Thanks to telemedicine programs, hospitals, clinics and all other health facilities can ensure that patients receive the best care possible when that care is in their hometown or even hundred of miles away. So what is telehealth’s role in this? It can play a major role in addressing some of the upcoming challenges for healthcare in the United States. For instance, the population growth from 2008-2030 is set at 20%, that is 363 million people, which is predicted to bring about a shortage of healthcare professionals and the lack of specialists and medical facilities in rural areas. Additionally, there is an expected increase in chronic diseases such as diabetes, congestive heart failure, and obstructive pulmonary disease. Statistics indicates that almost 5 million patients are admitted to the intensive care unit that accounts for 20% of the hospital’s operating budgets. Telemedicine can reduce the impact of such challenges by connecting the right people with the correct resources and expertise in real-time.
In Pakistan three pilot projects in telemedicine was initiated by the Ministry of IT & Telecom, Government of Pakistan (MoIT) through the Electronic Government Directorate in collaboration with Oratier Technologies (a pioneer company within Pakistan dealing with healthcare and HMIS) and PakDataCom (a bandwidth provider). Three hub stations through were linked via the Pak Sat-I communications satellite, and four districts were linked with another hub. A 312 Kb link was also established with remote sites and 1 Mbit/s bandwidth was provided at each hub. Three hubs were established: the Mayo Hospital (the largest hospital in Asia), JPMC Karachi and Holy Family Rawalpindi. These 12 remote sites were connected and on average of 1,500 patients being treated per month per hub. The project was still running smoothly after two years.[48]

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.


Blue Sky Telehealth is committed to making specialty healthcare services more accessible to patients nationwide. We partner with hospitals to create a customized telehealth system that integrates with the facility’s existing processes and technology. Through our service, medical facilities can contact highly experienced medical specialists 24/7 to assist with patient care, diagnosis, and treatment. This saves hospitals the cost of keeping a medical specialist on-call full time and ensures that a qualified medical professional will always be available to tend to a patient with special care needs.
“It really helped our emergency room with treating stroke patients and benefited patient care by avoiding transportation when minutes matter,” he explained. “We see telemedicine as a solution to expand access to care without leaving the home, as well as a solution for gaining access to a specialist who may not have the patient volumes to relocate to our market.”

“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.”


Without proper medication, asthma and other respiratory related illnesses can be extremely serious. Chronic asthma affects more than 20-million citizens across the United States, and can appear in early childhood or adolescence. The symptoms vary from person to person, with most individuals experiencing shortness of breath, tightening of the chest, coughing, and wheezing.
While this definition sounds a lot like telemedicine, there is one distinct difference. Unlike telemedicine, telehealth also covers non-clinical events like administrative meetings, continuing medical education (CME), and physician training. Telehealth is not a specific service, but a collection of methods to improve patient care and education delivery.

Although there were distant precursors to telemedicine, it is essentially a product of 20th century telecommunication and information technologies. These technologies permit communications between patient and medical staff with both convenience and fidelity, as well as the transmission of medical, imaging and health informatics data from one site to another.
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.
Patients often look for a quick and inexpensive second opinion from a specialist, after diagnosis of a medical condition. Telemedicine has stepped up, by providing solutions in this aspect as well. Companies and traditional healthcare services such as Partners Healthcare, 2nd.MD, DoctorSpring, and Cleaveland Clinic are providing quick and efficient second opinions using telehealth.
Once the need for a Telehealth service is established, delivery can come within four distinct domains. They are live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health. Live video involves a real-time two-way interaction, such as patient/caregiver-provider or provider-provider, over a digital (i.e. broadband) connection. This often is used to substitute a face to face meeting such as consults, and saves time and cost in travel. Store-and-forward is when data is collected, recorded, and then sent on to a provider.[1][2][10] For example, a patient's' digital health history file including x-rays and notes, being securely transmitted electronically to evaluate the current case. Remote patient monitoring includes patients' medical and health data being collected and transferred to a provider elsewhere who can continue to monitor the data and any changes that may occur. This may best suit cases that require ongoing care such as rehabilitation, chronic care, or elderly clients trying to stay in the community in their own homes as opposed to a care facility. Mobile health includes any health information, such as education, monitoring and care, that is present on and supported by mobile communication devices such as cell phones or tablet computers. This might include an application, or text messaging services like appointment reminders or public health warning systems.[10]
Although the Patient Protection and Affordable Care Act of 2010 governs telemedicine in certain situations under Medicare, telemedicine regulation for the most part falls to the states. As of spring 2018, 49 states and Washington, D.C., provide reimbursement via Medicaid for some version of live video care, according to the Center for Connected Health Policy, a group that promotes telemedicine.
The telemedicine foundation is quickly being built. But what do patients think about telemedicine? Are they ready to try it? Recent studies show that a majority of patients are interested in using telehealth services, especially once they see how it works and the potential benefits for them. NTT Data found 74% of surveyed US patients were open to using telemedicine services, and were comfortable communicating with their doctors via technology. 67% said telemedicine at least somewhat increases their satisfaction with medical care.
“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.”

* 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. 
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.
The company has made seven acquisitions: Consult A Doctor for $16.6 million cash in August 2013; AmeriDoc for $17.2 million in May 2014; and BetterHelp for $3.5 million in cash and a $1.0 million promissory note in January 2015.[23] The company also announced and closed the acquisition of HealthiestYou in July 2016.[23] Stat Health Services, Inc. (StatDoc) for $30.1 million, $13.3 million of cash and $16.8 million of Teladoc common stock (or 1,051,033 shares), net of cash acquired in June 2015[27] ; and HealthiestYou for $45 million in cash and 6.96 million shares of Teladoc's common stock in June 2016.[28] In 2017, the company purchased Best Doctors, Inc., a provider of medical second opinions and a "pay-to-play" medical award listing.[29] Most recently, Teladoc has acquired Advance Medical for $352 million. Advance Medical is a telemedicine company which has locations in Chile, Spain, and parts of Asia. It runs a virtual doctor service, called Global Care on Demand, which offers access to medical advice by phone or video by doctors located in eight main hubs around the world who speak more than 20 languages, and is targeted at expatriates.[30]
Healthcare systems, policymakers, vendors, and providers alike can attest to the many gray areas within telemedicine. One particular area that requires more clarity is the legalities surrounding telemedicine. With it being an industry that is constantly growing, it has become difficult to create a concrete solution. In addition, each state follows different laws for telemedicine, which makes it increasingly difficult to keep up with it.
While Doctor on Demand’s chief executive Adam Jackson says the start-up targets mainly retail customers who pay $40 for 10 minutes or so with a physician, it signed up Comcast , its first major corporate customer which will subsidize its employees video visits. Doctor on Demand has a network of more than 1,400 general practitioners, internists and pediatricians in 47 states. They diagnose simple ailments, such as pink eye, sore throat and allergies. Insurance doesn’t reimburse video consultations, but customers can use pre-tax dollars from their health savings account to pay.
Telemedicine for trauma triage: using telemedicine, trauma specialists can interact with personnel on the scene of a mass casualty or disaster situation, via the internet using mobile devices, to determine the severity of injuries. They can provide clinical assessments and determine whether those injured must be evacuated for necessary care. Remote trauma specialists can provide the same quality of clinical assessment and plan of care as a trauma specialist located physically with the patient.[41]

HIT is the generation and transmission of digital health data, often through an electronic health record. Generally, HIT is used for administrative functions (keeping track of patient's health history, sharing information between providers, etc.) while telemedicine is the delivery of an actual clinical service. HIT can facilitate telemedicine but it is not a requirement for delivering remote health care.
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]

Project ECHO, a knowledge-sharing enterprise that works both across the U.S. and globally, offers a good example of how technology-enabled collaborative learning models work. Launched initially in New Mexico to help patients with hepatitis C gain access to specialty treatment, Project ECHO connects a team of specialists at a university medical center "hub" with teams of primary-care clinicians at community health centers—or "spokes"—across a state or region. This connection is recurring: Typically, it takes place every week or every other week, during telementoring clinics that operate like virtual grand rounds.


Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.[3] It does not require the presence of both parties at the same time.[1] Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.
Yes. Guided by technical standards and clinical practice guidelines, and backed by decades of research and demonstrations, telemedicine is a safe and cost-effective way to extend the delivery of health care.  ATA has produced a series of standards, guidelines and best practices for healthcare providers to ensure that they are using telemedicine responsibly.
Store and forward telehealth refers to the capture, storage, and transmittal of patient health information for asynchronous healthcare delivery using data storage and transmission technology. CAT Scans, MRIs, X-rays, photos, videos, and text-based patient data are gathered and sent to specialists and other members of a care team to evaluate patients and assist in their treatment. Technologies used for store and forward telehealth include secure servers and routers that temporarily house incoming packets of information and then route them to the appropriate end users. Secure email platforms are also used for store and forward telehealth.
Healthcare providers currently earn their medical licenses for a specific state. This lets them practice medicine legally in that state, and only that state. This presents a problem for telemedicine, as the entire goal is to break down geographical barriers between a patient and provider. According to medical licensing regulations, a specialist based in Colorado would not be legally allowed to treat a patient in New Mexico.
Today, there are telemedicine solutions that allow patients to seek a second opinion from the comforts of their home. Sending another physician copies of your medical images and more can easily be done by uploading the content to their secure website. This is very convenient for those who need a specialist but do not have the resources to drive thousands of miles away or wait a long time.
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 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.


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.

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.

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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