Presenters or Patient Presenters – They are the ones who provide telehealth services and perform the overall exam for patients. Such presenters should be on the medical field and they must have experiences in providing health services to patients like registered nurses and licensed practical nurses. They were trained in the use of the equipment like cameras and computers, and they are the ones who communicate with the patients on the originating site. They can also perform the different activities which are part of the diagnostic examination.
The growth in telemedicine solutions means that telemedicine options are now more diverse, with many more affordable solutions. However, most telemedicine programs do require the purchase, set-up and staff training of new technology and equipment – some of which may be outside the budget of providers in smaller independent practices. Many providers are already stretched thin on new technology budgets and staff training for EHR systems, imposed by the Meaningful Use program. Also, for patients who may not have access to a smartphone or a computer with internet, real-time telemedicine may be out of reach.
Telepsychiatry – Telepsychiatry allows qualified psychiatrists to provide treatment to patients remotely, expanding access to behavioral health services. Telepsychiatry is incredibly popular, in part because of the nation-wide shortage of available psychiatrists, and because psychiatry often does not require the same physical exams of the medical field.
For developing countries, telemedicine and eHealth can be the only means of healthcare provision in remote areas. For example, the difficult financial situation in many African states and lack of trained health professionals has meant that the majority of the people in sub-Saharan Africa are badly disadvantaged in medical care, and in remote areas with low population density, direct healthcare provision is often very poor[90] However, provision of telemedicine and eHealth from urban centres or from other countries is hampered by the lack of communications infrastructure, with no landline phone or broadband internet connection, little or no mobile connectivity, and often not even a reliable electricity supply.[91]
To guide these decisions, the provider should create clinical protocols which include the condition to be treated (with ICD code), scope of that condition that can be treated using telemedicine, guidelines required to diagnose (when is telephone sufficient, vs. live video), documentation needed to properly assess the patient’s condition, parameters for when the condition can be treated and cannot be treated, and guidelines for when prescription can be done. While this section provides basic, overall guidelines for practicing telemedicine, it’s best practices for the healthcare provider to create more detailed protocols for each condition they intend to treat.

^ Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, et al. (February 2013). "Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial". BMJ (Clinical Research Ed.). 346: f653. doi:10.1136/bmj.f653. PMC 3582704. PMID 23444424.
Although this is more difficult to prove, big payers like Blue Cross Blue Shield and Aetna are benefiting from telemedicine too. Patients with substance abuse disorders who are treated using various telemedicine strategies provide cost-savings for payers. The cost per treatment is cheaper overall and offers cost savings across the board. As technology continues to improve, the cost savings will become more visible.

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]
Dr. Barnett attended the University of Southern California's Keck School of Medicine and completed his residency at Swedish Family Medicine. He has over 12 years of experience in practice and began working in Virtual Care over nine years ago. When Dr. Barnett is not providing Virtual Care, he works as a primary care provider for a local health system. He is fluent in Russian and proficient in Spanish. Outside of work, Dr. Barnett enjoys cooking, watching films, photography, and spending time with family.
Integrated Services Digital Network (ISDN): A common dial-up transmission path used for videoconferencing. ISDN services are on demand services where another IDSN based device is dialed, and per minuted charges are accumulated at a certain contracted rate. The site that places the call is then billed. The service is similar to the dialing features that come with making long distance phone calls. The person how initiates the call pays the bill. Connections of up to 128Kbps are permitted by ISDN.
Although, traditional medicine relies on in-person care, the need and want for remote care has existed from the Roman and pre-Hippocratic periods in antiquity. The elderly and infirm who could not visit temples for medical care sent representatives to convey information on symptoms and bring home a diagnosis as well as treatment.[5] In Africa, villagers would use smoke signals to warn neighbouring villages of disease outbreak.[6] The beginnings of telehealth have existed through primitive forms of communication and technology.[5]
The first example of an electronic medical record transfer occurred in 1948 in Pennsylvania, when radiology images were sent 24 miles between two townships via telephone line. A few years later, Canadian radiologists built on that early application of telemedicine technology and created a teleradiology system for use in and around Montreal. In 1959, clinicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television.
Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.

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.


In the last decade, rapid advances in medicine and technology has resulted in the use of new terms. Policymakers, healthcare systems, advocacy groups, and vendors may unknowingly use terms incorrectly when discussing medicine and technology. This is especially true when it comes to the terms, telemedicine and telehealth. Although the words are often used interchangeably, there is certainly a difference between the two.
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.
Between the years 2000 and 2050, the number of people aged 60 years or older is expected to increase from 605 million to 2 billion. The rapidly increasing elderly patient population have become one of the main beneficiaries of telehealth. Companies like Comarch, American Well, and Global Med are building doctor video chat platforms targeted at the elderly.
The definition of telemedicine is somewhat controversial. Some definitions (such as the definition given by the World Health Organization[2]) include all aspects of healthcare including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments.[3]
While many conditions not on this list can be treated via telemedicine, these conditions are an especially good fit for telemedicine: Allergies and asthma, Chronic bronchitis, Conjunctivitis, UTIs, Low back pain, Otitis media, Rashes, Upper respiratory infections, Diabetes, Hypertension, Mental illness/behavioral health, Prevention and wellness services.
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.
There’s a lot to be optimistic about in the future of telemedicine. With rapid advances in technology, it’s likely that telemedicine will only become easier and more widely accepted in the coming years. Already, smart glasses (like Google Glass) and smart watches (like the Apple Watch) can monitor patients’ health data and transmit them in real time to health professionals. Programs like clmtrackr can analyze a person’s emotional state based on their facial expressions and could be used to monitor mental wellness. Digital health startups like Augmedix, are experimenting with automatically transcribing documentation during a patient visit. Advances in robotic surgeries allow surgeons to operate on patients from afar.
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.
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
In the early days, telemedicine was used mostly to connect doctors working with a patient in one location to specialists somewhere else. This was of great benefit to rural or hard to reach populations where specialists aren’t readily available. Throughout the next several decades, the equipment necessary to conduct remote visits remained expensive and complex, so the use of the approach, while growing, was limited.
With telemedicine, a medical practice or hospital system can immediately expand access to niche medical specialists. This makes it easy for primary care doctors to consult medical specialists on a patient case, and for patients to see a needed specialist on a rare form of cancer, no matter their location. As another example, small hospitals without adequate radiology specialist on-staff can outsource evaluation of x-rays via telemedicine.
Real-time communication is probably what jumps to mind when you think of telehealth technology. It happens with the patient is at one location and the provider is at another and they connect using a video-enabled device and a telephone or computer audio. Sometimes the patient might be at a healthcare facility with a provider and they establish communications with a specialist at a remote location, other times the patient might not be at a medical office at all. She might join the encounter from work or the office, for example. Many state laws require insurers to reimburse for these types of video visits. Most don’t have a similar stipulation for telephone calls that don’t involve video.
“If there are areas of clinical need across the healthcare network, telemedicine may allow for better leveraging and expanding access to sub-specialists,” Sokolovich said. “Another opportunity could include better triaging patients through telemedicine-enabled provider-to-provider or provider-to-patient evaluations, which bring together experts who can quickly assess the best care path and eliminate unnecessary hospital admissions or emergency department visits.”

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.


The first example of an electronic medical record transfer occurred in 1948 in Pennsylvania, when radiology images were sent 24 miles between two townships via telephone line. A few years later, Canadian radiologists built on that early application of telemedicine technology and created a teleradiology system for use in and around Montreal. In 1959, clinicians at the University of Nebraska transmitted neurological examinations across campus to medical students using two-way interactive television.
Bao Ng has worked in primary care since 2013 and provided virtual care since 2013. Obtaining her Doctor of Nursing Practice from the University of Washington, she began working in telemedicine shortly thereafter. Her medical interests include international health, and maternal and child health. She works at an international community health clinic near her home, and is fluent in Vietnamese and proficient in conversational Cantonese. She volunteers as a caregiver in her church nursery and is an executive board member for a local pediatric and behavioral health clinic. Outside of work, she enjoys spending time with her husband and children and exploring new cuisines.
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