Medical schools need to catch up with telemedicine advances

Telemedicine is going to keep expanding, and the medical educational establishment needs to ensure that new doctors have the skills and understanding to use the technology effectively and ensure proper quality of care.

So argue a group of educators from the University of California, San Francisco School of Medicine in an editorial recently published in the Journal of the American Medical Association.  Describing the “core challenge of medical education” as an exercise in preparing physicians for future learning, the writers list an array of potential advantages to telemedicine, but they caution that “practicing telemedicine is fundamentally different from conducting a face-to-face encounter.  In addition to physical separation and its implications for examination, telemedicine automatically brings into the relationship a third partner – the organization providing the technology and setting the parameters of the e-visit.”

While recognizing that telemedicine meets the standards of traditional encounters in that, among other things, a clinician performs an evaluation, provides evidence-based recommendations and arranges follow-up visits, they also point to the new opportunities telemedicine can provide.  “For instance,” they say, “medicine could be more patient-centered if care for a child with cystic fibrosis included regular telemedicine visits to optimize home management the disease.”

But they caution that by creating new opportunities for home care and for communication with patients, telemedicine might also significantly increase physician workloads.  “More ominously,” they note, “telemedicine strategies that fail to meet the professional standards for a clinical encounter jeopardize patient care.”

As for the specific challenges telemedicine poses from a clinical perspective, the writers emphasize the importance of helping new doctors develop examination techniques that essentially mirror traditional, hands-on practices.  “Physicians have long equated the physical examination with laying on of hands,” they write, “but much evaluation can be done virtually –for example, by watching patients walks as a functional strength examination.”

In addition to clinical challenges and opportunities, however, the writers say doctors and their teachers must also anticipate the “professionalism challenges that may result from entrepreneurial promotion of delivery platforms. Health technology often changes faster than medical regulation, and physicians should ensure that novel delivery platforms meet professional standards for quality, safety and confidentiality.”

Simple Saliva Test Could Replace Blood Tests for Heart Failure

Research on a new non-invasive method of screening for the “silent killer,” heart failure, by testing saliva instead of blood being developed at QUT, has received a $75,000 Heart Foundation Vanguard Grant.

Associate Professor Chamindie Punyadeera from QUT’s Institute of Health and Biomedical Innovation (IHBI) said the aim of the research project was to produce a test that was quicker and easier to administer.

“The beauty of saliva is that you don’t need trained medical staff to collect a sample. You can monitor your heart health in your own home, using non-invasive technology,” Professor Punyadeera said.

“I am investigating ways to test saliva samples for the presence of a protein called Galectin-3, a biomarker specific for heart failure and whether it can be used to predict complications or the need for hospitalization.

“If the test finds elevated levels of Galectin-3 it could indicate the person needs medical attention.

“Using an e-health system, people with heart failure could be able to email the data from their saliva test to their GP who could advise them on medication levels, saving a trip to a heart specialist.”

Professor Punyadeera said heart failure was the inability of the heart to pump blood around the body.

“It has multiple causes including obesity, type 2 diabetes, high blood pressure, history of heart attacks and a family history of heart failure,” she said.

“Around the world 26 million people are diagnosed with heart failure each year and with an increasing and ageing population we can expect this annual rate to climb.

“In Australia, heart failure costs the healthcare system $685 million a year or 9 per cent of the country’s health budget.

“It’s a condition that lowers quality of life drastically. People with heart failure can’t walk far, they have swollen legs from a build-up of fluid that are prone to ulcers, they experience fatigue from not having enough oxygen carried through the body, and heart failure can lead to kidney damage.

“It’s a silent killer because it is asymptomatic in its early stages and people ignore it but heart failure can become life-threatening, if not treated.

“At the moment, identifying patients who need hospitalization is not adequate. We hope this test will be able to provide an accurate, quick and easy way for patients to know when they need hospital treatment.”

Professor Punyadeera will conduct a trial of testing saliva for heart failure in conjunction with the Royal Women’s Brisbane Hospital, the Mater and Prince Charles hospitals.

Heart Foundation Queensland fundraising director Bruce Macdonald said the foundation had invested more than $520 million in cardiovascular research since 1962.

“Each year we fund the best and brightest researchers through an independent peer review process in the hope of reducing the number of deaths from heart disease and improving the heart health of all Australians,” Mr. Macdonald said.

Susquehanna Health – Success with EHR integration

In theory, EHR integration can positively impact population health whenanalytics are applied to help translate raw data into actionable change. While most healthcare systems are moving in this direction, many are still striving to more to effectively utilize their data.

Susquehanna Health System, in Williamsport, Pa., is one institution that’s seen some sucesses on this front, by integrating their perioperative analytics tools from Surgical Information Systems with its EHR technology across its four campuses, including 30 operating rooms.

Integrating perioperative analytics has helped the health system bring down its average length of stay by 29 percent (from 4.7 days to 3.3), reduce its 30-day readmissions to below the national average and has placed them in the 100thpercentile in all areas of the Surgical Care Improvement Project, they say.

Moreover, as team members measure outcomes through data tracking, that’s allowing Susquehanna to meet all three Triple Aim goals and reduce workflow issues, while improving patient experience, productivity and outcomes.  The system is loaded with new data every day, while certain aspects create real-time monitoring for faster response times and reporting factors.

One of the biggest integration challenges was getting staff accustomed to electronic documentation, as many had used paper documentation for most of their careers. Education was crucial to ensure all were confident in its use. Staff were trained and tested with test patients and skilled supervisors.