^ Arora, Sanjeev; Thornton, Karla; Murata, Glen; Deming, Paulina; Kalishman, Summers; Dion, Denise; Parish, Brooke; Burke, Thomas; Pak, Wesley; Dunkelberg, Jeffrey; Kistin, Martin; Brown, John; Jenkusky, Steven; Komaromy, Miriam; Qualls, Clifford (2011). "Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers". New England Journal of Medicine. 364 (23): 2199–207. doi:10.1056/NEJMoa1009370. PMC 3820419. PMID 21631316.
One especially successful telemedicine project funded by the government was called the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), and was a partnership between NASA and the Indian Health Services. The program funded remote medical services to Native Americans living on the Papago Reservation in Arizona and astronauts in space! Projects like STARPAHC drove research in medical engineering, and helped expand advancements in telemedicine. The next few decades saw continued innovations in telemedicine and wider research at universities, medical centers and research companies.
As of 2015, Teladoc was the only telemedicine company to be publicly traded on the New York Stock Exchange. In December 2016, the American Hospital Association exclusively endorsed Teladoc's telehealth technology platform. Teladoc now operates its full suite of services 24 hours a day, 365 days a year, by web, phone, or mobile app in 48 of the 50 states.[7]

How much and which telemedicine services private payers pay for again can vary widely by state. While the trend is toward broader coverage of telemedicine services for plan enrollees, private payers are still deciding on exactly what they will cover and what they won’t. 29 states and Washington, DC have passed telemedicine parity laws, which mandate that private payers in those states pay for telemedicine services at the same rate as in-person visits.
With the nation’s estimated 1,400 rural hospitals looking to stay afloat in a challenging economic environment, connected care networks like Avera’s are part of a growing trend. Rural critical access hospitals – the spokes - see the virtual care platform as means of augmenting limited resources, keeping their patients in the community and reducing transfers.  Larger health systems, which serve as the hub, use the network to extend their reach, develop new business lines and reduce transfer and ED traffic that might strain their own resources.

^ Wadsworth, Hannah E; Galusha-Glasscock, Jeanine M; Womack, Kyle B; Quiceno, Mary; Weiner, Myron F; Hynan, Linda S; Shore, Jay; Cullum, C. Munro (2016). "Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment". Archives of Clinical Neuropsychology. 31 (5): 420. doi:10.1093/arclin/acw030. PMID 27246957.
Disease Management: A coordinated and continuous health process for the purposes of managing and improving the health status of a specifically defined population of patients over the complete course of the disease (e.g., DM, CHF). The targeted patient populations are high-cost, high-risk patients that have chronic conditions that require appropriate care in order to be maintained properly.
As of 2015, Teladoc was the only telemedicine company to be publicly traded on the New York Stock Exchange. In December 2016, the American Hospital Association exclusively endorsed Teladoc's telehealth technology platform. Teladoc now operates its full suite of services 24 hours a day, 365 days a year, by web, phone, or mobile app in 48 of the 50 states.[7]
A pathologist, Ronald S. Weinstein, M.D., coined the term "telepathology" in 1986. In an editorial in a medical journal, Weinstein outlined the actions that would be needed to create remote pathology diagnostic services.[65] He, and his collaborators, published the first scientific paper on robotic telepathology.[66] Weinstein was also granted the first U.S. patents for robotic telepathology systems and telepathology diagnostic networks.[67] Weinstein is known to many as the "father of telepathology".[68] In Norway, Eide and Nordrum implemented the first sustainable clinical telepathology service in 1989.[69] This is still in operation, decades later. A number of clinical telepathology services have benefited many thousands of patients in North America, Europe, and Asia.
Telehealth, the use of electronic communication to remotely provide health care information and services, is gaining more and more attention as providers, patients, and payers all seek more effective and cost-efficient ways to deliver care. Physical therapy is no exception, and while those services have developed mostly in rural areas to accommodate the long distances between patients and providers, telehealth in physical therapy is being considered in other geographic and clinical settings.
In 2014, the government of Luxembourg, along with satellite operator, SES and NGOs, Archemed, Fondation Follereau, Friendship Luxembourg, German Doctors and Médecins Sans Frontières, established SATMED, a multilayer eHealth platform to improve public health in remote areas of emerging and developing countries, using the Emergency.lu disaster relief satellite platform and the Astra 2G TV satellite.[93] SATMED was first deployed in response to a report in 2014 by German Doctors of poor communications in Sierra Leone hampering the fight against Ebola, and SATMED equipment arrived in the Serabu clinic in Sierra Leone in December 2014.[94] In June 2015 SATMED was deployed at Maternité Hospital in Ahozonnoude, Benin to provide remote consultation and monitoring, and is the only effective communication link between Ahozonnoude, the capital and a third hospital in Allada, since land routes are often inaccessible due to flooding during the rainy season.[95][96]
ISDN Primary Rate Interface (PRI): An ISDN interface standard which operates using one 64K data channel and 23, 64K channels. When the right multiplexing equipment is used, the user can selected the IDN PRI channels for a video call. As an example, if a user would like to have his videoconference at 384K bandwidth, the multiplexer can be instructed to utilize channels 1-6 (6 x 64k= 384k). It is actually quite importance since usually the user pays charges that are based on how many 64k channels get used on a videoconference. So the fewer channels that have to be used to get a quality video signal, the lower the cost of the call will be.
More accessible, convenient healthcare for patients is the driving force behind the telemedicine field. Telemedicine was originally developed in the U.S. as a way to address care shortages, especially in remote rural areas. Now telemedicine is used around the world, whether it’s to provide basic healthcare in third-world countries or allow an elderly patient with mobility issues to see the doctor from home. Telemedicine has the power not only to break down typical geographical barriers to care access, but to make the entire healthcare delivery model more convenient to patients.

Telehealth technology will play a critical role in meeting the healthcare needs of the US long into the future. It increases access, reduces costs, and provides a more convenient delivery channel for patients and providers alike. Practices that embrace the technology now will protect themselves from increasing competition, develop closer relationships with patients, increase profitability, and help their patients stay healthier. We’re proud to be helping make all of that happen for our customers.
Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.

More widespread use and success of telehealth applications might spur the resolution of these reimbursement issues. CVS has been providing clinical services via telehealth since 2015. According to their study in the Journal of General Internal Medicine, 95 percent of patients “were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” If CVS’s merger with Aetna is finalized, increased competition may motivate other payers to find ways to offer telehealth services and, by extension, levels of reimbursement. 


Telehealth requires a strong, reliable broadband connection. The broadband signal transmission infrastructure includes wires, cables, microwaves and optic fibre, which must be maintained for the provision of telehealth services. The better the connection (bandwidth quality), the more data can be sent and received. Historically this has priced providers or patients out of the service, but as the infrastructure improves and becomes more accessible, telehealth usage can grow.[1][2]
Router – This is a device which provides connection to at least two networks on an organization. It provides network connection on multiple locations and it is responsible in finding the best route between two sites. It tells the videoconferencing devices where the destination devices can be found and it will find the best way to gather the information from that specific destination.

Telecare is the term that relates to technology that enables patients to maintain their independence and safety while remaining in their own homes. This technology includes mobile monitoring devices, medical alert systems, and telecommunications technology like computers and telephones. Continuous remote monitoring of patients enables telecare to track lifestyle changes over time as well as receiving alerts relating to real-time emergencies.


Patients should ask their doctor, hospital or healthcare provider about telemedicine services that are already available. In many cases, the provider may have an existing home health monitoring program or other telemedicine services.  There are also numerous private companies that sell basic telehealth services, including 24/7 access to a health professional, remote monitoring, medication adherence and online wellness apps.


Mobile Telehealth Clinic – This involves using vehicles like van, trailer or any mobile unit to provide health care services for patients. The services are given by health care professionals. This is helpful to those who are living on areas far from the hospital. Some mobile units are equipped with medical technologies that are found in the hospital like mobile CT, MRI and TeleDentistry.

State legislation determines the restrictions and often, the reimbursement rates for telemedicine services administered in that state. For instance, any state that has passed a telemedicine parity law has mandated that private payers in that state to reimburse telemedicine visits at the same rate as a comparable in-person visit. While a majority of states have now passed telemedicine parity laws, changing state legislation is often a time-consuming, unwieldy process and can have a huge impact on the telemedicine practices in that state.


Referring to health information services, health care education, and health care services in a broad sense, the term telehealth is an all-encompassing one. In fact, telecare and telemedicine are generally covered within the broader scope of the term telehealth. Included in telehealth are health education services, remote monitoring of vital signs, ECG or blood pressure and remote doctor-patient consultations (telemedicine). Telehealth technology enables the remote diagnoses and evaluation of patients in addition to the ability to remote detection of fluctuations in the medical condition of the patient at home so that the medications or the specific therapy can be altered accordingly. It also allows for e-prescribe medications and remotely prescribed treatments.
The creation of telemedicine began with the inception of the telecommunications infrastructure, which included the telegraph, telephone, and radio. Casualties and injuries were reported using the telegraph during the Civil War, in addition to the ordering of medical supplies and consultations. This is considered one the earliest adoptions of telemedicine technology.
Router – This is a device which provides connection to at least two networks on an organization. It provides network connection on multiple locations and it is responsible in finding the best route between two sites. It tells the videoconferencing devices where the destination devices can be found and it will find the best way to gather the information from that specific destination.
Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.[22][23]

The technological advancement of wireless communication devices is a major development in telehealth.[19] This allows patients to self-monitor their health conditions and to not rely as much on health care professionals. Furthermore, patients are more willing to stay on their treatment plans as they are more invested and included in the process, decision-making is shared.[20][21] Technological advancement also means that health care professionals are able to use better technologies to treat patients for example in surgery. Technological developments in telehealth are essential to improve health care, especially the delivery of healthcare services, as resources are finite along with an ageing population that is living longer.[19][20][21]
Likely one of the most popular specialities for telemedicine, mental health practices can increase revenue, streamline patient flow, and provide counselling sessions from anywhere. With telemedicine, patients in rural areas can now access mobile and web apps to speak with their therapist. In addition, cancellations and no-shows are less likely to occur. Mental health practices that implement telemedicine can also see more patients and still provide a high level of patient care. This leads to increased profitability and effective time management.
Today, most people have access to basic telemedicine devices like mobile phones and computers. With improved accessibility, individuals in rural areas and busy urban areas can connect with a provider with ease. Home-use medical devices make it possible for caregivers to monitor everything from vitals to glucose levels. Physicians can gather essential medical information and make a diagnosis without patients stepping foot in a doctors office.

Telehealth for Education and Training: Numerous organizations provide healthcare education with the help of digital telehealth technologies including Harvard’s Safety, Quality, Informatics and Leadership (SQIL) program which takes a blended learning approach. SQIL uses on-demand content combined with in-person training to create a new medical education model that uses “information technology (IT), data, and a culture of continuous improvement to enable healthcare organizations to evolve into true learning systems.” Time-crunched physicians are increasingly using online and mobile platforms to meet their CME and MOC requirements, and to prepare for Board Exams.
Dr. Creelman has practiced family medicine since 1984 and provided care with our team since 2006. He received his medical degree from the University of Washington and completed the San Bernardino Medical Center Family Practice Residency Program. As director of clinical operations, he works with the service delivery team to ensure that providers deliver the highest quality medical care and create positive patient experiences. In addition to his career in telemedicine, Dr. Creelman is a volunteer and a member of the board of directors of a local free clinic. He has also served on short-term overseas medical missions. He enjoys jogging and hiking, fine woodworking and crafting gourmet sushi with his family.
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