The definition of telemedicine is somewhat controversial. Some definitions (such as the definition given by the World Health Organization[2]) 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.[3]
While laws about prescriptions issued via telemedicine consultations are stringent in many states, the general trend indicates more states will allow these types of online prescriptions, the Center for Connected Health Policy reported. A sticking point is that prescriptions require the establishment of a doctor-patient relationship, and some states do not qualify virtual visits as a legitimate relationship.
Today’s patient lives in an increasingly connected world and expects a different kind of care experience. Telemedicine engages patients by allowing them to connect with their doctor more frequently, in a convenient way. That means more questions asked and answered, a stronger doctor-patient relationship, and patients who feel empowered to manage their care.
Teleradiology : This is the transfer of radiological images. X-Rays, MRIs and CTs are all types of radiological images. These images are used for consultation, diagnosis or interpretation. They can be transferred through satellite connections, local area networks or even standard telephone lines. The Picture Archiving and Communications Systems allow centralized storage and the access of these images over information systems such as computers.
Medical City Virtual Care allows patients to see and talk to licensed, board-certified physicians, nurse practitioners or physician assistants from their mobile device or computer through a secure internet video connection. These healthcare professionals can diagnose, treat and prescribe non-narcotic medication for a wide variety of adult and pediatric non-emergency medical conditions, including:

Fundamentally, we tend to think of telemedicine as a way to overcome a serious distance barrier between a patient and a healthcare provider. This point-to-point connection supports a critical function. There are cases when a patient requires the care of a particular doctor at a particular time, and technology is the best way to facilitate that interaction.

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.
The term ‘telehealth’ is gaining popularity among medical professionals, compared to the original term, ‘telemedicine.’ [4] Some medical professionals use the names interchangeably. However, telemedicine is a term that may apply to the application of any technology in the clinical setting, while telehealth more distinctly describes the delivery of services to patients. Telemedicine is a familiar term, but telehealth more appropriately describes the latest trends in using technology to deliver treatments to patients. Depending on the organization, service providers may use a different definitions of telehealth. Although the basic premise remains similar, the context may change according to factors such as organizational objectives, and the needs of the patient population being served. Medical experts do agree on one point; telehealth is an innovative way of engaging patients, and it is highly beneficial for both providers and patients.
Telehealth and Provider Communication: A significant telehealth development is the increased communication via digital and telecommunications platforms among care providers. Care teams are enabled through telehealth technologies to more easily share information and collaborate in the treatment of their patients. PCPs are using telehealth platforms to consult with specialists and other providers to promote access for their patients in low provider availability areas.
Increased access: Patients in rural areas can obtain specialty services, such a mental health treatment or post-surgery follow up, that they otherwise might not get without traveling a large distance for an in-person visit. Similarly, patients who live in federally designated, underserved areas have increased access to primary, dental and mental healthcare.
VSee urges organizations interested in implementing telemedicine to find a telemedicine provider that offers HIPAA compliant software. This means that all data must be fully encrypted, have secure peer-to-peer network connections and have no storage of video. Telemedicine providers should also be comfortable signing a business associate agreement, which asserts that they will take responsibility in keeping patient information safe.

^ Arora, Sanjeev; Thornton, Karla; Murata, Glen; Deming, Paulina; Kalishman, Summers; Dion, Denise; Parish, Brooke; Burke, Thomas; Pak, Wesley; Dunkelberg, Jeffrey; Kistin, Martin; Brown, John; Jenkusky, Steven; Komaromy, Miriam; Qualls, Clifford (2011). "Outcomes of Treatment for Hepatitis C Virus Infection by Primary Care Providers". New England Journal of Medicine. 364 (23): 2199–207. doi:10.1056/NEJMoa1009370. PMC 3820419. PMID 21631316.

Brenda Stavish has practiced medicine since 1987 and provided virtual care since 2014. In 2006, she received her Master of Nursing from Seattle Pacific University. Over the course of her career, she has worked in women's health clinics, school districts, and primary/chronic care settings. She believes in patient care that brings together the health of the mind, body, and spirit, equally. In her spare time she enjoys travel, wine tasting and cooking.
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.
With telemedicine, a medical practice or hospital system can immediately expand access to niche medical specialists. This makes it easy for primary care doctors to consult medical specialists on a patient case, and for patients to see a needed specialist on a rare form of cancer, no matter their location. As another example, small hospitals without adequate radiology specialist on-staff can outsource evaluation of x-rays via telemedicine.
Several physicians and patients are finding it difficult to adapt to telemedicine, especially older adults. Physicians are very concerned about patient mismanagement. While advances in medicine have made it more efficient to use technology, there are times when system outages occur. There is also the potential for error as technology cannot always capture what the human touch can.
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
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.
Telehealth and Patient Engagement: With telehealth technologies, patients are taking more control of their well-being. Educational videos, health management apps for mobile devices, and online health learning and support communities empower patients to manage chronic conditions, lose weight, increase physical activity levels, and gain emotional support. Diabetes patients are benefiting from carbohydrate tracking apps and are using glucose monitoring devices to document and report their blood sugar measurements. Other patients are interacting with their providers and scheduling appointments through secure online communication portals. Additionally, they are accessing health education content via smartphones and computers to add to their self-care toolboxes. They are also using wearables and monitoring systems to gain knowledge about their sleep patterns, vital signs, and activity levels.
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.

"Not every holiday party is going to be Pinterest-perfect — and, more importantly, that's completely OK." @DrJohnMayer, a Clinical Psychologist at @drondemand, shares tips on staying happy this holiday season with @EliteDaily.https://www.elitedaily.com/p/how-to-get-along-with-family-during-the-holidays-because-it-is-possible-according-to-experts-13220182 …
The complex US health care system is under a tremendous amount of pressure. Many traditional health care business models are designed to allow high-volume, low-cost procedures to offset the costs of low- volume, high-cost procedures. An upward shift in the aging population is projected to result in a large increase in demand for health care, and new legislation such as the Affordable Care Act has added uncertainty to the future of health care business models and payment. Telehealth is projected to grow worldwide to 1.8 million users by 2017, according to the World Market of Telehealth.
In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren't licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions.

In the 2010s, integration of smart home telehealth technologies (wellness and health devices and software, Internet of Things) appears to be a growing phenomenon in the industry. Beyond that, healthcare organizations are increasingly adopting the use of self-tracking technologies, cloud-based technologies, and innovative data analytic approaches to accelerate the transformation of the healthcare system.
Wyoming Medicaid conducted a study measuring engagement and post-birth outcomes for patients  who used a mobile health app called, “Due Date Plus.” Use of the app, which allowed women to record pregnancy milestones, access medical services, and find symptom-related information was associated with increased compliance with prenatal care and decreased occurrence of babies born with low birth weights.
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.
mHealth, also known as mobile health, is a form of telemedicine using wireless devices and cell phone technologies.  It is useful to think of mHealth as a tool--a medium--through which telemedicine can be practiced. mHealth is a particularly powerful development because it delivers clinical care through consumer-grade hardware and allows for greater patient and provider mobility. ATA has an array of Special Interest Groups with one dedicated to the practice and development of mHealth.

Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth.[44] At present, several major companies along with a bevvy of startups are working to develop a leading presence in the field.
Online doctor consultation are rapidly gaining popularity these days as more health insurers offer telemedicine services to help cut costs. Studies have shown that virtual care may effectively used to treat common problems such as flu, acne, deer tick bites, sinus and urinary tract infections. Video doctor consultations can save patients a lot in time and convenience. 
Internet Protocol (IP): The protocol for sending data from one computer over the Internet to another. Every computer that is on the Internet has one address at least that identifies it uniquely from all of the other computers that are on the Internet. Internet Protocol is a connectionless form of protocol, meaning there isn’t a connection that is established between the two points that are communicating with one another. A videoconferencing system’s IP address is its telephone number.
Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.
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]
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.
On July 7th, 2015, House representatives introduced the Medicare Telehealth Parity Act of 2015. If passed, the bill will expand what telemedicine services Medicare will cover and get rid of many limitations (like the requirements for what qualifies as an “originating site“). Legislation like this one could have a huge impact on coverage for remote patient monitoring and other telemedicine services delivered to the patient in their own home.
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.
Telemedicine for intensive care unit (ICU) rounds: Telemedicine is also being used in some trauma ICUs to reduce the spread of infections. Rounds are usually conducted at hospitals across the country by a team of approximately ten or more people to include attending physicians, fellows, residents and other clinicians. This group usually moves from bed to bed in a unit discussing each patient. This aids in the transition of care for patients from the night shift to the morning shift, but also serves as an educational experience for new residents to the team. A new approach features the team conducting rounds from a conference room using a video-conferencing system. The trauma attending, residents, fellows, nurses, nurse practitioners, and pharmacists are able to watch a live video stream from the patient's bedside. They can see the vital signs on the monitor, view the settings on the respiratory ventilator, and/or view the patient's wounds. Video-conferencing allows the remote viewers two-way communication with clinicians at the bedside.[42]

Telehealth for Education and Training: Numerous organizations provide healthcare education with the help of digital telehealth technologies including Harvard’s Safety, Quality, Informatics and Leadership (SQIL) program which takes a blended learning approach. SQIL uses on-demand content combined with in-person training to create a new medical education model that uses “information technology (IT), data, and a culture of continuous improvement to enable healthcare organizations to evolve into true learning systems.” Time-crunched physicians are increasingly using online and mobile platforms to meet their CME and MOC requirements, and to prepare for Board Exams.
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.
All the numbers point to the exponential growth of telemedicine – in other words, it’s not going anywhere. The global telemedicine market was worth $17.8 billion in 2014, and is projected to grow well beyond that by 2020. ATA President Dr. Reed Tuckson estimated that approximately 800,000 virtual consultations will take place in the U.S. in 2015. And health systems, doctors, legislators, and patients are fueling that upward trend. A recent survey found an incredible90% of healthcare executives were in the process of developing or implementing a telemedicine program, and 84% said these program were important.  IHS projected the number of patients using telemedicine will rise from roughly 350,000 in 2013 to 7 million by 2018. And with this high demand for telemedicine, legislators are scrambling to pass bills that offer both support and needed regulations; in August 2015, Congress had 26 telemedicine-related bills waiting for decision.
JM: As the co-founder of Doctor On Demand and executive producer of The Doctors, my weekdays are pretty busy. Most of my morning is focused on producing episodes of The Doctors, and working with my team to plan upcoming episodes. After that’s a wrap, I connect with Adam to talk through anything from customer feedback to driving awareness for the company.
But it wasn’t until the early 20th century that the general population started to these technologies, and imagine they could be applied to the field of medicine. In 1925, a cover illustration of the Science and Invention magazine featured an odd invention by Dr. Hugo Gernsback, called the “teledactyl.” The imagined tool would use spindly robot fingers and radio technology to examine a patient from afar, and show the doctor a video feed of the patient. While this invention never got past the concept stage, it predicted the popular telemedicine definition we think of today – a remote video consult between doctor and patient.
Type of telehealth. Medicare primarily only reimburses for live telemedicine, where the physician and patient are interacting in real-time through secure, videochat. This type of telemedicine visit is meant to substitute a face-to-face in-person visit. The only exception is in Hawaii and Alaska, where Medicare reimburses for store-and-forward telemedicine as well.

With the recent news that Amazon’s Jeff Bezos, Berkshire Hathaway’s Warren Buffet, and J.P. Morgan Chase’s Jamie Dimon have teamed up to disrupt healthcare, it’s easy to speculate that telehealth technology will be a key strategy in efforts to bring down costs. Other employers are seeking to bring down prices as well with the help of telehealth. According to the Society for Human Resource Management (SHRM), not only are employers encouraging the use of telehealth services, their employees, many of whom are digital natives, are quite comfortable using these services. Because of remote healthcare’s lower costs and increased worker productivity and satisfaction, organizations will likely seek telehealth solutions. Moreover, payers, like employers, may be lured by decreased medical expenditures and consumers may be motivated by the convenience and promptness of care that it offers.

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.
Because of telemedicine, physicians can access patient medical records without being onsite. Some telemedicine providers offer the ability to do data entry using a point-and-click method or video/handwriting recognition. This can cut down on the amount of time that physicians dedicate to administrative tasks. As a result, physicians can see more patients or spend more time with those cases that are more complex.
Emergency room and urgent care environments are known for long wait times, overcrowding and even staffing shortages. This leads to additional stress being added to not only the patient, but the staff too. With tele-triage, patients can arrive to an emergency department and be seen by an off-site physician using video conferencing software. The off-site physician can order tests or determine a treatment plan, which moves patients through the system faster. Cases that are more severe can be moved to the next level of patient care and others can be discharged.

With many rural areas facing a shortage of specialists, telemedicine enables individual doctors to reach more patients. And the cost to patients for telehealth consultations is often lower than an in-office visit. By serving more patients in a shorter amount of time, healthcare organizations can cost-effectively grow their membership while increasing care quality and patient satisfaction.


Dr. Barnett attended the University of Southern California's Keck School of Medicine and completed his residency at Swedish Family Medicine. He has over 12 years of experience in practice and began working in Virtual Care over nine years ago. When Dr. Barnett is not providing Virtual Care, he works as a primary care provider for a local health system. He is fluent in Russian and proficient in Spanish. Outside of work, Dr. Barnett enjoys cooking, watching films, photography, and spending time with family.
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