The rise of the internet age brought with it profound changes for the practice of telemedicine. The proliferation of smart devices, capable of high-quality video transmission, opened up the possibility of delivering remote healthcare to patients in their homes, workplaces or assisted living facilities as an alternative to in-person visits for both primary and specialty care.
While many branches of medicine have wanted to fully embrace telehealth for a long time, there are certain risks and barriers which bar the full amalgamation of telehealth into best practice. For a start, it is dubious as to whether a practitioner can fully leave the "hands-on" experience behind.[23] Although it is predicted that telehealth will replace many consultations and other health interactions, it cannot yet fully replace a physical examination, this is particularly so in diagnostics, rehabilitation or mental health.[23]
Facility Fees. In addition to reimbursement for the telemedicine service, Medicare will pay the originating site a facility fee. For example, if you’re a primary care provider with a patient in your office and you do a telemedicine visit to consult a physician in another location, you could bill for two separate things – the telemedicine service, and a facility fee for using your practice to “host” of the patient visit. Check HCPCS code Q3014 for a full description on facility fees.
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.
Today, there are telemedicine solutions that allow patients to seek a second opinion from the comforts of their home. Sending another physician copies of your medical images and more can easily be done by uploading the content to their secure website. This is very convenient for those who need a specialist but do not have the resources to drive thousands of miles away or wait a long time.
Dr. Miller has practiced medicine since 1988, and provided virtual care since 2015. She completed her medical degree at the Sackler School of Medicine in Tel Aviv then returned to New York to complete her family medicine residency. She later completed her preventive medicine residency at the University of Washington, earning her MPH. Since 1992, she has worked in family medicine and public health in Washington. She continues to provide care at a local clinic and appreciates the opportunity to help her patients make effective healthcare choices. Dr. Miller received Top Docs Recognition for four years in Seattle Met Magazine. Away from work, she enjoys time with her family, traveling, gardening and being outdoors.
Telehealth Reimbursement Medicare: Medicare, which finances care for patients who can most benefit from telehealth, will only pay if the originating site (service location of the patient) is either in a non-Metropolitan Statistical Area (MSA) or a Health Professional Shortage Area (HPSA). Medicare also limits the types of providers and facilities that can provide telehealth services. For more information, the Telehealth Resource Center (TRC) has furnished lists of covered providers, sites, and services.
In the United States, the National Institute on Disability and Rehabilitation Research's (NIDRR)[38] supports research and the development of telerehabilitation. NIDRR's grantees include the "Rehabilitation Engineering and Research Center" (RERC) at the University of Pittsburgh, the Rehabilitation Institute of Chicago, the State University of New York at Buffalo, and the National Rehabilitation Hospital in Washington DC. Other federal funders of research are the Veterans Health Administration, the Health Services Research Administration in the US Department of Health and Human Services, and the Department of Defense.[39] Outside the United States, excellent research is conducted in Australia and Europe.
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.
In the early days of telemedicine, health professionals used the burgeoning technology as a way to reach patients living in rural areas. However, the technology quickly expanded into urban areas, especially those that suffered from healthcare shortages. In 1967, physicians at the University of Miami School of Medicine and Miami's Fire Department transmitted electrocardiographic rhythms over existing voice radio channels from fire-rescue units to the city's Jackson Memorial Hospital.
We have collaborated with major hospitals like Max Hospitals, Fortis Healthcare, Global Hospitals, Medica Super Specialty (Kolkata), Pushpanjali Crosslay, Nova Specialty Hospitals, Artemis Hospital, Enhance Clinics and Delhi ENT Hospital among many others covering all parts of India. Should you need any treatment of any kind at a hospital, iClinic can facilitate this at a partner hospital and ensure that you get prompt, efficient and economical service.
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.

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]
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Based on over 600 studies, the AMA has put together a comprehensive set of guidelines for professionals using telemedicine in primary and urgent care – a field that is quickly adopting telemedicine to expand basic healthcare access. Here are some of the basic protocols and rules a primary care or urgent care facility should put into place when starting their telemedicine program.
Telemedicine for trauma education: some trauma centers are delivering trauma education lectures to hospitals and health care providers worldwide using video conferencing technology. Each lecture provides fundamental principles, firsthand knowledge and evidenced-based methods for critical analysis of established clinical practice standards, and comparisons to newer advanced alternatives. The various sites collaborate and share their perspective based on location, available staff, and available resources.[43]
A telemedicine vendor should have no reservations in signing a Business Associate Agreement. Those that do sign one are confident in their ability to securely store patient information. VSee is currently the only company that offers a HIPAA Messenger App for organizations to try for free. They are confident that their telemedicine solutions can protect pertinent patient information.
Visit Teladoc and set up an account using the information provided on your GuideStone/Highmark BCBS ID card. You'll also complete a medical history so that it's easy for the Teladoc physician to access when providing treatment. Or you can set up your account and provide your medical history by calling 1-800-TELADOC (1-800-835-2362). If they ask for your employer's name, be sure to tell them your coverage is provided through GuideStone/Highmark BCBS and provide the identification information from your ID card. Learn more about How to Register.
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.

Project ECHO, a knowledge-sharing enterprise that works both across the U.S. and globally, offers a good example of how technology-enabled collaborative learning models work. Launched initially in New Mexico to help patients with hepatitis C gain access to specialty treatment, Project ECHO connects a team of specialists at a university medical center "hub" with teams of primary-care clinicians at community health centers—or "spokes"—across a state or region. This connection is recurring: Typically, it takes place every week or every other week, during telementoring clinics that operate like virtual grand rounds.


Telehealth and Patient Engagement: With telehealth technologies, patients are taking more control of their well-being. Educational videos, health management apps for mobile devices, and online health learning and support communities empower patients to manage chronic conditions, lose weight, increase physical activity levels, and gain emotional support. Diabetes patients are benefiting from carbohydrate tracking apps and are using glucose monitoring devices to document and report their blood sugar measurements. Other patients are interacting with their providers and scheduling appointments through secure online communication portals. Additionally, they are accessing health education content via smartphones and computers to add to their self-care toolboxes. They are also using wearables and monitoring systems to gain knowledge about their sleep patterns, vital signs, and activity levels.
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.

Telemedicine services can range widely by specialty. A surgeon might use telemedicine to do post-operation check-ins with patients, to make sure their wound is not infected. A gynecologist might use a live telemedicine solution to provide birth control counseling. An endocrinologist may do live videochats with patients to discuss recent lab results and answer questions.
The growth in telemedicine solutions means that telemedicine options are now more diverse, with many more affordable solutions. However, most telemedicine programs do require the purchase, set-up and staff training of new technology and equipment – some of which may be outside the budget of providers in smaller independent practices. Many providers are already stretched thin on new technology budgets and staff training for EHR systems, imposed by the Meaningful Use program. Also, for patients who may not have access to a smartphone or a computer with internet, real-time telemedicine may be out of reach.

In addition to the parity laws, some states require providers to obtain patient consent before using telehealth services. Failure to obtain patient consent may result in physicians not being paid. Providers also have to be aware that while some states do not legally require consent, if they bill telemedicine through Medicaid, they will need written consent.
There’s a lot to be optimistic about in the future of telemedicine. With rapid advances in technology, it’s likely that telemedicine will only become easier and more widely accepted in the coming years. Already, smart glasses (like Google Glass) and smart watches (like the Apple Watch) can monitor patients’ health data and transmit them in real time to health professionals. Programs like clmtrackr can analyze a person’s emotional state based on their facial expressions and could be used to monitor mental wellness. Digital health startups like Augmedix, are experimenting with automatically transcribing documentation during a patient visit. Advances in robotic surgeries allow surgeons to operate on patients from afar.

While widespread research on the effects of telemedicine is still relatively young, many studies do show positive results. When the Veterans Health Administration implemented telemedicine for past heart attack patients, they sawhospital readmissions due to heart failure drop by 51%. Another study on the Geisinger Health Plan showed that telemedicine reduced 30-day hospital readmissions by as much as 44%. And while telemedicine skeptics often claim virtual visits tend to be lower quality than in-person visits, a recent study of 8,000 patients who used telemedicine recorded no difference in care outcomes between in-person and virtual care.
Significantly, at the end of 2016 Congress unanimously approved legislation focused on emerging technology-enabled collaborative learning models. The new law directs HHS to assess these models and their ability to improve patient care and provider education, and to report its findings to Congress, along with recommendations for supporting their spread.
Telemedicine reimbursement is a difficult topic, especially with the constantly changing state policies. Many states now have parity laws which require private payers to reimburse for telemedicine visits the same way as in-person visits. The best way to navigate reimbursement is to call up your top payers and ask their policies. You can also check out our guide to telemedicine reimbursement and this helpful matrix from ATA on state policy.
In August 2017, hospitals across the country were penalized with Medicare reimbursement cuts due to high 30-day readmission rates. The potential to reduce these rates and avoid penalties has made telehealth a financial priority. Healthcare provider TripleCare was the subject of a study conducted by the TRECS Institute, which found that virtual physician services had both increased care quality and averted 91 unnecessary admissions. The result was $1.3 million in Medicare savings. Telehealth services can also provide patients and healthcare facilities in rural areas with additional benefits. NTCA — The Rural Broadband Association released a report in March 2017 that estimated the average annual cost savings per facility could add up to:
Between the years 2000 and 2050, the number of people aged 60 years or older is expected to increase from 605 million to 2 billion. The rapidly increasing elderly patient population have become one of the main beneficiaries of telehealth. Companies like Comarch, American Well, and Global Med are building doctor video chat platforms targeted at the elderly.
34 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services. Many other insurers cover at least some telehealth service--and many more have expressed interest in expanding their telehealth coverage. To find out if your insurance company covers telehealth services, please contact your benefits manager. 
A sexually transmitted illness, which affects men and women of all ages, herpes is embarrassing to deal with. Whether in the form of a cold sore on your mouth, or a rash on your genitals, discomfort and unease is sure to follow. While there is no cure for Herpes at this time, there are several treatment options which have been made available across the United States.
Interactive medicine, also known as “live telemedicine”, allows patients and physicians to communicate in real-time while also maintaining HIPAA compliance. Communication methods include both phone consultations and video conferences. Physicians can assess a patient’s medical history, perform psychiatric evaluations, and more using interactive medicine.
As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.
The growth in telemedicine solutions means that telemedicine options are now more diverse, with many more affordable solutions. However, most telemedicine programs do require the purchase, set-up and staff training of new technology and equipment – some of which may be outside the budget of providers in smaller independent practices. Many providers are already stretched thin on new technology budgets and staff training for EHR systems, imposed by the Meaningful Use program. Also, for patients who may not have access to a smartphone or a computer with internet, real-time telemedicine may be out of reach.
Like most telemedicine tools, remote patient monitoring solutions make it easier for patients and physicians to maintain close communication. Many RPM solutions record and transmit a patient’s medical data automatically, generating a regular report for the physician. In some cases, this medical data is transmitted to a team of health monitoring professionals who are responsible for flagging any warning signs and sending them on to the physician, if needed.
Telemedicine companies that are consumer-facing offer the huge benefit of on-demand care for patients. A sick patient can simply login online and request a visit with one of the company’s doctors and get treatment. But this model, similar to the retail health movement, leads to a breakdown in care continuity. A random doctor who doesn’t know the patient, doesn’t know their whole medical history. The best approach to telemedicine? Providing tools to providers to easily connect with their own patients. 
State medical licensing boards have sometimes opposed telemedicine; for example, in 2012 electronic consultations were illegal in Idaho, and an Idaho-licensed general practitioner was punished by the board for prescribing an antibiotic, triggering reviews of her licensure and board certifications across the country.[79] Subsequently, in 2015 the state legislature legalized electronic consultations.[79]
“Telepsychiatry, a subset of telemedicine, can involve providing a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management,” American Psychiatry Association. Telepsychiatry has several advantages over traditional psychiatry including reduced stigma, reduced time off work, and better access to mental health specialty care that might not otherwise be available. Companies like Iris Health, Genoa Health, InSight, and MDLive are already delivering telepsychiatry platforms across the US.
In the future, experts say, internet-­connected sensors—such as blood pressure monitors—could be paired with e-visits to help people manage chronic conditions from home. So far, such devices aren't widely used. But the list of conditions that patients and doctors can manage remotely is “ever expanding,” says Eric Topol, M.D., director of the Scripps Translational Science Institute.
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