While the industry is still a long way from a standard set of established guidelines for telemedicine, the American Telemedicine Association has put together guidelines for a range of specialties based on a survey hundreds of research study. What are the clinical, technical, and administrative guidelines a medical practice needs to put in place when they’re adopting telemedicine? Beyond the minimal legal requirements of that state, what are telemedicine best practices?
Leading telemedicine companies like VSee, assists healthcare organizations in being able to treat patients with chronic diseases. They recognize that 75% of the United States healthcare spending is dedicated to treating heart disease, cancer, and diabetes. As a result, they’ve created telemedicine solutions that can keep physicians abreast from hospital to home. In addition, the patient, their family members, and other healthcare professionals can collaborate in the patient care process.
Dr. Bernstein has practiced medicine since 1990 and provided virtual care with our team since 2006. He received his medical degree from the University of North Carolina and completed a residency at Providence Family Practice in Seattle. He also holds a Master's Degree in Public Health from the University of Washington. Dr. Bernstein is dedicated to quality preventive medicine, public health promotion, and research. As Director of Clinical Quality, he manages the development and maintenance of the clinical standards of patient care, working with the development team to create new systems for measuring clinical delivery effectiveness. In his spare time, he is an avid cyclist and a soccer fan.
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
Only some states have actually regulations requiring healthcare providers to get patients’ informed consent to use telemedicine. However, this is always good practice, whether or not your state requires it. Before the first telemedicine visit, providers should explain to patients how telemedicine works (when service is available, scheduling, privacy etc), any limits on confidentiality, possibility for technical failure, protocols for contact between virtual visits, prescribing policies, and coordinating care with other health professionals. Everything should be explained in simple, clear language.
Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they've already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor's office and sitting in a waiting room.
^ 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.
“It really helped our emergency room with treating stroke patients and benefited patient care by avoiding transportation when minutes matter,” he explained. “We see telemedicine as a solution to expand access to care without leaving the home, as well as a solution for gaining access to a specialist who may not have the patient volumes to relocate to our market.”
Store and Forward – This is a form of telehealth consultation which uses images from the patients to come up with the medical diagnosis. The different types of Store and Forward services include dermatology, radiology and wound care. It may also include transferring of patients’ clinical data like ECG and blood test results from the patients’ site to the hospital’s site.
Physicians and patients can share information in real time from one computer screen to another. And they can even see and capture readings from medical devices at a faraway location. Using telemedicine software, patients can see a doctor for diagnosis and treatment without having to wait for an appointment. Patients can consult a physician at the comfort of their home.
Kelly had the chance to test out the Doctor on Demand app, and it took her about ten minutes after downloading the app to start video chatting with a cool doc on her smartphone. Kelly’s session took about five minute total, and as soon as it was done, the doctor sent an antibiotic prescription straight to the pharmacy for her. 20 minutes later, she got a text saying it was ready to be picked up, and in under an hour, she had her prescription from Walgreens. For those who prioritize speed and low hassle over familiarity of their own doctor (or health center), or even those without insurance, this is a real win.
Used when both health providers are not available or not required at the same time. The provider’s voice or text dictation on the patient’s history, current affliction including pictures and/or video, radiology images, etc., are attached for diagnosis. This record is either emailed or placed on a server for the specialist’s access. The specialist then follows up with his diagnosis and treatment plan.
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.
Medicare pays for telemedicine services under certain circumstances. Primarily, Medicare covers live telemedicine services, or virtual visits delivered via interactive audio and video (think videochat). The goal is to cover medical services delivered virtually where an in-person visit may be difficult for the patient or provider. Store-and-forward telemedicine services are only covered in Hawaii and Alaska at this time.
A landmark 2010 report by the World Health Organization found that telemedicine – literally meaning “healing from a distance” — can be traced back to the mid-1800s, was first featured in published accounts early on in the 20th Century, and adopted its modern form in the late 1960s and early 1970s, primarily through the military and space industries. Owing to the fact that much of the technology encompassed in today’s telemedicine platform wasn’t around back then, and noting a 2007 study that found 104 different peer-reviewed definitions for the word, the WHO settled on its own broad-based definition:
If a practitioner serves several states, obtaining this license in each state could be an expensive and time-consuming proposition. Even if the practitioner never practices medicine face-to-face with a patient in another state, he/she still must meet a variety of other individual state requirements, including paying substantial licensure fees, passing additional oral and written examinations, and traveling for interviews.
“Our executive leadership have been strong supporters of telemedicine at UPMC for more than a decade,” said Sokolovich of the University of Pittsburgh Medical Center. “With the initial success of tele-stroke and tele-behavioral health services, leadership recognizes the potential of telehealth in implementing new models of care that enhance the patient experience, support access to quality care regardless of geographic location, and maximize efficiencies.”
The amount providers are reimbursed for telemedicine will vary depending on a state’s legislation. Some states specifically mandate that private payers reimburse the same amount for telemedicine as if the service was provided in-person. However, most states with reimbursement mandates leave this determination up to the payers. We have found the majority of private payers still reimburse at levels equivalent to in-person visits.
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In 1967 one of the first telemedicine clinics was founded by Kenneth Bird at Massachusetts General Hospital. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at Boston's Logan International Airport, located three congested miles from the hospital. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit. The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.
Medicare: Yes... in certain circumstances. Many “telehealth” services, such as remote radiology, pathology and some cardiology, are covered simply as "physician services." For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using videoconferencing and remote patient monitoring. The ~14 million beneficiaries in Medicare Advantage (managed care) plans, have complete flexibility in using telehealth, as long as their provider offers the service. ATA is pushing the Centers for Medicare and Medicaid, and Congress to removing the arbitrary restrictions that limit telehealth coverage, so that all beneficiaries can get this great benefit. The ATA Wiki has details explaining coverage details in Medicare.
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.
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.
As technology developed and wired communication became increasingly commonplace, the ideas surrounding telehealth began emerging. The earliest telehealth encounter can be traced to Alexander Graham Bell in 1876, when he used his early telephone as a means of getting help from his assistant Mr. Watson after he spilt acid on his trousers. Another instance of early telehealth, specifically telemedicine was reported in The Lancet in 1879. An anonymous writer described a case where a doctor successfully diagnosed a child over the telephone in the middle of the night. This Lancet issue, also further discussed the potential of Remote Patient Care in order to avoid unnecessary house visits, which were part of routine health care during the 1800s. Other instances of telehealth during this period came from the American Civil War, during which telegraphs were used to deliver mortality lists and medical care to soldiers.
The definition of telemedicine is somewhat controversial. Some definitions (such as the definition given by the World Health Organization) include all aspects of healthcare including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.
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.
Teladoc provides access to board-certified, state-licensed physicians 24 hours a day for non-emergency medical issues such as allergies, bronchitis, pink eye, sinus problems, and ear infection via audio-video technology for consultations regarding medical advice, diagnoses and basic prescription medications. The company bills itself as a telehealth provider due to its function of facilitating "remote house calls by primary care doctors". However, United States Department of Health and Human Services states that the term telehealth covers a broader range including "non-clinical services, such as provider training, administrative meetings, and continuing medical education" and that the term telemedicine means "remote clinical services". Its competitors include PlushCare, American Well, MDLIVE Inc., Doctor On Demand, and Carena.
Cheryl Graf has worked in primary care since 1996 and provided virtual care since 2014. She received her Master of Nursing from Pacific Lutheran University. She also works for a local health system and provides temporary support for emergency departments near her home. Her experience includes emergency services, family practice, pediatrics and urgent care. Additionally, she has created and developed training materials for the Sexual Assault Nurse Examiner programs in Washington State. In her spare time, she enjoys golf, gardening and family time.