One of the key advantages of telemedicine is the ability to provide healthcare to a patient, no matter the patient or provider’s location. However, since providers are licensed to practice in a specific state, they are only legally allowed to offer telemedicine services to patients in the same state. Currently, 49 state medical boards require physicians practicing telemedicine to be licensed in the state where the patient is located.

A tool that makes healthcare more accessible, cost-effective, and that increases patient engagement – is telemedicine. Since making its debut in the late 1950’s, advances in telemedicine has contributed to seniors having the choice to age in place. In addition, the patients that reside in rural areas that previously had difficulties accessing a physician, can now reach them virtually.
1. Request a visit with a doctor 24 hours a day, 365 days a year. Requests can be made by web, phone, or mobile app. Want to see the doctor with whom you’re speaking? Choose “video” as the method for your visit. Feeling camera shy? Choose “phone.” Got a busy schedule? Select a time that’s best for you by choosing “schedule” instead of “as soon as possible.”

Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.[22][23]


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.
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.
The popularity of real-time telemedicine solutions has increased rapidly in the past few years, as companies like Teladoc and DoctoronDemand have offered an affordable, easy way for patients to connect with a doctor from anywhere and get immediate treatment. Doctors are also starting to adopt real-time telemedicine solutions to give their patients the added convenience of virtual doctor visits, improve their care outcomes, boost work-life balance, and reap the many other benefits. With simply a compatible device, internet connection, microphone, and webcam – a patient can now get medical treatment. That’s the beauty of real-time telemedicine.   

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]


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.
“Although many definitions are similar, there are nuanced differences that reflect each organization's legislative intent and the population they serve,” the study concluded. “These definitions affect how telemedicine has been or is being applied across the healthcare landscape, reflecting the U.S. government's widespread and influential role in healthcare access and service delivery. The evidence base suggests that a common nomenclature for defining telemedicine may benefit efforts to advance the use of this technology to address the changing nature of healthcare and new demands for services expected as a result of health reform.”
Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.[22]

In developed countries, health promotion efforts using telehealth have been met with some success. The Australian hands-free breastfeeding Google Glass application reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called Small World Social, helped new mothers learn how to breastfeed.[27][28][29] Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world.[30][31] Widespread breastfeeding can prevent 820,000 infant deaths globally but the practice is often stopped prematurely or intents to do are disrupted due to lack of social support, know-how or other factors.[31] This application gave mother's hands-free information on breastfeeding, instructions on how to breastfeed and also had an option to call a lactation consultant over Google Hangout. When the trial ended, all participants were reported to be confident in breastfeeding.[29]
Thanks to telemedicine, physicians have the wonderful opportunity to connect with clients wherever they are. Patients who once could not see a physician due to access to care issues, can now do so almost seamlessly. However, many may wonder what is telemedicine’s most valuable applications? We’ll discover a few popular ways that telemedicine is used today.
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.
VSee urges organizations to try their free app so physicians can get a feel for sharing medical documents and streaming digital device images. In addition, organizations should ensure they have compatible microphones, webcams, speakers, and more. A telemedicine tech should be identified within the practice to help others get acclimated and resolve tech issues. Also, practices should be aware of their Internet connection. VSee’s video chat is robust, but how well it works comes down to the Internet connection and computer capabilities.
With telehealth allowing physicians to expand their coverage area, there have been questions regarding interstate medical licensing. Interstate medical licensing permits more physicians to serve individuals in underserved and rural areas, but currently, only a few states offer this. The Interstate Medical Licensure Compact helps streamline the licensing process for physicians that are interested in practising in participating states.
Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient). As such, states have the option/flexibility to determine whether (or not) to cover telemedicine; what types of telemedicine to cover; where in the state it can be covered; how it is provided/covered; what types of telemedicine practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are "recognized" and qualified according to Medicaid statute/regulation; and how much to reimburse for telemedicine services, as long as such payments do not exceed Federal Upper Limits.
With many rural areas facing a shortage of specialists, telemedicine enables individual doctors to reach more patients. And the cost to patients for telehealth consultations is often lower than an in-office visit. By serving more patients in a shorter amount of time, healthcare organizations can cost-effectively grow their membership while increasing care quality and patient satisfaction.
Medicaid: Every state Medicaid plan specifically covers at least some telehealth services, however states vary greatly in their coverage.  State-specific information is available on www.atawiki.org and the 50 State Telemedicine Gaps Analysis: Coverage and Reimbursement. ATA has challenged each state to fully cover telemedicine to increase coverage while simultaneously reducing service costs.
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.

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.

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. 
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.

As various parties seek more efficient ways to provide care at less cost to the patient, telemedicine's role has grown. It is often a time-saving way for a consumer to see and speak to a clinician for minor and non-urgent medical needs instead of going to a primary care physician's office or emergency department. In recent years, many states have passed laws that make telemedicine easier to practice, and federal health regulators are also exploring ways to further grant Medicare reimbursements for telemedicine services.

Doctor on Demand is currently available for patients in 15 states, including large states like California, Florida, New Jersey, New York, Ohio, and Texas. The company has more than 1,000 doctors available for video consultants one or two days a week, according to Bloomberg Businessweek. The company trains physicians on how to use the service, and covers other logistics like patient questionnaires and malpractice insurance.
All the guidelines and restrictions we’ve listed above are for billing telemedicine through traditional Medicare. Medicare Advantage plans under a commercial payer have complete flexibility to cover telemedicine however they want! This means, Advantage plans may cover telemedicine for your patient and not have any of those restrictions on what qualifies as an eligible originating site. Call the payer and ask what they’ll cover and what their telemedicine guidelines are.
In 1964, the Nebraska Psychiatric Institute began using television links to form two-way communication with the Norfolk State Hospital which was 112 miles away for the education and consultation purposes between clinicians in the two locations.[9] The Logan International Airport in Boston established in-house medical stations in 1967. These stations were linked to Massachusetts General Hospital. Clinicians at the hospital would provide consultation services to patients who were at the airport. Consultations were achieved through microwave audio as well as video links.[5][9]
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma. [5] The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.

Store-and-forward is the oldest form of telehealth technology. It refers to the transmission of images or information from one provider to another. For example, if your doctor sends digital images of an x-ray to a radiologist for analysis, they are leveraging store-and-forward telehealth technology. This is one of the most common uses, but images and information of any type can be transmitted in this matter. One thing we should point out, however, is that store-and-forward telehealth is not always covered by state telemedicine reimbursement laws, even in states that require parity for real-time communication.
Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!
“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.
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.
Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!
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.
Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.[22][23]
Likely one of the most popular specialities for telemedicine, mental health practices can increase revenue, streamline patient flow, and provide counselling sessions from anywhere. With telemedicine, patients in rural areas can now access mobile and web apps to speak with their therapist. In addition, cancellations and no-shows are less likely to occur. Mental health practices that implement telemedicine can also see more patients and still provide a high level of patient care. This leads to increased profitability and effective time management.
Not all state and federal agencies define telehealth in exactly the same terms, but most are fairly consistent with the federal Health Resources and Services Administration, which defines telehealth this way, “The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”
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.
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