07 June 2013

Statins Receive a Lot of Fuss – Justified?

Where some writers get their headlines, I am still trying to comprehend. This writer in Present eLearning states as her title “Should Statins Be in the Water?” has me very concerned and wondering why this could even be considered. For years, we have been taught that fluoride was necessary in our drinking water. Now that trend is slowly disappearing and more research is discovering some of the side effects of this that are not so healthy.

With statins and their side effects, I would fight this to the bitter end if I thought this writer was serious. We simply cannot allow this to happen, as our children do not need statins. One issue alone should stop this from happening and that would be if they included the wrong statins in our drinking water as this could exponentially increase the number of people developing type 2 diabetes. And we think we have an epidemic now. Certain fruits (grapefruit and its relatives) would need to be banned because of their potential deadly side effects when consumed by people on statins. See my blog here.

So when writers allow something like titles to be part of any discussion, they need to be called out about this. I have been carefully watching and since the publishing of this on March 12, 2013 and to-date have seen no one disputing this. Did Joy Pape, RN, BSN, CDE, WOCN, CFCN, PRESENT Diabetes, and Contributing Nursing Editor, really think that the title would go unnoticed?

06 June 2013

Telemedicine Is Gaining Support - Part 2

Part 2 of 2 parts

Some important history needs to be part of this blog. “The University of Kansas Center for Telemedicine & Telehealth is a recognized world leader in telehealth services and research.” I would not have included this if I did not believe it. I have a distant relative that has been a recipient of this service and he says it was needed and he was thankful it was available when he needed it.

“Beginning in 1991 with a single connection to a community in western Kansas, the Kansas telehealth network now has accessed more than 100 sites throughout the state, has conducted many thousands of clinical consultations for the people of Kansas and has hosted hundreds of educational events for health professionals, teachers, students and the public.”

This is not the total of universities, but none has had the success that U of K has had or the range of population across the state. Other universities are modeling after the University of Kansas and are still developing especially when not blocked by state medical boards.

The benefits of telemedicine in states that are largely rural are more evident than in states that have some large population areas. Rural physicians and clinics can,
  • Receive education from the specialist/provider
  • Better health outcome for their patients
  • Enhanced community confidence in local healthcare
  • Attend continuing medical education courses from their clinic

Patients benefit,
  • Loved ones remain in their community with family support
  • Cost savings from not having to travel extensively
  • Immediate urgent care
  • Confidentiality of specialty examination or visit (Because the patient visits the general practice doctor, he can be seen for any specialty care without anyone else knowing)
  • Patient education courses (nutrition, oncology, etc.)
  • Properly stabilize patient prior to transport
  • Early Diagnosis prior to escalated medical episode

Rural Patient's Community benefits because,
  • Dollars follow the patient
      • Patients that routinely travel to visit doctors in large urban areas tend to purchase their goods and services from those cities,
      • Telemedicine keeps those dollars local.

Telemedicine Providers (hub sites) benefit by,
  • Expand patient outreach
  • Major surgical procedures resulting from the initial telemedicine consultation
  • Reduction in ER visits
  • Promotion of Hospital
  • Charge tuition for clinician education courses (CME, CNE, etc.)
  • How can we give any hospital or clinic immediate access to a vast amount of medical experts, healthcare education/information, and support from other physicians.

These benefits can become powerful benefits for telemedicine in states like Kansas, Montana, Wyoming, and other states. Physicians with access to telemedicine will be more likely to remain in these largely rural states. Residents will be happier not needing to travel for hours to be treated and will welcome and utilize nearby physicians.

05 June 2013

Telemedicine Is Gaining Support – Part 1

Part 1 of 2 parts

I know that there are a lot of definitions available to apply to telemedicine. Telemedicine in one form or another has been around for about 50 plus years. Most of telemedicine pre 1990 was by use of telephone or occasionally when publicity could be had, some TV stations would lend their facilities to aid in telemedicine.

Then in 1991, the scene started to change. Computers became the medium for telemedicine. Today there are mobile devices and portable tablets being used for telemedicine. Terminology is expanding and more terms are gaining acceptance. Sometimes even I need to wonder which term(s) to use.

Almost 100 percent of telemedicine today uses telecommunications. We have the term telehealth, mHealth, eHealth, and health information technology (HIT). This is not a complete list as there is others gaining acceptance such as RPM for remote patient monitoring.

A concise and yet simplistic definition is, “Telemedicine is the ability to provide interactive healthcare utilizing modern technology and telecommunications.” I have encountered this usage from several sources and therefore do not know whom the source of the original use should be credited. This is also revealing in that telemedicine is not a separate medical specialty. Many specialists make use of telemedicine and think nothing of it.

Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. However, some state medical boards are lobbying for a different set of billing codes to differentiate and control groups using telemedicine.

Some attempts are being made throttle telemedicine and force patients into a doctor's office, or a hospital and eliminate telemedicine. I hope state legislatures will reverse this to allow telemedicine to expand in not only heavily populated areas, but also especially in largely rural areas where patients would need to travel several hours to see a doctor or have access to a hospital. Some federal programs have stepped into very remote areas to lend assistance to telemedicine.

04 June 2013

'Traditional' Research Being Modified

This time I learned something that I was not aware of and while I have seen the acronym in articles, this blog by Dr. Leana Wen lays out information I admit I have not read before from any source. PCORI is the Patient-Centered Outcomes Research Institute, and is a new federal institute mandated to figure out how meaningfully to involve patients in research. How did I miss this – good question, but I sure did.

In “traditional research,” patients are participants or subjects of the study or trial. Their participation is their decision and once accepted can chose to stop if something is not right for them. Under PCORI, patients will have the rare opportunity to help make decisions about what research is conducted, some of the design, and to be involved in the research activity from the beginning. After all, isn't it the patients with the disease that have the most at stake and the largest to gain from research?

Dr. Wen is correct in saying, Researchers not used to involving patients question whether they would be sophisticated enough to understand the research process. Patients, too, doubt whether they have the expertise required. Fueling this is mutual mistrust: will this new patient-centered approach derail existing research? Will patients end up being “used” for some nefarious ulterior motive?”

Have no doubt, some researchers will not work with patients as partners, and may patients may not have the desire to assist in design of a study. I also think that there will be a mutual mistrust, but whether this will derail existing research will remain to be seen. First is the existing research quality research or suspect research? One of the fears I would have as a patient involved in some studies is how I would be treated by researchers. I can envision them attempting to short circuit some areas and then blaming me.

Some of the points Dr. Wen lists do bother me and the first one is whether they approved representatives of patients. Then whom would they actually be speaking for as I suspect it might not be the patients. Patient groups may be okay unless they are not patient controlled. These are my concerns.

Read her blog and enter your thoughts. I have barely touched what Dr. Wen covered. Do I wish I was involved, maybe if I knew some research projects would be done and correctly done, unlike many prior studies. Mainly, I am very thankful for the information Dr. Wen has made more public.

03 June 2013

Is Telemedicine Ready for Prime Time?

Maybe, and there are many aspects that will need to come together for this to happen. I do not agree with the optimism of many writers.  From some of what I am seeing, the legal profession is sharpening their medical skills be hiring some doctors and legal medical specialists. This tells me that something is brewing on the legal front that may affect many aspects of medicine. No, I do not know what is being planned, but there are many possibilities.

Even the HIPAA rules are being expanded and as of yet there is some confusion. Some are saying telemedicine will be exempt for parts of HIPAA and others are saying don't count on it. One video program that is secure is now on the market and this link will give you information. Now, if we could find doctors that would be available and use it.

One problem that may prevent telemedicine from reaching prime time in 2013, is the number of states that have not approved mandatory private insurance reimbursement for telemedicine care. It is surprising that some of the more rural states have not taken action on this.

Another problem is the physical examination requirement (PER) some states have in place and this may prevent telemedicine from being used in a few states. A lot will depend on how the state laws are written.

Two efforts at the Congressional level may be favorable for telemedicine. One piece of legislation – The Telehealth Promotion Act of 2012 (HR 6719) has been introduced by Rep. Mike Thompson (D-CA 1). The proposed legislation fixes the two existing barriers to telemedicine in federal health programs: reimbursement and physician licensure. By eliminating arbitrary coverage restrictions and simplifying licensure requirements within federal health programs, the bill would extend the benefits of telehealth and mHealth (mobile health) to nearly 75 million Americans.

The second has not been introduced, but an aide to Sen. Tom Udall said the New Mexico Democrat is drafting legislation to create a national physician licensing system to operate in tandem with state boards.

Even if telemedicine does not make prime time this year, it is on the thresh hold to potentially receive a boost and gain some important ground.