Archive for December, 2009

In Health Care Today, It’s Electronic All the Way

Tuesday, December 22nd, 2009

Imagine that you see a new mole and don’t like the looks of it so you take a picture of it using your cell phone and e-mail it to your family doctor for an opinion.

Or perhaps you have heart disease and take your blood pressure using a cuff that automatically uploads the data to your cardiologist’s computer for review.

Using electronic communications equipment to transmit medical information for consultation or examination — known as telemedicine — has come a long way from its beginnings as a means for rural areas to have access via teleconferencing to top-flight specialists.

In fact, technology has advanced to the point that telemedicine is beginning to blur into the normal daily routine of a doctor, said Dr. Jason Mitchell, assistant director for the Center for Health Information Technology of the American Academy of Family Physicians.

“Someday we won’t even consider it telemedicine anymore,” Mitchell said. “It’ll just be part of the way we practice medicine.”

And evidence is mounting that telemedicine can play a positive role in health care. A study in the journal Stroke found that the use of teleconferencing and the transmission of CT brain scans is beneficial to the initial treatment of stroke victims, later assessment of the amount of brain damage they’ve received and the rehabilitation they will go through during their long-term recuperation.

Some new ways of practicing medicine already taking place that could be considered telemedicine include:
Ambulances transmitting EKG data to the hospital they’re en route to
Automated pill counters that transmit data that lets doctors know whether medications are being taken as prescribed
Teleconferences to bring in specialists for consultation in such fields as dermatology, neonatal care, surgery and psychotherapists
Electronic scales for heart patients that trigger an alert to a nurse if the patient’s weight increases dramatically

“One of the best early indicators for impending hospitalization for patients with congestive heart failure is an increase in body weight,” said Dr. Lee H. Schwamm, vice chairman of the neurology department and director of TeleStroke & Acute Stroke Services at Massachusetts General Hospital in Boston and an associate professor of neurology at Harvard Medical School.

Schwamm describes such examples of telemedicine as “low-hanging fruit,” easily done to great advantage for both the patient and the doctors involved.

Telemedicine could be a boon to preventative medicine, Mitchell and Schwamm said, giving doctors access to detailed data that would allow them to diagnose problems early. For example, data from the scales or the blood pressure cuff could give doctors a chance to get someone in for treatment before a heart attack or stroke occurs.

“It would identify for us when a patient should be seen rather than relying on the patient for that judgment,” Schwamm said. “In my mind, that’s the real promise.”

Telemedicine also could provide tremendous cost savings. People might not have to take time off from work and drive to see their doctor to have a question or concern addressed. And people with serious illnesses might not have to travel hundreds or thousands of miles for a consultant’s opinion. “It’s expensive and inefficient to move people around when many visits require minimal care,” Schwamm said.

Some impediments must be overcome, however. Insurance companies have not ironed out how a doctor should be compensated for different types of telemedical service. “That takes time. That takes expertise,” Mitchell said. “There should be some level of compensation for making that happen.”

And there are administrative barriers, too, Schwamm said. For example, can a doctor licensed and credentialed in one state “see” patients from another state via an Internet video link?

Mitchell believes telemedicine ultimately will strengthen people’s relationships with their doctors, allowing them to share health information more easily. However, people first need to have a relationship with a doctor they trust.

“This is an adjunct to a relationship with a physician that’s already there,” Mitchell said. “I don’t think the electronic interactions are going to completely replace the personal interaction, but they can augment them. You don’t have to be standing in front of a physician to accomplish certain things, but that hands-on interaction needs to be there in many cases.”

Don’t write off doctor visits just yet, though.

“It’s important to never underestimate the healing power of human touch,” Schwamm said.

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Most Adult Americans at Some Risk for Heart Disease

Tuesday, December 1st, 2009

Decades of steady progress against heart disease may be on the wane, experts say, with a new study showing that only 7.5 percent of Americans are now in the clear when it comes to heart disease risk factors.

The continuing U.S. obesity epidemic may bear much of the blame for the downturn, the researchers added.

“Our results raise the concern that a worsening cardiovascular risk profile in the population could potentially lead to increases in the incidence and prevalence of cardiovascular disease,” said lead researcher Dr. Earl S. Ford, from the U.S. Centers for Disease Control and Prevention. “Potential increases in cardiovascular disease and diabetes could affect the nation’s medical costs.”

Another expert agreed. Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, called the study “a wake-up call to the entire country to take more responsibility for their health by knowing their own cardiovascular risk factor profile and, in consultation with their physician, to take proactive steps to reduce their cardiovascular risk.”

The report is published in the Sept. 14 online edition of Circulation.

For the study, Ford’s team collected data on adults 25 to 74 years of age. They specifically looked for low-risk factors for heart disease — items such as not smoking, having low blood cholesterol, normal blood pressure, normal weight and no sign of diabetes.

Using data from the U.S. National Health and Nutrition Examination Surveys, Ford’s group found that in 1971 to 1975, a paltry 4.4 percent of adults had all five of these heart-healthy factors. However, by 1994 that number had risen to 10.5 percent of adults.

But the latest data, from 2004, found that the fraction of American adults with all five healthy characteristics had dropped to 7.5 percent.

Minorities tended to fare worst, since whites tended to have more low-risk factors than either blacks or Mexican-Americans, the report found.

Why the slide back in terms of heart health? Ford cited three reasons: “decreases in the percentages of adults who were not overweight or obese, who had a favorable blood pressure, and who did not have diabetes.”

There was one “bright spot,” however, a “decrease in the percentage of adults who were not currently smoking,” Ford said.

Because excess weight is a major cause of diabetes and hypertension, it is critical that the percentage of adults who are overweight or obese be reduced, the researcher said.

“To effect such change, the efforts of many will be required,” he said. “Furthermore, efforts at reducing smoking and improving nutritional practices to lower cholesterol concentrations in the U.S. population should be sustained. Clearly, there is a lot of room for improvement.”

Rob M. van Dam, an assistant professor of medicine at Harvard Medical School and author of an accompanying journal editorial, said that “the decline in cardiovascular disease mortality in the U.S. seems to be coming to an end and may even reverse because obesity and obesity-related conditions such as hypertension and type 2 diabetes are on the rise.”

“This alarming development is occurring despite great improvements in medical interventions to prevent cardiovascular diseases,” he said. “It is of particular concern that these trends do not yet reflect the consequences of the current epidemic of childhood obesity.”

Millions of Americans are now beginning their adult lives obese, van Dam noted. That could greatly increase their risk of chronic diseases and premature mortality.

“To fundamentally address this issue, population-wide initiatives are needed to prevent obesity,” he said.

Fonarow agreed. “If these trends continue, the recent gains in life expectancy in the U.S. will be lost,” he said.

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