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.[13] The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts.[14] Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings.[citation needed] 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.[15]
“In addition, clinical outcomes should be defined and data capture and review capabilities should be implemented to ensure clinical standards of care are followed, to evaluate clinical outcomes and patient and provider satisfaction, and to continually look for opportunities to improve the virtual process,” Sokolovich said. “In addition, having a dedicated IT support system in place for telehealth providers across the system is key to long-term success and removes the concern for equipment failure and connectivity issues that may result in virtual visit challenges.”
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.
Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.

Because of telemedicine, physicians can access patient medical records without being onsite. Some telemedicine providers offer the ability to do data entry using a point-and-click method or video/handwriting recognition. This can cut down on the amount of time that physicians dedicate to administrative tasks. As a result, physicians can see more patients or spend more time with those cases that are more complex.

A major legal action prompt in telehealth thus far has been issues surrounding online prescribing and whether an appropriate clinician-patient relationship can be established online to make prescribing safe, making this an area that requires particular scrutiny.[22] It may be required that the practitioner and patient involved must meet in person at least once before online prescribing can occur, or that at least a live-video conference must occur, not just impersonal questionnaires or surveys to determine need.[43]

Yet healthcare systems struggle to turn this form of technology into a profitable revenue stream. Consumers have been slow to adopt this model. And, according to a Rand study published in 2017, it appears to attract a new set of consumers who might not otherwise use medical services, thereby driving costs up. Findings related to utilization and spending for acute respiratory illness based on commercial claims data from more than 300,000 patients between 2011 and 2013 included:


The field of telemedicine has changed drastically from its inception. It was only about fifty years ago that a few hospitals started experimenting with telemedicine to reach patients in remote locations. But with the rapid changes in technology over the last few decades, telemedicine has transformed into a complex integrated service used in hospitals, homes, private physician offices, and other healthcare facilities.
According to a May 2017 article by Alignment Chief Medical Officer Ken Kim, the organization’s efforts paid off. “Because of the program, Alignment’s seniors are seeing reduced 30-day readmission rates … compared to the national Medicare average readmission rate of about 18%. In 2016, Alignment members enrolled in remote [monitoring] across all markets saw hospital readmission rates of 7.2%.”
While telemedicine is the older of the two phrases, telehealth is rapidly gaining acceptance, in large part because of the evolution of the healthcare landscape. The rise of consumer-directed healthcare and the shift from fee-based care to quality- and outcomes-based care has put more of an emphasis on health and wellness and care management. And in that atmosphere, telehealth fits the mold.
Telemedicine is an important and quickly growing component of healthcare delievery in the United States.  There are currently about 200 telemedicine networks, with 3,500 service sites in the US.  In 2011 alone the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. More than half of all U.S. hospitals now use some form of telemedicine.

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?
“Creating a viable telemedicine program is both a short-term and a long-term proposition,” said Daniel Barchi, CIO at New York-Presbyterian. “It is possible, with a small team and early investment of resources, to create telemedicine capability in a specific vertical. It could be post-surgical follow-up visits for patients and surgeons, medication reconciliation video visits with a pharmacist, or urgent care emergency department video calls.”
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.
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.
In layman’s language, telemedicine and telehealth are terms that represent the transfer and exchange of medical information between different sites. From the American Telemedicine Association’s point of view; telemedicine, as well as telehealth, are all about transmission of still images, patient’s consultations through video conferencing, patient portals, remote control and monitoring of vital signs, continuing medical education, patient-focused wireless applications and nursing call centers and many other applications.

But as the National Policy Telehealth Resource Center notes, “Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is more complex than simply using products that claim to be ‘HIPAA-compliant.” Not only does the telemedicine platform need to be compliant, all providers, patients, and staff using the tool need to ensure they are in compliance with HIPAA. A telemedicine software vendor, for instance, not only needs to build a secure product, but also ensure their company is operating in accordance with HIPAA.


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.
Today’s competitive health care marketplace has created an environment where patients demand lower costs, higher service quality, and convenient access to services. [2] Telehealth is an innovative and valuable mechanism that provides patients with efficient access to quality services. Lowering costs and removing barriers to service access, are critical components in promoting patient wellness and population health. Convenience and cost-effectiveness are important commodities in the modern health care marketplace, as patients tend to avoid treatment that is difficult to access or too expensive. As a result, telehealth technology is emerging as a preferred choice among patients and providers. Telehealth has also attracted the attention of US legislators. They utilize this tool for improving the competitiveness of American health care services. This is especially important, seeing as health care represents 17 percent of the nation’s gross domestic product (GDP). In fact, the resource has helped to define the role that lawmakers play in ensuring that patients benefit in a competitive health care market.
Traditional use of telehealth services has been for specialist treatment. However, there has been a paradigm shift and telehealth is no longer considered a specialist service.[15] This development has ensured that many access barriers are eliminated, as medical professionals are able to use wireless communication technologies to deliver health care.[16] This is evident in rural communities. For individuals living in rural communities, specialist care can be some distance away, particularly in the next major city. Telehealth eliminates this barrier, as health professionals are able to conduct a medical consultation through the use of wireless communication technologies. However, this process is dependent on both parties having Internet access.[16][17][18]

Like most technology solutions, telemedicine platforms usually require some training and equipment purchases. How much is really dependent on the solution – a more extensive inpatient telemedicine platform that will be used between primary doctors and consulting specialist may require more training and the purchase of a telemedicine cart and various mobile health devices. A secure videochat app like eVisit, requires much less staff training and usually only requires purchase of a webcam.

Additionally, Medicare will only pay for telemedicine services when the patient is located in a Health Professional Shortage Area and receives care from an eligible provider. The medical service itself also has to fall under one of thesecovered CPT/HCPCS codes. When all these conditions are met, Medicare pays for 80% of the physician fee (other 20% is paid by the patient) and will additionally pay a facility fee to the originating site.

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.
Teladoc Health enjoys a killer advantage with its head start in telehealth. Around 40% of the largest companies in the world contract with Teladoc to provide virtual healthcare services to their employees. Over 35 of the biggest health plans in the U.S. have partnered with Teladoc. More than 290 hospitals and health systems have teamed up with the telehealth leader.
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
The development of modern telemedicine began with the invention of the telecommunications infrastructure, including the telephone and telegraph. Early on, telemedicine technology was adopted for use in military situations during the Civil War, such as ordering medical supplies or medical consultations. Casualty and injury lists were also delivered via telegraph.
Teladoc charges an annual subscription fee for its service plus a $40 co-pay per video or phone appointment with a doctor, though employers sometimes subsidize or cover the co-pay completely for their employees. Health insurance startup Oscar (co-founded by venture capitalist Joshua Kushner), for one, has promoted its ACA-compliant health plans with the perk of getting to talk to doctors 24 hours a day—through Teladoc—for free.

Teladoc is a fantastic product offered by AgileHealthInsurance and a great way to take control of your health care. But what is it? It’s simple. Teladoc is the nation's leading telehealth service. Whenever you feel unwell or have a health question, you can receive convenient, quality care from a variety of licensed healthcare professionals. Teladoc doctors are available anytime, day or night.
Teladoc charges an annual subscription fee for its service plus a $40 co-pay per video or phone appointment with a doctor, though employers sometimes subsidize or cover the co-pay completely for their employees. Health insurance startup Oscar (co-founded by venture capitalist Joshua Kushner), for one, has promoted its ACA-compliant health plans with the perk of getting to talk to doctors 24 hours a day—through Teladoc—for free.

Healthcare systems that are thinking about implementing telemedicine solutions should consult with experts in the industry. VSee, a leading telemedicine organization, suggests that practices do not rush into telemedicine without having the right equipment. They offer a variety of practical solutions for practices wanting to add telemedicine to their clinic and can make the integration more seamless.

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.[13] The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts.[14] Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings.[citation needed] 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.[15]
Increased access: Patients in rural areas can obtain specialty services, such a mental health treatment or post-surgery follow up, that they otherwise might not get without traveling a large distance for an in-person visit. Similarly, patients who live in federally designated, underserved areas have increased access to primary, dental and mental healthcare.
“When you see this, risks will decrease quickly: Reimbursement will move forward, and where the money goes, vendors’ energy to continuously improve the technology will follow,” he said. “The key is to securely allow the patient and provider to feel connected to one another and follow that connection through to the post-visit workflows that complete the experience – the doctor or his nurse completing documentation and orders, the patient scheduling follow-up and payment.”

“Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.”
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.
Online doctor consultation are rapidly gaining popularity these days as more health insurers offer telemedicine services to help cut costs. Studies have shown that virtual care may effectively used to treat common problems such as flu, acne, deer tick bites, sinus and urinary tract infections. Video doctor consultations can save patients a lot in time and convenience. 
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