The first radiologic images were sent via telephone between two medical staff at two different health centers in Pennsylvania by 1948. The health centers were 24 miles apart from one another! Then in 1959, physicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television. Five years later, a closed-circuit television link was built that allowed physicians to provide psychiatric consultations 112 miles away at Norfolk State Hospital.
Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another.
The development and history of telehealth or telemedicine (terms used interchangeably in literature) is deeply rooted in the history and development in not only technology but also society itself. Humans have long sought to relay important messages through torches, optical telegraphy, electroscopes, and wireless transmission. In the 21st century, with the advent of the internet, portable devices and other such digital devices are taking a transformative role in healthcare and its delivery.[5]
“Telehealth is not a specific service, but a collection of means to enhance care and education delivery,” says the Center for Connected Health Policy (CCHP). CCHP further classify telehealth into four types of services, live-video conferencing, mobile health, remote patient monitoring, and store-and-forward. Most telehealth platforms provide one or more of these services, to a niche patient or consumer segment.
To date, there are 33 states plus the District of Columbia, that have parity laws that require private payer reimbursement for telemedicine services. All states with parity laws require private payers to pay for video-conferencing. To date, only a few states require reimbursement for store and forward telemedicine. Organizations should also understand that payment for telemedicine services may not equal that of onsite services.
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.    
Universal Service Administrative Company: Abbreviated as USAC, the Universal Service Administrative Company is responsible for administering USFs or Universal Service Funds to allow easy access to telecommunication services across the country. The Rural Health Care Division which is under USAC as well manages discount programs for telecommunications health care.
This system enabled wireless transmission of ECG from the moving ICU van or the patients home to the central station in ICU of the department of Medicine. Transmission using wireless was done using frequency modulation which eliminated noise. Transmission was also done through telephone lines. The ECG output was connected to the telephone input using a modulator which converted ECG into high frequency sound. At the other end a demodulator reconverted the sound into ECG with a good gain accuracy. The ECG was converted to sound waves with a frequency varying from 500 Hz to 2500 Hz with 1500 Hz at baseline.
Many doctors who choose to offer virtual visits to their patients will do so as part of a direct-pay or concierge practice model. Instead of having their doctor bill through an insurance carrier, these patients might have a high-deductible insurance plan for emergencies and then pay a yearly fee to essentially have their doctor on retainer. The patients might pay an additional convenience fee for each virtual visit, or just have access to virtual visits with their doctor as part of their subscription fee for the practice.
Store and forward, a type of telemedicine that allows providers to share information over a distance, has been a game changer. Today, primary care physicians can connect with specialists who are in another location than them. Healthcare information like diagnostic images, blood analysis, and more can be shared for appropriate patient assessment in real time.
Today the telemedicine field is changing faster than ever before. As technology advances at exponential levels, so does the widespread affordability and accessibility to basic telemedicine tools. For example, not only do we now have the technology for live video telemedicine, but much of the U.S. population has experience using online videochat apps (like Skype or Facetime), and access to a computer or mobile device to use them.
Telehealth Addresses Primary Care Physician Shortages/Specialist Scarcity: Telehealth is allowing patients at smaller, less-resourced hospitals to gain access to specialists based at larger regional facilities. Undeniably, lack of access and hard-to-reach populations are drivers of telehealth innovations as supported by this 2014 MUSC study on the use of telehospitalists to address physician shortages. Telehealth is being implemented to treat prison populations, as well as being deployed in rural communities and underserved urban areas to improve healthcare availability.
Telehealth requires a strong, reliable broadband connection. The broadband signal transmission infrastructure includes wires, cables, microwaves and optic fibre, which must be maintained for the provision of telehealth services. The better the connection (bandwidth quality), the more data can be sent and received. Historically this has priced providers or patients out of the service, but as the infrastructure improves and becomes more accessible, telehealth usage can grow.[1][2]
Applications of telehealth in physical therapy already have roots that expand throughout patient/client care and consultation, as it allows PTs to better communicate with patients/clients and provide more flexible care. Telehealth will not replace traditional clinical care. However, it will give PTs and PTAs the flexibility to provide services in a greater capacity. Examples:
Universal Service Administrative Company: Abbreviated as USAC, the Universal Service Administrative Company is responsible for administering USFs or Universal Service Funds to allow easy access to telecommunication services across the country. The Rural Health Care Division which is under USAC as well manages discount programs for telecommunications health care.
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.
Doctor On Demand’s board-certified physicians are available on-demand and by appointment. The typical average wait time to connect with a doctor is under 3 minutes. Doctor On Demand psychologists are available by appointment between the hours of 7am and 10pm and have extensive experience coaching patients through natural disasters and traumatic events.
There are a variety of payment models to fund telemedicine services. For example, some health systems offer telemedicine consultations as part of their regular care services, and payers charge patients based on insurance plans or government reimbursement schedules. In other cases, a patient's employer offers virtual care options as part of health insurance coverage premiums. Some people may opt to independently use a telemedicine vendor for a flat fee.
Glenda Clemens has worked in primary care since 2001 and provided virtual care since 2012. She has practiced medicine as a nurse's aide, licensed practical nurse and registered nurse before receiving her Master of Nursing from the University of Oklahoma. From running her own practice to caring for veterans, she demonstrates a commitment to providing care to underserved populations. When she is not working, she enjoys knitting, crocheting and writing poetry.
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