Healthcare systems, physician practices, and skilled nursing facilities are using telemedicine to provide care more efficiently. Technologies that comes integrated with telemedicine software like electronic medical records, AI diagnosis and medical streaming devices, can better assist providers in diagnosis and treatment. The latter allows providers to monitor patients in real-time and adjust treatment plans when necessary. Ultimately, this leads to better patient outcomes.
Policies and regulations in the telemedicine arena can be confusing for providers, vendors, and payers. Organizations interested in implementing telemedicine should be familiar with the laws in their state. For example, some states require informed consent from patients, while others do not. Some payers may not pay the same rate for telemedicine services as they do for in-person services. Practices should identify how providers will be paid, as some organizations seek grant funding.
Whether on vacation with your kids, away from your home base for business, or in between family doctors, the use of online medical care opens windows and doors to around the clock consultations and medical services. The internet has made it possible for people in rural towns to reach city doctors, for men and women on the road to access much needed prescriptions, and for busy parents to get medical help without packing the kids up and hauling them down to the nearest clinic.
Dr. Creelman has practiced family medicine since 1984 and provided care with our team since 2006. He received his medical degree from the University of Washington and completed the San Bernardino Medical Center Family Practice Residency Program. As director of clinical operations, he works with the service delivery team to ensure that providers deliver the highest quality medical care and create positive patient experiences. In addition to his career in telemedicine, Dr. Creelman is a volunteer and a member of the board of directors of a local free clinic. He has also served on short-term overseas medical missions. He enjoys jogging and hiking, fine woodworking and crafting gourmet sushi with his family.
Remote Patient Monitoring involves the reporting, collection, transmission, and evaluation of patient health data through electronic devices such as wearables, mobile devices, smartphone apps, and internet-enabled computers. RPM technologies remind patients to weigh themselves and transmit the measurements to their physicians. Wearables and other electronic monitoring devices are being used to collect and transfer vital sign data including blood pressures, cardiac stats, oxygen levels, and respiratory rates.
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.
“Another distinction between telemedicine and D2C telehealth is that telemedicine consultations are often with medical specialists like cardiologists, dermatologists and pulmonologists,” Downey continued. “These often occur when the patient is in an underserved rural community and the specialist is in a large urban area. The distance makes it difficult to make and keep appointments otherwise. D2C telehealth, on the other hand, best deals with minor primary care issues over the phone. If deemed to be a more serious health concern, the patient is told to make an appointment with a specialist or to proceed to a hospital emergency room.”
There certainly has been a lot of excitement around how novel digital technology can change the patient-provider relationship. A recent survey found that 64% of patients are willing to have video visits with their physicians, and the telehealth industry is expected to expand 10-fold by 2018. Apps like Doctor on Demand could play a major role in bringing telehealth mainstream; notably, Richard Branson (the man behind the Virgin Group empire), has recently invested in Doctors On Demand. The biggest benefits of virtual health apps are in lowering costs and saving time, particularly for those who cannot access care nearby. In a disease like diabetes, where blood glucose data can be analyzed remotely, there certainly is a lot of potential for technology to improve care. For more information on the role of virtual health in diabetes, check out our conference pearls from AADE 2014. –AJW/KC/AB
Sometimes the answer to the question “What is telemedicine?” is simply mobile medicine. It doesn’t require a heavy desktop computer or a lot of equipment. Activities that used to happen only in person are now easy to do on a smartphone. Modern consumers are accustomed to downloading apps and using their smartphones for simple transactions. The same is true for doctor visits. For example, with MDLIVE the patient simply opens the app and clicks to choose a doctor, with whom they can speak either by phone, instant message, or video.
In developed countries, health promotion efforts using telehealth have been met with some success. The Australian hands-free breastfeeding Google Glass application reported promising results in 2014. This application made in collaboration with the Australian Breastfeeding Association and a tech startup called Small World Social, helped new mothers learn how to breastfeed. Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world. Widespread breastfeeding can prevent 820,000 infant deaths globally but the practice is often stopped prematurely or intents to do are disrupted due to lack of social support, know-how or other factors. This application gave mother's hands-free information on breastfeeding, instructions on how to breastfeed and also had an option to call a lactation consultant over Google Hangout. When the trial ended, all participants were reported to be confident in breastfeeding.
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. 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. 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.
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.
Monitoring center links are used for one type of telemedicine – remote patient monitoring. This type of telemedicine link creates a digital connection between a patient’s house and a remote monitoring facility, so that a patient’s medical data can be measured at home and transmitted electronically to a distant medical monitoring facility. These links usually take the form of internet, SMS, or telephone connections. They’re most commonly used for monitoring of pulmonary, cardiac, or fetal medical data.
The concept of telemedicine started with the birth of telecommunications technology, the means of sending information over a distance in the form of electromagnetic signals. Early forms of telecommunications technology included the telegraph, radio, and telephone. In the late 19th century, the radio and telephone were just starting to emerge as viable communication technologies. Alexander Graham Bell patented the telephone in 1876 and Heinrich Rudolf Hertz performed the first radio transmission in 1887.
It is common for outlying healthcare facilities to transfer unnecessarily or forced to refer patients to complex cases that are beyond the knowledge-base of the local providers. Patients are therefore frequently transported over long distances to get direct care or for specialist’s consultation. These referrals and transfers can be quite costly for the patient since they present clinical, operational and financial challenges to all the parties that are involved. Telemedicine can curb such issues, reduce the frequency of travel and deliver considerable efficiencies and returns for all parties involved.
But as the National Policy Telehealth Resource Center notes, “Compliance with the Health Insurance Portability and Accountability Act (HIPAA) is more complex than simply using products that claim to be ‘HIPAA-compliant.” Not only does the telemedicine platform need to be compliant, all providers, patients, and staff using the tool need to ensure they are in compliance with HIPAA. A telemedicine software vendor, for instance, not only needs to build a secure product, but also ensure their company is operating in accordance with HIPAA.
Telecare is the term that relates to technology that enables patients to maintain their independence and safety while remaining in their own homes. This technology includes mobile monitoring devices, medical alert systems, and telecommunications technology like computers and telephones. Continuous remote monitoring of patients enables telecare to track lifestyle changes over time as well as receiving alerts relating to real-time emergencies.
Soon after Alexander Graham Bell patented the telephone in 1876, ideas of using a telephone to communicate with physicians started appearing in the medical literature. However, telemedicine was truly born in the 1950s, when radiologic images were successfully transferred by telephone between West Chester and Philadelphia, Pennsylvania. In the late 1960s and 1970s, telemedicine developed with support from National Aeronautics and Space Administration (NASA), U.S. Public Health Service, Department of Defense and other federal agencies.
As the population grows and ages, and medical advances are made which prolong life, demands increase on the healthcare system. Healthcare providers are also being asked to do more, with no increase in funding, or are encouraged to move to new models of funding and care such as patient-centered or outcomes based, rather than fee-for-service. Some specific health professions already have a shortage (i.e. Speech-language pathologists). When rural settings, lack of transport, lack of mobility (i.e. In the elderly or disabled), decreased funding or lack of staffing restrict access to care, telehealth can bridge the gap.
The United States has 14 Telehealth Resource Centers, all funded by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth. These resource centers serve as a local hub of information and research about telehealth, usually with a focus on increasing healthcare access for underserved communities. Plus, the services they provide are generally free!
Likely a favorite among patients aging in place, telemedicine permits providers to monitor their patients in their own homes. Using patient portals, a physician can gather and share information with their patient. In addition, medical devices can send vital signs and more to providers so they can make adjustments to care as needed. VSee offers their clients the following telemedicine solutions:
Through telemedicine, doctors and other health professionals provide an array of important clinical services—from diagnosis to imaging to surgery to counseling—to patients in remote locations. You can find telemedicine (sometimes referred to as "telehealth" in certain contexts) in hospital operating rooms, in rural community health centers, in school-based clinics, in ambulances, and in nursing homes.
Point-to-point connections link small remote health centers to one, large, central health facility via high speed internet. This type of telemedicine connection lets smaller or understaffed clinics outsource medical care to specialists at other locations within the same health system. Point-to-point connections are especially common for telepsychiatry, teleradiology, and urgent care services.
Telemedicine also can eliminate the possible transmission of infectious diseases or parasites between patients and medical staff. This is particularly an issue where MRSA is a concern. Additionally, some patients who feel uncomfortable in a doctors office may do better remotely. For example, white coat syndrome may be avoided. Patients who are home-bound and would otherwise require an ambulance to move them to a clinic are also a consideration.
The Health Insurance Portability and Accountability Act (HIPAA), is a United States Federal Law that applies to all modes of electronic information exchange such as video-conferencing mental health services. In the United States, Skype, Gchat, Yahoo, and MSN are not permitted to conduct video-conferencing services unless these companies sign a Business Associate Agreement stating that their employees are HIPAA trained. For this reason, most companies provide their own specialized videotelephony services. Violating HIPAA in the United States can result in penalties of hundreds of thousands of dollars.
The definition of telemedicine is somewhat controversial. Some definitions (such as the definition given by the World Health Organization) 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.
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.
Those in the healthcare industry recognize that medication management is a big deal, especially among seniors. Older adults are more likely to forget to take their medications, which is where telemedicine comes in. Providers and other healthcare professionals can use telemedicine technology to monitor when and if their patients took their medicine. As a result, this leads to fewer hospital readmissions and enhances medication compliance.
“Telemedicine is not a separate medical specialty,” the organization continues. “Products and services related to telemedicine are often part of a larger investment by healthcare institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth.”
When a patient is in the hospital and he is placed under general observation after a surgery or other medical procedure, the hospital is usually losing a valuable bed and the patient would rather not be there as well. Home health allows the remote observation and care of a patient. Home health equipment consists of vital signs capture, video conferencing capabilities, and patient stats can be reviewed and alarms can be set from the hospital nurse’s station, depending on the specific home health device.
In 1967 one of the first telemedicine clinics was founded by Kenneth Bird at Massachusetts General Hospital. The clinic addressed the fundamental problem of delivering occupational and emergency health services to employees and travellers at Boston's Logan International Airport, located three congested miles from the hospital. Over 1,000 patients are documented as having received remote treatment from doctors at MGH using the clinic's two-way audiovisual microwave circuit. The timing of Bird's clinic more or less coincided with NASA's foray into telemedicine through the use of physiologic monitors for astronauts. Other pioneering programs in telemedicine were designed to deliver healthcare services to people in rural settings. The first interactive telemedicine system, operating over standard telephone lines, designed to remotely diagnose and treat patients requiring cardiac resuscitation (defibrillation) was developed and launched by an American company, MedPhone Corporation, in 1989. A year later under the leadership of its President/CEO S Eric Wachtel, MedPhone introduced a mobile cellular version, the MDPhone. Twelve hospitals in the U.S. served as receiving and treatment centers.
Inability to prescribe medications: Many states generally do not allow online prescribing (not to be confused with e-prescribing) without an established relationship between the physician and patient. A physical examination or evaluation may be required before a physician can write a prescription for a patient, but there are inconsistencies in state laws as to what constitutes a physical examination.
With the interrelated fields of mobile health, digital health, health IT, telemedicine all constantly changing with new developments, it’s sometimes difficult to pin down a definition for these terms. In much of the healthcare industry, the terms “telehealth” and “telemedicine” are often used interchangeably. In fact, even the ATA considers them to be interchangeable terms. This isn’t surprising since the telehealth and telemedicine definitions encompass very similar services, including: medical education, e-health patient monitoring, patient consultation via video conferencing, health wireless applications, transmission of image medical reports, and many more.
This term has a narrower scope than that of telehealth. It refers more specifically to education over a distance and the provision of health care services through the use of telecommunications technology. Telemedicine refers to the use of information technologies and electronic communications to provide remote clinical services to patients. The digital transmission of medical imaging, remote medical diagnosis and evaluations, and video consultations with specialists are all examples of 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.
Based on over 600 studies, the AMA has put together a comprehensive set of guidelines for professionals using telemedicine in primary and urgent care – a field that is quickly adopting telemedicine to expand basic healthcare access. Here are some of the basic protocols and rules a primary care or urgent care facility should put into place when starting their telemedicine program.
Where telemedicine refers specifically to the practice of medicine via remote means, telehealth is a blanket term that covers all components and activities of healthcare and the healthcare system that are conducted through telecommunications technology. Healthcare education, wearable devices that record and transmit vital signs, and provider-to-provider remote communication are examples of telehealth activities and applications that extend beyond remote clinical care.
I'm a former scientist, using words and an audio recorder as my new research tools to untangle the health and food issues that matter most to consumers. I live in Brooklyn, N.Y., where I cook as much as possible. You can find me in the grocery aisle scrutinizing the fine print of every food item I put into my cart. Follow me on Twitter @juliacalderone.