Medicaid guidelines require all providers to practice within the scope of their State Practice Act. Some states have enacted legislation that requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the state are binding under current Medicaid rules.
Dr. Barnett attended the University of Southern California's Keck School of Medicine and completed his residency at Swedish Family Medicine. He has over 12 years of experience in practice and began working in Virtual Care over nine years ago. When Dr. Barnett is not providing Virtual Care, he works as a primary care provider for a local health system. He is fluent in Russian and proficient in Spanish. Outside of work, Dr. Barnett enjoys cooking, watching films, photography, and spending time with family.
More specific and widely reaching laws, legislations and regulations will have to evolve with the technology. They will have to be fully agreed upon, for example, will all clinicians need full licensing in every community they provide telehealth services too, or could there be a limited use telehealth licence? Would the limited use licence cover all potential telehealth interventions, or only some? Who would be responsible if an emergency was occurring and the practitioner could not provide immediate help – would someone else have to be in the room with the patient at all consult times? Which state, city or country would the law apply in when a breach or malpractice occurred? [23][42]
“If there are areas of clinical need across the healthcare network, telemedicine may allow for better leveraging and expanding access to sub-specialists,” Sokolovich said. “Another opportunity could include better triaging patients through telemedicine-enabled provider-to-provider or provider-to-patient evaluations, which bring together experts who can quickly assess the best care path and eliminate unnecessary hospital admissions or emergency department visits.”
Teledermatology – Teledermatology solutions are usually store-and-forward technologies that allow a general healthcare provider to send a patient photo of a rash, a mole, or another skin anomaly, for remote diagnosis. As frontline providers of care, primary care practitioners are often the first medical professionals to spot a potential problem. Teledermatology solutions lets PCPs continue to coordinate a patient’s care, and offer a quick answer on whether further examination is needed from a dermatologist.
With approximately 30-million cases of thyroid conditions across the U.S., including some 15-million which are undiagnosed, the need for fast and efficient prescriptions in this area is high. Women have a higher chance of contracting disorders of the thyroid, but they can affect men as well. Symptoms include anxiety, chronic fatigue syndrome, numbed senses of smell and taste, lowered sex drive, dry skin, stomach pain, digestive issues, high blood pressure, pain in the joints and muscles, heart palpitations, weight gain, hair loss, and uncontrollable body temperature.
The most common forms of treatment include medications like Cialis, Levitra, or Viagra. After completing the online questionnaire and speaking with a registered doctor, a physician will be able to determine which medication will work best for your situation, or prescribe a refill from a previous prescription. For more information on prescription medication for ED,click here!
Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!

Telehealth specialists with specialized training in talking with patients and diagnosing over the phone and via online video, while adhering to Teladoc's set of 130 proprietary, evidence-based, clinical practice guidelines for the telephonic and audio-video treatment of common, uncomplicated medical conditions (the only guidelines in the industry specific to telehealth).
Remote surgery or telesurgery is performance of surgical procedures where the surgeon is not physically in the same location as the patient, using a robotic teleoperator system controlled by the surgeon. The remote operator may give tactile feedback to the user. Remote surgery combines elements of robotics and high-speed data connections. A critical limiting factor is the speed, latency and reliability of the communication system between the surgeon and the patient, though trans-Atlantic surgeries have been demonstrated.
Presenters or Patient Presenters – They are the ones who provide telehealth services and perform the overall exam for patients. Such presenters should be on the medical field and they must have experiences in providing health services to patients like registered nurses and licensed practical nurses. They were trained in the use of the equipment like cameras and computers, and they are the ones who communicate with the patients on the originating site. They can also perform the different activities which are part of the diagnostic examination.

Healthcare systems that adopt telemedicine solutions can attest that it requires a lot of time and money. Implementing a new system requires training and sometimes staff members find it difficult to welcome this change. Practice managers, nurses, physicians, and more have to learn how to utilize the system so that practices can see the benefits. Although telemedicine is expensive in the beginning, healthcare systems should see a positive return on investment over time due to more patients and less staff.
As the population grows and ages, and medical advances are made which prolong life, demands increase on the healthcare system. Healthcare providers are also being asked to do more, with no increase in funding, or are encouraged to move to new models of funding and care such as patient-centered or outcomes based, rather than fee-for-service. Some specific health professions already have a shortage (i.e. Speech-language pathologists). When rural settings, lack of transport, lack of mobility (i.e. In the elderly or disabled), decreased funding or lack of staffing restrict access to care, telehealth can bridge the gap.[4]

Telepsychiatry – Telepsychiatry allows qualified psychiatrists to provide treatment to patients remotely, expanding access to behavioral health services. Telepsychiatry is incredibly popular, in part because of the nation-wide shortage of available psychiatrists, and because psychiatry often does not require the same physical exams of the medical field.

There are the typical discussions about balance between expanding vs. deepening what we currently do. Fair arguments on both sides of the discussion. The company tends to be conservative. Unclear decision making can lead to confusion across the company. Some decisions are made by corporate leaders who don't understand the day to day realties. Needs of the company have outgrown some functional leaders. These issues are...


Store-and-forward telemedicine is a great way to increase healthcare efficiency since a provider, patient, and specialist don’t need to be in the same place, at the same time. It also facilitates faster diagnosis, especially for patients located in underserved settings that may not have the necessary specialist on staff. Overall, this adds up to lower patient wait times, more accessible healthcare, better patient outcomes, and a more optimized schedule for physicians.
The future of telemedicine is wide open, with room for drastic improvement and more technology based medical care. As the world of tech continues to evolve, so too can the world of telehealth. Already, patients can sit down for a one on one appointment anywhere and anytime with the use of nothing more than a mobile phone. Imagine what new technology will bring in terms of holographic imaging, long distance x-ray, and more work in the field of ultrasounds.
The United States has 14 Telehealth Resource Centers, all funded by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth. These resource centers serve as a local hub of information and research about telehealth, usually with a focus on increasing healthcare access for underserved communities. Plus, the services they provide are generally free!
With telemedicine, patients can connect with their dermatologist using a smartphone, tablet, or computer. Using high definition images and video, dermatologists can examine a patient suffering from psoriasis, eczema, bedsores, and more. This is extremely convenient for those patients that are housebound. Using telemedicine solutions, dermatologists can diagnose and treat skin care conditions effectively and efficiently. In addition, it not only saves a patient from travelling to a clinic but it also helps them maintain their dignity.

Thanks to telemedicine, physicians have the wonderful opportunity to connect with clients wherever they are. Patients who once could not see a physician due to access to care issues, can now do so almost seamlessly. However, many may wonder what is telemedicine’s most valuable applications? We’ll discover a few popular ways that telemedicine is used today.
Bao Ng has worked in primary care since 2013 and provided virtual care since 2013. Obtaining her Doctor of Nursing Practice from the University of Washington, she began working in telemedicine shortly thereafter. Her medical interests include international health, and maternal and child health. She works at an international community health clinic near her home, and is fluent in Vietnamese and proficient in conversational Cantonese. She volunteers as a caregiver in her church nursery and is an executive board member for a local pediatric and behavioral health clinic. Outside of work, she enjoys spending time with her husband and children and exploring new cuisines.
It is common for outlying healthcare facilities to transfer unnecessarily or forced to refer patients to complex cases that are beyond the knowledge-base of the local providers. Patients are therefore frequently transported over long distances to get direct care or for specialist’s consultation. These referrals and transfers can be quite costly for the patient since they present clinical, operational and financial challenges to all the parties that are involved. Telemedicine can curb such issues, reduce the frequency of travel and deliver considerable efficiencies and returns for all parties involved.
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.
Inability to prescribe medications: Many states generally do not allow online prescribing (not to be confused with e-prescribing) without an established relationship between the physician and patient. A physical examination or evaluation may be required before a physician can write a prescription for a patient, but there are inconsistencies in state laws as to what constitutes a physical examination.
Teleradiology is the ability to send radiographic images (x-rays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another.[62] For this process to be implemented, three essential components are required, an image sending station, a transmission network, and a receiving-image review station. The most typical implementation are two computers connected via the Internet. The computer at the receiving end will need to have a high-quality display screen that has been tested and cleared for clinical purposes. Sometimes the receiving computer will have a printer so that images can be printed for convenience.
But it wasn’t until the early 20th century that the general population started to these technologies, and imagine they could be applied to the field of medicine. In 1925, a cover illustration of the Science and Invention magazine featured an odd invention by Dr. Hugo Gernsback, called the “teledactyl.” The imagined tool would use spindly robot fingers and radio technology to examine a patient from afar, and show the doctor a video feed of the patient. While this invention never got past the concept stage, it predicted the popular telemedicine definition we think of today – a remote video consult between doctor and patient.

A native of rural Washington, Katie Gieseke has practiced medicine since 2009, and provided virtual care since 2015. She received her undergraduate degree in Nursing from the University of Portland and received her Doctorate of Nursing Practice and Family Nurse Practitioner certification from the University of Washington. Her nursing career ranges from experience in the emergency department to home health assessments. During her time in the emergency department, she became interested in improving the effectiveness, efficiency and continuity of the health care system. She has a strong interest in illness prevention and look forward to having the time to spend with patients providing education on maintaining wellness, disease prevention and motivating patients to take control of their health.

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