Do you think Alexander Graham Bell fathomed the potential reach of his invention when he received a patent for the telephone in March of 1876? One hundred and forty-one years later an expanded technology is assisting doctors and nurses to better treat their patients. People living in rural areas now have access to specialists who in the past would have required hours of driving and even an overnight hotel stay in order to see, making the prospect of access to a specialist out of reach for many Americans.
Telemedicine is one of the fastest growing delivery methods of healthcare today. The American Telemedicine Association (ATA) touts “Telemedicine is the natural evolution of healthcare in the digital world. It’s no wonder why this has become a multi-billion-dollar industry and why nearly every major healthcare system leverages it to transform and to re-invent healthcare.”1 Advances in technology have allowed the healthcare provider to make “house calls” in a modern way. Phones have more computational capacity and video-based transactions are frequently used in healthcare facilities. The ATA comments that “patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers are just some of the related applications.”2
Use of telemedicine is transforming healthcare in rural states like mine - Mississippi. Our state’s academic medical center, the University of Mississippi Medical Center (UMMC) is a shining light in the world of telemedicine. The UMMC Center for Telehealth was created in 2003 in response to an immediate need for specialized care and other public health services for the rural hospitals in our state. In 2014, UMMC created a pilot program called the Diabetes Telehealth Network, a partnership of UMMC, Care Innovations, C Spire, GE Healthcare, the office of Governor Phil Bryant and North Sunflower Medical Center and began providing services in 20 counties located in the impoverished Delta Region of Mississippi. Through the program, doctors and other health practitioners treated patients remotely, but in real time, at home, using online streaming video technology and other tools for two-way live communication. Patients were trained on tablet computers. The pilot program was a huge success, improving clinical outcomes and care coordination for managing diabetes, increasing access to care and conveniently bringing healthcare resources into patients’ homes. The administrator of the Center for Telehealth at UMMC, Michael Adcock said, “A lot of our patients hadn’t touched technology before the Diabetes Telehealth Network.” Adcock indicated that the benefits were verified through initial data on the first 100 patients in the pilot and the results were so encouraging that there was no need to wait for final data to expand remote patient monitoring to those coping with other chronic illnesses. “What we’ve learned has prompted us to change the technology a bit. We now use an iPad Mini instead of the larger tablet. And, we're using Bluetooth so that they don’t have to plug anything into their device.” UMMC has been able to expand the reach of the Center for Telehealth into 68 of the state’s 82 counties - up from seven in July of 2015. The Center has established 218 remote patient monitoring service locations including 35 medical specialties for adults and children. A unique part of UMMC’s telehealth program is Telemergency medicine. Under the program, nurse practitioners are placed in the emergency rooms of 15 rural hospitals throughout the state in addition to UMMC’s campuses in Holmes County and Grenada. Emergency room staff members connect via live video to emergency medicine physicians in UMMC’s Emergency Department in Jackson.
UMMC reports that the results from the diabetes pilot program were remarkable - 96 percent took their medications as directed; 83 percent kept their scheduled telehealth appointments. The data also showed that the patients’ average hemoglobin A1c level dropped, bringing them closer to the normal range for those without diabetes, Adcock said. There were no hospitalizations or ER visits because of complications from diabetes and providers diagnosed nine cases of diabetic retinopathy that might have otherwise been undetected. The best part - patients stayed off the roads more than 9,000 miles rather than driving to Jackson to see specialists. “We’re addressing health disparities that have to be addressed. Our team is dedicated to helping healthcare organizations deliver better care and access to more patients at a lower cost,” said Adcock. Key to encouraging the use of telemedicine was a 2014 statute passed by the Mississippi legislature that requires insurance companies and Medicaid to reimburse for both remote patient monitoring and store-and-forward telemedicine. Adcock and his staff are sought-after speakers - logging 47 presentations (locally, nationally and internationally) on the success of the program in 2016 alone.3
The Health Law Section is committed to educating our members about the legal issues associated with the use of telemedicine. We recently entered into a Memorandum of Understanding with the ATA to coordinate to provide educational opportunities to members of both the ABA Health Law Section and the ATA on emerging telehealth topics. The Section has developed a session for ATA 2017 Telehealth 2.0, being held April 23-25 in Orlando, entitled “Emerging Technologies - Tackling the Legal and Regulatory Challenges and Seizing the Opportunities.” Julian Rivera of Husch Blackwell is the point person for the Health Law Section on this joint effort. Feel free to contact Julian if you are interested in getting involved. The place where emerging technology and delivery of care intersect is indeed a win-win for patients, healthcare providers and payors alike.
C. Joyce Hall
Mississippi Trivia: Hometown hero Archie Manning of Drew, Mississippi and his beautiful wife, Olivia, (better known in Mississippi as “The First Family of Football”) have committed to raising funds to help the mission of UMMC through their Manning Family Fund. They have launched a campaign for a Healthier Mississippi to grow the awareness of UMMC’s mission.