Synchronous, real-time or Clinical Video Telehealth requires the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Video-conferencing equipment is one of the most common forms of technologies used in synchronous telehealth. There are also peripheral devices that can be attached to computers or the video-conferencing equipment which can aid in an interactive examination.

The potential benefits of telehealth services may be limited by other factors, such as the ability to pay for them. Insurance reimbursement for telehealth still varies by state and type of insurance. Also, some people who would benefit most from improved access to care may be limited because of regional internet availability or the cost of mobile devices.


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]
Restrictive licensure laws in the United States require a practitioner to obtain a full license to deliver telemedicine care across state lines. Typically, states with restrictive licensure laws also have several exceptions (varying from state to state) that may release an out-of-state practitioner from the additional burden of obtaining such a license. A number of states require practitioners who seek compensation to frequently deliver interstate care to acquire a full license.

Telenursing refers to the use of telecommunications and information technology in order to provide nursing services in health care whenever a large physical distance exists between patient and nurse, or between any number of nurses. As a field it is part of telehealth, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, telemonitoring, etc.
Multi-point Teleconferencing – This is the process of connecting multiple users from different sites. It allows electronic communication between the users as well as transmission of video, voice and data between computers and systems. Multi-point teleconferencing requires the use of a multi-point control unit or the bridge to be able to connect the different sites for the videoconference.
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.

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.
The Satellite African eHEalth vaLidation (SAHEL) demonstration project has shown how satellite broadband technology can be used to establish telemedicine in such areas. SAHEL was started in 2010 in Kenya and Senegal, providing self-contained, solar-powered internet terminals to rural villages for use by community nurses for collaboration with distant health centres for training, diagnosis and advice on local health issues[92]
Chiron Health believes that the right technology is the key to ensuring both patient satisfaction and provider reimbursement. Our easy-to-use, real-time telehealth solution gives providers the piece of mind that they will be able to deliver top-quality care, while increasing revenues and remaining compliant with HIPAA and other laws and regulations. It is perfectly suited for chronic disease management and follow-up visits.

It’s also important to note that many doctors using telemedicine will charge the patient a convenience fee, ranging from $35 – $125 per visit. This fee is direct from the patient and is on top of (or in place of) any reimbursement through a payer. While that means patients are paying out-of-pocket, many of eVisit’s clients have found patients don’t mind, and in fact are happy to pay the additional fee for the convenience.

Dr. Parker has practiced medicine since 1994 and provided virtual care since 2013. He received his medical degree from the Medical College of Wisconsin and went on to complete a family practice residency at St. Joseph's Hospital and St. Mary's Family Practice. In addition to his work in telemedicine, he is an Assistant Clinical Professor at the St. Louis University School of Medicine. Dr. Parker and his family have a strong commitment to organic, sustainable, and humane food preparation, raising and growing much of their own food. In his spare time, he is a trail runner, half-marathoner and amateur photographer.


The concept of telemedicine started with the birth of telecommunications technology, the means of sending information over a distance in the form of electromagnetic signals. Early forms of telecommunications technology included the telegraph, radio, and telephone. In the late 19th century, the radio and telephone were just starting to emerge as viable communication technologies. Alexander Graham Bell patented the telephone in 1876 and Heinrich Rudolf Hertz performed the first radio transmission in 1887.

Devices are also being used to track blood glucose levels and report high or low levels to patients and providers. In partnership with Stanford, Apple is testing whether its Apple Watch can be used to detect irregular heart patterns, and AliveCor’s KardiaBand allows Apple Watch wearers to perform electrocardiograms in 30 seconds that can easily be transmitted to physicians. Patients often go months without seeing their providers. RPM can allow for earlier detection of complications and identify patients who need to seek medical attention prior to in-person appointments. Moreover, chronic conditions can be more readily and efficiently managed resulting in higher quality care and outcomes as well as reduced costs.


Internet Protocol (IP): The protocol for sending data from one computer over the Internet to another. Every computer that is on the Internet has one address at least that identifies it uniquely from all of the other computers that are on the Internet. Internet Protocol is a connectionless form of protocol, meaning there isn’t a connection that is established between the two points that are communicating with one another. A videoconferencing system’s IP address is its telephone number.
Their distinguishing feature is that they expand the point-to-point connection that is the foundation of telemedicine. Instead of connecting one person to one person for a single interaction, they connect many to many, on an ongoing basis. To address system challenges like access, quality and dissemination of best practices, we need these more powerful linkages.

Effective September 1, 2018, the AlaskaCare Employee Health Plan has partnered with Teladoc® to provide you with a convenient and affordable way to receive quality medical care. Teladoc® lets you talk with experienced doctors by phone or video anytime, anywhere. All Teladoc® doctors are board-certified, state-licensed and can treat many health issues, including:
Currently, smokers can seek help in the form of one on one therapy, group counselling sessions, or through medicated means, such as a patch or gum. There are also prescription medications which have shown increasing success across the United States. The most popular of these are Wellbutrin, Zyban, and Chantix. To learn more about these prescriptions and to obtain your own today,click here.
For purposes of Medicaid, telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.
Telerehabilitation (or e-rehabilitation[36][37]) is the delivery of rehabilitation services over telecommunication networks and the Internet. Most types of services fall into two categories: clinical assessment (the patient's functional abilities in his or her environment), and clinical therapy. Some fields of rehabilitation practice that have explored telerehabilitation are: neuropsychology, speech-language pathology, audiology, occupational therapy, and physical therapy. Telerehabilitation can deliver therapy to people who cannot travel to a clinic because the patient has a disability or because of travel time. Telerehabilitation also allows experts in rehabilitation to engage in a clinical consultation at a distance.
Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.
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."
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]
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.[5] 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.[5][7] 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.[7]
* Physicians on Silver Cross Hospital’s Medical Staff have expertise in their areas of practice to meet the needs of patients seeking their care.  These physicians are independent practitioners on the Medical Staff and are not the agents or employees of Silver Cross Hospital. They treat patients based upon their independent medical judgment and they bill patients separately for their services. 
Shannon Edmonds has practiced medicine since 2009, and provided virtual care since 2015. She started out her professional career as a teacher and eventually went back to school for her BSN, then Master's and Doctoral degrees in nursing at University of Washington. Her nursing experience ranges from being a school nurse, nursing research, and most recently, doing in-home health assessments. As a family Nurse Practitioner, she finds the gamut of diagnoses and ages interesting.
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