New Research Shows Telemedicine Applications Extend To Homeland Security, Emergency And Disaster Response, Obesity, And Beyond

ATA Annual Meeting to Showcase Outstanding Research That Promises to Generate New Areas for Telemedicine Applications

April, 2006

San Diego, CA – The American Telemedicine Association will be reporting the latest telemedicine research at their 11th Annual Meeting, May 7-10, 2006, in San Diego, CA. Cutting-edge research highlights applications and issues will be covered including:

• Homeland Security/Emergency and Disaster Response
• Quality of Care and Lower Costs
• Mental Health
• Military and War Zone Healthcare
• Access for Underserved Populations
• Aging and Chronic Disease Management

Homeland Security/Emergency and Disaster Response

Army’s New Trauma Simulators Result In Improved Emergency Response
In a post-Sept. 11th world, the need to have adequately trained emergency responders who can manage trauma-related mass casualties on U.S. soil is of utmost importance. Currently, the commercial trauma simulators available provide exercises for individual trauma patients, but none for the simulation of mass-casualty exercise. Additionally, many commercial simulators are unusable for on-site exercise due to their being bulky and dependant on AC power. The Army has developed a system of trauma simulators that combine portable tablet computers, wireless communications, and portable power sources. The National Training Center, Fort Irwin, CA has demonstrated significant improvements in emergency response training.

Gary Wheeler MD
National Training Center Surgeon
US Army National Training Center
gary.a.wheeler@us.army.mil

Vital Signs Data Recorders (VSDRs) Could Assist with Triage during the Next Disaster
In the immediate aftermath of a man-made or natural disaster, emergency responders often lack physiological information about trauma casualties during pre-hospital (field) management. The Department of Defense TATRC has funded research for a vital signs data recording system (VSDR) to help emergency responders better manage sites and deliver care more efficiently to trauma-casualty patients. VSDR uses a hand-held instrument (PDA) that gathers real-time patient vitals and can store up to 24 hours of patient data. The PDA can also wirelessly transmit patient data to a central server, and has a built-in, error-detection mechanism to ensure the data retains integrity.

Peter Hu MS, CNE
Director of Systems Integration
University of Maryland Medical Center
phu@umm.edu

“Integration Engine” Helps Military & Civilian Disaster Responders Communicate
Previous attempts to integrate military and civilian medical information systems have been hampered by a lack of universal data standards, formats, semantics, and other differences between the two medical systems. The events of Sept. 11th have highlighted the need integrate medical and civilian medical information systems more efficiently to ensure rapid responses to homeland security related incidents. TATRC has launched a Small Business Innovative Research project to create “Integration Engine,” software that can foster uninterrupted data exchanges between military and civilian medical information systems. This integration will help telemedicine and electronic medical information exchange during responses to homeland disasters by the military health system. It will also help maintain continuity of care when military personnel and their dependents receive treatment at civilian healthcare facilities.

Gary Gilbert PhD
Chief Knowledge Engineering Group
Telemedicine and Advnced Technology Research Center
gilbert@tatrc.org

Sim “Patients” Replace Live Actors in Emergency Response Training
The researchers at RTI have developed a Mass Casualty Triage Simulator for emergency response and preparedness. Typically, emergency exercises with live actors are costly and require advance planning and coordination. The Sim-Patient Triage Program allows for the same learning opportunities and is available 24/7 without cost of actors and time for planning. The Sim-Patient Triage Simulator depicts patients exhibiting signs and symptoms related to specific physical and psychological injuries. The Sim-Patients have facial expression, gestures, movement, and other behaviors based on dynamic cognitive, emotional, physiological, and pathological models. The “patients” cry, cough, vomit, and have convulsions in accordance with medical status, and are presented within varying scenarios including trauma, chemical, and psychological traumas. The simulator also allows for multiple providers to join a scenario and coordinate triage, patient assessments, and medical care by viewing and interacting in the scenario from different computers. This gives emergency personnel an opportunity to gain experience in coordinating disaster responses and provides a valuable learning tool to EMS services, fire houses, emergency care facilities, and individual providers that can be disseminated at low cost.

Robert Furberg MPH, NREMTP
Research Health Analyst
Research Triangle Institute
rfurberg@rti.org

Hurricane Katrina Spurs Development of Health Information Management System
The confusion surrounding the personal information and records of Hurricane Katrina’s victims in the aftermath of the storm’s devastation demonstrated the need to develop a centralized health information management system for disaster relief efforts. A researcher at the University of Texas Health Sciences Center constructed a conceptual model of a health information management system based on lessons learned from the Hurricane Katrina relief efforts. The system is easily deployable and helps disaster relief efforts meet the need for housing, medical care, reunification of families, social services and education of displaced victims. The system was deployed and tested during the subsequent Hurricane Rita that hit Texas a month later. 348

Adol Esquivel MS, MD
University of Texas Health Sciences Center
adol@informaticasalud.com

Quality of Care and Lower Costs

Videophone Consults Popular, Cost-effective Among CA Families with Diabetic Children
Telemedicine can improve patient compliance and increase cost savings without compromising patient satisfaction and quality of care. The Sutter Medical Center in Sacramento, CA showed how videophone technology helped health care providers communicate and manage children using insulin pumps spread over 17 California counties. The results demonstrated that the videophone delivered care and patient satisfaction that was comparable to in-person exams. Additionally, the videophone greatly reduced the number of school hours missed. The biggest impact was on valuable provider time, where patients missed substantially fewer videophone exams than in-person exams.

Gnanagurudasan Prakasam MD MRCP MHA
Medical Director, Pediatric Endocrine
Sutter Medical Center
gprakasam@yahoo.com

Even Inexpensive, Low-Resolutions Cameras Effective In Detecting Signs Of Diabetes
A barrier to the widespread dissemination of telemedicine technology is the perception that quality of care may be sacrificed for cost savings. A study at the University of Texas Medical Branch showed that teleopthalmology quality of care is comparable to care from traditional exams. Even inexpensive, low-resolutions cameras can capture the signs of microaneurysms, small lesions in the eye that can accurately indicate the stage of diabetes. They also accurately predict pre-diabetes conditions in some cases.

Helen Li MD
Associate Professor
University of Texas Medical Branch
hli@utmb.edu

Home Telemonitoring Effective in Managing Adolescent Asthma Patients
Researchers from the Army Medical Department demonstrated that home telemonitoring of children afflicted with asthma is comparable to the traditional, office-based care. The group of “virtual patients” recorded and submitted their peak flow scores online to their case managers weekly. The one-year trial showed that children who accessed care through the web-based case management system as “virtual patients” had better MDI/S scores, more adherence to keeping a journal of daily asthma symptoms, and a greater increase in asthma knowledge. In sum, the “virtual patients” achieved excellent asthma care, revealing that store-and-forward technology combined with case management can provide an additional tool to assist in the disease management.

Debora Chan ParmD, FASHP, CDM, AE
Pediatric Clinical Pharmacist
Army Medical Department
Debora.chan@amedd.army.mil

Telehealth Network Improves Hepatitis C Treatment in Remote New Mexico
New Mexico Telehealth Network Provides Specialty Care to Remote Hepatitis C Patients
Hepatitis C is a disease requiring a complex and costly treatment regimen. Most primary care providers can not extend treatment due to the complexities of the disease and the ratio of specialists to patients is extremely low. In an effort to improve Hepatitis C treatment in New Mexico, the University of New Mexico created Project ECHO (Extension for Community Healthcare Outcomes), a telehealth network that connects urban Hepatitis C experts with rural medical practitioners. Together, experts and practitioners co-manage the disease and deliver improved local treatment of infected patients in underserved areas.

Stephen Burd PhD
Associate Professor
University of New Mexico
burd@mgt.unm.edu

Telehealth Patients Report Reduced Travel and Improved Access To Specialty Care
A study by the Office for the Advancement of Telehealth (OAT) showed that patients had positive perceptions regarding care they received through telemedicine. Of the 339 patients, 79% stated they were satisfied overall with their telemedicine visits and 67% reported they would recommend the telemedicine services to others. Patients also reported a significant decrease in travel. The three-year study confirmed earlier research findings indicating that patients’ views are positive regarding telemedicine, and that the primary advantage reported is improved access to specialty care and reduced patient travel.

Ryan Spaulding PhD
Director
Kansas University Medical Center
rspaulding@kumc.edu

Mental Health

University Students Aided By Virtual Mental Health Consults
Students attending rural academic institutions often lack immediate access to psychiatrists to supplement on-site counseling services. In order to compensate for Georgia Southern University’s (GSU) lack of cost-effective, on-site psychiatry for students, the Medical College of Georgia (MCG) implemented a telehealth program in which psychiatry residents at MCG used IP video-conferencing to consult with clients through MCG’s virtual private network. Client satisfaction was comparable to face-to-face sessions. Telephysiciatry successfully supplemented GSU’s counseling center services within the milieu of student life, especially for the most serious cases.

Elena Khasanshina MD PhD
Associate Director for Research
Medical College of Georgia
ekhasanshina@mcg.edu

Remote Mental Health Visits Can Be Superior To Face-To-Face Consultations
Researchers at Fletcher Allen Health Care have discovered cases in which telemental health is superior to face-to-face consultations. Some psychiatric/psychological conditions that actually benefit from a “distance” approach to treatment include paranoid or schizoid states, extreme shyness, comorbid nonpsychiatric illness, terminal illness, and some phobias. Additionally, the videoconferencing allowed nurse facilitators, family members, or social workers to be present and improved scheduling coordination with different parties. Finally, videoconferencing allows providers to tilt or zoom in to observe specific body parts (eyes, mouth, hands, face) or to watch family’s or others’ responses to consultants questions or remarks without disturbing the patient and /or other parties.

Terry Rabinowitz MD
Clinical Director of Telemedicine
Fletcher Allen Health Care
terry.rabinowitz@vtmednet.org

Military and War Zone Healthcare

Autonomous Robots Part of Army’s Vision for Battlefield Medical Care
TATRC has proposed the Autonomous Combat Casualty Care (ACCC) technology as a way to improve future battlefield extraction, treatment, and evacuation of injured soldiers. In TATRC’s vision of the ACCC, autonomous robots locate casualties, diagnose traumatic conditions, provide life-saving treatment, and evacuate the injured to a battlefield hospital. However, researchers must make major advancements in the fields of machine perception and cognition before this vision can be realized. TATRC recommends a development strategy based on intermediate, semi-autonomous robots that can be deployed with current technology but allow growth room for future technologies.

Jason Wheeler MS
Senior Member of Technical Staff
Sandia Labs
jwwheel@sandia.gov

Telehealth Technology Effective in Treating Vets with PTSD
Past research has shown that therapy delivered via telephone can improve work and social functioning for individuals suffering from depression. Using this idea, researchers from the Department of Veterans Affairs studied the efficacy of videophone therapy to treat veterans exhibiting symptoms of Post-Traumatic-Stress Disorder (PTSD). Seventy-five veterans participated in the study. The study demonstrated that therapy provided via telehealth technology significantly reduced symptoms of PTSD.

Mary Roberts PhD
Department of Veterans Affairs
mary.roberts2@med.va.gov

Access for Underserved Populations

Homeless Populations Benefit From Teledermatology Services
In urban settings, the homeless lack the necessary transportation and money to receive healthcare and are often distrustful of institutionalized care settings. Additionally, certain afflictions such as rashes and complicated dermatological conditions disproportionately affect the homeless population, making access to dermatological care critical. An efficacy study in new York City demonstrated that teledermatology could effectively provide immediate access to dermatological services for the homeless. The study evaluated a teledermatology program, launched by Project Renewal and SUNY Downstate Medical Center serving homeless patients in Project Renewal’s mobile medical unit (MedVan) in New York City. MedVan staff sent digital images of patient’s skin and patient histories via the internet to SUNY Downstate Medical Center, where they were diagnosed and used as real-time educational tools for residents. The medical center sent treatment plans to providers at MedVan within one week. The program effectively diagnosed and planned treatment for 90% of the cases (40).

Jeffrey Ellis MD
Clinical Assistant Professor
SUNY Downstate Medical Center
doctorellis@gmail.com

Personal Health Monitoring Effective In Managing Depression Among Diabetes Patients
Saint Francis University’s Center for Remote and Medically Underserved Areas (CERMUSA) studied telehealth’s impact on the quality of life for rural Pennsylvanians with diabetes. In the nine month study, a group of participants entered their blood glucose readings into a secure database and viewed the information via the website “MyCare Team.” Participants in the group that received telehealth support consistently reported fewer days of feeling depressed and anxious than participants that did not receive telehealth support.

Camille Wendekier CRRN MSN
Telehealth Development Specialist
Saint Francis University’s Center for Remote and Medically Underserved Areas (CERMUSA)
cwendekier@cermusa.francis.edu

Rural Breast Cancer Victims Participate In Support Groups Via Videoconferencing
In Most people in rural areas lack access to support groups, which are known to reduce distress, improve coping, and possibly lengthen survival time for individuals with life-threatening conditions. Stanford University performed a study to assess the feasibility, acceptability, and effectiveness of support groups for rural women with breast cancer using videoconferencing. Thirty-four women from rural areas of California attended local clinics and participated in videoconferencing support group sessions. The study concludes that such services are urgently needed with more professionally-led support groups catering to women with breast cancer. Videoconferencing presents a feasible, appealing, acceptable, way to meet this need.

Kate Collie PhD
Stanford University
krcollie@stanford.edu

Aging and Chronic Disease Management

Remote Monitoring of Congestive Heart Failure Patients Saved $115 Million Annually
Aging individuals with chronic conditions account for a disproportionate percentage of
healthcare costs in the United States. The Centers for Medicare and Medicaid Services (CMS) recognize that a condition such as congestive heart failure (CHF) can cost more than 28 billion annually, including 270 million for physician visits. As a result, CMS launched a study to assess the impact of telehealth technology on CHF patients. The study found that patients managing their CHF via telehealth technology experienced a reduction in overall healthcare costs by 41%, physician office visits by 43%, ED visits by 33%, and hospitalizations by 29%. The 43% reduction of physician office visits offered a savings of more than 115 million dollars annually.

Craig Lehmann PhD CC (NRCC) FACB
Dean/Professor
State University of New York, Stony Brook
craig.lehmann@sunysb.edu

Internet-based Healthcare Plays Large Among Aging Floridians
Despite a persisting digital divide among older adults, the internet still holds much potential in providing health information resources and services to seniors. In order to investigate the untapped resources of the internet for this age group, the University of South Florida studied the needs, preferences, and uses of internet-based health resources and healthcare services of older adults in Southwest Florida. Seniors in the SeniorNet program completed questionnaires about perceived needs, preferences, and uses of internet health resources, along with their perceived self-efficacy with computer and e-technology. Of the 103 participants, 55% reported daily internet use, 75% indicated they suffered from chronic illness, and 78% preferred internet-based resources to help them better manage medications and regimens for chronic diseases. Web portals present a way to meet the rising demands of retiring baby-boomers within the comforts of home.

Linda Moody PhD RN MPH FAAN
Distinguished Professor
University of South Florida
lmoody@hsc.usf.edu

Obesity and Weight Management

Children & Adolescents Embrace Telemedicine-based Weight Management Services
Obesity has reached epidemic proportions in the US, with 16% of children and adolescents being overweight. This condition puts young people at risk for early onset of many chronic illnesses such as type 2 diabetes, hypertension, and hyperlipidemia. In response to the growing health crisis, the University of California - Davis performed a study to evaluate patient satisfaction regarding telemedicine weight management services. 337 telemedicine consults were conducted with 19 patients. Patients responded warmly to the program. The study concluded that children struggling with weight problems embraced the telemedicine weight management services and that telemedicine could help facilitate care to individuals in rural areas lacking access to healthcare.

Ulfat Shaikh MD MPH
Assistant Professor of Pediatrics
University of California - Davis
ulfat.shaikh@ucdmc.ucdavis.edu

Telehealth Monitoring Helps Dieters Keep the Weight Off
Comprehensive weight loss programs are effective in helping people initially lose weight, but effective approaches for weight maintenance remain elusive. Two common barriers to providing support necessary for continued diet/exercise adherence and weight maintenance are accessibility and time constraints. Telehealth shows promise in providing a new approach to reinforcing behavioral strategies that promote weight maintenance after a successful weight loss program. The University of Colorado implemented the Colorado Weigh High-Tech, a remote option to the university’s traditional weight loss program that provides individuals with access to self-monitoring software programs, web-based reporting, and health professionals from their home. The program materials focus on the cornerstones of behavioral change: self-monitoring and accountability. The convenient and individualized telehealth program has increased participation in the university’s traditional weight loss program.

Heather Haugen MS RD
Cambridge Healthtech Institute
hhaugen@healthtech.com