Subject: Fwd: Daily Pulse 3.27.14 - Doctor's home visit is back -- kind of -- as telehealth flourishes nationwide
From: "paul rowan" <[email-masked]>
To: "Hunter Biden" <[email-masked]>
Date: Thu, 27 Mar 2014 10:33:38 -0400

FYI

---------- Forwarded message ----------
From: GONZALO GMAIL <[email-masked]>
Date: Thu, Mar 27, 2014 at 9:43 AM
Subject: Fwd: Daily Pulse 3.27.14 - Doctor's home visit is back -- kind of --
as telehealth flourishes nationwide
To: Paul Rowan <[email-masked]>

this may be of interest to you...

Begin forwarded message:

*From: *Catherine Anderson <[email-masked]>
*Subject: **Daily Pulse 3.27.14 - Doctor's home visit is back -- kind of --
as telehealth flourishes nationwide*
*Date: *27 Mar 2014 14:16:00 GMT+1
*To: *Undisclosed recipients:;

Good morning,

Below, please find today's news articles.

Best Wishes,
Catherine

*Competitors*
·         Facebook CEO sees telemedicine opportunity with $2B Oculus
acquisition

*Industry News/Legislation*
·         Doctor's home visit is back -- kind of -- as telehealth flourishes
nationwide
·         Texas telemedicine taking off

------------------------------

*Competitors:*

Facebook CEO sees telemedicine opportunity with $2B Oculus acquisition
http://mobihealthnews.com/31449/facebook-ceo-sees-telemedicine-opportunity-with-2b-oculus-acquisition/
The multibillion dollar tech news this week is that Facebook is set to
acquire virtual reality gaming company Oculus for more than $2 billion.
During a call with reporters and analysts following the announcement,
Facebook CEO Mark Zuckerberg explained that while Oculus will continue to
focus on gaming in the short term, the deal was more about placing a bet on
the next big computing platform shift.
"We still have a lot of work to do on mobile," Zuckerberg said, "but at
this point, we feel strong enough in our position that strategically we
also want to start focusing on the next major computing platform that will
come after mobile. The history of our industry is that every 10 or 15 years
there is a new major computing platform, whether it is the PC, the web, or
now mobile. History suggests that there will be more platforms to come. To
me, by far one of the most exciting future platforms is around vision -- by
modifying what you see to create augmented or immersive experiences.
Today's acquisition is a longterm bet on the future of computing. I believe
Oculus can be one of the platforms of the future."
Zuckerberg said that Oculus' Rift headset makes you feel like you are in
another place with other people.
"Gaming is just the start," he said. "After games, we are going to make
Oculus a platform for many other experiences. Imagine enjoying a courtside
seat at a game, studying in a classroom of students and teachers from all
over the world, consulting with a doctor face-to-face, or going shopping in
a virtual store where you can touch and explore the product you are
interested in just by putting on goggles in your own home."
Prior to the acquisition Oculus managed to raise tens of millions of
dollars, and some of the company's investors told Fortune's Dan Primack
that Oculus has always been considered much more than a gaming peripheral --
"such a characterization would have never made it past their investment
committees," Primack wrote. "Instead, they view Oculus as a software
platform that happens to work on top of proprietary hardware. The Facebook
partnership, they argue, reflects how many people view virtual reality as
the next major paradigm shift after mobile."
Wired picked up on Zuckerberg's telemedicine reference too, and Gartner
analyst Brian Blau -- a longtime virtual reality watcher told the
publication: "I didn't hear anything that Zuckerberg said that hasn't been
talked about before in the VR community for a very long time. It has always
been billed as a next-gen communication technology -- something that can
provide a more immersive and deeper connection to somebody else," but do
date it has mostly been a solitary experience.
Still, some researchers are already using Oculus technology for medical
reasons. The Institute for Creative Technologies (ICT) at University of
Southern California has used the Oculus Rift for post-traumatic stress
disorder treatment, which Oculus CEO Palmer Luckey has said (during a
student interview after his Games for Health keynote last year) has proven
to be an effective therapy that doesn't involve drug use.
Back to Facebook -- Zuckerberg isn't the only billionaire who believes
virtual reality gaming technology might have a role to play in the future
of healthcare. Back in 2011 Dr. Patrick Soon-Shiong, CEO of digital health
rollup NantHealth, invested $200 million into virtual reality gaming
company Fourth Wall Studios. At the time of the announcement, he stated:
"The best ideas often occur when different industries intersect. As I work
with new technologies for healthcare and medicine, I see more and more
parallels with what's happening in entertainment; for example, the rapidly
accelerating use of mobile devices and social media platforms, and the use
of novel algorithms to create machine vision. As pioneers in the field,
Fourth Wall Studios is the ideal team to help take advantage of these
synergies through the development of augmented reality."

*Industry News/Legislation:*

Doctor's home visit is back -- kind of -- as telehealth flourishes nationwide
http://www.omaha.com/article/20140327/LIVEWELL01/140328813
There is nothing futuristic about telehealth, the use of technology to
connect patients to doctors without an office visit.
Telehealth is flourishing and growing rapidly in Nebraska, Iowa and
nationwide. It uses long-standing technology such as videoconferencing and
telephones as well as emerging devices that enable patients to track and
deliver their own heart rates and blood sugar levels.
"This is like the tsunami. So much is happening. Technology is changing
really rapidly. Legislation is changing," said Mandi Constantine, who was
hired 15 months ago as executive director of telehealth for the Nebraska
Medical Center to hasten the hospital's efforts.
Doctors and hospitals are finding many purposes for telehealth and numerous
ways to implement it. The Nebraska Med Center alone has at least 13 new
test projects or initiatives in telehealth, ranging from stroke exams to
cancer care.
The technology allows frail patients to have psychiatric appointments in
their nursing homes and women enduring high-risk pregnancies to be seen by
specialists without having to drive 100 miles or more. It holds the promise
to restore, in a sense, the long-vanished doctor's home visit. Telehealth
has special value in vast rural states such as Nebraska and Iowa, where
specialists can be thinly distributed. It can reduce costly visits to the
emergency room and hospital admissions.
Telehealth proponents say it's a struggle for laws and rules to keep up.
The Nebraska Legislature, for instance, is considering an amendment that
would require the state Medicaid program to cover remote monitoring of
patients by technology.
Among other things, the amendment also would remove the requirement that a
patient be at least 30 miles from the doctor in a videoconference
consultation for that interaction to be reimbursed by Medicaid.
"We're just trying to eliminate as many barriers to it (telehealth) as
possible," said State Sen. Jeremy Nordquist of Omaha, who introduced the
legislation.
Although Constantine said Nebraska has a long way to go before it maximizes
telehealth, a former University of Nebraska Medical Center dean and
chancellor, Dr. Cecil Wittson, was perhaps the first in the nation to use
it.
Wittson did some psychiatric consultations with two-way audio and video
about 55 years ago with patients in the regional center in Norfolk, Neb.
Max Thacker, associate director of info technology at UNMC, said Wittson
used technology similar to closed-circuit television.
This month, Dr. Michael Barsoom, a maternal fetal medicine specialist at
Bergan Mercy Medical Center, consulted with 25-year-old Nicole Gronenthal
about her pregnancy.
Gronenthal, who had lost a baby near the end of pregnancy a couple of years
ago, was in a doctor's office in Norfolk. Barsoom was in a meeting room in
the Omaha hospital.
They could see each other by video monitor. Barsoom observed the ultrasound
as it proceeded from the office of Dr. Keith Vrbicky, an
obstetrician-gynecologist whose office in Norfolk is equipped with the
videoconferencing technology. Vrbicky spent about $30,000 for the
technology in 2008 so his patients could have easy access to
sub-specialists such as Barsoom.
"How you doing, dear?" Barsoom asked.
"Just really uncomfortable," Gronenthal answered. "A lot of back pain and a
lot of difficulty breathing." She was more than 31 weeks along in her
pregnancy.
Barsoom asked Norfolk sonographer Nora Petersen to give him views of
specific fetal body parts.
"Can you show me the face and the stomach?" Barsoom asked. "Heart looks
good."
They discussed whether she should come to Omaha to have some fluid drained.
"Everything looks good, Nicole," Barsoom said. "We're still seeing the baby
running on the smaller side."
Gronenthal said she appreciated getting Barsoom's expertise without having
to drive 110 miles to Omaha.
The Nebraska Medical Center's Constantine said the Department of Veterans
Affairs has helped lead development and use of telehealth. "Their work is
just incredible."
The VA began using telehealth in the late 1990s and started doing remote
patient monitoring in the early 2000s. Last year the VA cared for 608,900
patients through home monitoring, videoconferences and other technology,
said Dr. Adam Darkins, the Veterans Health Administration's chief
consultant for telehealth.
A home-monitoring device, sometimes called a "health buddy," records a VA
patient's blood sugar, blood pressure and other vital signs and relays them
to a secure website for data collection. The device also asks patients
questions about shortness of breath, ankle swelling and other problems. A
care coordinator may then contact the patient and adjust his medications,
give advice or schedule an appointment.
That technology costs $300 to $400 per patient annually, Darkins said. But
the VA determined that it saved about $2,000 yearly per patient by keeping
them out of the hospital.
The region's VA health system had more than 550 patients in home telehealth
in January, up from 300 two years ago. Dr. Ahsan Naseem, associate chief of
staff for telehealth in the region, said the remote system helps clinicians
keep a "virtual eye" on patients.
"It's like a home visit every day," Naseem said. "It holds tremendous
value."
Naseem said the Nebraska-Western Iowa VA health system also does video
telehealth for specialties as varied as wound care, nutritional counseling,
infectious diseases and psychiatry.
Mike Lachance of David City, Neb., used to drive a 130-mile round trip to
and from the VA in Omaha twice a week for meditation and group sessions for
post-traumatic stress disorder.
Now Lachance, 48, just meets a VA psychiatrist by videoconference through
his home computer once a week. Lachance likes it that way.
"I'm a lot more comfortable in my home," the former Air Force security
police officer said. "For myself, it's a major home run."
Dr. Cliff Robertson, CEO of Alegent Creighton Health and the state network
of Catholic Health Initiatives, said the CHI system he came from in
Washington state started a fairly simple method of telehealth.
After providing it to employees of the Franciscan Health System since 2009,
the system last fall started offering the public a "virtual urgent care"
service by phone or by a videoconference with a smartphone or computer. The
service costs $35, puts the patient in contact with a doctor and, in most
cases, prevents expensive emergency room or urgent care visits for colds,
upset stomachs or other manageable health problems.
Robertson, who declined to say if and when virtual urgent care would arrive
in the metro area, said technology has changed the way families and friends
interact. "It's having the same impact on health care."
Far from every doctor has developed a passion for telehealth. Dr. Herschel
Stoller, an Omaha dermatologist, said he has heard plenty about it and
believes it is "an up and coming field."
But Stoller, 63, said, "I'm old school. I like to see people in person and
interact -- touch, see, feel -- because that's how I was trained."
Younger practitioners with more experience in computers and technology
might feel comfortable with telehealth, he said, but he would need training
before he would feel at ease diagnosing a skin condition without an
in-person appointment.
In Iowa, distribution of abortion pills through a videoconference
appointment with a physician has led to legal, legislative and Iowa Board
of Medicine debate. For now, remote dispensing of abortion-inducing pills
by a physician to a woman is legal.
Nebraska Dr. Hemant Satpathy, a maternal fetal medicine specialist at
Methodist Health System, said he would see every patient in person if he
could. In difficult cases, he will hold hands and pray with patients.
But time and money are saved by videoconferencing with women with high-risk
pregnancies who are a long way from Omaha, Satpathy said. "I think it's a
great thing."
Satpathy and other maternal fetal specialists at Methodist connect by
videoconference with the women through Vrbicky's practice in Norfolk.
Dr. Tom Magnuson, an associate professor of psychiatry at UNMC, said seeing
elderly psychiatric patients by videoconference has transformed the service
he provides. Some used to have to drive in from rural Nebraska, "and we'd
see them once," Magnuson said.
Now he can see patients by videoconference in nursing homes across the
state. He talks with geriatric patients and prescribes medicine for
long-standing mental health problems, depression, mild impairments and
dementia. He has done it by telehealth for 10 years now and has seen
patients that way in about 50 nursing homes.
Eydie Schrad, director of nurses at Cloverlodge Care Center in St. Edward,
Neb., said that for a time the staff had to drive patients to Boone County
Health Center 12 miles away because the hospital was hooked up for
videoconferences and the nursing home wasn't. But UNMC's Thacker helped
Cloverlodge get connected, Schrad said, and since then they haven't had to
take elderly patients out in the cold or the heat for psychiatric
appointments.
Donna Hammack, now of St. Elizabeth Regional Medical Center in Lincoln,
helped Good Samaritan Hospital in Kearney acquire a $1.5 million federal
grant in 1994 to connect that hospital by videoconference to small central
Nebraska hospitals. Hammack said it cost about $60,000 to connect each
site, but the cost of the technology has declined to less than $10,000.
By the mid-2000s, Hammack, the Nebraska Hospital Association, the Nebraska
Public Service Commission and others collaborated to install
videoconference technology in virtually all hospitals and public health
departments in the state.
UNMC's Thacker said that system for years was used mainly for meetings and
continuing medical education.
Now, he and others said, Nebraska doctors and hospitals are starting to use
it extensively to see and treat patients.

Texas telemedicine taking off
http://ketr.org/post/texas-telemedicine-taking
A shortage of medical specialists, combined with a glut of newly insured
patients has put some rural Texas hospitals in a bind, according to
Breakthrough.
One solution is telemedicine. Think of it as a kind of video conferencing
on steroids that links doctors to patients hundreds of miles away.
Dr. Pritam Ghosh is in Dallas, listening with a stethoscope to a patient's
lungs, in the east Texas town of Sulphur Springs. And no, this isn't a
story about a 100 mile long stethoscope...it's about a Dallas company
bringing high tech telemedicine to the masses.
Naomi Crofford, who's 82, has been in the Intensive Care Unit (ICU) at
Hopkins County Memorial Hospital for two days. She's sedated and has wires
and tubes running in all directions. Dr. Ghosh, who's a face on a 24-inch
flat screen, is trying to determine whether she's ready to be removed from
a ventilator.
"Even if the numbers looked great," Ghosh says, "Given what we're about to
try to do, this extubation process, I would never do unless I actually laid
eyes on the person."
And while he may not be here in person, with this telemedicine setup he can
control a 360 degree camera, zoom in on charts and monitors, and listen to
the chest and lungs with a stethoscope plugged in to a USB port.
Bringing Critical Care Specialists To Rural Texas
Many hospitals in rural Texas have trouble recruiting critical care
specialists like Dr. Ghosh. That means transferring local patients to
larger hospitals in other cities -- losing business and often putting an
emotional and financial strain on family.
Mrs. Crofford's daughter, Sharon says she's relieved she won't have to move
her mom to Tyler.
"I think this is one of the greatest things they've got. For him to be in
Dallas and still be able to check on her, this is wonderful," she says
after talking with Dr. Ghosh via video after he examined Mrs. Crofford.
This Isn't Skype
Chris Gallagher, a physician at Hopkins County Memorial Hospital and
founder Access Physicians, a telemedicine organization that delivers
specialty healthcare to underserved patient populations, worked with
Dallas-based US Medical IT to customize this computer on wheels.
"We wanted to try and make it as natural as we possibly could," he says.
So the cart is the height of a human and has its "ears" - the
omnidirectional microphone, next to the face, along with its "eyes" - a
pan, tilt, zoom HD camera attached above the screen.
The brain is a Microsoft tablet that uses Lync online - a secure platform -
to keep patient data safe and private.
Cost Of Care
Gallagher says purchasing the telemedicine cart, including delivery,
monthly maintenence and 24/7 IT cost around $30,000 dollars.
That might sound expensive, but the founder of US Medical IT, Stephen
Cracknell, says his company is doing everything it can to make telemedicine
affordable for the masses.
"Our telemedicine solutions start at under $6,000. But, in addition to that
we recognize that the cash flow challenges are very real, particularly for
rural healthcare providers," Cracknell says.
So US Medical IT is working with partners, like AP Global, to offer a
bundle of technology and clinical services that allow hospitals to pay for
these services either under a monthly or even hourly plan.
Cracknell says demand for telemedicine has been pent up for a long time,
and although barriers like cost and reimbursement from insurers still
exist, they're beginning to crumble.
Return On Investment
Telemedicine has the power to transform the way we provide critical care in
rural areas, says Jeremey Kahn, "but there are questions about whether the
financial investment is justified."
Kahn is associate professor of Critical Care, Medicine and Health Policy at
the University of Pittsburgh. He says access to trained critical care
physicians at ICUs is linked to better survival rates and faster
discharges. But studies looking specifically at the impact of telemedicine
in ICU's have shown mixed results.
"Conceptually," he says, "the argument is very strong and there are some
type of hospitals where telemedicine is likely to have a very large impact.
And it's most likely to occur at these small rural hospitals where they
don't have access to the trained intensivists without this remote
technology."
Return on investment for telemedicine may be hard to calculate in part
because there's no one right dosage. It's a medicine that has to be
customized for each hospital and clinic.
Done right, Kahn says it can keep patients in their own communities,
connected to health care specialists at a reduced cost and greater
convenience.

*Catherine Anderson, M.S.* | Marketing & Public Relations Manager
American Well Systems | 75 State Street, 26th Floor | Boston, MA 02109
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