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.

From the late 1800s to the early 1900s the early foundations of wireless communication were laid down.[5] Radios provided an easier and near instantaneous form of communication. The use of radio to deliver healthcare became accepted for remote areas.[5][8] The Royal Flying Doctor Service of Australia is an example of the early adoption of radios in telehealth.[6]

"The awareness piece is a big problem," admits Ian Tong, a physician and the chief medical officer at Doctor On Demand, an app that offers smartphone consultations for $75. Tong believes that part of the problem is the branding of the term "telemedicine," which isn't particularly descriptive, so he's opting to use the term "video visits" instead when he talks to patients about it.
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.[27][28][29] Breastfeeding is beneficial to infant health and maternal health and is recommended by the World Health Organisation and health organisations all over the world.[30][31] 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.[31] 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.[29]
“Our executive leadership have been strong supporters of telemedicine at UPMC for more than a decade,” said Sokolovich of the University of Pittsburgh Medical Center. “With the initial success of tele-stroke and tele-behavioral health services, leadership recognizes the potential of telehealth in implementing new models of care that enhance the patient experience, support access to quality care regardless of geographic location, and maximize efficiencies.”
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.
To guide these decisions, the provider should create clinical protocols which include the condition to be treated (with ICD code), scope of that condition that can be treated using telemedicine, guidelines required to diagnose (when is telephone sufficient, vs. live video), documentation needed to properly assess the patient’s condition, parameters for when the condition can be treated and cannot be treated, and guidelines for when prescription can be done. While this section provides basic, overall guidelines for practicing telemedicine, it’s best practices for the healthcare provider to create more detailed protocols for each condition they intend to treat.

Thanks to telemedicine, physicians have the wonderful opportunity to connect with clients wherever they are. Patients who once could not see a physician due to access to care issues, can now do so almost seamlessly. However, many may wonder what is telemedicine’s most valuable applications? We’ll discover a few popular ways that telemedicine is used today.


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.
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Telemedicine reimbursement is a difficult topic, especially with the constantly changing state policies. Many states now have parity laws which require private payers to reimburse for telemedicine visits the same way as in-person visits. The best way to navigate reimbursement is to call up your top payers and ask their policies. You can also check out our guide to telemedicine reimbursement and this helpful matrix from ATA on state policy.
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.
Teledermatology – Teledermatology solutions are usually store-and-forward technologies that allow a general healthcare provider to send a patient photo of a rash, a mole, or another skin anomaly, for remote diagnosis. As frontline providers of care, primary care practitioners are often the first medical professionals to spot a potential problem. Teledermatology solutions lets PCPs continue to coordinate a patient’s care, and offer a quick answer on whether further examination is needed from a dermatologist.
The study of 15 of the state’s hospitals using the platform to treat some 500,000 patients saw a 25 percent reduction in a hospital’s staffing costs, while the hospitals saw a 20 percent increase in admissions – patients who would have been transferred to UMMC for ultimately non-serious issues, depriving the local hospital of revenues and taxing UMMC’s resources.

The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
WiFi :  Wifi was originally licensed bu the Wi-Fi alliance and it is used to describe the technology of wireless local area networks, abbreviated as WLAN. This technology was primarily developed for mobile computing devices like laptops in Local Area Networks, but with technological advancements, it is now used for an array of services which include VoIP phone access, gaming as well as basic connection of electronics such as smartphones, DVD players, Home theaters and Televisions.
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]
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.
Between the years 2000 and 2050, the number of people aged 60 years or older is expected to increase from 605 million to 2 billion. The rapidly increasing elderly patient population have become one of the main beneficiaries of telehealth. Companies like Comarch, American Well, and Global Med are building doctor video chat platforms targeted at the elderly.
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.
In the early days of telemedicine, health professionals used the burgeoning technology as a way to reach patients living in rural areas. However, the technology quickly expanded into urban areas, especially those that suffered from healthcare shortages. In 1967, physicians at the University of Miami School of Medicine and Miami's Fire Department transmitted electrocardiographic rhythms over existing voice radio channels from fire-rescue units to the city's Jackson Memorial Hospital.
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."
Several decades later, in the 1950’s, a few hospital systems and university-based medical centers experimenting with how to put concept of telemedicine into practice. Medical staff at two different health centers in Pennsylvania about 24 miles apart transmitted radiologic images via telephone. In 1950’s, a Canadian doctor built upon this technology into a Teleradiology system that was used in and around Montreal. Then, in 1959, Doctors at the University of Nebraska were able to transmit neurological examinations to medical students across campus via a two-way interactive television. By 1964, they had built a telemedicine link that allowed them to provide health services at Norfolk State Hospital, 112 miles away from campus.
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Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service, such as laboratory service, x-ray service or physician services (under section 1905(a) of the Social Security Act).

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Telemedicine is used in many different medical fields, throughout ambulatory and hospital settings. Almost every medical field has some use for consulting a patient or another provider (usually a specialist) remotely. Because of shortages of care, limited access to specialists in some areas, and remote locations of patients (especially in rural or sparsely populated areas), telemedicine is incredibly useful to any healthcare provider trying to expand access to quality patient care.
The field of telemedicine has changed drastically from its inception. It was only about fifty years ago that a few hospitals started experimenting with telemedicine to reach patients in remote locations. But with the rapid changes in technology over the last few decades, telemedicine has transformed into a complex integrated service used in hospitals, homes, private physician offices, and other healthcare facilities.
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.
More widespread use and success of telehealth applications might spur the resolution of these reimbursement issues. CVS has been providing clinical services via telehealth since 2015. According to their study in the Journal of General Internal Medicine, 95 percent of patients “were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” If CVS’s merger with Aetna is finalized, increased competition may motivate other payers to find ways to offer telehealth services and, by extension, levels of reimbursement. 
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]
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!

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.
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.
Applications of telehealth in physical therapy already have roots that expand throughout patient/client care and consultation, as it allows PTs to better communicate with patients/clients and provide more flexible care. Telehealth will not replace traditional clinical care. However, it will give PTs and PTAs the flexibility to provide services in a greater capacity. Examples:

Dr. Parker has practiced medicine since 1994 and provided virtual care since 2013. He received his medical degree from the Medical College of Wisconsin and went on to complete a family practice residency at St. Joseph's Hospital and St. Mary's Family Practice. In addition to his work in telemedicine, he is an Assistant Clinical Professor at the St. Louis University School of Medicine. Dr. Parker and his family have a strong commitment to organic, sustainable, and humane food preparation, raising and growing much of their own food. In his spare time, he is a trail runner, half-marathoner and amateur photographer.
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