Telehealth and Medicine Today

Medical Boards: Impact of Growing Virtual Care and Need for Integrated Approach to Enhance Quality and Safety

2022-04-13T07:08:32-07:00

The increased amount of virtual care during the COVID-19 pandemic has exacerbated the challenge of providing appropriate medical board oversight to ensure proper quality of care delivery and safety of patients. This is partly due to the conventional model of each state medical board (SMB) holding responsibility for medical standards and oversight only within the jurisdiction of that state board and partly due to regulatory waivers and reduced enforcement of privacy policies. Even with a revoked license in one state, significant number of physicians have continued to practice by obtaining a medical license in a different state. Individualized requests were sent to 63 medical boards with questions related to practice of telemedicine and digital health by debarred or penalized medical doctors. The responses revealed major deficiencies and the urgent need to adopt a nationwide framework and to create an anchor point to serve as the coordinator of all relevant information related to incidents of improper medical practice. The ability to cause damage to large number of patients is significantly more now. Federal and state agencies urgently need to provide more attention and funding to issues related to quality of care and patient care in the changing ecosystem that includes medical specialists at a distance and the use of evolving digital health services and products. The creation, maintenance, and use of an integrated information system at national and multinational levels is increasingly important.

Maternal Deaths During a Pilot Study Using Digitized Maternal Early Warning System

2022-05-13T08:38:05-07:00

Background:

India accounts for nearly one in six maternal deaths and over the last two decades, maternal mortality in India has decreased rapidly and faster than the global rate. However, the rate of decline has been slowing and further progress calls for new interventions and improvements in existing programs and the care-delivery process.

Objective(s):

We developed and tested a telehealth solution that included an early warning system and a clinical decision support tool for timely detection of clinical deterioration and appropriate management of women in labor at a large general hospital in India. The pilot study with 15,184 patients was associated with a significant decrease in maternal mortality and in-hospital eclampsia. The results were published earlier this year. Here we examine and analyze the maternal deaths that occurred during that study period and discuss reasons why preventable deaths occurred despite the telehealth early warning system and recommend possible approaches to further reduce the maternal mortality rate.

Study Design:

We carefully reviewed medical records of all maternal deaths during the two-year pilot from admission until death or transfer of these patients to a tertiary care center. We deconstructed the events leading to the adverse outcome and evaluated each based on the three delay modules for maternal deaths, namely seeking care, reaching the facility, and receiving care after reaching the facility.

Results:

Twelve maternal deaths occurred during the period of the study, six deaths occurred at the study sites and six deaths occurred after transport to a tertiary institution. Nine deaths were determined to be preventable. In five cases although multiple alerts were created indicating a clinical deterioration of the patients’ condition, lack of adequate knowledge and insufficient training on the part of the staff contributed to delays in initiating treatment and/or delays in timely transport. In all cases where the deaths occurred after the patient was transported, the warning system had identified the acute risk appropriately prior to the initiation of the transport. Considering all cases, the telehealth early warning system generated red alerts in every case, indicating an acute emergency (66.7%) and/or yellow alerts requiring continued observation (33.3%).

Conclusion(s):

Telehealth solutions incorporating early warning capability for identifying clinical deterioration among patients can play a crucial role in resource-constrained settings. Telehealth early warning systems have the potential to accelerate the care-delivery process and expose gaps in an organization’s operating procedures as well as in the knowledge base of providers. Successful implementation of such telehealth systems requires strong referral networks and appropriate protocols to take advantage of the system’s early warning capabilities. In addition, it may be necessary that the early warning system be implemented in all referring and receiving institution within the system to ensure no fallout in patient care.

Strategies to Improve Time to Activation within an Ambulatory Remote Patient Monitoring Program

2022-03-18T17:03:09-07:00

Remote patient monitoring (RPM) programs have been shown to effectively decrease rates of healthcare utilization among patients with chronic conditions. Immediately enrolling a patient and activating them in the RPM program either upon or soon after discharge is an important step in achieving these benefits. We tested interventions across three Plan-Do-Study-Act quality improvement cycles to understand the extent to which operational improvements would lead to timely activation. Each improvement cycle resulted in decreased time to activation, with the cumulative effect (as applied to patients on the COVID-19 RPM program) resulting in a reduction that was overall greater than the sum of the individual improvements. As additional healthcare systems develop and deploy RPM programs, the learnings from this project can help to provide insight into the operational and logistical challenges encountered in providing these services as well as potential interventions that can be used to achieve timely activation.

The Systematic Overview of Remote Patient Monitoring in Nigeria (West Africa)

2022-04-22T06:05:43-07:00

Remote Patient / Physiologic Monitoring (RPM), as a tool helps in eliminating or reducing the cost of care in Nigeria and West Africa, and hence has contributed to the advancement of telemedicine. As a result, telemedicine conserves time and improves cost factors of care delivery by achieving efficiencies through technology while demonstrating quality and outcomes in new and novel ways. This paper looks into the growth and application of RPM in Nigeria. Management of diseases using RPM, measures, and regulations taken to incorporate RPM in Nigeria, and their connectivity to remote and rural areas are all highlighted within the context of this paper. This paper identifies effective utilization of RPM technology as a solution to address problems of poor health care delivery and outcomes in Nigeria by identifying the prevailing limitations mitigating the incorporation and growth of RPM in the country’s healthcare delivery system.

Promote Scientific Discourse, Not Lawsuits

2022-03-16T08:39:46-07:00

Pacira Biosciences initiated a lawsuit asserting trade libel over articles and related materials produced by Anesthesiology. The defendants filed a motion to dismiss. After hearing oral argument and considering briefs, the presiding court dismissed the case with prejudice. The court focused on the preference for scientific disputes to be addressed through scientific discourse and under peer review. The court recognized that courts are not an appropriate venue absent specific circumstances. The decision will optimistically encourage dialogue and not chill future questions from being raised.

The Critical Role Telehealth Plays in War

2022-05-07T11:53:13-07:00

Telehealth solutions can play a critical role in conflict and combat situations to identify
injury, illness, rehabilitation, recovery support, and even behavioral and mental health
care to aid civilian patients.

Join THMT to learn what impact telehealth plays in war, how continuous care can be
provided, and what specific needs must be met for guaranteed remote and emergency
care.

For a quick link to the podcast, visit https://rss.com/podcasts/partnersindigitalhealth/480804/?listen-on=true

Home-based “Virtual” Primary Care - Opportunities and Challenges

2022-05-07T12:26:12-07:00

Topics addressed include:

How does the "primary care" model consumers want virtually play out in the home?
What is required for success?
What are the best scenarios for virtual primary care, and what are the limitations?
Can we create a solution with all the benefits of virtual and overcome perceived limitations, too?

For a quick link to listen to the podcast visit https://rss.com/podcasts/partnersindigitalhealth/483477/?listen-on=true