High-tech health care

When the University of Virginia launched its telestroke program in 2009, stroke victims in the commonwealth faced grim prospects. Certain parts of the state, especially rural areas, lack access to stroke-neurological services. As a result, less than one-half of 1 percent got a timely dose of a clot-dissolving drug called tissue plasminogen activator, or TPA. Although powerful, the drug must be administered within three to four hours of the onset of a stroke.

Four years after the inception of U.Va.’s telestroke program, the number of stroke patients to receive TPA now has increased to 17 percent. It is one clear example of how telemedicine is helping Virginia improve the quality and delivery of health-care services, says Dr. Karen Rheuban, medical director of U.Va.’s Office of Telemedicine. “The hospitals to which we’re connected had previously never administered TPA,” she says.

Stroke intervention is just one part of U.Va.’s telemedicine program, which connects 108 hospitals and clinics in Virginia. It enables physicians across the state to consult with specialists in more than 40 subspecialties, including prenatal care, acute care for seniors, chronic disease management and tele-psychiatry. A similar telemedicine program is in place at Virginia Commonwealth University Medical Center.

Long known as a high-tech hotbed, Virginia is being hailed as a leader in the use of technologies that promote telemedicine. In particular, Virginia outpaces most states in deployment of high-speed broadband connectivity, a necessary component to advancing tele-health initiatives, according to a recent study by Virginia’s Center for Innovative Technology (CIT).

Across Virginia, average download speeds jumped 22 percent from 2011 to 2012, reaching 8.3 megabytes of data per second (mbps). That’s good for eighth place in the U.S., the report says.

During the same time frame, more Virginia hospitals upgraded to superfast fiber networks for rapid exchange of data, CIT says. The average download speed at Virginia hospitals skyrocketed 35 percent, to more than 47 mbps in this year’s study. The result: 54 percent of Virginia hospitals now are able to offer some form of tele-health services, well above the national average of 42 percent.

“Virginia health-care providers are continuing to find that tele-health not only improves patients’ access to quality care. It also helps them better coordinate care among diverse providers, which helps improve patient outcomes and drives inefficiencies and cost out of the system,” says Kirby Farrell, CEO of Broad Axe Technology Partners, a Charlottesville-based consulting company that helped compile CIT’s report.

Speed cures
Nearly all Virginia hospitals use some form of broadband communications, the report says, with 52 percent using dedicated high-speed fiber and nearly 39 percent using cable. About 28 percent of providers get their access through digital subscriber lines, whose use declined about 4 percent since 2011.

The report notes rising use of systems that permit secure electronic exchange of medical records. About 90 percent of Virginia’s hospitals use health-care records systems that are at least partially electronic. Among smaller physicians’ practices in Virginia, 59 percent have adopted electronic systems, up 17 percent year over year.

Telemedicine got a big lift when Virginia lawmakers in 2010 passed a bill that requires health insurers, HMOs and health-care subscription plans to reimburse physicians for telemedicine services. That “opened the field up for many providers in Virginia to use telemedicine as a tool for delivery of care,” says Rheuban, whom McDonnell appointed to serve on Virginia’s Board of Medical Assistance Services in 2012.

Electronic records sharing is expected to become more firmly entrenched once Virginia’s statewide health information exchange becomes fully operational in 2014. Known as ConnectVirginia, the initiative was launched in 2011 with nearly $12 million in federal stimulus money. The exchange is administered by the Office of Information Management and Health Technology at the Virginia Department of Health (VDH).
(Health information exchanges are not to be confused with the creation of state-by-state health insurance exchanges, which would let patients shop around for the best coverage. The insurance exchanges were mandated as part of the federal Patient Protection and Affordable Care Act).

ConnectVirginia is one of the first HIEs to be based on the Nationwide Health Information Network, a federal effort that defines the standards, technology specifications and policies that govern the secure exchange of health information via the Internet.  It was enacted as part of the American Recovery and Reinvestment Act of 2009.

Adhering to nationally recognized standards enables ConnectVirginia to build a scalable system, says Sandy McCleaf, its executive director. “Some states are exchanging more information than Virginia is, but the systems are based on proprietary technologies or older specs that will need to be updated. We waited for national standards so our system could interoperate as much as possible, not only for Virginia providers but for those in other states as well,” McCleaf says.

ConnectVirginia is optional for patients and health-care providers. Patients that sign up to participate consent to let their medical information be shared among providers as needed. Meanwhile, health-care providers sign agreements to adhere to national standards on technology and data privacy.

Virginia’s system differs in another way. While some states keep patient data in a centralized database, ConnectVirginia uses cloud computing to enable providers to query one another and “push” patient information across a secure messaging platform in real time. “It eliminates sending a fax or waiting for an envelope to arrive in snail mail,” McCleaf says.

ConnectVirginia is recruiting health-care providers to join its exchange. Last year, Falls Church-based Inova Health System became the first provider to sign up for ConnectVirginia. McCleaf says other large hospital systems are being recruited to join.

The program is funded through VDH this year but needs to be self-sustaining by 2014, McCleaf says.

Virginia continues to flex its muscle in telemedicine in other ways. U.Va. has been instrumental in helping expand the reach of tele-health initiatives to neighboring states. U.Va.’s Center for Telehealth in 2011 received a $1 million grant from the U.S. Health Resources and Services Administration. Rheuban says the federal money was used to create the Mid-Atlantic Telehealth Resource Center, which includes health-care providers in seven states and the District of Columbia.

In the meantime, the promise of telemedicine continues to emerge. Virginia physicians are using technologies to give patients broader access to treatment and obtain better results. U.Va.’s program for high-risk obstetric patients has helped reduce the number of pre-term deliveries in the commonwealth by 25 percent, in part because expectant mothers don’t need to travel to a doctor’s office for consultation, Rheuban says. Telemedicine also is being used for remote in-home monitoring of patients, including those recently discharged from hospitals or suffering from chronic illness. 

It is difficult to predict how health care will evolve in the future, but one thing seems clear: telemedicine is here to stay, and Virginia’s providers seem poised to play a key role.