What we learned spending 2 nights watching residents work in a Phoenix emergency room | 12news.com

Team 12’s Mike Gonzalez got an inside look at how residents at Maricopa Medical Center’s emergency department train under the most stressful life-and-death situations.

More than 1,400 applicants vie for a spot in their residency program every year, but there’s only room to train 400 doctors in 13 different specialties.

One of the most coveted areas is their emergency medicine department. It’s where 42 residents train for three years under the most stressful, pressure-packed life-and-death situations.

Team 12’s Mike Gonzalez spent two nights inside the emergency department at Maricopa Medical Center with residents to see what they go through and why being a part of this program means so much.

Life inside the ER can go from 0 to 100 in a matter of seconds. And for residents, it can be even more stressful, because not only are you trying to save lives, you’re learning how to practice emergency medicine at the same time.

12 News had a chance to follow around Dr. Aaron Johnson, a resident who graduated from Midwestern Medical School in Glendale, Arizona, to find out what he goes through on a daily basis.

For 32-year-old resident Aaron Johnson, there’s no other place he’d rather be.

“It’s a high-stress job where we rapidly evaluate people and get them where they need to go,” Johnson said.

The sounds, the seriousness and moving parts—all parts of what attracted Johnson to the Maricopa Medical Center Emergency Department.

It’s a place where Johnson and 41 other young residents spend three years after med school, learning to save lives while armed security guards roam the halls protecting them.

Doctors here deal with everything from the mundane to people coming off of mind-altering drugs.

“I’m only here because doctors think I’m crazy, but it’s the meth,” said one patient waiting to be discharged.

The only thing is certain: Every night will be different.

“I always wanted to be a doctor. I always admired doctors. Throughout junior high and high school, I never thought I was smart enough to be a doctor. Once I got into undergrad, it was a motivation issue, not an intelligence issue,” Johnson said.

The allure of Maricopa Medical Center for residents like Johnson is the multitude and diverse makeup of patients here

“We’re going to see the least privileged. Some of it is economics, some of it is language or cultural barriers. But it gives us a great experience,” said Dr. Anthony Krause.

Each one of the 42 residents has their own reason for wanting to practice emergency medicine.

“It’s been a 10-year process. I’m 39. I’ll be turning 40 this year,” said Dr. Brant Jaquen, who left a lucrative job in the financial world to start his new career.

Maricopa Medical Center is located in the heart of Phoenix, where the patient population is largely underserved, and knowing Spanish is not a luxury—it’s a life-saving necessity.

Dr. Frank Lovecchio is one the attending doctors.

“¿Cómo está ustéd?”  he asks a patient.

He’s a veteran of the emergency department wars. Dr. Lovecchio speaks fluent Spanish and Italian.

“We like to say, ‘Every patient every time'”.

Dr. Lovecchio says training these young physicians is a balancing act.

“For example, this gentlemen Krause is about four months away from graduating. I’d do an injustice to him if I don’t leave him alone a bit. So, I’m right by his side to make sure he’s in control,” said Lovecchio.

Dr. Johnson is a third-year resident who grew up on a small farm in Idaho. After completing his undergrad at BYU, Johnson attended Midwestern Medical School in Glendale. He says the emergency department is the only place he ever wants to be.

It wasn’t long before we had to cut his interview short and see Dr. Johnson in action.

He was called to the ER for a patient with labored breathing—who needed life-saving intervention fast.

“Would you mind talking to the doctor that we need to intubate this patient? Tell him really fast,” said Johnson as he raced toward the ER for the patient.

Upon arriving in the ER, to make things even more stressful, a crash victim screams in pain inside the same room.

After about 10 minutes, Dr. Johnson gets his patient to stabilize.

I asked the doctor what happened and he explained:

“This is a gentleman who came in with COPD, he came in complaining of shortness of breath. What we think happened is the CO2 built up in his blood stream where he had to have assisted breathing. But it became so altered mentally that he wasn’t responding appropriately, and that’s we had to intubate him to assist his breathing,” said Johnson.

But life in the ER isn’t always this exciting. These young doctors and nurses get an up close look at the realities of medical care in the U.S., where economically disadvantaged patients use the emergency room for primary care.

And those without the money or the means will rarely follow up on recommended care plans.

“Yes, it’s a combination of health education, health literacy, being able to afford your medications, being able to physically get to your doctor’s appointments that you’re supposed to have. If I refer you to a specialist and you don’t have a car, and it’s 10 miles away, what are you going to do?” Dr. Krause said.

“One of the biggest challenges is the language barrier. The biggest one is just determining who’s sick and who’s not sick,” said registered nurse Tiffany Wilson.

Solving the health care crisis is one emergency these brilliant young doctors can’t seem to figure out.

As for Dr. Aaron Johnson, his residency will conclude in just a few months. He says he’s excited to start his new full-time job and a somewhat normal life.

“The last 11 years of my life has been dedicated to getting the level of training. I’d like to do some traveling and spend more time with my wife and 8-month-old baby,” said Johnson.

Dr. Johnson will be working with Banner Health in their emergency department in the East Valley.


Daily Mail: Documents reveal FDA efforts to limit fentanyl prescriptions are failing miserably

Doctors are over-prescribing powerful fentanyl opioid painkillers – and the FDA’s program to oversee the drugs is letting too much slip through the cracks, a new study suggests.

Transmucosal immediate-release fentanyl (TIRF) drugs are potent drugs approved only to treat the most severe ‘break through’ pain for cancer patients.

Fentanyl is often sold or made as an illicit drug as well and, because it is up to 50 times more potent than heroin, and is now believed to be driving the overdose epidemic in the US.

In 2012, the US Food and Drug Administration created a program to oversee and monitor TIRF prescriptions to ensure they didn’t fall into the wrong hands, leading to addictions and overdoses – but punted the ‘administration’ to a drug company.

A newly completed report by Johns Hopkins University found that the FDA and its partner in the program, McKesson, are failing to stop doctors from prescribing TIRFs to patients that have no need for them.

Potent fentayl painkillers like these are only FDA-approved to treat extreme, sudden pain in cancer patients that isn't blocked by their other round-the-clock pain medications, yet half of these prescriptions are written for 'opioid naive' people, and the FDA isn't stopping doctors 

Potent fentayl painkillers like these are only FDA-approved to treat extreme, sudden pain in cancer patients that isn’t blocked by their other round-the-clock pain medications, yet half of these prescriptions are written for ‘opioid naive’ people, and the FDA isn’t stopping doctors

In decades past, heroin was the drug of destruction, known for its lethal potency and crippling withdrawals that made it hard to give up.

In the 1960s, an estimated 80 percent of people treated for opioid addiction had started with heroin.

Now the tables have turned.

Opioid addiction started at a physician’s prescription pad for 80 percent of people end up using heroin.

As fentanyl has become the driving force of opioid overdoses in the US, public health watchdogs are watching the drug – in prescription and street forms – more closely.

Fentanyl is used primarily to reduce pain during surgery or for people who are already tolerant to other more moderate opioids.

TIRFs are particularly dangerous because they are intended to act very quickly and relief intense pain – called breakthrough pain – from cancer that comes on suddenly and in spite of their regular regimens of painkillers.

The ‘risk evaluations and mitigation strategy’ (REMS) was introduced in 2012 to make sure the drugs’ ‘benefits outweigh the risks,’  FDA Commissioner Dr Scott Gottlieb said in a later statement.

REMS involved measures to educate prescribers on the proper uses of TIRFs and their dangers and, perhaps most importantly, a monitoring system that is supposed to flag doctors who prescribe it inappropriately and take away their permissions to prescribe the drug if they did so repeatedly.

The FDA collaborated with manufacturers and McKesson, a drug company conglomerate assigned to be administrator of the REMS program.

Johns Hopkins University researchers reviewed nearly 5,000 pages of FDA reports on  a subset of TIRF prescriptions written between 2012 (when the oversight program was introduced) to 2017.

Rather than falling after the monitoring program was introduced, prescriptions for off-label uses of the drug – like chronic pain or headaches – had increased.

By 2016, over half of all TIRF prescriptions were written for patients that were opioid naive – meaning they’d never tried weaker opioid painkillsers like OxyContin.

‘Even though these products account for only a small proportion of all opioid sales, this is a really serious issue, because the adverse outcome we’re talking about here is death, not heart burn,’ says study author and co-director of Johns Hopkins’s Center for Drug Safety and Effectiveness, Dr Caleb Alexander.

‘Drugs are prescribed off label all the time, but this is no ta typical drug, and not a typical use. This should be a “never” event.’

Most worrying of all, by the time the program had been operating for three years, over half of those who were prescribed TIRFs were opioid naive.

‘That’s a huge deal’ says Dr Alexander.

And over the entire study period, despite the clear evidence that TIRFs are being prescribed dangerously – and more often than not – not a single doctor was so much as flagged, let alone disenrolled from prescribing the drugs.

‘We are left with this jarring conclusion … and it’s hard to understand what went wrong,’ says Dr Alexander.

‘But if the system were functioning as intended, these instances of unsafe prescribing would never have occurred.’


Telemedicine Market is Expected to Rise Around Worth of US$ 36.3 Bn by the End of 2020 – Cryptocurrency News

The rapid development of the healthcare industry and the expansion of the computerized well-being stages, which are projected to enhance the growth of the global tele-medicine market in the next few years. The advent of computerized health stages in order to enhance the remote checking of patients and the increment of healthcare conveyance efficiencies are further estimated to support the market growth in the coming few years. In addition to this, the rise in the awareness among people concerning the benefits of telemedicine is projected to propel the telemedicine market across the globe in the near future. The rising research activities and the increasing investments for innovations are likely to provide promising growth opportunities in the next few years.

Rising Adoption of Telemedicine to Encourage Market Growth

As per the research report by Transparency Market Research, in 2014, the global market for telemedicine stood at US$14.3 bn and is estimated to attain a value US$36.3 bn by the end of 2020. The market is likely to register a promising 14.30% CAGR between 2014 and 2020.

The global market for telemedicine has been classified on the basis of service type into tele-care, tele-surgery, tele-consultation, tele-monitoring, tele-training, and tele-education. Among these, the tele-consultation segment is predicted to hold a major share of the market in the next few years. The rise in the geriatric population and the increasing prevalence of cardiovascular and diabetes are the few factors that are estimated to enhance the market growth in the next few years. In addition to this, the rising cases of Parkinson’s and Alzheimer’s is another factor that is estimated to support the market growth in the near future. The rise in the demand for continuous monitoring of patients is predicted to boost the demand for tele-monitoring in the near future. Furthermore, the tele-training, tele-education, and tele-surgery segments are predicted to witness healthy growth in the coming few years.

Perceive the Sample of the Report: https://www.transparencymarketresearch.com/sample/sample.php?flag=S&rep_id=3032

Asia Pacific to Offer Lucrative Growth Opportunities for Players

Among the major regional segments, a large share of the global telemedicine market is expected to be held by North America. As per the research study, this region is estimated to remain in the dominant position in the next few years, thanks to the presence of several leading players. Furthermore, Asia Pacific is estimated to witness a strong growth in the next few years holding a significant share of the global telemedicine market. The high growth of this region can be attributed to the rise in the urban and rural population and the increasing government initiatives. In addition to this, the rising focus on advancements and improvements in this field and the presence of several manufacturing units, who are providing comparatively cheaper equipment, thus encouraging the overall growth of the market in the near future.

The global market for telemedicine is developing at a rapid rate with a participation of a large number of local as well as international players operating in it. The development of new products and the rising focus on the research and development activities are projected to support the growth of the global telemedicine market in the next few years. In addition to this, the market players are emphasizing on advertising and marketing and creating an awareness among people concerning the benefits of telemedicine, which is estimated to accelerate the growth of the market in the next few years. The key players operating in the telemedicine market across the globe are Siemens Healthcare, Allscripts Healthcare Solutions, Inc., Agfa HealthCare NV, AMD Global Telemedicine, Inc., CISCO Systems, Inc., CARDIOCOM, LLC, F. Hoffmann-La Roche Ltd., InTouch Technologies, Inc., Honeywell HomMed LLC, LifeWatch AG, Medtronic, Inc., and McKesson Corp.

Source: Telemedicine Market is Expected to Rise Around Worth of US$ 36.3 Bn by the End of 2020 – Cryptocurrency News

What Are the Top Trends that Will Shape the Global Telemedicine Industry In 2019? – Crypto News

Latest market research report titled Telemedicine Market in India 2014 illuminates the dynamics in the tele-health market. In India, a massive urban – rural gap exists within the overall population of India, out of which a sizeable chunk of rural population is deprived of the basic healthcare facilities.

Download PDF Sample of Telemedicine Market report @ http://www.arcognizance.com/enquiry-sample/233310

Shortage of healthcare professionals in rural areas is a major reason why government and healthcare companies are looking to use technology as a mean to reach the needy. Rural population uses only 15% of the total healthcare resources available to the Indian population.
Progression in the field of connectivity such as broadband, 3G and 4G data services and IT have made tele-health based services closure to reality in the country.

Presence of superior healthcare service providers in the country reinforces the ability to provide top-notch telemedicine consultation and services. Furthermore, government initiatives to enhance healthcare facilities across the country creates substantial opportunity for telemedicine in India.

Public Companies
1. Fortis Healthcare Ltd.
2. Polycom Inc.
3. HealthFore Technologies Ltd.
4. SHL Telemedicine Ltd.
5. Wipro Ltd.

Private Companies
1. Apollo Telehealth Services Pvt. Ltd.
2. Bharat Sanchar Nigam Ltd.
3. Cisco Systems (India) Pvt. Ltd.
4. HP India Pvt Ltd.
5. Narayana Hrudayalaya Pvt. Ltd.
6. Teleradiology Solutions Pvt Ltd
7. Televital India Pvt Ltd

Brief about Telemedicine  Market Report with TOC @ http://www.arcognizance.com/report/telemedicine-market-in-india-2014

Some Point of TOC:

Slide 1: Executive Summary

Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2010-11 – 2013-14), Inflation Rate: Monthly (Jun 2013 – Nov 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly (Aug 2013 – Jan 2014)
Slide 4: Lending Rate: Annual (2008-09 – 2011-12), Trade Balance: Annual (2009-10 – 2012-13), FDI: Annual (2009-10 – 2012-13)

Slide 5-10: Telemedicine – Overview, Telemedicine Implementation, Types of Telemedicine, Framework

Buy The Report @ http://www.arcognizance.com/purchase/233310

Source: What Are the Top Trends that Will Shape the Global Telemedicine Industry In 2019? – Crypto News

Global Telemedicine Market Analysis to Reach USD 38.00 billion by 2022 – Industry News Network

The global Telemedicine Market offers a wide spectrum of opportunities to different product developers and services providers including industries, vendors, and firms to develop and grow in the market at a global level. The global Telemedicine Market provides detailed and relevant information regarding major key players along with emerging industries competing for grabbing the share in the market in terms of revenue, sales, demand, supply, and providing quality.

Some of the Major Market Players Are:

  • MedtronicInc.
  • OBS Medical Ltd.
  • Siemens Healthcare
  • McKesson Corp
  • Agfa HealthCare NV
  • CISCO SystemsInc.
  • AMD Global TelemedicineInc.
  • Polycom Corp.
  • F. Hoffmann-La Roche Ltd.
  • Honeywell HomMed LLC
  • InTouch TechnologiesInc.

The global Telemedicine Market report offers the detailed information regarding the market by segmenting [Product, Applications, End-Users, and Major Regions] it on the basis of manufactured product shape, type, and form; its processing technology, product applications, and others. Along with this, the global Telemedicine Market report offers the analytical information of the market with respect to different regions [Latin America, North America, Asia Pacific, Middle & East Africa, and Europe]. The global Telemedicine Market forecast, growth pattern, previous development studies, and current market development patterns are also included in the report. The global Telemedicine Market report offers the significant factors that can affect the growth of the market by either escalating it or retarding it. The report also provides a short description on the various policies and regularizations launched by the government or to be launched in the upcoming years, which may affect the global Telemedicine Market either directly or indirectly.

Promising Regions & Countries Mentioned In The Telemedicine Market Report:

  •   North America ( United States)
  •   Europe ( Germany, France, UK)
  •   Asia-Pacific ( China, Japan, India)
  •   Latin America ( Brazil)
  •   The Middle East & Africa

The global Telemedicine Market report comprises the analyzed data generated by the experts using various methodological and analytical techniques such as SWOT analysis, probability, and others. The global report represents the information in a clean and easily understandable format comprising flowcharts, graphs, and examples.

Following are significant Table of Content of Telemedicine Market Report:

  • Industry Overview of Telemedicine Market.
  • Assembling Cost Structure Analysis of Telemedicine Market advertise.
  • Specialized Data and Manufacturing Plants Analysis of Telemedicine Market.
  • Limit, Production and Revenue Analysis.
  • Value, Cost, Gross and Gross Margin Analysis of Telemedicine Market by Regions, Types and Manufacturers.
  • Utilization Volume, Consumption Value and Sale Price Analysis of Telemedicine Market industry by Regions, Types and Applications.
  • Supply, Import, Export and Consumption Analysis of Telemedicine Market Market.
  • Significant Manufacturers Analysis of Telemedicine Market industry.
  • Advertising Trader or Distributor Analysis of Telemedicine Market.
  • Industry Chain Analysis of Telemedicine Market.
  • Advancement Trend Analysis of Telemedicine Market Market.
  • New Project Investment Feasibility Analysis of Telemedicine Market.
  • Conclusion of the Telemedicine Market Industry.

Worldwide Telemedicine Market Report Provides Comprehensive Analysis of:

  • Telemedicine Market industry diagram
  • Up and Downstream industry examination
  • Economy sway features finding
  • Channels and hypothesis believability
  • Market challenge by Players
  • Upgrade proposals examination

Purposes Behind Buying Telemedicine Market Report:-

  • This report gives stick direct examination toward changing centered components.
  • It gives a forward-looking perspective on changed components delivering or limiting business sector advancement.
  • It allows a five-year evaluation reviewed dependent on how the market is foreseen to create.
  • It helps in understanding the fundamental part areas and their prospect.
  • It gives stick point examination of changing contention components and keeps you before contenders.
  • It helps in settling on educated business choices by having complete bits of knowledge of the market and by making a top to bottom investigation of market fragments.

Thanks for reading this article; you can also get individual chapter wise section or region wise report version like North America, Europe or Asia.

About Us:

Zion Market Research is an obligated company. We create futuristic, cutting-edge, informative reports ranging from industry reports, company reports to country reports. We provide our clients not only with market statistics unveiled by avowed private publishers and public organizations but also with vogue and newest industry reports along with pre-eminent and niche company profiles. Our database of market research reports comprises a wide variety of reports from cardinal industries. Our database is been updated constantly in order to fulfill our clients with prompt and direct online access to our database. Keeping in mind the client’s needs, we have included expert insights on global industries, products, and market trends in this database. Last but not the least, we make it our duty to ensure the success of clients connected to us—after all—if you do well, a little of the light shines on us.

Source: Global Telemedicine Market Analysis to Reach USD 38.00 billion by 2022 – Industry News Network

Minnesota Sees Steep Rise in Telemedicine Use

Telemedicine, or the remote diagnosis and treatment of patients, has grown at a rapid pace in Minnesota, according to a recently published study by the Minnesota Department of Health and University of Minnesota School of Public Health.

The study found a nearly seven-fold growth in visits, from 11,113 in 2010 to 86,238 visits in 2015.

For the first-of-its-kind study, Health Department and School of Public Health researchers joined together to analyze the Minnesota All Payer Claims Database for patterns of telemedicine use in Minnesota between 2010 and 2015.

The research did not look into the effectiveness of telemedicine, but it did find a rapid increase in its use.

Though still a very small slice of Minnesota’s health care pie — less than 1 percent of patients used telemedicine — the researchers found that telemedicine evolved to serve somewhat different uses for metro-area and Greater Minnesota patients and for those with private or public insurance, such as Medicare, MinnesotaCare and Medical Assistance, Minnesota’s Medicaid program.

Nonmetro patients in Greater Minnesota more commonly used telemedicine for real-time visits initiated by providers and for specialty consultations. Examples include a telemedicine visit with a neurologist to help make decisions in the emergency room for treating a patient with a suspected stroke, or the use of telemedicine to provide psychotherapy and medication management for clinical depression.

The research indicates that telemedicine is emerging as an option to overcome some of the geographical barriers to accessing specialty care in Greater Minnesota, especially for mental health, said Jan Malcolm, Minnesota Commissioner of Health.

“We need more research to ensure quality is being maintained, but this study highlights the importance of seeking innovative ways to provide access to health care in Greater Minnesota, including thinking broadly about funding investments in the health care workforce, as well as technology such as telemedicine equipment and broadband access,” Malcolm said

In metropolitan areas, which included the Twin Cities, Rochester, St. Cloud and Duluth, the majority of telemedicine services were online evaluation visits for primary care provided by nurse practitioners to patients with commercial insurance. Such “direct-to-consumer” telemedicine visits provide care for common non-emergency conditions, such as the common cold or strep throat.



The Akron Legal News

Walmart workers can now see a doctor for only $4. The catch? It has to be a virtual visit.

The retail giant recently rolled back the $40 price on telemedicine, becoming the latest big company to nudge employees toward a high-tech way to get diagnosed and treated remotely.

But patients have been slow to embrace virtual care. Eighty percent of mid-size and large U.S. companies offered telemedicine services to their workers last year, up from 18 percent in 2014, according to the consultant Mercer. Only 8 percent of eligible employees used telemedicine at least once in 2017, most recent figures show.

“There’s an awful lot of effort right now focused on educating the consumer that there’s a better way,” said Jason Gorevic, CEO of telemedicine provider Teladoc Health.

Widespread smartphone use, looser regulations and employer enthusiasm are helping to expand access to telemedicine, where patients interact with doctors and nurses from afar, often through a secure video connection. Supporters say virtual visits make it easier for patients to see a therapist or quickly find help for ailments that aren’t emergencies. But many still fall back to going to the doctor’s office when they’re sick.

Health care experts have long said that changing behavior can be hard. In telemedicine’s case, patients might learn about it from their employer and then forget about it by the time they need care a few months later. Plus emotions can complicate health care decisions, said Mercer’s Beth Umland.

“My little kid is sick, I want them to have the best of care right away, and for some people that might not register as a telemedicine call,” she said.

Some patients, especially older ones, also just prefer an in-person visit.

“Going to the doctor’s office is a big event in their life and something they look forward to,” said Geoffrey Boyce, CEO of InSight Telepsychiatry, which provides virtual mental health services.

Tom Hill is among that crowd. The 66-year-old from Mooresville, Indiana, said he’s never used telemedicine and has no plans to.

“I believe in a handshake and looking a guy in the eye,” said Hill during a recent shopping break at a downtown Indianapolis mall. “I don’t buy anything online either.”

But the practice does gain fans once patients try it.

Julie Guerrero-Goetsch has opened her MDLive telemedicine app several times since first using it about a year ago to get help for a sinus infection.

The Fallon, Nevada, resident was skeptical, but she didn’t have time to go in person. MDLive connected her to a doctor soon after she opened the app. She said he started asking questions about symptoms “just as if I was sitting in a doctor’s office” and prescribed an antibiotic.

Caitlin Powers tried telemedicine recently after hearing about it through a friend. The Columbia University graduate student was feeling stuffed up and worried she might be coming down with the flu. She said her appointment started on time, lasted 10 minutes, and she spoke by video with a doctor in Florida while never leaving her Brooklyn apartment.

“As a student, I don’t really have time to spend three hours waiting to see a doctor, and this was so easy,” she said.

Doctors have used telemedicine for years to monitor patients or reach those in remote locations. Now more employers are encouraging people covered under their health plans to seek care virtually for several reasons.

Telemedicine can reduce time spent away from the job, and it also can cost half the price of a doctor’s visit, which might top $100 for someone with a high-deductible plan. However, those savings can be negated if telemedicine’s convenience causes people to overuse it.

Walmart said it cut the cost for virtual visits to give another care option to the more than one million people covered by its health benefits.

Employers aren’t the only ones pushing the technology.

The drugstore chains CVS Health and Walgreens are promoting apps that let customers connect to doctors. Some insurers like Oscar Health are offering it for free to customers as a first line of treatment.

Ease of use is one of the reasons researchers and telemedicine providers think the practice will become more widespread in several areas of care. Those include dermatology and follow-up doctor visits after a surgery or medical procedure.

Mental health visits are another area ripe for virtual care because patients can feel more comfortable talking to a therapist in their own home, said Boyce of InSight Telepsychiatry, which delivers mental health care in about 30 states.

Boyce said people also like the anonymity of a virtual visit.

Mental health visits were the most common use of telemedicine by patients until primary care overtook that specialty a few years ago, Harvard’s Dr. Ateev Mehrotra and other researchers found in a recent study of claims data from a large insurer.

Research firm IHS Markit estimates that telemedicine visits in the U.S. will soar from 23 million in 2017 to 105 million by 2022. But even then, they will probably amount to only about one out of every 10 doctor visits, said senior analyst Roeen Roashan.

MDLive CEO Rich Berner said telemedicine is like the digital video recorder TiVo, which took a while to catch on with viewers.

“People were so used to doing things the other way that it just took a little while to kind of really go mainstream,” he said. “But when it did, it went mainstream big-time.”

Source: The Akron Legal News

How Telemedicine Could Be The Future Of Health Care In AZ | KJZZ

Last week, in front of the Arizona Senate Health committee, Dr. Bart Demaerschalk used his laptop to give lawmakers a closer look at the possibilities available in telemedicine — and it’s a little more high-tech than you might think.

It was part of his live demonstration of the Mayo Clinic’s telestroke system, which has already been used in emergency rooms across rural Arizona.

Demaerschalk was there to speak on behalf of Senate Bill 1089, a bill that aims to expand coverage of telemedicine in the state by allowing any health service that’s covered by an in-person insurer to be covered when it’s provided through telemedicine. Currently, state law only requires coverage of telemedicine in certain specialties.

But, according to Demaerschalk, telemedicine has advanced a lot in recent years, and will be a major part of the future of medicine.

The bill aiming to expand telemedicine passed unanimously out of that committee last week and is headed to the full Senate floor for debate.

Source: How Telemedicine Could Be The Future Of Health Care In AZ | KJZZ

Filling the Rural Gap With Good Recruiting, Telemedicine

February 12, 2019 04:34 pm Sheri Porter Washington, D.C. – The National Rural Health Association (NRHA) held its 30th annual Rural Health Policy Institute here Feb. 5-7 to focus on the growing health care divide between America’s urban and rural communities. It’s no secret that rural America is facing a serious physician shortage at a time when, according to NRHA statistics,(www.ruralhealthweb.org) populations in rural communities are older, sicker and poorer than at any time in recent history.

During a presentation on rural workforce shortages at the Rural Health Disparities Summit, family physician Michael Kennedy, M.D., tells the audience that medical students want to go back and serve in communities like those they grew up in. “They also need to pay off their loans … and they want to practice medicine, not paperwork,” he added.

Family physicians are on the front lines. According to an AAFP position paper titled “Keeping Physicians in Rural Practice,” family physicians comprise 15 percent of the U.S. outpatient workforce but handle 23 percent of those outpatient visits overall — and a whopping 42 percent of those in rural areas.

For that reason and more, the AAFP partnered with the NRHA to host, on the final day of the policy institute, the Rural Health Disparities Summit. It was a morning filled with speakers versed on topics critical to the future health and well-being of rural America.

During this final event, Julie Wood, M.D., AAFP senior vice president for health of the public and interprofessional activities, hosted a panel discussion on workforce shortages and their impact on rural health.

Recruiting Rural Physicians

As part of that panel, two family physicians working in very different rural environments — one in Alaska, the other in Kansas — spoke about the challenges of recruiting family physicians to their communities.

  • The AAFP recently partnered with the National Rural Health Association (NRHA) to host the Rural Health Disparities Summit in Washington, D.C.
  • The summit, scheduled on the third day of the NRHA’s 30th annual Rural Health Policy Institute, featured speakers well-versed on issues related to health care in rural America.
  • Two family physicians, AAFP President John Cullen, M.D., of Valdez, Alaska, and Michael Kennedy, M.D., of Wichita, Kan., tackled the topics of how to recruit rural physicians and utilize telemedicine.

They agreed that giving students an up-close and personal view of the joys of rural practice is the best approach.

“That’s how you recruit residents, by having them in your clinic, because it’s a really important way to get them excited about what we do,” said AAFP President John Cullen, M.D., of Valdez, Alaska.

“I use all of my medical education every single day. Rural family medicine is an absolute challenge, and it requires you to use all of your faculties,” he added.

Cullen’s practice in his frontier town of 4,000 has just recently grown to include five family physicians who provide all the outpatient, inpatient and emergency physician care for this population.

Except for the two founders of the practice, all the physicians, Cullen included, first visited Valdez as residents.

“I was my senior partner’s resident, and that tradition has continued. We’ve never been able to recruit anybody who didn’t come through that process. You have to grow your own if you’re going to do this,” said Cullen.

And it helps to have an older physician there as an anchor, because without that anchor, it’s very hard to start things up, he added. “If you have older physicians in your community, make sure they stay. Do everything you can to keep them,” advised Cullen.

Michael Kennedy, M.D., associate dean for rural health education at the University of Kansas School of Medicine-Wichita, tells a similar tale, but with a twist.

He started out in a rural practice in Burlington, Kan., population 2,500, and for nine years practiced full-spectrum family medicine alongside two FP colleagues. “We built our practice and did some amazing things. We had students come out with us on a frequent basis, and that led to a love of teaching,” said Kennedy.

Kennedy left private practice to return to his medical school and make an impact, or, as he put it, “to take this rural family doc and get in front of as many medical students as I possibly could. So that’s what I do now for a living, and it is extraordinary.”

Kennedy noted that Kansas has some major workforce challenges. Thirty-four counties in the state have two physicians or fewer, a situation he called “unsustainable, long term.”

His job, simply put, is to get students out to the rural areas for hands-on experience.

“I go around and talk with the docs in this region and I’ve heard some incredible stories,” along with disheartening ones about practices that have been recruiting for a new physician for 10 years and come up short, said Kennedy.

But what does get results is hosting medical students in the community. “It’s magical because students fall in love with the place,” said Kennedy. That hosting has become all the more important as rural hospitals facing financial crisis cut budgets — including housing allowances for visiting medical students.

During the recent Rural Health Disparities Summit, broadcast journalist Ted Koppel serves as moderator for a panel discussion on chronic disease challenges in rural America. At one point, Kopple said to panel members, “As I listened to all of the speakers who’ve been up here today, I realize there is a limited supply of funding, and it is not equitably distributed; diseases come in conflict with one another. How do we deal with that?”

The physician shortage in Kansas is set to worsen because 254 rural Kansas physicians are age 55 or older. “In the next 10 years, we’ll need close to 300 new doctors,” said Kennedy.

In response, his medical school has deviated from the standard pipeline program to something called rural medicine training.

“We have a rural track with ‘destination rural,’ but we have cars on the train that represent various programs, and the students can safely get on, test it out and get off — or they can ride the whole train. About two-thirds of the students on this rural track are students who are dedicated to rural,” said Kennedy.

And, ever the teacher, Kennedy brought five of those students with him to D.C.

Utilizing Telemedicine

The use of telemedicine has become mainstream in remote areas such as Valdez. For instance, when Cullen first diagnosed a patient’s malaria, he wanted confirmation.

“I just took a picture of the microscope through my iPhone and sent it off to an infectious disease specialist. She agreed it was malaria. This is the kind of stuff you do as a physician in a rural community,” said Cullen.

“Telemedicine works really well when you have providers in the community who are able to access specialists in a metropolitan area. I have tried to talk people through the emergency procedures in other communities, and I can tell you that it’s really hard.”

AAFP Launches Rural Health Tool

At the close of a panel discussion during the Rural Health Disparities Summit — recently hosted in Washington, D.C., by the AAFP and the National Rural Health Association (NHRA) as part of the NHRA’s Annual Rural Health Policy Institute — the AAFP introduced a new tool called the Rural Health Explorer.(www.healthlandscape.org)

The tool, developed by HealthLandscape for the AAFP, focuses on health outcomes and access to care in rural America. It includes, among other things, a rural population health mapper and a health care workforce mapper.

“The AAFP is excited to announce this, and we hope you can use this in your advocacy moving forward,” said Shawn Martin, AAFP senior vice president for advocacy, practice advancement and policy. “We’ll certainly use it in ours.”

Ideally, Cullen would like to have telemedicine access to any subspecialist he needs — straight from his office with his patient right there.

But telemedicine alone won’t cut it. “I do worry a lot when people think of telemedicine as the solution without trained providers in those communities. You have to have people there who are interactive,” he added.

Telemedicine can provide huge cost savings to patients. Subspecialists, said Cullen, often don’t realize the financial hit patients take when they make that extra appointment.

“It costs my patients at least $1,000 every time they see a subspecialist, and most of the time, they don’t need to seem them at all. If you look at subspecialties like endocrinology and pulmonology, that consult is more of a reassurance that we haven’t missed anything, said Cullen.

And when a patient in Valdez is diagnosed with cancer, even chemotherapy is available right there in the community.

“I have a really good relationship with oncologists in Alaska, so we actually do provide chemotherapy, because when people have complications from that treatment, it happens here, not at the infusion center in the city,” said Cullen.

With this kind of technology, “there is no reason why we have to accept a lower level of care in rural communities.”

And, Cullen added, the same telemedicine capabilities that work for rural Americans also have potential in big cities such as Los Angeles — where terrible traffic, more than geographic distance, can keep patients from accessing their physicians.

Source: Filling the Rural Gap With Good Recruiting, Telemedicine


(Austin)  Mental health care for children and adolescents would be coordinated by a central commission charged with increasing detection and access to treatment under a bill approved by the Senate Health and Human Services Committee on Tuesday.  Another of Governor Greg Abbott’s emergency items for the session, the Texas Mental Health Consortium would be created through SB 10 by Flower Mound Senator Jane Nelson. As chair of the Finance Committee, Nelson filed a base budget bill that includes more than $7 billion for mental health services across state agencies.  This bill would create a board to ensure that those agencies coordinate and cooperate to improve mental health services in Texas, especially for children. She said that the dire need for better mental health care for minors was impressed upon her by the Santa Fe High School shooting last May as well as the surge in youth suicides in recent years.  “As we’ve seen with recent acts of violence, increased suicide rates and lives shattered by drug and alcohol abuse, Texas students need our help,” said Nelson.

Texas is facing a significant shortage of mental health professionals.  According to a 2016 University of Texas at Austin report, 206 of the 254 counties in Texas fall short of the 1 provider to 30000 population ratio recommended by the federal government.  SB 10 looks to address these gaps by creating comprehensive child psychiatry centers, what Nelson called “hubs”, at state medical schools and other health-related institutes of higher education.   These hubs would provide mental health consultation services from on-call mental health professionals, via telemedicine, to pediatricians and family physicians. Nelson said that in 75 percent of cases, it’s pediatricians who first identify developing behavioral health disorders, but many feel uncomfortable managing treatment.

The centers will also use remote services to conduct behavioral health assessments for at-risk students.  It would authorize these students to have two consultations via telehealth services with social workers or other mental health care professionals, and then determine if a referral for additional treatment is called for.  “We need to identify mental illness early, we need to treat it without stigmatizing it, just as we would any other physical condition,” Nelson said. “I firmly believe that this legislation will help identify youth at risk, get them to treatment, and prevent them from becoming a danger to themselves or others.”  She said the goal is to work with local school districts to ensure that these programs are available in every region across the state.

Identifying and treating mental health disorders in children as early as possible is key to better outcomes, according to testimony offered by psychologist and mental health policy expert Dr. Andy Keller, who helped develop SB 10.  The reason that mental health has become a crisis is that too many disorders go unidentified and untreated for too long, he said. According to research, the time between the appearance of behavioral health disorder symptoms and treatment averages ten years.   “Just like any illness, if you wait that long, and you wait until it’s a crisis until you intervene, it’s going to be much harder to help, it’s going to be far more risky to the individual as well as the folks around them,” said Keller. “The point of this bill is to help us help children as soon as possible.”  He highlighted the detection provisions in the bill, which would help identify emerging mental health disorders in both pediatricians’ offices and public schools, as well as opening pathways towards treatment and other mental health services through telemedicine and telehealth programs. “It’s not just physicians, it’s also social workers, other people who can be of help,” said Keller.  “Because it’s not actually even usually medication that’s helpful, it’s a range of things, and a lot of support to parents.”

The bill received unanimous support from the committee and won’t face much opposition moving through the Senate, as all 31 Senators are signed on as co-authors of the measure.