tag:blogger.com,1999:blog-2447438783001404385.post5484030183175616766..comments2024-03-28T07:49:18.778-05:00Comments on Jackson Jambalaya: Should telemedicine serve doctors or serve patients in Mississippi? Kingfishhttp://www.blogger.com/profile/06184990110961727404noreply@blogger.comBlogger43125tag:blogger.com,1999:blog-2447438783001404385.post-32620020093021985712016-03-02T20:56:57.375-06:002016-03-02T20:56:57.375-06:00Excellent Discussion and good, thoughtful points. ...Excellent Discussion and good, thoughtful points. Here's my observation: <br />1) mandated patient-driven choice of technology even if this technology may not be appropriate;<br />The committee substitute bill does not mandate patient-driven choice. It mandates that the company have alternative choices to telephone only services. The limits may be on the patient side depending on their equipment or location. If the patient has a choice and the cost is the same, then he will most likely choose what the physician recommends which dovetails into your next issue.<br /><br />2) mandated equal cost regardless of communication method even if some methods are significantly cheaper; <br />This is not new as Miss. Code Ann. 83-9-353 (12) already mandates equal cost for health insurance and employee benefit plans that use telemedicine. However, by having equal cost for all communication methods a patient will be more likely to use the most appropriate method, which addresses your first concern. This would help keep costs down while utilizing the most appropriate communication method.<br /> <br />3) dangerous codification of physician-patient relationship that makes it easily defined for a singular visit and then easily terminated after one visit;<br />The purpose of Telemedicine, as opposed to Telehealth, is to treat minor, non-emergent medical issues complementing, not supplanting, the patient’s primary physician. <br /><br />I believe it will be important not to specify the type of technology and how it's used. The technology will change as soon as we try to regulate it. Let the technology take care of itself while setting the standards of performance.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-54480724458738087592016-03-02T12:56:28.619-06:002016-03-02T12:56:28.619-06:00@11:16- you trust Randy Easterling to determine a ...@11:16- you trust Randy Easterling to determine a patient's best interest? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-26514118184409751182016-03-02T11:16:54.225-06:002016-03-02T11:16:54.225-06:00Heddy-Dale Matthias, MD, I encourage you to reach ...Heddy-Dale Matthias, MD, I encourage you to reach out and visit and learn more about UMMC’s Center for Teleheatlh.<br /><br />They are currently doing everything that you speak of including the eICU with amazing results. They are also using the technology you speak of to simulate all aspects of the physical examination for the patient visit, although not with Skype and FaceTime as they are not HIPAA compliant. They are also helping other health systems do this for themselves. The Governor is also a huge proponent as you say, and he is bringing the “best and brightest” in the State to both UMMC and many private telehealth companies.<br /><br /><br />Kingfish, again, I think you are partially missing the point. There are currently 20 telemedicine companies practicing in Mississippi:<br /><br />•24 7 Dr. Help<br />•American Well<br />•ClickMedix<br />•Doctor on Demand<br />•E-Psychiatry<br />•First Stop Health<br />•FlexCare<br />•HealthTap<br />•InSight Telepsychiatry<br />•LiveHealth Online<br />•MDLive<br />•Memorial Hospital at Gulfport<br />•My Dr. Now<br />•North Mississippi Medical Center<br />•Specialists on Call<br />•St. Dominic Hospital<br />•Teladoc<br />•telehealthONE<br />•University of Mississippi Medical Center (UMMC) – Center for Telehealth<br />•WorldClinic<br /><br /><br />This has nothing to do with protecting only 'one system', and that one system being UMMC. It has very much to do with understanding the clinical implications of phone-only medicine (as the doctor at 9:07 AM and others have talked about above), and much more to do with implications of language in the bill itself.<br /><br /><br />You, nor anyone else have yet to directly address among others, the three huge glaring issues with the language in this legislation:<br /> <br /> <b>1) mandated patient-driven choice of technology even if this technology may not be appropriate</b>; <br />(<i>I want to start a taxi cab company, but I have to have an SUV, a convertible, and a truck to start it. Much more expensive to start this service now. A patient wants me to take them to the cold frozen mountains. I have a taxi vehicle that is 4 wheel drive and warm, but the patient insists it has to be in a top-down convertible. I now have to figure out how make my two wheel drive convertible go up the frozen mountain safely when it did not even make sense to be used in this context to begin with.</i>) <br /><br /><b>2) mandated equal cost regardless of communication method even if some methods are significantly cheaper</b>; <br /><br /><b>3) dangerous codification of physician-patient relationship that makes it easily defined for a singular visit and then easily terminated after one visit</b>;Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-75110275655365794052016-03-02T10:30:41.865-06:002016-03-02T10:30:41.865-06:00KF- agreed, UMMC has a great telemedicine program....KF- agreed, UMMC has a great telemedicine program. They just want to control the entire market. What do you expect from a state run system? Government run industry does not welcome competition. Jason Seagernoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-54296094563283142152016-03-02T10:06:33.188-06:002016-03-02T10:06:33.188-06:00I don't think anyone is saying UMMC has a bad ...I don't think anyone is saying UMMC has a bad system at all when it comes to telehealth. Its been innovative. However, the disagreement I think is over whether it is the only system or model that should be used. Kingfishhttps://www.blogger.com/profile/06184990110961727404noreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-9293604124260019982016-03-02T10:04:36.862-06:002016-03-02T10:04:36.862-06:00To the William Carey Student at 7:13-
Clearly you...To the William Carey Student at 7:13-<br /><br />Clearly you have no understanding of what these quality surveys measure. While their results have been disputed considering that the baseline is not based off the patient population and types of procedures that happen at UMMC, that is not the issue.<br /><br />Most of the quality measures rated are not at all related to anything that would happen over telemedicine.<br /><br />I suggest for you to learn more about how quality is determined for hospital systems and to then learn a lot more about telehealth.<br /><br />Assuming you are a medical student, best of luck in your pursuit of your D.O. degree. We need more primary care physicians in this state.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-24332635331028045462016-03-02T09:49:49.139-06:002016-03-02T09:49:49.139-06:007:07 PM
You may be some type of medical professio...7:07 PM<br /><br />You may be some type of medical professional considering your specific comments on Pathology, but you clearly have no understanding of the Specialty. Go back and do a rotation in Pathology.<br /><br />It is not an issue of forked tongues. It is an issue of understanding medicine at a level you clearly do not.<br /><br />Second opinion diagnoses and sub-specialty expert diagnoses (renal pathology, neuro pathology, dermatopathology) are sometimes absolutely essential in order to determine the correct diagnosis for a tissue sample. Sending a sample to an expert in a certain diagnoses is a great quality control tool to validate a diagnosis determined locally.<br /><br />Some of these expert sub-specialty pathologists are located throughout the country. <br /><br />For example, we have 3 or so dermatopathologists in the State.<br /><br />Your example of Pathology and Dermatology to try and prove your point just does not make any sense.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-90506762772990473602016-03-02T09:21:19.600-06:002016-03-02T09:21:19.600-06:00@ 7:07pm and @ 7:13am. As previously stated, the U...@ 7:07pm and @ 7:13am. As previously stated, the UMMC Center for Telehealth has received an A grade from the American Telemedicine Association. <br /><br />http://www.americantelemed.org/docs/default-source/policy/2016_50-state-telehealth-gaps-analysis--coverage-and-reimbursement.pdf?sfvrsn=2<br /><br />(reference page 9)<br /><br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-65998505611400557442016-03-02T09:07:11.640-06:002016-03-02T09:07:11.640-06:00I am very much in favor of telemedicine, with some...I am very much in favor of telemedicine, with some stipulations. Although there are many "specifics" to work out at this time, it IS the wave of the future, and there is no reason why MS shouldn't embrace it AT ITS BEST. However, there are many things that must happen to make it BEST. <br /><br />There are many things telemedicine can do simply over the phone without face-to-face contact as are done by most physician offices today: 1. durable medical equipment ordering, such as braces and splints, etc. 2. simple URI calls (which usually don't require an office visit at all. (most of the time the patient should go to the pharmacy and get symptomatic relief over the counter.) 3. Advice over the phone of WHEN to go to the emergency room . (Most of the time late night phone calls are about whether someone SHOULD go to the ER.)<br /><br />I am a touchy-feely type of physician, and, I believe that, in most circumstances, a "look is worth a thousand words." I want to SEE the patient, because my 35 years of practice tell me when someone is sick. However, playing "devil's advocate," when was the last time a physician actually EXAMINED YOU by "laying hands" on you? I've found that most physicians never touch their patients. And often, with the HORRORS of electronic medical records, never even LOOK at their patients.<br /><br />Instead of being obstructionistic, I would like to see MS embrace telemedicine, and find the best solutions to make telemedicine in MS the best for all patients. With most cellphones, a face-to-face may occur between a doc and a patient. What cellphone doesn't have Skype or FaceTime? "Fit-Bit" types of monitors can do this already, almost. Telemedicine stethoscopes? They already exist.<br /><br />Let's move forward on having patients with automatic blood pressure cuffs, pulse recorders, face-to-face interfaces, temperature probes, etc. that are uploaded to a physician for a consultation. Let's have scales and oxygen saturation apps that can be uploaded.<br /><br />In fact, why doesn't our Governor bring together the "best and the brightest" in our state and start a business incubator for all of this? There is NOTHING this state couldn't do to bring telemedicine to EVERYONE in MS and sell this technology to the rest of the world.<br /><br />There are many large hospital systems that employ physicians like me to sit in a room that monitors 20 -30 ICU beds from many different hospitals on cameras, and IMPROVES care immensely with peer-reviewed literature.<br /><br />I challenge this state, and the state's medical community, to find answers to existing problems with telemedicine, and to bring this EXTRAORDINARY technology to all our patients.<br /><br />BTW, I am personally knowledgeable about TelADoc. They have EXCELLENT credentialing and all their "practicing" physicians are licensed in the states in which they treat patients.Heddy-Dale Matthias, MDnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-10125975976031342252016-03-02T07:13:06.747-06:002016-03-02T07:13:06.747-06:00@9:59- UMMC is at bottom of the list. Does that me...@9:59- UMMC is at bottom of the list. Does that mean it's telemedicine program is bottom of the list as well? #smokeandmirrors #FWilliam Carey Studentnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-55968611467480749172016-03-01T23:19:26.455-06:002016-03-01T23:19:26.455-06:00Teladoc is the Oxford House of telemedicine: a lit...Teladoc is the Oxford House of telemedicine: a litigious out-of-state company whose survival depends on half-truths, threats of litigation, aggressive PR, and special treatment from the government...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-83251343730015189572016-03-01T21:59:52.559-06:002016-03-01T21:59:52.559-06:00http://www.residentphysician.com/Medicalschool_ran...http://www.residentphysician.com/Medicalschool_rankings.htmAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-13411959434775834242016-03-01T20:27:30.252-06:002016-03-01T20:27:30.252-06:00Dear Med students in Mississippi at the public ins...Dear Med students in Mississippi at the public institution; you attend a "Center of Excellence" that received a F. People around the country make fun of your Med school. Tell your leadership to raise their standards. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-26711288850069453202016-03-01T19:52:23.938-06:002016-03-01T19:52:23.938-06:00A good takeaway from this is Please let this appli...A good takeaway from this is Please let this application develop now, let people who want to use it go with it and the small kinks will get worked out with the who and whats. With modern technology so much of medical care is still held up by bottlenecks in systems. Not enough of one resource or another. Find those bottlenecks and remove them. Medical associations are more interested in keeping Doctors Incomes and power at an archaic level than getting this system to work.<br /><br />We also need a Truth In Billing Law nationwide whereby all charges are the same for cash payers, insurance companies and government pay. This would give the effect of removing the fear of medical bills, lower insurance rates and people would be more likely to pay when the charges are not the rip off rates that hospitals charge without the help of third party payers.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-30503908983168318192016-03-01T19:08:37.334-06:002016-03-01T19:08:37.334-06:00@1:53 - thanks Kristi -- I think you meant F@1:53 - thanks Kristi -- I think you meant FAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-21013360616922834592016-03-01T19:07:12.743-06:002016-03-01T19:07:12.743-06:00The Mississippi State Medical Association and the ...The Mississippi State Medical Association and the Board of Medical Licensure speak with, as Tonto said, "forked tongues." The are there to assure the quality of care by requiring a medical license in Mississippi for telemedicine and for any derivatives like it.<br /><br />Of course, that is not always the case with all specialties. The State Board and the Mississippi State Medcial Association have no problem with pathologists from out of state (and not licensed by the State of Mississippi) examining and rendering diagnoses for patients seen in Mississippi physician's offices. Gastroenterologists, dermatologists, and many others are free to send their tissue samples out of state (to non-Mississippi licensed physicians) and this has the "A-OK" from the Board and the Association.<br /><br />Forked tongues.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-36840257856907243902016-03-01T17:51:05.977-06:002016-03-01T17:51:05.977-06:00No one is talking about using a phone app to diagn...No one is talking about using a phone app to diagnose a stroke, heart attack, or other serious medical condition. However, for typical "bugs" such as the flu, colds, or something similar, I've yet convinced that the UMMC model of telemedicine is the only way. I've never said UMMC had a bad system. Quite the opposite. I've just said it is not the only model as well. <br /><br />If anything, Dr. Brunson should remove himself from the committee so as to remove any hint of a conflict of interest. Kingfishhttps://www.blogger.com/profile/06184990110961727404noreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-3245278176800571022016-03-01T17:46:13.608-06:002016-03-01T17:46:13.608-06:00This has nothing to do with UMMC being the only co...This has nothing to do with UMMC being the only competition. There’s a reason why many large private hospital systems in Jackson and all throughout the State (over 200 locations) are partnering with UMMC to provide complex telehealth services as appropriate. It’s not as simple as just “building your own program” or “making an app.” It is not an issue of raising capital much more quickly. There are very complex clinical protocols and mechanisms required for some of these services offered. This is all very expensive and has taken years to figure out and implement. It’s about building a network and system that does not cut corners and truly maintains the same standard of care as in-person.<br /><br /><br />I am talking about Stroke evaluations, Emergency Room to Emergency Room consultations, ICU monitoring and much more complex interactions than a phone call from a doctor to a patient via an iPhone for a sore throat.<br /><br /><br />Again, Kingfish, I would encourage you to check your facts. See how the Center for Telehealth is organized within the UMMC structure. You may be surprised that it is much more agile than typical ‘state institutions’. Research who its nationally recognized technology partners are for Remote Patient Monitoring. Learn about the history of the physician-patient relationship and its legal ramifications in telemedicine.<br /><br /><br />I’m for expanding access to care. I’m for TelaDoc figuring out how to increase access to care (to at least those with enough money for a smartphone that has access to internet). I'm for TelaDoc providing this care at the same level of quality as in-person and bearing the full responsibility for that physician-patient relationship.<br /><br /><br />I’m for innovation. This is just a bad bill.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-23230170022118744522016-03-01T17:44:36.658-06:002016-03-01T17:44:36.658-06:00I am not Dr. Easterling.
The issue and goal is no...I am not Dr. Easterling.<br /><br />The issue and goal is not to stifle competition. 2:03’s statement is true and I agree with it, however, 2:03 is failing to address policy issues specific to this <a href="http://billstatus.ls.state.ms.us/documents/2016/pdf/HB/1100-1199/HB1178PS.pdf" rel="nofollow">bill</a>.<br /><br /> 1)<b>The bill’s adverse effects of stipulating that patients, not qualified health professionals, drive the choice of telemedicine technology</b> [Section 1, Part 9]<br /><br /> 2) <b>The bill’s adverse effects of mandating that cost of services be the same regardless of communication method</b> [Section 1, Part 9]<br /><br /><br />These two issues have the possibility to be harmful to the innovation we all want and dangerous from a health outcomes perspective.<br /> <br /><br />Even more harmful is <b>Section 1 Part (3)</b> of the <a href="http://billstatus.ls.state.ms.us/documents/2016/pdf/HB/1100-1199/HB1178PS.pdf" rel="nofollow">bill</a>.<br /> <br />***It tries to specifically classify the physician-patient relationship in the context of telehealth. Lines 26-28 state that this physician-patient relationship can be terminated when<br /><br /><br /><i>“the physician agreed to treat or diagnose only a specific condition or agreed to diagnose or treat only at a specific time or place and that condition diagnosis or treatment has ended”</i><br /><br /><br />**Based on this language, I can over the phone only consent to treat you for only one specific visit and treat your headache based only over what symptoms you describe to me in that specific visit. If you think the issue resolved and later something much more serious happens, well our physician-patient relationship was established and terminated only in the very specific context described above. I am not liable.<br /><br />I am not trying to fear monger. I am simply pointing out a terrible flaw in the proposed language that should be addressed. Teladoc is indeed disrupting the way healthcare is delivered and that is a good thing. But they too understand their limitations of voice only consultations and are moving in 2016 towards partnerships with companies like <a href="https://kinsahealth.com/" rel="nofollow">Kinsa</a> (thermometer that connects to your phone) to provide a much needed level of interaction in order to begin to address the issue of the level of care being the same as in-person.<br /><br /><br />And this directly ties into the fact 2:03 also does not address the difference between phone medicine and the definition of telehealth.<br /><br /><br /><b>-As earlier stated, phones are great tools currently employed by virtually all physicians in existing provider-patient relationships for management of known conditions. Using them to strictly diagnose is much different.</b><br /><br /><b>-Telehealth uses an audio-visual connection that includes otoscopes and stethoscopes that allows a physician to simulate everything involved in a physical examination except for smell. This is crucial for quality of care and diagnosing appropriately.</b><br /><br /> <br />I’m for TelaDoc trying to innovate a way to deliver care through phone only. It is a noble effort, and there are many partnering companies like Kinsa above helping in this endeavor. However, if they are going to do so in this State, they should not be absolved of liability and responsibility through an arguably bad specific definition of the physician-patient relationship.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-23189548548927905142016-03-01T15:12:28.689-06:002016-03-01T15:12:28.689-06:00UMMC has a very good telemedicine program. Howeve...UMMC has a very good telemedicine program. However, why does their system have to be the only way allowed? There can be different models. There is nothing stopping local networks such as St. Dominic and MBMC from creating their own programs and building apps. <br /><br />However, what I suspect will happen is the private sector providers will be able to move more quickly than UMMC. They can raise capital much more quickly, aren't subject to bid laws and other features of government, and can make decisions much more quickly. Kingfishhttps://www.blogger.com/profile/06184990110961727404noreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-64023712016010058032016-03-01T14:28:07.568-06:002016-03-01T14:28:07.568-06:00*I have dropped my membership to MSMA... Not have ...*I have dropped my membership to MSMA... Not have notAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-35492047420018271682016-03-01T14:20:23.299-06:002016-03-01T14:20:23.299-06:00@1:12 - I believe it is UMMC not UMMV. You are cor...@1:12 - I believe it is UMMC not UMMV. You are correct about the F grade. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-1138256585661375232016-03-01T14:05:17.557-06:002016-03-01T14:05:17.557-06:00I dropped my membership to the AMA for endorsing O...I dropped my membership to the AMA for endorsing Obamacare. I have not dropped my membership to MSMA for opposing this bill. Our associations are anti free market. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-65482996487942427472016-03-01T14:03:36.805-06:002016-03-01T14:03:36.805-06:00Let's ask ourselves why the push back by UMMC,...Let's ask ourselves why the push back by UMMC, Dr. Easterling and the Board of Medical Licensure? Is it about the competition? Why would they be against a proven method of patient interaction? Especially when we are the sickest state in the nation?<br /><br />Telemedicine is not new and was not started by UMMC/Dr. Henderson. During the 1990's, national groups, including physicians and private companies, worked on telemedicine of many different forms. This bill requires Mississippi licensed physicians - that's why the Board of Medical Licensure should exist - licensure. It should not be up to a few to continue to keep Mississippi down - many companies and physicians are using telephone and other telemedicine products with great success. <br /><br />Let's start thinking about health care policy for the year 2016 instead of 30 or 40 years ago.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2447438783001404385.post-47595940723178433172016-03-01T13:53:42.399-06:002016-03-01T13:53:42.399-06:00The UMMC Center for Telehealth has received an A f...The UMMC Center for Telehealth has received an A from the American Telemedicine Association. UMMC's Center for Telehealth is leading the nation in it's efforts. Anonymousnoreply@blogger.com