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.
Teleradiology – Teleradiology is actually one of the earliest fields of telemedicine, beginning in the 1960s. Teleradiology solutions were developed to expand access to diagnosticians of x-rays. Smaller hospitals around the U.S. may not always have a radiologist on staff, or may not have access to one around the clock. That means patients coming into the ER, especially during off-hours, will have to wait for diagnosis. Teleradiology solutions now offer providers at one location to send a patient’s x-rays and records securely to a qualified radiologist at another location, and get a quick consult on the patient’s condition.

But for growth investors, Teladoc looks like a great pick. Telehealth is still in its early stages with a tremendous opportunity for growth. Teladoc Health is the top player in the space with a lead that will be difficult to overcome. The stock might experience sharp declines now and then, but there should be more ups than downs for Teladoc over the long run.
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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.

Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency.[70] Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education.[71][72][73] The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.[74]

A radiologist specializes in using medical imaging techniques to both diagnose and treat disease. Their day-to-day responsibilities include working with other healthcare professionals, which can be extremely time-consuming. With telemedicine, radiologists can receive high-quality images and provide feedback on where ever they are. They no longer have to be in the same area as the provider sending over the images, which allows for a more streamlined process.
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]
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Type of telehealth. Medicare primarily only reimburses for live telemedicine, where the physician and patient are interacting in real-time through secure, videochat. This type of telemedicine visit is meant to substitute a face-to-face in-person visit. The only exception is in Hawaii and Alaska, where Medicare reimburses for store-and-forward telemedicine as well.
Asynchronous or "Store and Forward": Transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not be considered telemedicine but may be utilized to deliver services.

^ Parikh, Mili; Grosch, Maria C; Graham, Lara L; Hynan, Linda S; Weiner, Myron; Shore, James H; Cullum, C. Munro (2013). "Consumer Acceptability of Brief Videoconference-based Neuropsychological Assessment in Older Individuals with and without Cognitive Impairment". The Clinical Neuropsychologist. 27 (5): 808–17. doi:10.1080/13854046.2013.791723. PMC 3692573. PMID 23607729.
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.

Today, 95 percent of Americans own cell phones and 77 percent own smartphones. These and other mobile devices can be leveraged to promote better health outcomes and increased access to care. mHealth or mobile health refers to healthcare applications and programs patients use on their smartphones, tablets, or laptops. These applications allow patients to track health measurements, set medication and appointment reminders, and share information with clinicians. Users can access hundreds of mHealth applications including asthma and diabetes management tools as well as weight loss or smoking cessation apps. Additionally, mobile devices allow users to schedule appointments and communicate with providers via video conference and text message.

While the loss of an in-person human interaction is often cited by skeptics of telemedicine, 76% of patients said they care more about access to healthcare than having an in-person interaction with their doctors. Also, only 16% if surveyed patients would rather go to the ER for minor conditions if they could instead use telemedicine for treatment. With the ongoing shortage of patient slots open with overburdened primary care doctors, these stat says a lot about patients’ willingness to try out telemedicine.

The field of telemedicine has changed drastically from its inception. It was only about fifty years ago that a few hospitals started experimenting with telemedicine to reach patients in remote locations. But with the rapid changes in technology over the last few decades, telemedicine has transformed into a complex integrated service used in hospitals, homes, private physician offices, and other healthcare facilities.
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]

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]
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:
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.

Once shared, that knowledge takes on a life of its own, growing and moving in all directions. Primary-care clinicians learn from their specialist mentors at the university hubs, but they also learn from each other. And by applying the knowledge they gain in the field, they produce new knowledge, which they then relay to their specialist and primary-care colleagues in their learning community.
^ 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.
Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency.[70] Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education.[71][72][73] The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.[74]
A question popular among organizations that want to implement telemedicine solutions is regarding how their physicians will be reimbursed. With telehealth regulations varying for each state and with payers setting up different policies, it is difficult to find consistency. What does remain consistent is that telemedicine is advancing and its becoming difficult for the key players to keep up.
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. 
Only some states have actually regulations requiring healthcare providers to get patients’ informed consent to use telemedicine. However, this is always good practice, whether or not your state requires it. Before the first telemedicine visit, providers should explain to patients how telemedicine works (when service is available, scheduling, privacy etc), any limits on confidentiality, possibility for technical failure, protocols for contact between virtual visits, prescribing policies, and coordinating care with other health professionals. Everything should be explained in simple, clear language.
Today, most people have access to basic telemedicine devices like mobile phones and computers. With improved accessibility, individuals in rural areas and busy urban areas can connect with a provider with ease. Home-use medical devices make it possible for caregivers to monitor everything from vitals to glucose levels. Physicians can gather essential medical information and make a diagnosis without patients stepping foot in a doctors office.
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.
Store-and-forward telemedicine works best for interprofessional medical services – where a provider needs to outsource diagnosis to a specialist. For instance, teleradiology relies heavily on store-and-forward technology to allow technicians and healthcare professionals at smaller hospitals to share patient x-rays for diagnosis by a specialist at another location. Asynchronous telemedicine is also commonly used for teledermatology and teleophthalmology.
According to a May 2017 article by Alignment Chief Medical Officer Ken Kim, the organization’s efforts paid off. “Because of the program, Alignment’s seniors are seeing reduced 30-day readmission rates … compared to the national Medicare average readmission rate of about 18%. In 2016, Alignment members enrolled in remote [monitoring] across all markets saw hospital readmission rates of 7.2%.”
Before setting up a telemedicine practice, an organizations administration and providers should know how laws differ when using telemedicine solutions. They should also consult with an expert to determine what equipment they need, and have a basic understanding of why they want to offer this in the first place. In addition, if it’s an existing practice, they should get buy-in as some physicians are not ready to make the transition.

Teladoc Health enjoys a killer advantage with its head start in telehealth. Around 40% of the largest companies in the world contract with Teladoc to provide virtual healthcare services to their employees. Over 35 of the biggest health plans in the U.S. have partnered with Teladoc. More than 290 hospitals and health systems have teamed up with the telehealth leader.


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.
Even the American Telemedicine Association also considers telemedicine and telehealth to be interchangeable. “While the term telehealth is sometimes used to refer to a broader definition of remote healthcare that does not always involve clinical services, (the) ATA uses the terms in the same way one would refer to medicine or health in the common vernacular,” the organization states. 

Disease Management: A coordinated and continuous health process for the purposes of managing and improving the health status of a specifically defined population of patients over the complete course of the disease (e.g., DM, CHF). The targeted patient populations are high-cost, high-risk patients that have chronic conditions that require appropriate care in order to be maintained properly.
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.
According to the American Telemedicine Association, telehealth encompasses a range of services, from health monitoring and patient consultation to the transmission of medical records. It’s more broadly defined as any electronic exchange of health information. A growing number of healthcare organizations have embraced telehealth because of the benefits it provides to patients and clinicians.

Telehealth - powered by Teladoc - is a convenient, affordable new way to access quality care for general medical, behavioral health, and dermatology2 services by web, phone3, or mobile app. Connect with a board-certified doctor, therapist, or dermatologist from the comfort of home, during your lunch break, or while traveling throughout the country. 


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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