Content: Day 1 ATA (American Telemedicine Association) Mid-Year Meeting ... Priceless!

[CC-Conrad Clyburn-MedForeSight]

"It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” ... Charles Darwin

Colleagues,

In the continuing quest to bring you the 3Cs of "Content, Community and Collaboration", I offer you a summation of Day 1 of the ATA Mid-Year meeting in Baltimore, Maryland ...

Every so often we get to see something important. In a perfect embodiment of the "Triple Helix" of Academic, Industry, Government collaboration the ATA presented a meeting yesterday that may be looked back upon as a milestone in the progression of "Telemedicine, mHealth, eHealth" into the mainstream of American healthcare ...

The meeting was opened by an Academic, ATA President Dr. Dale Halverson, M.D., Director, Center for Telehealth, University of New Mexico, who offered his welcome to the 500 or so assembled attendees. He was followed by Government presentations from the FCC (Federal Communications Commission), the NIH (National Institutes of Health), and a capstone presentation by Dr. Don Berwick, M.D., the recently installed Director of CMS (Centers for Medicare and Medicaid Services) ... Dr. Berwick's presentation was followed shortly thereafter by ATA Board Member, Dr. Reed Tuckson, M.D., Senior Vice President, United Health Group, an Industry representative from the nation's largest health insurer...

... The exhibit hall was populated by Industry consolidators including GE Healthcare, Phillips, Polycom, Cisco/Tandberg, and rapidly growing smaller colonizer companies such as AMD Telemedicine, Global Media, InTouch Health, WellDoc, Waldo Health, Cardiocom, MedVision, MedApps and IdeaLife ...

Medical technology is translated from "Lab to Market" thru an intricate interplay between Academic "Pioneers", who create innovation (funded and regulated by Government), initially brought to market by Industry Colonizers, and scaled to mass markets by Consolidators...

We saw all these forces in play yesterday. Congratulations to the organizers of the ATA 2010 Mid-Year meeting for skillfully bringing together all of the elements of the "Triple Helix". We look forward to Day 2 of the meeting which will feature more presentations from the FDA (Food and Drug Administration), Continua Health Alliance, HRSA (Health Resources and Services Administration), and Academic experts ... We can all anticipate even more interesting developments as ATA leadership is transitioned to venture capitalist, astronaut and physician, President-Elect Dr. Bernard Harris, M.D., in 2011.

... Interesting times indeed!

Look out for subsequent MedTech-IQ posts. We will be providing details you can use about the new funding opportunities discussed at the meeting coming from NIH, CMS, HRSA, ect., and as always ...

ENJOY!

CC

[Avi Dey]

Looking at the AZ Model for Telemedicine & Health Innovation+ IT linked to Tornado risks at AZ-NM-TX border georgaphy ?

We have initiated a discussion via a proposed project Twin Project USA C2C anchored with Southern Arizone, with Tucson as a possible "anchor". AZ is an inteesting population distribution. Most of the state's population is in two "urban" hub, in the south this being, Tucson, surrounded by vast issolated rural populations where telehealth+ IT is a logical choice. Your second point regarding cross-border fits well in this geography, by extending from this "urban hub' to outreach in the issolated regional population in the surrounding area , cross-border in NM, TX & OK. This topic is proposed as a "model" for examination via Twin Project USA C2C, with anchor at Tucson. My link at Tucson right now is Michael Faraday, a Facebook friend, who moved in retirement from VA to AZ, about 100 miles south of Tucson, a rather issolated rural area. I am seeking broader discussion in the context also of preparation and response to a possible tornado for emerency medicine for this rural geography. Tornados have high probablity in this geography according to govie stats, twice that of our risk here at Chesapeake Bay geogrpahy. Question: Can anyone suggest links to look at PPP in this region that combines these two issues in the context of 'emergency medical' response, on the seven issues relating to preparation & response for natural disasters ?

(we will ignore the earthquake risk issues in this region for the moment as not to get too many elements !).

[John A. Liebert, MD]

Avi Dey raised the question of applicability of the McGill/Quebec model to the USA because of the unique vastness and large remote, diversified populations of this province. This is a good point in regard to the Commonwealth of Virginia and majority of state like it - i.e. smaller scale with both well served urban areas with Medical Colleges and rural and underserved areas like Blacksburg, site of Virginia Tech massacre. Although there are more states like South Dakota than he mentioned that are similar in scale and demographics to Quebec, Avi Dey makes a good point. Perhaps we need to start thinking beyond state boundaries, as does the Army need to do; a telehealth system deployed now services Fort Leonard Wood in Missouri as well as Fort Lewis in Washington. There are reasons for this; however, geography and state boundaries obviously have nothing to do with it. With satellite wireless infrastructure, jurisdicitional boundaries will be less important, whereas aligned needs should become more important. For example, the Quebec model may not have significance to Virginia's healthcare delivery needs, but it may have relevance to NATO in Operation Enduring Freedom because of extreme climatic condtions and remoteness of medics working in Central Asia. Similarly, the urban medical centers of Mid Atlantic States might begin to start thinking beyond their traditional jurisdicitional cachment areas; there are many remote areas nearby that are underserved in certain specialites- i.e. Western Viriginia (Blacksburg) and West Virginia - in fact, Appalachia in general. I work in Phoenix and Northern Arizona; most of Arizona is remote and underserved, despite presence of The University of Arizona School of Medicine in Tucson and many large medical centers in Phoenix. Still, the Navajo Nation is the size of Connecticut and very similar to a third-world nation socioeconomically; it is almost entirely in Arizona. So, one might consider the Four Corners region, rather than any one of the four states meeting there; it is a long ways from there to 24/7 multispecialty services! John Liebert, MD

[John A. Liebert, MD]

Re Commonwealth of Virginia: I think that the Virginia Tech Massacre demonstrated the need for Telehealth to leverage clinical assets on campuses - particularly more remote ones like VT, because educational institutions cannot ramp up healthcare services to meet the new demands of 20 million young adults now on campus. A significant percentage of them are on psychotropic meds or need to be; this is a new phenomenon. But, as in case of VT, there were inadequate campus resources to deal with a young man obviously deteriorating mentally before all who were in his presence. There was no mention in the Commonwealth report on this massacre re potential to leverage urban to rural psychiatric assets - i.e. UVA to Cook Counseling via Telepsychiatry. Instead, there was a minor change in the Involuntary Commitment Law that would not have made any difference in the case of Cho. And, there was an increase of funding for Emergency Crisis workers for state ERs, which also would not have helped in this case. For this disaster, Telepsychiatry could have been key to prevention of a disaster. John Liebert, MD

[Avi Dey]

Follwo up on "Telemed" elements & Non-Telemed elements to link Urban-Rural on a geography.

Like to see more specific comments or discussion on two key topics now being discussed in Virginia by industry/govenrment/non-profis where telemed is a key issue for innovation but not the dominant element.

Topic 1: Response & Preparation for Hurricane & Tornado (link rural communities with urban geography as is logical to do) for this topic that has been identfifed as 7 elements including emergency medical via telemed & linked telecom.

Topic 2: Health Innovation & Diagnostics via Health+ IT format (linking rural & urban on geography)
again, telemed is a key element but not the dominant element.

comments toward outocme of PPP as you have discussed in these two context for follow ups ?

[John A. Liebert, MD]

Conrad, Thank you for bringing this information to us. Your citing The Helix of development from idea to deployment is critically important. For example, McGill University Faculty of Nursing is developing a Telenursing program for remote Quebec - most of that province. It will integrate Computerized Clinical Decision Support for Interview, Workup and Triaging MCIs that enables Triage nurses in Montreal to support initial assessment and continuous navigation of patients for Prehospital Care. Significantly, Quebec has no Medical Helicopters - just a couple of fixed wing planes. It is so important, therefore, for the scattered health care professionals throughout the province to have continuous 24/7 support from the major medical center at McGill. Because of the extreme climate and broad diversity of remote populations served multilingually, the challenges for parsing protocols and development of durable, wearable computers is also a challenge. Assuming we succeed, of course, this project will have significant potential for Operation Enduring Freedom, because of extreme cold and remoteness of medical communications and coordination. But, through McGill's traditional Tropical Medicine school that dates back to colonial support of The West Indies, it also has potential for third world nations. The process you describe is more complex than most can conceive, but your portraying how participants at this conference interface really provides hope for distributing higher quality health care to the remote regions of the world. In the case of Quebec, of course, one has not only the urban problems of two large cities, but the cultural diversity of First Nations Peoples in the Arctic; increasing multinational military buildup in the newly-navigable Arctic Ocean - or, a real Northwest Passage - and both modern industrial populations serving mining and HydroQuebec - source of most Northeastern America's electric power. And, we cannot forget that Natasha Richardson would have had a lot better chance to survive her skiing accident in Quebec, had her initial clinical encounter with Medics and prehospital care been supported by Telenursing from McGill. She was not thirty minutes from a Level II trauma center, but was, instead, transported by land to Montreal, thus sacrificing her Golden Hour.
Thank you for this excellent and timely reporting, John Liebert, MD