utah Hospitals and Clinics in Salt Lake City and Mayo Clinic in Phoenix.

They calculated cost-effectiveness by comparing the costs and quality-adjusted life years of patients treated by telestroke to those treated by usual care, such as a rural emergency department without telestroke or a stroke expert available.

Quality-adjusted life year is a measure of disease burden based on the number of years of life that would be added by using telestroke and the quality of life during those years.

The cost of telestroke over a person’s lifetime was less than $2,500 per quality-adjusted life year, the study found. The threshold of $50,000 per quality-adjusted life year commonly is cited as the cut-off for cost-effectiveness.

Telestroke also can help with increasing the low number of patients in rural areas receiving tPA, the clot-busting drug that can reduce death and disability from stroke but must be given within the first three to four-and-a-half hours after symptoms begin, Dr. Majersik stated.

“Only 2 to 4 percent of stroke patients receive this treatment, with the lowest percentage in rural areas largely because there aren’t enough stroke experts with experience using tPA. Telestroke has the potential to lower this barrier by providing long-distance consultation to rural areas, increasing the expertise and quality of stroke care at rural hospitals.”

The study was supported by the National Institutes of Health and the National Cancer Institute.

http://speech-language-pathology-audiology.advanceweb.com/News/In-The-News/Virtual-Stroke-Care-Appears-Cost-Effective.aspx

“Amerigroup understands the use of telemedicine is key to getting access to health care specialists and providers in rural Georgia,” GPT CEO Paula Guy said. “This partnership shows their commitment to get efficient, high-quality and cost-effective care and education to their members.”

“Amerigroup Georgia is delighted to partner with the Georgia Partnership for TeleHealth to expand access to high-quality care and specialty services for our members,” Amerigroup Georgia Chief Executive Officer (CEO) Dr. Tunde Sotunde said. “In many cases, the members who will be served by this partnership otherwise might never receive the care they need in a timely fashion. This partnership enhances our ability to serve members when they need care, regardless of their geographic barriers to access.”

The partnership will provide Amerigroup Georgia members and providers with access to one of the most comprehensive telemedicine networks in the nation, and it will enhance the level of and access to care for the significant rural populations that Amerigroup serves throughout the state of Georgia.

About Amerigroup Georgia

Amerigroup Georgia helps improve health care access and quality for more than 270,000 low-income Georgians by developing innovative care management programs and services. Our members are assured care that is not only accessible but also accountable, comprehensive, integrated and patient-centered.

About Georgia Partnership for TeleHealth

The Georgia Partnership for Telehealth has become one of the most robust, comprehensive telemedicine networks in the nation. Recent expansion has included nursing homes, school-based clinics, jails, clinics and emergency rooms. The network now has more than 350 partners and locations and more than 175 specialists and health care providers. Providing access to health care via telemedicine has proven to cut costs on travel, work time and provides earlier access to care therefore preventing the large costs of untreated health care problems. For more information, visit http://www.gatelehealth.org or call 866.754.4325.

Georgia Partnership for TeleHealth (GPT) and Specialists On Call (SOC) are partnering to create a 24/7/365 emergency teleneurology network to bridge this gap in Georgia, Alabama and Florida. The partnership will allow GPT members to use the GPT telemedicine equipment to gain immediate access to board-certified neurologists for patients suffering from stroke and other neurologic emergencies. In addition, GPT members will also have access to on-demand SOC psychiatrists for mental health patients arriving in the emergency room and needing immediate consultations.

“Having become one of the most robust, comprehensive telehealth networks in the nation, GPT is proud to add emergency teleneurology as an available service to our partners. Emergency psychiatry is also a great need among many of our partners, and we feel very fortunate to be able to offer both services through our partnership with Specialists on Call,” states Paula Guy, GPT C.E.O.

Georgia Partnership for TeleHealth, Inc. is a charitable nonprofit corporation which was formed to promote improvements in healthcare and healthcare facilities in rural and underserved communities throughout the state of Georgia by assisting in the establishment of Telemedicine Programs. By partnering with Specialists On Call, GPT network members will have immediate and around-the-clock access to neurologists in order to treat stroke patients, as well as patients in need of emergency psychiatric consultations.

Specialists On Call, Inc., or “SOC,” is the leading and fastest growing provider of clinical telemedicine services to hospitals in the United States. Led by a physician with 20 years of successful business experience across multiple service industries, since early 2007 SOC has offered to hospitals expert, experienced neurologists providing 24/7/365 on-call service with a 15 minute response time via telemedical link with hospital clients. In 2011, SOC added on-demand psychiatry consultations as a service line and will continue to offer additional on-demand specialties throughout 2012.

“Patients need immediate access to specialists where and when they need it,” added Dr. Joe Peterson, the C.E.O. of Specialists On Call. “We’re proud to be working with the Georgia Partnership for TeleHealth to provide emergency specialists to their member hospitals and together help to improve patient care across the region.”

Georgia Partnership for TeleHealth

Georgia Partnership for TeleHealth is the leading agency in Georgia focusing on increasing access to healthcare through innovative use of technology including telemedicine, health information exchange and telehealth. GPT’s success has been built on providing technical assistance and education to its network partners and has been recognized nationally for its robust, statewide network with over 170 physicians serving patients in more than 100,000 encounters to date in 200 access points. GPT is well positioned with the expertise and strong commitment to continue aggressively expanding the network across Georgia and into bordering states.

For more information please visit, www.gatelehealth.org

Specialists On Call

Specialists On Call, Inc. (SOC), is a Joint Commission-accredited organization that is changing emergency medicine. As the leading provider of emergency telemedicine consultations, SOC gives hospitals vital 24/7/365 access to more than 45 board certified, fellowship trained academic specialists, each with a minimum of 10 years experience. With operations on both coasts, SOC provides more than 1,100 emergency consultations per month for hospitals nationwide and hospital systems such as Vanguard Health Systems, HCA, Inc. and Tenet Healthcare Corporation.

For more information please visit www.specialistsoncall.com

SOURCE: Specialists On Call and Georgia Partnership for TeleHealth

        Specialists On Call, Inc.
        Kathleen Plath
        (571) 439-2741
        plath@soctelemed.com
        or
        Georgia Partnership for TeleHealth, Inc.
        GiGi Goble
        (866) 754-4325
        gigi.goble@gatelehealth.org

The nurse’s offices at two elementary schools in South Georgia are on the cutting edge of innovation when it comes to delivering health care in rural areas of America.

This fall, the students, faculty and staff returning to school in the small town of Nashville in Berrien County have access to a full range of pediatric, family practice and other medical experts from around the state. These may be the most advanced school-based telemedicine clinics in the country.

Early next year, all the public schools in Berrien should be equipped with specialized computers capable of transmitting high-resolution images of everything from blocked ear canals to the earliest signs of skin cancer.

Federal health officials are watching the experience at the schools as part of a $200 million initiative in the Affordable Care Act to promote school-based medical care in underserved areas. The Berrien County telemed clinics, which went into operation a year ago, are getting about $400,000 of that money.

The school clinics are the latest telemedicine development in Georgia, which is setting the pace nationally for promoting telemedicine as a way to deliver medical care in regions where the nearest doctors are often hours away from their patients.

“Georgia is definitely a model for other states,” said Sherilyn Pruitt, director of the Office for the Advancement of Telehealth, part of the division of rural health in the U.S. Health Resources Services Administration.

The nonprofit group that has pushed the Peach State to the forefront – a position it rarely occupies on issues of health care services for the disadvantaged – is the Georgia Partnership for TeleHealth, headquartered in Waycross. The partnership is one of nine “resource centers” designated by the feds to help promote the concept around the country.

“We’ve come a long way,” said Paula Guy, executive director of the partnership, who as a public health worker remembers the earliest efforts 20 years ago to organize telemedicine services through a handful of clinics connected to the Medical College of Georgia in Augusta.

Now, through the work of the partnership, there are nearly 250 places in the state –- hospitals, nursing homes, doctor’s offices, clinics — where telemedicine care is delivered. It’s done through what she describes as a “network of networks” of more than 175 physicians.

The two clinics in the schools in Berrien typify the kinds of services now available around the state. The school-based clinics are also supported by grants from the Emory Urban Health program and the Governor’s Office for Children and Families.

Each clinic is equipped with a $30,000 computer and specialized scopes that send images of the inner ear, eyes, skin and other body parts –- as well as heart sounds, blood pressure readings and other monitors –- to doctors as near as the next county or as far away as Atlanta or Macon.

A nurses usually conducts the physical exam and stays with the patient while the physician oversees the encounter, seeing and talking with the patient and monitoring the readings on a laptop.

Sometimes better than a conventional visit

For diagnosing common ailments — ear and sinus infections, bronchitis, skin abrasions and basal cell cancers — telemedicine sometimes proves better than hands-on treatment, because the cameras used to illuminate problem areas and transmit them to the physician often provide clearer pictures than can be seen through the scope alone, nurses and physicians say.

The real booster shot for telemedicine in Georgia came in 2005, when the state insurance commissioner at the time, John Oxendine, negotiated an agreement with WellPoint, Inc. for a $126.5 million donation for rural health programs as a condition for approving the merger of insurance giants Anthem and WellPoint in the state. (WellPoint is the parent company of Blue Cross and Blue Shield of Georgia.)

Most of that money was earmarked for rural hospital improvements, but $11.5 million was set aside to establish the current telemedicine network. That paved the way for the state’s other medical schools and academic health centers to start participating, according to Jimmy Lewis, chief executive officer of HomeTown Health, a coalition of about 50 rural hospitals and medical centers around the state.

“What happened is that it was built outside the government and it was built right,” said Lewis, who is also on the board of the telemedicine partnership. “That freed us from making political decisions about how to proceed and it expanded interest in participation. It exploded after that.”

Around the same time, the Georgia General Assembly passed legislation requiring insurance companies writing health insurance plans in the state to cover telemedicine visits the same way they would pay for ordinary visits to a doctor’s office.

The insurance mandate made physicians in the state – particularly specialists – take notice. Since then, more and more of them have joined telemedicine networks, 50 in the last six months alone, according to Guy.

One inducement to join the program is that the telemed partnership often makes all the arrangements for appointments for both doctor and patient. The physician can block out a period of time to be available, and the partnership staff will schedule the appointments and make sure each patient’s medical history and other paperwork are in order before the patient is linked to the telemed clinic.

New federal rules make it easier to credential and grant privileges to doctors who are telemedicine providers and are miles away from patients, said Sidney Welch, a health care attorney at Atlanta law firm Arnall Golden Gregory.

Telemedicine has also moved the state in other directions, especially in the area of children’s services.

Dr. Jordan Greenbaum, a forensic pathologist and medical director of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Hospital of Atlanta, uses telemedicine to improve investigation and treatment of victims of childhood abuse and neglect. She and colleagues had “real time” consults via telemedicine in 100 cases of suspected child abuse last year.

By the end of 2011, Dr. Greenbaum hopes there will be a network of 21 child advocacy centers, walk-in clinics and physician offices capable of using telemedicine to conduct forensic physical exams and psychological counseling for children in need of help. (There are five such centers running now.)

“The ability to provide real-time assistance with medical exams of these kids is essential,” she said. “Telemedicine allows that. I can interact with the child and the examiner as if they were sitting in my office with me.”

Because of the shortage of medical providers trained in child abuse evaluations in the state, many victims many not get the appropriate services they need, she said. “Telemedicine helps us deal with the shortage. It isn’t the whole answer, but it is a major step forward.”

New weapon against learning disabilities

Similarly, telemedicine has come to the forefront in the treatment of common behavioral and mental health issues for children in underserved areas of Georgia, said Sherrie Williams, a licensed clinical social worker who directs the Berrien County school clinics. Perhaps the greatest advancement is using it to diagnose and treat autism and autism-related disorders, thanks to a partnership with the Marcus Autism Center in Atlanta, Williams said.

When a student is falling behind in school because of attention deficit disorder or some other common problem, it’s no longer necessary to send the child to a psychiatrist 50 miles away, Instead the student, accompanied by his or her parents, can go to the school clinic, take the necessary battery of tests, and consult via computer with a specialist. “The fact that we can do that all right here makes a big difference for the kids and their parents,” Williams said.

Lewis, of HomeTown Health, said that even though the state has accelerated telemedicine availability in recent years, it still is just scratching the surface. He envisions telemedicine links in state prisons and county jails, nursing homes and a lot more schools around the state in the next five years.

Williams points out that in the Berrien school district there are more than 250 students who report having problems with childhood asthma. Not only can they get a full range of services at the clinic, but the computer there has programs available to help them learn how to use inhalers, limit their exposure to things that trigger attacks, and otherwise control the risks involved with the disease.

“It’s amazing what this technology has the potential to do,” she said. “We see new adaptations all the time.”

www.georgiahealthnews.com

According to an MUMC spokesperson, the program anticipates performing about 100 acute patient consults a year with further growth in the future.

The telestroke service will be carried over the Georgia Partnership for Telehealth network (GPT private network- T1 Line), which was built specifically for the purpose of providing telemedicine services throughout the state of Georgia, according to a MUMC spokesperson. Each physician has a lap top and can take call from virtually anywhere.

According to MUMC, the program uses a secure web based stroke portal which utilizes real-time audio and video conferencing, called a Mediport Telemedicine Cart.

“The stroke platform is a purpose built portal that is web based. It can be accessed from any PC with internet connectivity,” says the MUMC spokesperson. “For the video portion we use video conferencing equipment from Cisco. Specifically for Memorial Hospital the equipment is a Cisco C20 codec integrated onto a Rubbermaid Medical Solutions cart.”

The telestroke platform was developed in collaboration with Second Opinion Telemedicine Solutions (Torrance, Calif., U.S.A.), a company providing telehealth products to hospitals.

“Access to telemedicine services is especially important in stroke because time lost is brain lost,” says Joel Greenberg, M.D., co-medical director of Memorial Stroke and one of the developers of the telestroke platform. “Patients with acute ischemic stroke (AIS) require immediate attention and stroke expertise; services rarely offered in smaller community hospitals. Through the use of audio and video, telestroke essentially adds a neurologist to the rapid response teams of underserved regions, providing better stroke care for the local community.”

According to the American Stroke Association, strokes are the third leading cause of death in the U.S. and the primary cause of adult disability. Approximately 795,000 strokes occur in the U.S. each year, resulting in medical and disability costs of almost $74 billion annually.

“Georgia is considered part of the “stroke belt,’” says a MUMC spokesperson. “[It is] one of 11 states that have an unusually high incidence of stroke.”

www.telecomengine.com