Cheryl Graf has worked in primary care since 1996 and provided virtual care since 2014. She received her Master of Nursing from Pacific Lutheran University. She also works for a local health system and provides temporary support for emergency departments near her home. Her experience includes emergency services, family practice, pediatrics and urgent care. Additionally, she has created and developed training materials for the Sexual Assault Nurse Examiner programs in Washington State. In her spare time, she enjoys golf, gardening and family time.
“Telehealth is not a specific service, but a collection of means to enhance care and education delivery,” says the Center for Connected Health Policy (CCHP). CCHP further classify telehealth into four types of services, live-video conferencing, mobile health, remote patient monitoring, and store-and-forward. Most telehealth platforms provide one or more of these services, to a niche patient or consumer segment.
Equipping nursing homes and hospital rooms this way would enable a variety of practitioners to provide bedside care more conveniently—for the patient and the provider. Patients wouldn't have to be transported, and practitioners could see more patients without disruption. In addition, the primary care provider, family, and friends located elsewhere could link into the video consultations, enhancing communication between all parties involved in the patient's care.
In layman’s language, telemedicine and telehealth are terms that represent the transfer and exchange of medical information between different sites. From the American Telemedicine Association’s point of view; telemedicine, as well as telehealth, are all about transmission of still images, patient’s consultations through video conferencing, patient portals, remote control and monitoring of vital signs, continuing medical education, patient-focused wireless applications and nursing call centers and many other applications.
Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.
These emerging models produce virtual communities of learning and practice that embrace all members of the healthcare team. They are the latest point on the telemedicine continuum that began with the point-to-point connection achieved by Einthoven's pioneering electrocardiogram. Building out the connection established under telemedicine into an ever-expanding knowledge-sharing network can create new potential to improve health and save lives.
For purposes of Medicaid, telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.
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.
Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Also impacting the rise of telemedicine today is the growing mobile health field. With the wide variety of mobile health apps and new mobile medical devices that are consumer-friendly, patients are starting to use technology to monitor and track their health. Simple home-use medical devices that can take vitals and diagnose ear infections, monitor glucose levels, or measure blood pressure let patients gather needed medical information for a doctor’s diagnosis, without going into the doctor’s office. And again, as more patients get proactive about using technology to manage their health, they also will be more open to alternative ways to get care – through telemedicine!
At the Consumer Electronics Show (CES), TV celebrity Dr. Phil McGraw discussed the Doctor On Demand app, which connects any patient with a Board Certified physician or pediatrician via video chat in just two minutes. To use Doctor On Demand, patients download the app, give some background on their medical history, enter information on what’s wrong, and the app connects them to a health care provider from there. The service is currently available in 47 US states (excluding Arkansas, Louisiana, and Alaska) and can be accessed through the iPhone, iPad, Android, and on the web. Doctor on Demand’s hours of operation are 7 am to 11 pm local time (we're hoping it will one day become available 24 hours a day). A 15-minute session costs $40, which is a bit higher than the average co-pay many patients have for in-office visits, and the program currently does not accept health insurance. From the app demo at CES and from Kelly’s experience (more on that below), the Doctor On Demand app is quite sleek and the video chat is as easy to use as Facetime or Skype. Patients can find pharmacists and manage their prescriptions right from their smartphone – no more hard-to-read prescriptions or the potential to lose the prescription slip. Dr. Phil characterized the service as a “game-changer” and proposed that it could address 17 of the top 20 reasons people see a doctor (the flu, skin conditions, etc.) – these day-to-day conditions seem to be a key focus of Docotor on Demand, as opposed to more chronic conditions like full-time diabetes management. To learn more about Doctor on Demand’s policies and most frequently asked questions, please see this page.
Dr. Miller has practiced medicine since 1988, and provided virtual care since 2015. She completed her medical degree at the Sackler School of Medicine in Tel Aviv then returned to New York to complete her family medicine residency. She later completed her preventive medicine residency at the University of Washington, earning her MPH. Since 1992, she has worked in family medicine and public health in Washington. She continues to provide care at a local clinic and appreciates the opportunity to help her patients make effective healthcare choices. Dr. Miller received Top Docs Recognition for four years in Seattle Met Magazine. Away from work, she enjoys time with her family, traveling, gardening and being outdoors.
Originally, health professionals developed this technology to reach remote patients living in the rural areas. But with time, medical staff and the U.S. government saw the big picture – the potential to reach urban populations with healthcare shortages, and to respond to medical emergencies by sharing medical consults and patient health records without delay. In the 1960s, heavy investments from the U.S. Government, including the Public Health Department, NASA, Department of Defense, and the Health and Human Sciences Department drove research and innovation in telemedicine. Sending cardiac rhythms during emergencies started at about this time. For instance, in Miami, the university medical center worked together with the fire rescue department by sending electro-cardiac rhythm signals over the voice radio channels from the rescue sites.
The future of telemedicine is wide open, with room for drastic improvement and more technology based medical care. As the world of tech continues to evolve, so too can the world of telehealth. Already, patients can sit down for a one on one appointment anywhere and anytime with the use of nothing more than a mobile phone. Imagine what new technology will bring in terms of holographic imaging, long distance x-ray, and more work in the field of ultrasounds.
There are several areas where telehealth medicine could make a significant impact. It could be used as a tool to remotely monitor patients who have recently been discharged. It may also help treat individuals with behavioral health issues who might normally avoid treatment due to its high cost, or to avoid any perceived public stigma.  The largest area where technology could advance medicine is in treating the chronically ill. These patients usually require many visits with several specialists who may practice at different and distant originating sites. To move telehealth forward, organizational leaders must present evidence to peers and patients that the technology offers value. In addition, care providers must work to transition patients from using telehealth services only for minor conditions (for headaches, colds, etc.), to accepting the technology as a viable replacement for costly physician office visits. Advocates for telehealth medicine must also develop quality controls, so that this potentially transformational tool can maximize its problem solving capabilities and its service effectiveness. To harness the benefits of telehealth technology, America’s brightest medical professionals (both experienced and up-and-coming) must make a concerted effort to incorporate the tool into their practices and make it a regular service offering. Today’s medical students — as they enter a world where telehealth is becoming more pervasive — can take part in what might be a monumental change in the way health professionals think about medical treatment.
Telenursing is achieving significant growth rates in many countries due to several factors: the preoccupation in reducing the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.
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.
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Because of telemedicine, patients who previously had limited access to health care services can now see a physician without leaving their home. Seniors who would prefer to age in place can now do so with the use of medical streaming devices. The spread of disease is reduced as individuals with contagious diseases don’t have to expose it to others in crowded waiting rooms.
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%.”
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."
Application Service Provider (ASP): Various applications are hosted by an ASP on a central server. Customers can pay a fee to access the applications they want to use over either a private network or secure Internet connection. This allows customers to rent applications that they need to use from an ASP instead of having to buy, install and then maintain software on their own. Usually software upgrades and new releases are included in the rental price.
Dr. Bernstein has practiced medicine since 1990 and provided virtual care with our team since 2006. He received his medical degree from the University of North Carolina and completed a residency at Providence Family Practice in Seattle. He also holds a Master's Degree in Public Health from the University of Washington. Dr. Bernstein is dedicated to quality preventive medicine, public health promotion, and research. As Director of Clinical Quality, he manages the development and maintenance of the clinical standards of patient care, working with the development team to create new systems for measuring clinical delivery effectiveness. In his spare time, he is an avid cyclist and a soccer fan.