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 delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.”
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.
In 2009, the South Carolina Department of Mental Health established a partnership with the University of South Carolina School of Medicine and the South Carolina Hospital Association to form a statewide telepsychiatry program that provides access to psychiatrists 16 hours a day, 7 days a week, to treat patients with mental health issues who present at rural emergency departments in the network.[51]
Telehealth is defined as the use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

The population of the United States is growing, aging, and becoming more prone to chronic conditions like diabetes, congestive heart failure, and COPD. This is creating a perfect storm of demand on the healthcare system, yet there is a shortage in the pipeline of healthcare providers being educated, trained, and licensed to practice. This necessitates getting very smart about how healthcare resources are leveraged to provide high-quality care to the highest number of people possible.  Telehealth technologies increase the efficiency of the healthcare system overall by maximizing the productivity of each provider and removing geographical barriers to care.

In 2009, the South Carolina Department of Mental Health established a partnership with the University of South Carolina School of Medicine and the South Carolina Hospital Association to form a statewide telepsychiatry program that provides access to psychiatrists 16 hours a day, 7 days a week, to treat patients with mental health issues who present at rural emergency departments in the network.[51]
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.
Once a medical history and symptoms are detailed, the patient is either then immediately connected to a clinician via video conferencing technology or gets an interactive call back from a physician or nurse. The provider that the patient speaks to may not be the patient's primary care physician, but instead a contracted clinician at a telemedicine network.

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 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]
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.
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.

Today’s patient lives in an increasingly connected world and expects a different kind of care experience. Telemedicine engages patients by allowing them to connect with their doctor more frequently, in a convenient way. That means more questions asked and answered, a stronger doctor-patient relationship, and patients who feel empowered to manage their care.
^ 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.
Tim Panek has worked in primary care since 1999 and provided virtual care since 2011. He received his Master of Nursing from the University of Washington and has worked in many primary and urgent care settings in Washington State. He is an adjunct clinical faculty member at the University of Washington School of Nursing. He is also a high school soccer coach and enjoys golf, fly-fishing, skiing and hiking with his family.
The benefits posed by telehealth challenge the normative means of healthcare delivery set in both legislation and practice. Therefore, the growing prominence of telehealth is starting to underscore the need for updated regulations, guidelines and legislation which reflect the current and future trends of healthcare practices.[2][23] Telehealth enables timely and flexible care to patients wherever they may be; although this is a benefit, it also poses threats to privacy, safety, medical licensing and reimbursement. When a clinician and patient are in different locations, it is difficult to determine which laws apply to the context.[41] Once healthcare crosses borders different state bodies are involved in order to regulate and maintain the level of care that is warranted to the patient or telehealth consumer. As it stands, telehealth is complex with many grey areas when put into practice especially as it crosses borders. This effectively limits the potential benefits of telehealth.[2][23]
Reimbursement for telemedicine services is often not as straightforward for traditional medical services. State telemedicine policy landscape is continuously shifting, affecting rules around reimbursement through state Medicaid programs and through private payers. Medicare does now reimburses for real-time telemedicine services, but places restrictions on the eligible healthcare providers, the location of the patient, the medical procedures that can be done, etc. The good news is, there is a shift towards more widespread reimbursement for telemedicine through all third-party payers, with less restrictions.  

As telehealth continues to replace traditional health care, it is going to inherit some of its challenges. These include increased cost of care due to multiple vendors, complex care pathways, and government policies. However, the question that remains to be answered is will this advanced technology that we call telehealth, be able to redefine the quality, equity and affordability of healthcare throughout the world.

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.


Telehealth projects underway before and during the 1980s would take off but fail to enter mainstream healthcare.[6][8] As a result, this period of telehealth history is called the "maturation" stage and made way for sustainable growth.[5] Although State funding in North America was beginning to run low, different hospitals began to launch their own telehealth initiatives.[5] Additionally, NASA started experimenting with their ATS-3 satellite. Eventually, NASA started their SateLife/HealthNet programme which tried to increase the health services connectivity in developing countries.[8]
Limitations of Online Doctor/Medical Consultations and Online Prescriptions, QuickRxRefills Cannot and Will NOT Prescribe, Dispense, or Resell any and all medications Narcotics/Controlled Substances (this policy is fully enforced by theDrug Enforcement Administration (DEA)) for Anti-depressants, Pain, Anxiety, Weightloss, Sleep, ADHD/ADD, Anabolic Steroids, Testosterone Replacement Therapy and any and all Medications that contain GabaPentin or Pseudroephedrine including non-controlled substances or any medications that are considered controversial, Off Labeled (Growth Hormone aka HGH) or recalled in nature such (i.e. Retin-A, Accutane). Furthermore, QuickRxRefills is not a substitute for an office based physician in your location nor is it a substitute for Emergency Medical Care or 911. If you do experience a "true" medical emergency your are encouraged to pick up the phone and dial 911 as soon as possible.

Sometimes the answer to the question “What is telemedicine?” is simply mobile medicine. It doesn’t require a heavy desktop computer or a lot of equipment. Activities that used to happen only in person are now easy to do on a smartphone. Modern consumers are accustomed to downloading apps and using their smartphones for simple transactions. The same is true for doctor visits. For example, with MDLIVE the patient simply opens the app and clicks to choose a doctor, with whom they can speak either by phone, instant message, or video.    
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?
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).
“Another distinction between telemedicine and D2C telehealth is that telemedicine consultations are often with medical specialists like cardiologists, dermatologists and pulmonologists,” Downey continued. “These often occur when the patient is in an underserved rural community and the specialist is in a large urban area. The distance makes it difficult to make and keep appointments otherwise. D2C telehealth, on the other hand, best deals with minor primary care issues over the phone. If deemed to be a more serious health concern, the patient is told to make an appointment with a specialist or to proceed to a hospital emergency room.”
When you need to find care, let us bring a healthcare provider to you. From your mobile device or computer, it’s never been easier for you and your family to instantly access world class care at home or work. For nonemergency concerns, patients ages 2 and older can get a diagnosis or prescription online from a healthcare provider in about a 10-minute virtual visit. Our Express Care Online service allows you to choose between an on demand visit right away or to schedule a virtual follow-up visit for a later date.
"Being able to tie [telehealth] to a larger strategic goal is critical to success," said Mr. Heller. UnityPoint Health aimed to provide the same quality of care for lower acuity visits at a reduced cost. The company looked at more than 1,000 visits from its self-insured health plan, assessing the additional value it generated from its employees using telehealth rather than taking off of work for medical care.
Alan Pitt, MD, is a neuroradiologist at Barrow Neurological Institute. He is the former chief medical officer of Avizia, which was acquired by American Well earlier this year. Dr. Pitt also serves as an advisor to several health IT companies and operates his own podcast. He offers a four-pronged framework to examine the current world of telemedicine: direct-to-consumer, self-service, clinician collaboration, and "spaces."
Telemedicine is a subset of telehealth, which includes both remote clinical service delivery and nonclinical elements of the healthcare system. In practice, however, the two terms are often used interchangeably. While eCare is often used as a synonym for telemedicine, the Federal Communications Commission adopted the term eCare as an umbrella concept for the electronic exchange of information to aid in the practice of advanced analytics and medicine.
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]
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 doctors can treat flu symptoms, rashes, allergies, urinary tract infections, and bronchitis—and even prescribe medication—without ever physically seeing the patient. Gorevic says nurses then go back and review the charts to effectively audit the diagnoses and treatment. Teladoc refers about 1% of consultations to the E.R., and 5% to 6% to a primary care physician or urgent care center. (No, you can’t find a new doctor through Teladoc: The company prohibits its doctors from seeing their online patients in real life.) Soon, Teladoc plans to expand its specialty offerings to include dermatology and behavioral health.
With the recent news that Amazon’s Jeff Bezos, Berkshire Hathaway’s Warren Buffet, and J.P. Morgan Chase’s Jamie Dimon have teamed up to disrupt healthcare, it’s easy to speculate that telehealth technology will be a key strategy in efforts to bring down costs. Other employers are seeking to bring down prices as well with the help of telehealth. According to the Society for Human Resource Management (SHRM), not only are employers encouraging the use of telehealth services, their employees, many of whom are digital natives, are quite comfortable using these services. Because of remote healthcare’s lower costs and increased worker productivity and satisfaction, organizations will likely seek telehealth solutions. Moreover, payers, like employers, may be lured by decreased medical expenditures and consumers may be motivated by the convenience and promptness of care that it offers.
In the NICU/ICU, telemedicine can be used in a variety of ways. One approach is by using HD webcams to see the baby from different angles. High-risk infants can be seen by a specialist at another hospital by simply sharing the video within seconds. This decreases the need for infants to be transferred to another hospital, which is costly and time consuming.

ECGs, or electrocardiographs, can be transmitted using telephone and wireless. Willem Einthoven, the inventor of the ECG, actually did tests with transmission of ECG via telephone lines. This was because the hospital did not allow him to move patients outside the hospital to his laboratory for testing of his new device. In 1906 Einthoven came up with a way to transmit the data from the hospital directly to his lab.[46] See above reference-General health care delivery. Remotely treating ventricular fibrillation Medphone Corporation, 1989
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world.
Kaitlin Brasier has worked in primary care since 2012 and provided virtual care since 2013. She received her Doctor of Nursing Practice from the University of San Diego in 2012. In addition to providing virtual care, she works in a dermatology clinic. She has extensive experience in family practice nursing and women's health and has conducted research on childhood obesity prevention. She enjoys outdoor activities, including hiking, snowboarding and horseback riding. She also likes cooking, reading and travel.
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