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10 Jan 2018

Clinicians Brace for AI to Transform Medicine

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Artificial intelligence is coming … how will it affect medicine?




The doctor enters and pulls up the electronic medical record. The patient’s history is already there. So is the CT scan. The doctor drags and drops the image, presses the “analyze” button. An actionable diagnosis appears a moment later.


If artificial intelligence (AI) were to one day take over much of clinical practice, as some fear or anticipate — being potentially faster, more reliable, and generally better at certain tasks than humans — clinical decisions may no longer depend on tired eyes, imperfect risk scores, or lagging guidelines. Does that leave a role for physicians as decision-makers? Or will they become like Uber drivers in the age of GPS, just following directions issued from a device?


“GPS is not always precise,” offered Thomas Luscher, MD, a cardiologist at Switzerland’s University Hospital in Zurich, during a recent panel at the American Heart Association (AHA) meeting. “If you’re smart enough you can figure out how false it is.”


That’s the general idea of how things may also go in medicine once AI enters the mainstream. Clinicians today are cautiously optimistic that AI won’t exactly take their jobs. At risk, however, are those whose tasks involve a lot of repetitive tasks, such as looking at scans.


And that’s what automation is good for: processing information in rote, or nearly rote, fashion at high speed and with no issues of distraction or fatigue.


“I tell young people, ‘Don’t become a radiologist. You will be substituted by a machine,'” Luscher said.


Skeptics might point out that automation in medicine is hardly new in 2017. Automated ECG analysis began in the 1970s; computer vision is long established in liquid cytology for analyzing Pap smears; the MelaFind device for screening skin lesions is FDA approved.


Those systems, however, were narrowly focused and to a large extent still rely on human backup. ECG analysis software, for example, makes enough false diagnoses of atrial fibrillation and inappropriate cardiac catheterization laboratory activations that cardiologists generally know not to rely on it for clinical decisions.


What sets AI apart is the growing sophistication enabled by increased computing power and, just as important, the emergence of “Big Data” for training the algorithms.


Earlier this year, an AI system reportedly beat clinicians at recognizing 12 out of 14 arrhythmias and with better sensitivity and specificity. And just a few weeks ago, a computer algorithm outperformed human pathologists in diagnosing cancer metastasis in sentinel lymph node specimens.


The reach of AI is expected to increase as databases grow with the influx of information from wearables, electronic health records, and personal genomics firms as well as conventional sources.


Turning Point


“AI is a critical transformative part of the history of medicine. Medicine is an information system, now firmly so than ever before,” commented Harlan Krumholz, MD, of Yale School of Medicine in New Haven, Connecticut, at the AHA panel, adding that his academic group started hiring mathematicians and people who can code in Python.


“It will find its way into decision support, providing guidance on diagnostic interpretations, assisting in assessing prognosis, enabling better assessments of risks and benefits of particular clinical strategies – and generally spreading expertise. It will be a foundation for precision medicine,” he later told MedPage Today.


“The biggest impact of AI in medicine in the short term will be in the area of pattern recognition and image interpretation. Currently we are limited by human cognitive capabilities, which lead to high miss rates on image interpretation and marked inter and intra-observer variability,” Krumholz said. “We will also be able to extract useful information that is hard to discern with our eyes. Other important areas will center on prediction, with improved means of estimating prognosis – and of complications and risk.”


In addition to its potential for delivering better care, AI will be a democratizer of healthcare wherever it is available, according to Rima Arnaout, MD, a cardiovascular imaging sub-specialist at University of California San Francisco.


“Right now, the big academic medical centers with experienced niche specialists often provide better diagnosis and care for patients with rare or complex conditions. But if models for patient diagnosis and management are trained on data from those experts and made widely available, patients at big academic centers and rural clinics alike will have better access to better care,” she said.


Arnaout and Krumholz are both in the trenches of making AI a reality in medicine, her taking part in the effort to develop image-recognition tools to diagnose disease with higher accuracy and precision than human beings, and him investigating ways that AI may improve patient care and outcomes by identifying high-risk patients — those who may, say, be more likely to be re-admitted to the hospital after a medical procedure.


But to call today’s technology in its infancy would be an understatement.


Joseph Hill, MD, chief of cardiology at UT Southwestern in Dallas, said that he doesn’t know anyone practicing medicine with AI today. “In my world, AI-facilitated interpretation of echocardiograms is on the horizon but likely 10 years from prime time,” he said, predicting that initial uses will likely be in analyzing x-ray images.


It comes down to the technology not being widely available at an affordable cost, said George Welch, MD, a cardiologist at New York’s Manhattan Cardiology. “The cost of that technology will have to come down significantly before any of us are using it on a larger scale.”


Available Now or Soon


One application Welch is following is IBM’s Watson, which is being trained by a coalition o CVf hospitals, ambulatory radiology providers, and imaging technology companies for use in health imaging. Other Watson-enabled projects include WatsonPaths and Watson EMR Assistant, two projects launched in collaboration with the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the former seeking to make it easier to trace how AI determined the best option for each clinical scenario and the latter designed to highlight the most important information from patient medical records.


Yet another recent AI-based rollout comes from Hitachi and Boston-based Partners Connected Health, which purportedly can predict hospital readmissions within 30 days for patients with heart failure. It identifies patients who would benefit from a special readmission prevention program, saving the healthcare system a substantial number of dollars.


And it’s not just the big names that are putting real effort into this technology: Andreessen Horowitz just created a new $450-million fund to invest in startups developing AI and machine learning for healthcare.


After all is said and done, when AI has been fed enough data and cash, when it moves from infancy to its teenage years, and people are satisfied with its reliability and accessibility, the question remains: will doctors really lose their jobs to a computer?


“This type of capacity will reduce a lot of the roadwork that cardiologists do and will free up our time to spend with patients and create a better connection and bond with patients,” Welch suggested.


“There’s still a role for radiologists — all the machine is doing is giving you a prediction,” said former FDA Commissioner Robert Califf, MD, at the AHA panel. “What do you do with probabilities? There’s a tremendous role for radiologists. This is bringing humanism back to medicine, the interaction with people. The role of the doctor is going to get bigger and bigger.”


For his part, Califf is now employed at Verily, Google’s life sciences division, where he has a hand in Project Baseline. The study continues to recruit for a goal of 10,000 participants who will volunteer massive amounts of their daily health information via wearable technology, surveys, and clinic visits — perfect fodder for feeding to AI, ostensibly.


Yet “AI is not a cure-all for the problems in healthcare,” Arnaout emphasized, adding that “especially with respect to supervised learning, an AI tool is only as good as the data you train it with. The medical community needs to be very careful in curating training data for these models, providing high-quality data that represents all ages, genders, races, ethnicities, and patient conditions.”


“If we don’t do this, we can allow some dangerous biases about our patients and diseases to get baked right into our systems of care,” she warned


  • by Nicole Lou,Contributing Writer, MedPage Today – December 26, 2017
  • article reposted by Physician Licensing Service – January 10, 2018
22 Dec 2017

BEST YEAR of PRODUCTION in 20 years at Physician Licensing Service

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Thank you to some of the top producers at Physician Licensing Service that helped to make 2017 one of our best years on record for PHYSICIAN LICENSE ACQUISITION. We are honored to hold the title of highest rated and most used medical licensing service in the United States in 2017.



“The staff we have now is so amazing to work with. I have never felt more camaraderie and team cohesion than in all my years at PLS.”                                                                                                         – PLS Verification Specialist 


The process of medical licensure in the United States has never been more complicated and having seasoned professionals with over two decades of experience to help you navigate the waters of multi-state acquisition is critical to a healthy practice.


“I am really happy that we have revamped the licensure process here because we are getting better and better and helping doctors get licensed quickly.”                                                                               – PLS Senior Consultant






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12 Dec 2017

Walgreens makes telemedicine deal with NewYork-Presbyterian for Duane Reade stores

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The telemedicine services will rely on software and kiosks from AmericanWell.


Walgreens has embarked on a deal with NewYork-Presbyterian health system to provide non-emergency telemedicine services at drugstore retailer Duane Reade stores around New York City, starting with a branch on Wall Street with plans to roll out to other branches in Manhattan, Brooklyn, and Queens. It marks the first time Walgreens has collaborated with a local healthcare provider to deliver its telehealth and digital strategy, a company news release noted.


NewYork-Presbyterian and Walgreens are providing the telemedicine services as part of the NYP OnDemand suite of digital health services. They will be delivered through in-store-kiosks at $99 per visit. The kiosks are provided by AmericanWell, a company with which NewYork-Presbyterian has an existing partnership, said NewYork-Presbyterian Chief Transformation Officer Dr. Peter Fleischut in a phone interview.


The kiosks are equipped with connected medical devices including a thermometer that measures temperature by swiping the forehead, a blood pressure cuff, and a pulse oximeter that measures the amount of oxygen in the body. A dermascope, which allows the provider to see a high-resolution view of skin conditions, is also available through a Walgreens partnership with Iagnosis, according to the news release. The teledermatology service is referred to as DermatologistOnCall.


The service will also be provided through the Walgreens website as NYP OnDemand Urgent Care. Customers can use it to have a video chat with board-certified emergency medicine doctors.


NewYork-Presbyterian has been piloting the use of telemedicine as a way of triaging walk-in patients at emergency departments through NYP On Demand Express Care. It has been rolled out to four of the hospitals in its network to date: Weil Cornell, Columbia Presbyterian, The Allen Hospital, and Lower Manhattan Hospital. Fleischut said the service has helped it whittle down the duration of emergency room visits from an average of two hours to 30 minutes. Patients who have used the service span 18 to 98 years old, noted Fleischut.


By increasing access points to NY-Presbyterian physicians, the deal with Walgreens allows the hospital to expand access points to the hospital, extending its brand and network reach, adding more patients to its system.  Fleischut also addressed the question of how to help patients who use the service but may have a more urgent condition that can be addressed in the setting of a Duane Reade.


“We find there is more and more need for immediate access to physicians and lot of low acuity needs. That is why we provide these services. If a condition is more severe…we can provide some services virtually and refer some situations onto a specialist or an emergency department,” said Fleischut.


In addition to the in-store kiosks, Walgreens customers in the New York area using the Walgreens website can access NYP OnDemand Urgent Care to video chat with board-certified emergency medicine doctors, the news release said.


Walgreens inked a collaboration deal with MDLive two years ago to offer telemedicine services in its stores around the country.


Asked about the deal, Greg Orr, Walgreens divisional vice president of digital health said in an email that the deal expands Walgreens’s strategy to provide healthcare access for its customers in a convenient way. He noted that it complements an existing collaboration with MDLive, which focuses on general health issues and mental health services.


Telemedicine delivered through kiosks failed for one healthcare startup, HealthSpot, which went out of business  last year. RiteAid purchased its assetsfor just over $1 million. Still, Walgreens and NewYork-Presbyterian have the scale that HealthSpot was never able to achieve, plus they are bringing to bear different telemedicine capabilities.


“We see the kiosks as only part of a larger collaboration between Walgreens and NYP,” Orr said in an email. “Similar to our approach in retail, we believe in the power of omni-channel to connect customers with our brand both inside our stores and digitally to meet them wherever they are.  By collaborating with a well-known health brand like NYP in the New York City market we believe we can maximize convenience for our customers both inside our stores through kiosks as well as online through our digital properties.”


The deal will make Walgreens more competitive with other companies seeking to add on to their healthcare services such as CVS Health, which has entered into a deal to acquire Aetna.


Photo: NewYork-Presbyterian

Re-posted by Physician Licensing Service – Dec 12, 2017

Original link:

08 Dec 2017

How to reduce Christmas stress

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“It’s the most wonderful time of the year,” but also a time when stress levels soar. We have put together some top tips to stop stress in its tracks and make the season of goodwill more enjoyable.
stressed woman wearing christmas hat

The holidays can be a time of high stress levels, but managing stress can help you to have a happy and healthy Christmas.


While Christmas is known as “the season to be jolly,” it can be a significant source of stress, pressure, and conflict for many of us. Some people can feel overwhelmed by the excess, expectations, and exchange and become depressed during the holidays.


A lack of time and money, credit card debt, and the pressure of gift giving can often contribute to stress during the holiday season.


Most of us are aware of the adverse effects that stress can have on our body. It can impact our thoughts, feelings, and behaviors, and it can lead to high blood pressureheart diseasediabetes, and obesity if left unchecked.


In fact, research has shown that there is an increase in the occurrence of heart attacks and heart-related deaths during the festive season, which may be due to stress, heavy alcohol consumption, a fatty diet, or all three. Therefore, it is of utmost importance that holiday stress is dealt with — pronto.


With all the cooking, decorating, visiting, and gift giving, the holidays can seem more like trying to meet a high-pressure deadline than a vacation. So, try these Christmas stress-busting strategies to ease the strain and help stress melt away.

1. Limit spending


Money issues are one of the leading causes of stress during the holiday season, according to a pollconducted by the American Psychological Association (APA) in 2004. Recent data collected in the APA’s annual Stress in America survey reflect this finding and report that 62 percent of us feel stressed about money.

woman wearing Christmas hat and shopping

Avoid overspending by setting a budget.


Holiday retail sales in November and December 2017 are expected to increase between 3.6 and 4 percent and total between $678.75 billion to $682 billion, according to the National Retail Federation. These figures are up from $655.8 billion last year.


Gift buying, entertainment, and travel can all fuel financial burden, even for the savviest shoppers. However, here are some steps that you can take to limit financial stress.

Set a budget. First of all, make sure that all your usual expenses are accounted for so that you do not fall short on bills such as rent. Plan for any other spending over the holidays, including any parties you may be hosting or traveling to visit friends or family.

Once these items have been subtracted from your budget, you can then work out how much you can spend on gifts. Being organized and realistic about your budget will help you to ensure that you do not overspend.


Make one financial decision at a time. Make sure that you space spending-related decisions out. Trying to make too many decisions at once can be overwhelming, which can lead to depletion of your willpower and an increased risk of overspending.


Avoid temptation. It is often impossible to steer clear of stores and shopping malls altogether over the festive season, but limiting the time that you spend in these places can also help you to curb your spending.


Manage impulsive spending by taking only the cash you can afford to spend on shopping trips and leaving all credit and debit cards at home.

Recognize how you deal with stress-related money problems. Sometimes, during tough economic moments, individuals turn to smoking, alcohol, gambling, or excessive eating to try to relieve stress. These behaviors can lead to arguments and conflicts between partners and families.


Be mindful and seek help from a healthcare professional if you find that these behaviors are causing you problems.


Keep in mind what is important. Overspending can overshadow the true sentiment of Christmas. If your expense list exceeds your monthly budget, keep in mind that your relationships with friends and family are more important than material objects.


2. Manage expectations

Everyone has an idea in their heads of the perfect holiday, but when reality falls short of the vision, stress can ensue. Try to manage expectations with these simple tips.

Be realistic

family sitting at the table with Christmas dinner

Having a late dinner will not ruin your day.


Despite your grand plans, no event ever runs seamlessly, and this also rings true for holiday celebrations. Rather than accumulating stress along the way from any mishaps that might occur, view these miniature calamities as an opportunity to exercise flexibility and resilience.


Dinner being 30 minutes late, spilling food on your festive outfit, or having a lop-sided tree is not going to ruin your day. Instead, they’ll create fond memories that you can reflect on in years to come.

Help children to be realistic


When children get older and start to become more aware of what they want and what their friends have, parents can feel pressurized to deliver, meet their expectations, and provide them with the perfect presents.

Help your child to create a wishlist that outlines any gifts they desire. Make sure they know that they will not receive everything on the list and highlight anything that is not acceptable or obtainable.

Remind your child that Christmas is about being together, not a list of presents to tick off a list. Planning fun activities that encourage everyone to come together and have fun can create excitement.

Take some time out

Carrying the world on your shoulders and trying to achieve everything alone during the holidays can take its toll on your mind and body.


Enlist some help in accomplishing some of the tasks on your list and take some time out. Destressing can benefit you and the rest of your family. Focus on doing something that you find relaxing to recharge your batteries, such as reading a book, watching a Christmas movie, listening to music, or going for a massage.

3. Avoid overindulging


‘Tis the season for indulgence, and whether it be a festive holiday party or a family dinner, we are surrounded by extravagant foods and alcoholic drinks.

person standing on the scales after eating Christmas food

Allow yourself some holiday treats, but quickly go back to eating healthful foods and doing exercise to avoid weight gain.


Although many of us only gain an extra pound during the holiday period, that extra pound may build up over the coming years and contributeto obesity later in life, according to the National Institutes of Health (NIH).

Excessive stress raises appetite and cravings for sugary and fatty foods, and chronic drinking can further exacerbate stress by raising levels of the stress hormone cortisol.


Dietitians from the University of Missouri in Columbia recommend that families should aim to maintain healthful dietary habits during the holidays in order to avoid weight gain and stress.

  • Eat a healthful diet during the day. Eat some high-protein snacks, such as yogurt or an apple with peanut butter, so that you are not too hungry by the time that dinner arrives.
  • Make simple food swaps. Eat whole-wheat bread instead of white, and brown rice instead of white, to help keep you feeling fuller for longer.
  • Be treat-wise. Enjoy seasonal treats, but try to control portion sizes.


If you do find yourself overindulging, maintain perspective. One day of indulgence will not lead to significant weight gain, as long as you plan to get back on track with healthful food choices and exercise the next day.


4. Go for a walk

The antidote for holiday stress could be just as simple as taking a walk around the block. Researchdemonstrates that physical activity reorganizes the brain in such a way that it reduces its response to stress.

Family walking in the woods

Go out for a walk with the family to decrease stress.


Regular exercise can help to decrease tension and boost and stabilize mood. Furthermore, exercising produces endorphins — natural painkilling chemicals that are released in the brain — that improve your ability to sleep and reduce stress.


Research also shows that if you convince the rest of the family to leave the couch and come along on the walk with you, your stress levels will be reduced even further.


Researchers found that working out in a group reduced stress levels by 26 percent and improved physical, mental, and emotional quality of life.

5. Have some fun

As you decorate the tree or bake festive cookies, forget all the items left on your to-do list and give yourself permission to have fun.

family playing Christmas games

Organize fun activities to boost laughter and reduce stress.


Laughter goes a long way in the fight against stress and could be just what the doctor ordered.


Laughter lightens your mood, stimulates your heart, lungs, and muscles, and also releases endorphins. Laughter also boosts circulation, helps muscles relax, and lessens the physical symptoms that are associated with stress.


Whether your laughter is powered by sidesplitting moments in your favorite movie, jokes at the dinner table, a holiday prank, or an afternoon of fun activities, be sure to include some holiday humor, giggles, and guffaws. Even looking forward to a funny event raises relaxation-inducing hormones and decreases stress hormones.


Finding positive, healthful ways to manage stress could reduce many of the related adverse health consequences. Finding stress-busting techniques that work best for you can enable you to have a stress-free Christmas.

Original Published
Reposted by Physician Licensing Service
06 Dec 2017


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The Michigan House of Representatives passed a bill to join an interstate compact to synchronize its medical licensing regulations with those of 22 other states, allowing health care providers licensed in participating states to provide services.


OCTOBER 30, 2017
Original By Joshua Paladino
Re-posted By Physician Licensing Service








The Michigan House of Representatives passed a bill to join an interstate compact to synchronize its medical licensing regulations with those of 22 other states, allowing health care providers licensed in participating states to provide services in Michigan.


Legislators approved House Bill 4066 (HB 4066) on October 10. The bill now awaits action by the Michigan Senate Committee on Health Policy.


Increasing Health Care Access


HB 4066’s sponsor, state Rep. Jim Tedder (R-Clarkston), says the bill would help increase consumers’ access to quality health care.


“In an age when we see advances in telemedicine, we also hear recurring themes of lack of access to quality care in rural and underserved areas,” Tedder said. “The interstate medical licensure compact allows a means through which specialty practice physicians can maintain multistate licensure in an expedited process.”


The bill would synchronize Michigan’s health care licensing rules with other states’, Tedder says.


“In effect, through a compact, we’re really coordinating our statutory and regulatory rules in line with others,” Tedder said. “This brings a lot of states in line with what I consider to be very highly scrutinized rules here in Michigan.”


Staving Off Federal Overregulation


Interstate compacts can preempt federal regulatory overreach, Tedder says.


“In many cases, when you see an interstate compact established, it preempts any potential for federal licensure of physicians,” Tedder said. “With increasing health care costs and increasing encroachment from the federal government, this is a prudent preemption of any forthcoming licensing regulations at the federal level.”


Pros and Cons of Compact


Jarrett Skorup, strategic outreach manager with the Mackinac Center for Public Policy, says the proposed compact has advantages and disadvantages.


“There’s two sides to this, from a free-market standpoint,” Skorup said. “The one side is licensing restrictions are too high in all professions, so we want to work toward lessening that. To the extent that this allows people to move among states with one license, it’s a good thing. The problem with it is, you don’t want Michigan to lock itself into restrictive licensing agreements or into a compact that will vote to raise requirements.”


Skorup says reciprocity agreements, in which states agree to recognize other states’ occupational licenses, are a good idea.


“You pretty much have the same requirements in every state to be a medical doctor, so for those states with similar requirements, it makes sense for states to enter a reciprocity agreement,” Skorup said.

30 Nov 2017

State Medical Boards Slammed After New Year – Experts Suggest Applying NOW

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The contract rush is real around the turn of every new calendar year for physicians looking to relocate or extend their telemed reach into new markets. Expect the medical boards to be extra busy this holiday season with all of the movement in the medical industry to expand its operations.

20-year-anniversary-v2Because of the high demand for physicians in the United States, many experts in the medical licensing field have suggested that doctors get ahead of the new year’s rush by applying now for needed medical licenses. Medical boards prioritize licensure by the order of submission and getting in early before the January 1 rush ensures you will be licensed first.

Physician Licensing Service has spent the last 20 years mastering each state medical board in United States. The expertise gained in our 20 years of serving physicians have made us a valuable asset to 1,000’s of medical practices in North America.

Take advantage of our Preferred Pricing Structure for practicing physicians by emailing Tony Hendricks at or by calling at 801-449-9196.


You can also order new medical licensing services through a secure, 128bit encrypted, website by going to HERE.

22 Nov 2017

HAPPY THANKSGIVING to all of the friends and family of PLS

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PHYSICIAN LICENSING SERVICE would like to give a heartfelt thank you to all of our friends and family this holiday season and we wish the best for you and yours.





Consider our service to alleviate medical licensing pressure this season by contacting  Tony Hendricks at



Special custom pricing for multi-state license acquisition. Take advantage of our new Quantum licensing division specifically designed for inter-office coordination to augment the backlogged licensing divisions within.


10 Nov 2017

NewYork-Presbyterian specialists use telemedicine to treat stranded Puerto Ricans

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The medical center jumped in after Hurricane Maria to deliver care services in what it calls a proof-of-concept for using telehealth tools in emergency response.

telemedicine in Puerto Rico

Original by Bill Siwicki – posted November 09, 2017 – 02:56 PM

Reposted by Physician Licensing Service


NewYork-Presbyterian Weill Cornell Medical Center sent an emergency team to work with patients on the ground in Puerto Rico and conduct visits with specialists using telemedicine tools in the wake of Hurricane Maria’s devastation.


The move comes amid a 2017 hurricane season during which other hospitals such as Nemours, and telemedicine companies including LiveHealth Online, Doctor On Demand and EpicMD, have been offering free virtual consultations to people in storm-ravaged areas in Florida, Texas and Puerto Rico.


Beginning on Oct. 27, NewYork-Presbyterian sent people to Puerto Rico to deploy the telemedicine equipment that enabled them to consult with specialists back in New York.


“On the first day, I received a call from physician assistant Nancy Pagan that she needed a consultation for a 2-year-old boy with diabetes who had elevated blood sugar for the past two weeks,” said Shari Platt, MD, chief of pediatric emergency medicine at the medical center. “Within one hour, we were using our telemedicine service to perform peer-to-peer consultation in a three-way communication.”


That live video conference included Pagan, Platt and and Zoltan Antal, MD, the chief of pediatric endocrinology at NewYork-Presbyterian Weill Cornell Medical Center.


The caregivers were able to virtually see the child, speak with the mother, and advise Pagan on how to adjust the insulin dose and diet to better manage his diabetes, which had become uncontrolled.


“Being able to see the child, and assess his behavior, his level of comfort and hydrated state, and his well appearance, was a priceless aspect of this evaluation, as a simple phone discussion could not have provided this critical information that helped to guide his care,” Platt said. “Further, for his mother to be able to speak with Dr. Antal, to see his face, and have an eye-to-eye contact, offered a powerful connection and an intangible sense of trust and faith in our care.”


Clinicians are using such telemedicine technologies in Puerto Rico Rico and elsewhere to deliver specialist and sub-specialist care in ways that emergency teams simply cannot without the tools.


“Many of the patients have had complex medical conditions that even in our own emergency department would be managed with the consultation of a sub-specialist,” Platt said. “And this level of specialization cannot be duplicated by emergency teams on the ground.”


Access to specialized medical care is frequently difficult, if not impossible, following disasters. And with people having grown accustomed to seeing and speaking with friends and family via video or Facetime, Platt said telemedicine enables patients to be cared for by a specialist when necessary.


That said, it’s still early to tell for certain what impact telemedicine will have on Puerto Rico overall as it continues to recover and what that might mean for other areas that face storms in the future.


Telemedicine bridges the gap and allows the medical center’s physicians to treat patients as if the medical center’s caregivers were there in person. So from that standpoint, the use of telemedicine in Puerto Rico is in essence a proof of concept that the digital health services can be of tremendous value in emergency and disaster response situations.


“What we can say is that as a result of our time providing aid in Puerto Rico, we know now that we can still provide access to general and sub-specialty care that can adequately address chronic conditions such as diabetes and dermatological care for certain skin reactions that occur during times like this and especially when the patients might not have access,” said Rahul Sharma, MD, emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center.



15 Sep 2017

Patients and families save time and money with telemedicine visits study finds

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Patients and families who use telemedicine for sports medicine appointments saved an average of $50 in travel costs and 51 minutes in waiting and visit time, according to a new study by Nemours Children’s Health System. Each telemedicine visit also saved the health system an average of $24 per patient, researchers reported at the American Academy of Pediatrics National Conference & Exhibition.


Original posted 9/15/17 by:

Reposted 9/15/17 by: Physician Licensing Service


“There’s a constant need to innovate care delivery to demonstrate value to patients and families,” said Alfred Atanda Jr., MD, an orthopedic surgeon at the Nemours/Alfred I. duPont Hospital for Children and author of the study. “Nemours’ tech-savvy care environment provides another way to get patients the care they need — where and when they need it. We were able to do so while saving families time and money.”


In a cohort study of 120 patients younger than 18 who had at least one telemedicine visit between September, 2015 and August, 2016, the Nemours researchers compared total time of clinical visit, percentage of time spent with attending surgeon, and wait time, to data from in-person visits in the department. Data were collected for postoperative evaluations, surgical/imaging discussions, and follow-up visits. Demographic data and diagnosis were recorded from the electronic medical record.


The findings support the use of telemedicine to reduce costs for both the patient and hospital system, while maintaining high levels of patient satisfaction, researchers said. After each visit, parents were asked to complete a five-item satisfaction survey. Ninety-one percent of parents found the application easy to download, 98 percent would be interested in future telemedicine visits, and 99 percent would recommend telemedicine to other families.


The study, which was conducted in a pediatric sports medicine practice, also found that the percentage of time spent with the provider was significantly greater for telemedicine than for in-person visits (88% vs. 15% of visit time). Families also saved significant travel time and expense, avoiding an average of 85 miles of driving, resulting in $50 of savings in transportation cost per telemedicine visit.


Researchers said the study demonstrates that telemedicine can successfully be used in pediatric subspecialties to maximize healthcare resources and stretch the availability and expertise of the limited number of pediatric subspecialty providers.


“We know that telemedicine is often looked to for common childhood ailments, like cold and flu, or skin rashes. But we wanted to look at how telemedicine could benefit patients within a particular specialty such as sports medicine,” said Atanda. “As the healthcare landscape continues to evolve and the emphasis on value and satisfaction continues to grow, telemedicine may be utilized by providers as a mechanism to keep costs and resource utilization low, and to comply with payor requirements.”


Nemours has implemented telemedicine throughout its health system with direct-to-consumer care for acute, chronic, and post-surgical appointments, as well as through its partner hospitals, schools, and even cruise ships. Nemours CareConnect is a 24/7 on-demand pediatric telehealth program which provides families access to Nemours pediatricians through a smartphone, tablet, or computer–whether they are at home, school, or even on the sports field. If necessary, the physician may order a prescription, using geo-location service on the smartphone or tablet, and send it to the nearest pharmacy.​​


Original found here:

28 Jul 2017

Both sides of aisle agree in Congress — telemedicine is the future!

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Last Thursday, in the midst of the intense debate about the future of ObamaCare, Congress held yet another hearing extoling the virtues of telehealth and remote patient monitoring, and lamenting the barriers in Medicare that are preventing seniors from accessing these new technologies in the same way as patients in the commercial market.




The hearing in the House Small Business Committee followed a typical pattern of hearings on telehealth. It began with witnesses outlining the litany of evidence of how telehealth and remote monitoring are supporting patients with chronic disease like diabetes, COPD and CHF, as well as patients who can’t access primary care or behavioral health services because of distance or workforce shortages.


Testimony always includes evidence of improved access, quality and reduced costs. At Thursday’s hearing, Michael Adcock, administrator of the Center for Telehealth at the University of Mississippi, testified about a remote patient monitoring pilot for patients with diabetes that resulted in a “marked decrease in blood glucose, early recognition of diabetes-related eye disease, reduced travel to see specialists and no diabetes-related hospitalizations or emergency room visits among our patients.”



The program demonstrated savings of over $300,000 in the first 100 patients over six months. The Mississippi Division of Medicaid extrapolated this data to show potential savings of over $180 million per year if 20 percent of the diabetics on Mississippi Medicaid participated in this program.



What more could we want? We are locked in a national debate about coverage, but the underlying issue is cost. Telehealth and remote patient monitoring have proven through the Veterans Administration, the commercial sector and health systems that these tools can save money, improve quality and access, and there are plenty of peer-reviewed studies that show it.



Last Thursday’s hearing also hosted Nicole Clowers, the managing director of the Health Care team at the General Accounting Office (GAO). She detailed a GAO report in which they determined that only 0.2 percent of Medicare Part B fee-for-service beneficiaries accessed services using telehealth in 2014. Not two percent — but 0.2 percent. That compares with more than 90 percent of large employers in the commercial market offering telehealth.



There is something that Congress can do to finally facilitate more telehealth and remote monitoring in Medicare. First, they can make telehealth and remote monitoring part of the basic benefit in Medicare Advantage (MA). MA plans are already trying to offer these tools to their beneficiaries, but the administrative burden of a supplemental benefit creates barriers. By simply allowing plans to offer them as part of the basic package, we would facilitate access for 18 million Medicare beneficiaries.



On the fee-for-service side of Medicare, Congress can grant the Secretary of Health and Human Services authority to waive telehealth restrictions if the Actuary of the Center for Medicare and Medicaid Services (CMS) determines that allowing particular codes in Medicare Part B to be offered through telehealth will decrease costs and maintain quality, or increase quality while maintaining costs.




This solution is far from simply lifting all telehealth restrictions, as stakeholders from the patient, doctor, hospital and health plan communities would like. It is instead, a painstaking process of code-by-code review of evidence related to cost savings that will ensure the Medicare budget is protected (for those who believe that telehealth would somehow cost Medicare money rather than save it). Rep. Bill Johnson (R-Ohio) and Rep. Doris Matsui (D-Calif.) introduced a bill Thursday that will do just that.



On remote monitoring, we already have codes that allow for the collection and interpretation of physiologic data, such as remote ECG, blood pressure and glucose monitoring, but it’s bundled with other codes, which means it can’t be billed separately. Congress or CMS could unbundle this code and open remote monitoring in the Medicare program.



This is an ideal time to take action on telehealth and remote monitoring in Medicare.


It is a bipartisan issue with support from members as diverse as Sens. Roger Wicker (R-Miss.), John Thune (R-S.D.) and Thad Cochran (R-Miss.) to Brian Schatz (D-Hawaii), Ben Cardin (D-M.D.), Mark Warner (D-Va.).


In the House, Reps. Diane Black (R-Tenn.), Greg Harper (R-Miss.), Peter Welch (D-Vt.), Bill Johnson (R-Ohio), Mike Thompson (D-Calif.) and Doris Matsui (D-Calif.) are all working together.


If Republicans from Mississippi and Tennessee and Democrats from Vermont and California can come together — surely we can get this done.






Krista Drobac is the executive director of the Alliance for Connected Care, an advocacy organization dedicated to achieving the promise of connected care in Medicare.