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.
Ravyn Ramos has practiced medicine since 2009 and provided virtual care since 2014. She received her Doctor of Naturopathic Medicine degree from Bastyr University in 2004, and her Master of Nursing from Seattle University in 2007. In addition to her work in telemedicine, she serves as clinical faculty in Walden University's distance learning program, as well as practicing as a Family Nurse Practitioner in several local medical centers. In her spare time, she enjoys Bikram yoga, baking bread, traveling and watching the Sounders.

The range and use of telehealth services have expanded over the past decades, along with the role of technology in improving and coordinating care. Traditional models of telehealth involve care delivered to a patient at an originating (or spoke) site from a specialist working at a distant (or hub) site. A telehealth network consists of a series of originating sites receiving services from a collaborating distant site.
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.
Telepsychiatry, another aspect of telemedicine, also utilizes videoconferencing for patients residing in underserved areas to access psychiatric services. It offers wide range of services to the patients and providers, such as consultation between the psychiatrists, educational clinical programs, diagnosis and assessment, medication therapy management, and routine follow-up meetings.[49] Most telepsychiatry is undertaken in real time (synchronous) although in recent years research at UC Davis has developed and validated the process of asynchronous telepsychiatry.[50] Recent reviews of the literature by Hilty et al. in 2013, and by Yellowlees et al. in 2015 confirmed that telepsychiatry is as effective as in-person psychiatric consultations for diagnostic assessment, is at least as good for the treatment of disorders such as depression and post traumatic stress disorder, and may be better than in-person treatment in some groups of patients, notably children, veterans and individuals with agoraphobia.
However, whether or not the standard of health care quality is increasing is quite debatable, with literature refuting such claims.[23][34][35] Research is increasingly reporting that clinicians find the process difficult and complex to deal with.[34][36] Furthermore, there are concerns around informed consent, legality issues as well as legislative issues. Although health care may become affordable with the help of technology, whether or not this care will be "good" is the issue.[23]
“While ‘telemedicine’ has been more commonly used in the past, ‘telehealth’ is a more universal term for the current broad array of applications in the ­field,” the TRC network states in its online resource guide. “Its use crosses most health service disciplines, including dentistry, counseling, physical therapy and home health, and many other domains. Further, telehealth practice has expanded beyond traditional diagnostic and monitoring activities to include consumer and professional education. Note that while a connection exists between health information technology (HIT), health information exchange (HIE) and telehealth, neither HIE nor HIT are considered to be telehealth.”

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) that states can choose to cover under Medicaid. This definition is modeled on Medicare's definition of telehealth services (42 CFR 410.78). Note that the federal Medicaid statute does not recognize telemedicine as a distinct service. 
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.
States may submit a coverage SPA to better describe the telemedicine services they choose to cover, such as which providers/practitioners are; where it is provided; how it is provided, etc. In this case, and in order to avoid unnecessary SPA submissions, it is recommended that a brief description of the framework of telemedicine be placed in an introductory section of the State Plan and then a reference made to telemedicine coverage in the applicable benefit sections of the State Plan. For example, in the physician section it might say that dermatology services can be delivered via telemedicine provided all state requirements related to telemedicine as described in the state plan are otherwise met.
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 company employs its own doctors and staffs its video consultation service 24 hours a day, seven days a week, Ferguson says. Despite the workload — which sees the company’s virtual doctors consult with four patients each hour on average — the company’s 14-day readmission rate (a standard measure of effective diagnoses) is on par with brick and mortar services, Ferguson says.

Telemedicine solutions that fall into the remote patient monitoring (RPM) allow healthcare providers to track a patient’s vital signs and other health data from a distance. This makes it easy to watch for warning signs and quickly intervene in patients who are at health-risk or are recovering from a recent surgery, for example. This type of telemedicine is sometimes also called telemonitoring or home telehealth.

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.


In the United States, the major companies offering primary care for non-acute illnesses include Teladoc, American Well, and PlushCare.[81] Companies such as Grand Rounds offer remote access to specialty care.[82] Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well's AmWell, and its own Optum's NowClinic, which is a white-labeled American Well offering.[83][84] On November 30, 2017, PlushCare launched in some U.S. states, the Pre-Exposure Prophylaxis (PrEP) therapy for prevention of HIV. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies.[85][86][87]
This service removes the need for impromptu walk-in clinic visits, lengthy waiting room stays, and long lines at the pharmacy. It also creates a safe space without judgment or the need to explain your condition to multiple strangers before you receive a prescription. Our professional and experienced team takes great care to make you feel comfortable and protected as your medical needs are met and your prescription is written, sent, and filled.
Telemedicine has come a long way and there’s still so much room for growth. Currently, telemedicine is used to conference specialists on important appointments when patients have no other access, to provide diagnosis and prescriptions to remote areas where access to a physician isn’t always possible, and even to assist in invasive surgeries when a high caliber surgeon can’t reach a patient in time.
In the United States, the major companies offering primary care for non-acute illnesses include Teladoc, American Well, and PlushCare.[81] Companies such as Grand Rounds offer remote access to specialty care.[82] Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well's AmWell, and its own Optum's NowClinic, which is a white-labeled American Well offering.[83][84] On November 30, 2017, PlushCare launched in some U.S. states, the Pre-Exposure Prophylaxis (PrEP) therapy for prevention of HIV. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies.[85][86][87]
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]
Obamacare—or the Affordable Care Act, as it is officially called—has been a catalyst for Teladoc’s recent growth surge. The law puts pressure on doctor’s offices, who are seeing more patients, as well as employers, who are looking to cut healthcare costs. As a result, telemedicine is becoming increasingly popular as a cheaper alternative to going to the emergency room. Insurance companies including Aetna (AET), Blue Shield of California and Oscar—which offers Obamacare plans on New York’s health exchange—have recently signed on with Teladoc, as have Home Depot (HD), T-Mobile (TMUS), pension giant CalPERS, and others.

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.
Kaitlin Brasier has worked in primary care since 2012 and provided virtual care since 2013. She received her Doctor of Nursing Practice from the University of San Diego in 2012. In addition to providing virtual care, she works in a dermatology clinic. She has extensive experience in family practice nursing and women's health and has conducted research on childhood obesity prevention. She enjoys outdoor activities, including hiking, snowboarding and horseback riding. She also likes cooking, reading and travel.
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