Without a doubt, the emergency room is one of the most expensive, overcrowded, and stressful environments in healthcare. With telemedicine, overcrowded emergency rooms can be reduced by having patients see a remote physician using video chat first. The remote physician can determine if that individual should seek care in an emergency department, which increases ED efficiency.
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]

Significant hurdles for more wide-spread telehealth adoption are the limits on reimbursement and the inconsistent payer landscape. In a KLAS-CHIME study from October of last year, over 50 percent of respondents from 104 health care organizations indicated that limits on reimbursement constrict their ability to expand telehealth services for patients. Medicare and Medicaid offer disparate degrees of flexibility while private payers also represent varying levels of funding.
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.
^ Wadsworth, Hannah E; Galusha-Glasscock, Jeanine M; Womack, Kyle B; Quiceno, Mary; Weiner, Myron F; Hynan, Linda S; Shore, Jay; Cullum, C. Munro (2016). "Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment". Archives of Clinical Neuropsychology. 31 (5): 420. doi:10.1093/arclin/acw030. PMID 27246957.
However, for a while, adopting and investing in telehealth services had been too high, and the distribution of telehealth resolutions and hospital-based networks proved to be too costly. But now, due to technological improvement, improved broadband services are now powerful and easily affordable which makes the level of return on investment in telehealth higher than ever before. Across almost all medical specialties, telehealth services can be applied in connecting providers with different patients in different locations via real-time audio and video. In other cases, service centers can use telemedicine to collect remotely as well as send data to a central monitoring system for interpretation.
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.
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.
A major legal action prompt in telehealth thus far has been issues surrounding online prescribing and whether an appropriate clinician-patient relationship can be established online to make prescribing safe, making this an area that requires particular scrutiny.[22] It may be required that the practitioner and patient involved must meet in person at least once before online prescribing can occur, or that at least a live-video conference must occur, not just impersonal questionnaires or surveys to determine need.[43]
Patients who are planning to visit India for medical treatment can make the most of our Medical Tourism service. We are associated with the best hospitals and through our secure virtual platform we can assist you 8/7 between 11 AM to 7 PM and connect you with the best doctors online to resolve your medical concern. Get everything you need to know about various treatments before planning your travel. Receive pre and post travel assistance, plan the right treatment procedure, compare cost options and stay connected with your doctor online after returning to your home country.
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.
Telemedicine in the trauma operating room: trauma surgeons are able to observe and consult on cases from a remote location using video conferencing. This capability allows the attending to view the residents in real time. The remote surgeon has the capability to control the camera (pan, tilt and zoom) to get the best angle of the procedure while at the same time providing expertise in order to provide the best possible care to the patient.[44]
When you need to find care, let us bring a healthcare provider to you. From your mobile device or computer, it’s never been easier for you and your family to instantly access world class care at home or work. For nonemergency concerns, patients ages 2 and older can get a diagnosis or prescription online from a healthcare provider in about a 10-minute virtual visit. Our Express Care Online service allows you to choose between an on demand visit right away or to schedule a virtual follow-up visit for a later date.

Telemedicine reimbursement is a difficult topic, especially with the constantly changing state policies. Many states now have parity laws which require private payers to reimburse for telemedicine visits the same way as in-person visits. The best way to navigate reimbursement is to call up your top payers and ask their policies. You can also check out our guide to telemedicine reimbursement and this helpful matrix from ATA on state policy.
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.
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.
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]
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.
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.
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.
Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service, such as laboratory service, x-ray service or physician services (under section 1905(a) of the Social Security Act).
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]
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]
Any technology that is used to store, share, or analyze health information can be referred to as “health information technology” or healthIT. This broad category includes things like practice management systems and online patient portals. Telehealth, or telemedicine, is a group of technologies within health IT that is used to provide clinical care, health information, or health education at a distance. Telehealth technology includes both software and hardware.

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients.[75][76] In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.[77]
There are many new medical tech terms being used today that the average patient may not be familiar with. For example, a common misunderstanding is that the terms telemedicine, telecare, and telehealth are interchangeable. The truth is that each of these terms refers to a different way of administering health care via existing technologies or a different area of medical technology. To clarify the subtle differences between these three terms, we have provided a detailed definition of each.

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]

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]
Two important areas of telerehabilitation research are (1) demonstrating equivalence of assessment and therapy to in-person assessment and therapy, and (2) building new data collection systems to digitize information that a therapist can use in practice. Ground-breaking research in telehaptics (the sense of touch) and virtual reality may broaden the scope of telerehabilitation practice, in the future.
While telemedicine has shown to be a game changer in the field of medicine, there are still a number of barriers to overcome. Physicians face challenges regarding how they’ll be paid and where they can practice, while patients voice security concerns. Once these barriers are removed, we can anticipate greater access to care and improved patient outcomes.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients.[75][76] In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.[77]
“Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” the ATA writes. “Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smart phones, wireless tools and other forms of telecommunications technology.”
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."

Patient Exam Cameras – These cameras are used to examine the patient’s overall condition. The different types of patient exam cameras are handheld cameras, camcorders, gooseneck cameras and those which may be placed above the set-top units. Analog and digital cameras are available and the ones that should be used depend on the connection to the set-top unit.


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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